In the (neutral) position of adduction of the CMC joint, the thumb lies within the plane of the hand. The proximal interphalangeal (PIP) joints are formed by the articulation between the heads of the proximal phalanges and the bases of the middle phalanges (Figure 7-21). The terminology used to describe the surfaces of the carpal bones and all bones of the fingers is standard: The palmar surface faces anteriorly, the radial surface faces laterally, and so forth. Figure 7-6 The natural concavity of the palm of the hand is supported by three integrated arch systems: One longitudinal and two transverse. Suppose that you are a manufacturer of running shoes and a well-known brand amongst the athletes who run a marathon, play sports, etc. Return a substring to the right of the last delimiter. Then the unique number, such obtained is called the left hand limit of f(x) at x = a. This motion allows the tip of the thumb to more easily contact the tip of the little finger. This special terminology, which is used to define the movement of the thumb, serves as the basis for the naming of the “pollicis” (thumb) muscles, for example, the opponens pollicis, the extensor pollicis longus, and the adductor pollicis. The first CMC joint (known as the thumb’s saddle joint) is the most mobile, especially during the movement of opposition. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-30.) (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-25.) Transverse flexibility within the hand occurs as the peripheral metacarpals (first, fourth, and fifth) fold around the more stable central (second and third) metacarpals. Motions at the CMC joint occur primarily in 2 degrees of freedom (Figure 7-11). Among the apes and some New World monkeys, the hand is specialized for brachiation—hand-over-hand swinging through the trees. The basic structure of the MCP joint of the thumb is similar to that of the fingers. tenodesis action • Justify the primary actions of the muscles of the hand. This can be verified by observing your own relaxed hand. Movement of the fingers is described in the standard fashion using the cardinal planes of the body: Flexion and extension occur in the sagittal plane, and abduction and adduction occur in the frontal plane (. The capsule that surrounds the CMC joint of the thumb is naturally loose to allow a large range of motion. These accessory motions permit the fingers to better conform to the shapes of held objects, thereby increasing control of grasp (Figure 7-15). Several metacarpal bones have been removed to expose various joint structures. Movement of the fingers is described in the standard fashion using the cardinal planes of the body: Flexion and extension occur in the sagittal plane, and abduction and adduction occur in the frontal plane (Figure 7-7, A through D). This common condition receives more surgical attention than any other osteoarthritis-related condition of the upper limb. The Learned Hand formula is an algebraic formula (B = PL), according to which liability turns on the relation between investment in precaution (B) and the product of the probability (P) and magnitude (L) of harm resulting from the accident. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-8.) With the MCP joint relaxed and nearly extended, appreciate on your own hand the amount of passive mobility of the proximal phalanx relative to the head of the metacarpal. Flexion stretches and therefore increases tension in both the dorsal part of the capsule and the collateral ligaments. Increased tension in the dorsal capsule and collateral ligaments stabilizes the joint in flexion; this is useful during grasp. From the anatomic position, the CMC joint can be extended an additional 10 to 15 degrees. With three exceptions, all primates have retained five digits on hand and foot. As with most arches in buildings and bridges, the arches of the hand are supported by a central keystone structure. Learned Hand Formula: Learned hand formula is an important process to assess negligence or fault. The hand has 14 phalanges. Figure 7-8 shows a simplified illustration of relative mobility at the CMC joints. Several examples of the construction of Bode plots are included here; click on the transfer function in the table below to jump to that example. (Modified from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-29.) The major function of the hand in all vertebrates except human beings is locomotion; bipedal locomotion in humans frees the hands for a largely manipulative function. Because the proximal surface of the proximal phalanx is concave and the head of the metacarpal is convex, the arthrokinematics of flexion and extension occurs as a roll and slide in similar directions. • Neck: Slightly constricted region just proximal to the head; common site of fracture, especially of the fifth digit In the anatomic position, the dorsal surface of the bones of the thumb (i.e., the surface where the thumbnail resides) faces laterally (Figure 7-5). During flexion, the metacarpal rotates slightly medially (i.e., toward the third digit); during extension, the metacarpal rotates slightly laterally (i.e., away from the third digit). The metacarpals, like the digits, are designated numerically as one through five, beginning on the radial (lateral) side. However, these can only be used in problems of low dimensionality. Metacarpophalangeal Joints of the Fingers Permit Volitional Movements Primarily in 2 Planes The capsule that surrounds the CMC joint of the thumb is naturally loose to allow a large range of motion. As discussed earlier, the MCP joints serve as keystones that support the mobile arches of the hand. Figure 7-5 Palmar and lateral views of the hand showing the orientation of the bony surfaces of the right thumb. Toprol XL is available as 100 mg per tablets. extensor mechanism The large size of the hand indicates the large proportion of the brain dedicated to controlling the hand. The carpometacarpal (CMC) joints of the hand form the articulation between the distal row of carpal bones and the bases of the five metacarpal bones. Summary In contrast, the peripheral CMC joints (shown in, Palmar view of the right hand showing a highly mechanical depiction of mobility across the five carpometacarpal joints. This chapter describes the basic anatomy of the bones, joints, and muscles of the hand—information essential to understanding impairments of the hand, as well as the treatments used to help restore its function following injury or disease. Traumatic insult…. The joints of the second and third digits, shown in gray, are rigidly joined to the distal row of carpal bones, forming a stable central pillar throughout the hand. Osteologic Features of a Metacarpal The natural concavity of the palm of the hand is supported by three integrated arch systems: One longitudinal and two transverse. Convert five hands to inches: 5 hands = 5 × 4 = 20 inches. ), (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-9. This special terminology, which is used to define the movement of the thumb, serves as the basis for the naming of the “pollicis” (thumb) muscles, for example, the opponens pollicis, the extensor pollicis longus, and the adductor pollicis. These joints are positioned at the extreme proximal region of the hand (see Figures 7-3 and 7-4). For all practical purposes, the MCP joint of the thumb allows only 1 degree of freedom: Flexion and extension within the frontal plane. Flexion is the movement of the palmar surface of the thumb in the frontal plane across and parallel with the palm. The distal interphalangeal (DIP) joints are formed through the articulation between the heads of the middle phalanges and the bases of the distal phalanges. For ease of discussion, Figure 7-12, A, shows the full arc of opposition divided into two phases. This feature is one of the most impressive functions of the human hand. Adduction returns the thumb to the plane of the hand. Motion at the MCP joint occurs predominantly in two planes: (1) Flexion and extension in the sagittal plane, and (2) abduction and adduction in the frontal plane. The joints of the second and third digits, shown in gray, are rigidly joined to the distal row of carpal bones, forming a stable central pillar throughout the hand. The characteristic feature of a saddle joint is that each articular surface is convex in one dimension and concave in the other—just like the saddle on a horse. Step 1: Determine your givens. Arches of the Hand Active abduction and adduction of the thumb MCP joint is limited and therefore these are considered accessory motions. The formula subtracts the cashless expenses from the operating expenses. to that used in carpentry to join planks of wood. Abduction and adduction at the MCP joints occur to about 20 degrees on either side of the midline reference formed by the third metacarpal. This motion allows the tip of the thumb to more easily contact the tip of the little finger. Figure 7-12 The kinematics of opposition of the carpometacarpal joint of the thumb. In contrast, the peripheral CMC joints (shown in green) form mobile radial and ulnar borders, which are capable of folding around the hand’s central pillar. They want to calculate what percentage return is required to break even on an investment adjusted for the time value of money. Figure 7-15 Passive accessory motions and axial rotation at the metacarpophalangeal joints are evident during the grasp of a large round object. The arthrokinematics of active abduction at the metacarpophalangeal joint. This palmar concavity is supported by three integrated arch systems: Two transverse and one longitudinal (Figure 7-6). Definition: Tukey's post-hoc test is a method that is used to determine which groups among the sample have significant differences. Example 1: Toprol XL, 50 mg PO, is ordered. The basic structure of the MCP joint of the thumb is similar to that of the fingers. (Modified from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-29. Without a healthy and mobile thumb, the overall function of the hand is significantly reduced. 8 = 720. The MCP joint of the thumb consists of the articulation between the convex head of the first metacarpal and the concave proximal surface of the proximal phalanx of the thumb (Figure 7-19). As is shown in Figure 7-14, the concave component of an MCP joint is extensive, formed by the articular surface of the proximal phalanx, the collateral ligaments, and the dorsal surface of the palmar plate. Unlike the MCP joints of the fingers, extension of the thumb MCP joint is usually limited to just a few degrees. Before progressing to the study of the joints, the terminology that describes the movement of the digits must be defined. Flexion elongates the dorsal capsule and other associated connective tissues. Abduction and adduction occur generally in the sagittal plane, and flexion and extension occur generally in the frontal plane. Surgical intervention is typically used when conservative therapy is unable to retard the progression of pain or the instability. A ray describes one metacarpal bone and its associated phalanges. Cylindrical objects, for example, can fit snugly into the palm, with the index and middle digits positioned to reinforce grasp (Figure 7-9). From full extension, the proximal phalanx of the thumb can actively flex about 60 degrees across the palm toward the middle digit (Figure 7-20). The formula is used to calculate whether the duty of care has been followed properly or not. ), (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-7. But increase in order size means that average inventory balance on hand will be high which increases total carrying costs for the period. Flexion and Extension. During abduction, the proximal phalanx rolls and slides in a radial direction: The radial collateral ligament becomes slack, and the ulnar collateral ligament is stretched. As can be seen by the change in orientation of the thumbnail, full opposition incorporates at least 45 to 60 degrees of medial rotation of the thumb. Figure 7-2 Palmar view of the major bones and joints of the hand. Opposition is a special term that describes the movement of the thumb across the palm, making direct contact with the tips of any of the fingers. A, Two phases of opposition are shown: (1) Abduction and (2) flexion with medial rotation. This complex motion is a composite of the other primary motions already described for the CMC joint. The medially rotated thumb requires unique terminology to describe its movement and position. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-7.) • Abduction and adduction occur in the frontal plane about an anterior-posterior axis of rotation. Muscle force, especially from the opponens pollicis, helps guide and rotate the metacarpal to the extreme medial side of the articular surface of the trapezium. Loss of pain-free function of the thumb markedly reduces the functional potential of the entire hand and thus of the entire upper extremity. • Identify the bones and primary bony features of the hand. The digits include a medial thumb (when viewed with the palm down), containing two phalanges, and four fingers, each containing three phalanges. St. Louis, 2013, Saunders.) Formula: Amount DESIRED (D) Amount on HAND (H) X QUANTITY (Q) = Y (Tablets Required) Note: When medication is given in tablets, the QUANTITY = 1 since the amount of medication available is specified per (one) tablet. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-19.) In phase 2, the abducted metacarpal flexes and medially rotates across the palm toward the small finger. The doctor’s order is in grains and the dose on hand is in mg, therefore the appropriate conversion must be included. Virtually all motions of the hand require the thumb to interact with the fingers. Figure 7-1 Motor homunculus of the brain showing the somatotopic representation of body parts. Key Terms From full extension, the thumb metacarpal flexes across the palm about 45 to 50 degrees. Muscular Function in the Hand Motion at the MCP joint occurs predominantly in two planes: (1) Flexion and extension in the sagittal plane, and (2) abduction and adduction in the frontal plane. The carpometacarpal (CMC) joints of the hand form the articulation between the distal row of carpal bones and the bases of the five metacarpal bones. Our editors will review what you’ve submitted and determine whether to revise the article. Fingers have a proximal interphalangeal joint and a distal interphalangeal joint. Evidence of the hand’s enormous functional importance is evident by observing the disproportionately large area of the cortex devoted to the sensory and motor functions of the hand (Figure 7-1). The second through fifth metacarpals are aligned generally side by side, with their palmar surfaces facing anteriorly. Joint Deformities of the Hand Convert two hand to angstroms: dois hand = 2 × 1016000000 = 2032000000 angstroms. The palms and undersides of the fingers are marked by creases and covered by ridges called palm prints and …  Objectives B, Dorsal view of the right wrist and hand. Flexion is the movement of the palmar surface of the thumb in the frontal plane across and parallel with the palm. The proximal transverse arch is formed by the distal row of carpal bones. Except for differences in size, all phalanges within a particular digit have similar morphology (see Figure 7-3). This static, rigid arch forms the carpal tunnel, permitting passage of the median nerve and many flexor tendons coursing toward the digits. ), (Courtesy Teri Bielefeld, PT, CHT, Zablocki VA Hospital, Milwaukee, Wisconsin. Its unique saddle shape allows the thumb to fully oppose, thereby easily contacting the tips of the other digits. Increased mobility of the fourth and fifth CMC joints improves the effectiveness of the grasp and enhances functional interaction with the opposing thumb. Justify the primary actions of the muscles of the hand. Reversing your thinking, the LEFT worksheet function can also be used to remove unwanted text say everything after character 6 is garbage and unwanted. Figure 7-8 Palmar view of the right hand showing a highly mechanical depiction of mobility across the five carpometacarpal joints. In most other regions of the body, abduction and adduction describe movement of a bony segment toward or away from the midline of the body; however, abduction and adduction of the fingers is described as motion toward (adduction) or away (abduction) from the middle finger. Except for differences in size, all phalanges within a particular digit have similar morphology (see Figure 7-3). Abduction and adduction occur in the frontal plane about an anterior-posterior axis of rotation. Dorsal view of the proximal interphalangeal and distal interphalangeal joints opened to expose the shape of the articular surfaces. The CMC joint of the thumb is the classic saddle joint of the body (Figure 7-10). Convert five hands to angstroms: 5 hands = 5 × 1016000000 = 5080000000 angstroms. The palms and undersides of the fingers are marked by creases and covered by ridges called palm prints and fingerprints, which function to improve tactile sensitivity and grip. Interphalangeal Joints Structure and Function of the Hand It is interesting to note that persons who needlepoint or milk cows for many years frequently develop painful arthritis at the base of the thumb. • Explain why the fourth and fifth digits cannot be fully extended across all interphalangeal joints after a severance of the ulnar nerve. The exceptions are the spider monkeys and the so-called woolly spider monkey of South America and the colobus monkeys of Africa, which have lost or reduced the thumb. Carpometacarpal Joints More Examples: Convert ten hands to inches: 10 hands = 10 × 4 = 40 inches. This feature is one of the most impressive functions of the human hand. • Deep transverse metacarpal ligaments: These three ligaments merge into a wide, flat structure that interconnects and loosely binds the second through fifth metacarpals The more common conservative therapeutic intervention for basilar joint arthritis includes splinting, careful use of non-strenuous exercise, physical modalities such as cold and heat, non-steroidal anti-inflammatory drugs, and corticosteroid injections. Infinite graphs. When functioning normally, the 19 bones and 19 joints of the hand produce amazingly diverse functions. The digits of the hand are designated numerically from one to five, or as the thumb and the index, middle, ring, and little (small) fingers (Figure 7-2). Flexion and extension occur in the sagittal plane about a medial-lateral axis of rotation. This common condition receives more surgical attention than any other osteoarthritis-related condition of the upper limb. The development of dexterity in the hands and increase in brain size are believed to have occurred together in the evolution of humans. Kinematics The kinematics of opposition of the carpometacarpal joint of the thumb. Opposition is a special term that describes the movement of the thumb across the palm, making direct contact with the tips of any of the fingers. Figure 7-9 The mobility of the carpometacarpal joints of the hand enhances the security of grasping objects such as this cylindrical pole. When functioning normally, the 19 bones and 19 joints of the hand produce amazingly diverse functions. It is made up of the wrist joint, the carpal bones, the metacarpal bones, and the phalanges. Congenital defects involving the hand range from absent or incomplete development (agenesis) to anomalies of limb structures. (This can be appreciated by noting how abduction and adduction of the fingers are much less in full flexion than in full extension.) Encyclopaedia Britannica's editors oversee subject areas in which they have extensive knowledge, whether from years of experience gained by working on that content or via study for an advanced degree.... Bones of the hand, showing the carpal bones (wrist bones), metacarpal bones (bones of the hand proper), and phalanges (finger bones). Active and passive motions at the MCP joint of the thumb are significantly less than those at the MCP joints of the fingers. Abduction and adduction at the MCP joints occur to about 20 degrees on either side of the midline reference formed by the third metacarpal. • Describe the planes of motion and axes of rotation for the motions of the hand. Hand calculations play a useful and important role in gaining an insight into problems. The axis of rotation for flexion and extension at all three finger joints is in the medial-lateral direction, through the convex member of the joint. Arthrology You realize that there is a problem with the brakes. • Identify the carpometacarpal, metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the hand. Consider this… Figure 7-8 shows a simplified illustration of relative mobility at the CMC joints. Tags: Essentials of Kinesiology for the Physical Therapist Assistant To appreciate this mobility, imagine transforming your completely flat hand into a cup shape that surrounds a baseball. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-28.) As you saw in the examples above, the variables that are included in a formula can be vectors, for example. A hand that is totally incapacitated by arthritis, pain, stroke, or nerve injury, for instance, can dramatically reduce the overall function of the entire upper limb. The metacarpals, like the digits, are designated numerically as one through five, beginning on the radial (lateral) side. For example, if you have a worksheet with 2 character codes embedded on the left hand-side of its text and you wanted to extract those codes, then you would use the LEFT function. You may also needStructure and Function of the WristStructure and Function of the KneeStructure and Function of the Shoulder ComplexStructure and Function of the HipStructure and Function of the Ankle and FootStructure and Function of the Elbow and Forearm ComplexStructure and Function of JointsBasic Principles of Kinesiology • Fingers have a proximal interphalangeal joint and a distal interphalangeal joint. The ability to precisely oppose the thumb to the tips of the other fingers is perhaps the ultimate expression of functional health of this digit and, arguably, of the entire hand. • Explain why an injury to the radial nerve would reduce the effectiveness and strength of one’s grasp. The articulations between the distal end of the metacarpals and the proximal phalanges form the metacarpophalangeal (MCP) joints. The proximal interphalangeal (PIP) joints are formed by the articulation between the heads of the proximal phalanges and the bases of the middle phalanges (Figure 7-21). Actively performing flexion and extension of the CMC joint of the thumb is associated with varying amounts of axial rotation (spinning) of the first metacarpal. ), (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figures 8-4 and 8-5. In contrast to the rigid proximal arch, the ulnar and radial sides of the distal arch are relatively mobile. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figure 8-3, A.) Without this ability, the dexterity of the hand is reduced to a primitive, hinge-like grasping motion. Evidence of the hand’s enormous functional importance is evident by observing the disproportionately large area of the cortex devoted to the sensory and motor functions of the hand (Figure 7-1). In the (neutral) position of adduction of the CMC joint, the thumb lies within the plane of the hand. Each metacarpal has the following similar anatomic characteristics: Radial view of the bones of the third ray (metacarpal and associated phalanges), including the capitate bone of the wrist. How many tablets would the nurse administer? The assumptions that should be met to … • Tuberosity (distal phalanx only) We write it as $$\lim_{x\to a} f(x)$$ Left Hand Limit : It then divides the answer by the number of days in a year (which is 365 days). Figure 7-16 The arthrokinematics of active flexion at the metacarpophalangeal (MCP), proximal interphalangeal, and distal interphalangeal joints of the index finger. These accessory motions permit the fingers to better conform to the shapes of held objects, thereby increasing control of grasp (Figure 7-15). The hand may be used in a primitive fashion such as a hook or a club or, more often, as a highly specialized instrument performing complex manipulations that require multiple levels of force and precision. (The CMC joint of the thumb is extremely important and is described separately in a subsequent section.) Osteology In the healthy hand, stability at the MCP joints is achieved by an elaborate set of interconnecting connective tissues (Figure 7-14). Corrections? Cylindrical objects, for example, can fit snugly into the palm, with the index and middle digits positioned to reinforce grasp (Figure 7-9). Therefore, the palmar surface faces medially, the radial surface anteriorly, and the ulnar surface posteriorly. The phalanges within each finger are referred to as proximal, middle, and distal (see Figure 7-4). Extension returns the thumb back toward its anatomic position. Instead of focusing on ordering costs or carrying costs individually, a company should attempt to reduce the sum of these costs. The carpometacarpal (CMC) joints of the hand form the articulation between the distal row of carpal bones and the bases of the five metacarpal bones. Full abduction opens the web space of the thumb, forming a wide concave curvature useful for grasping objects like a coffee cup. This feature is one of the most impressive functions of the human hand. • Describe the primary mechanism that causes an ulnar drift deformity. Opposition. Without a healthy and mobile thumb, the overall function of the hand is significantly reduced. In the healthy hand, stability at the MCP joints is achieved by an elaborate set of interconnecting connective tissues (Figure 7-14). In phase 1, the thumb metacarpal abducts. Each metacarpal has the following similar anatomic characteristics: Base, shaft, head, and neck. In phase 1, the thumb metacarpal abducts. The more common conservative therapeutic intervention for basilar joint arthritis includes splinting, careful use of non-strenuous exercise, physical modalities such as cold and heat, non-steroidal anti-inflammatory drugs, and corticosteroid injections. The capsule, however, is strengthened by stronger ligaments and by forces produced by the over-riding musculature. The capsule at each interphalangeal (IP) joint is strengthened by radial and ulnar collateral ligaments and a palmar plate. What is the process capability of the process? • Explain the interaction between the intrinsic and extrinsic muscles when opening and closing the hand. The metacarpophalangeal (MCP) joints, or knuckles, of the fingers are relatively large articulations formed between the convex heads of the metacarpals and the shallow concave proximal surfaces of the proximal phalanges (Figure 7-13). The term basilar refers to the location of the CMC joint at the base of the entire thumb. (The CMC joint of the thumb is extremely important and is described separately in a subsequent section.) In primates the tips of the fingers are covered by fingernails—a specialization that improves manipulation. Mechanical stability at the MCP joint is critical to the overall biomechanics of the hand. From the anatomic position, the CMC joint can be extended an additional 10 to 15 degrees. Position of Function: Placing Useful Tension in the Metacarpophalangeal Joints’ Collateral Ligaments. Flexion stretches and therefore increases tension in both the dorsal part of the capsule and the collateral ligaments. Convert two hand to inches: dois hand = 2 × 4 = 8 inches. Opposition and reposition of the thumb are special movements that incorporate the two primary planes of motion. The location of the first metacarpal allows the entire thumb to sweep freely across the palm toward the fingers. Formula : Where, USL = Upper Specification Limit, LSL = Lower Specification Limit. The articular surfaces of these joints appear as a tongue-in-groove articulation similar to that used in carpentry to join planks of wood. Its unique saddle shape allows the human hand to securely hold and manipulate objects of many varied! The index finger, controlled by the metacarpophalangeal joints are shown in gray and! 5080000000 angstroms, CHT, Zablocki VA Hospital, Milwaukee, Wisconsin work. Function is crucial for maintaining independence during daily life activities supporting structures figure 7-14 ) to! Last delimiter between full extension and abduction and adduction occur in the wrist extension only that for! Mechanical depiction of mobility across the palm reposition is discussed after the two primary motions already described the... That incorporate the two primary planes of motion most recently revised and updated by https! 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