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Effexor XR

By I. Boss. Trinity International University.

The report produced by the committee (usually known as the Rolleston Report) effexor xr 150mg amex,3 reaffirmed the doctor’s freedom to prescribe regular supplies of opioid drugs to certain addicted patients in defined circumstances that the committee regarded as ‘treatment’ rather than the ‘gratification of addiction’ buy cheap effexor xr 75 mg. While the possession of dangerous drugs without a prescription was still the subject of the criminal law buy effexor xr 150mg on line, addiction to opioid drugs was recognised as the legitimate domain of medical practice (and hence prescribing). This balance of a medical approach within a penal framework became a hallmark of British drug control and has been called the ‘British System’ by commentators. The League of Nations was established after the First World War and provided a centralised body for administration of international drug control. The second Geneva Convention of 1925 was signed under the auspices of the League of Nations and required parties to the treaty to provide annual statistics on drug stocks and consumption, the production of raw opium and coca, and the manufacture and distribution of heroin, morphine and cocaine. The Geneva Convention was also notable in bringing cannabis under international control, and restrictions on cannabis were implemented in Britain with the 1928 Dangerous Drugs Act. This was a settled approach, as a major addiction problem was not apparent in the British drug scene. In the early 1960s, the first reports about the activities of young heroin users began to appear in British newspapers – a phenomenon that was new to Britain. The Home Office convened an interdepartmental committee under the chairmanship of Sir Russell Brain, largely prompted by concern about whether long-term prescribing was still appropriate more than 30 years after the Rolleston Report. The Brain Committee published its first report early in 1961,4 and concluded that the drug problem remained small and no changes in approach were needed. Increasing media and professional evidence of a heroin epidemic in Britain involving younger heroin users led to a Second Interdepartmental Committee on Drug Addiction, again chaired by Brain. Drug addiction was formulated as a ‘socially infectious condition’, for which it was appropriate to provide treatment. The committee concluded that the increase in heroin use had been fuelled by a small number of doctors who were overprescribing heroin and that individual doctors were unable to meet the demands of the new situation. The doctors who obtained licences were mostly consultant psychiatrists in charge of drug treatment centres. This limitation of doctors’ clinical autonomy received some criticism from the medical profession. Prescription of heroin to addicts declined in the early 1970s, as doctors at the drug clinics were uncomfortable prescribing it. Concern over the use of amphetamines, or ‘purple hearts’ or ‘pep pills’ as they were commonly called, led to their control under the Drugs (Prevention of Misuse) Act 1964. A Home Office Advisory Committee (the ‘Wootton Report’) in 1968 recommended that the legal penalties for simple possession of cannabis should be reduced and casual users of cannabis should not receive custodial sentences. The Misuse of Drugs Act 1971 was introduced to meet the treaty obligations and has an analogous scheme of drug scheduling, with drugs considered the most harmful such as heroin and cocaine classified as Class A drugs (see Table 1, Section 1. Further details of drugs covered by the Misuse of Drugs Act are given in Section 1. The numbers of addicts notified to the Home Office and the amount of heroin seized rose dramatically. There was widespread media coverage of this new wave of heroin use, and drug use became an important and sustained policy issue for the first time since the 1960s. The then Conservative Government sought to encourage a coordinated response from across the range of Government departments, by setting up an interdepartmental working group of ministers and officials, which resulted in the first Government strategy document Tackling drug misuse, issued in 1985. The generalist doctor was seen as key to dealing with drug-related problems, and drug use was no longer seen as the sole province of the specialist clinic psychiatrist. Harm minimisation was the core principle of this policy and received support from the Government. Harm minimisation was characterised by adopting measures that sought to reduce the harm caused by continued drug use, through modification of using behaviours. The number of drugs offenders rose from 24,000 in 1986 to 95,000 in 1996, with the majority of these offences related to cannabis possession. This and subsequent Government drug strategies reconceptualised drug treatment as an intervention that might lead to a reduction of criminal behaviour. Criminals who use drugs were to be encouraged to enter treatment as a means of altering their behaviour. The strategy also indicated a move away from the harm- minimisation approach of the preceding years. There was to be an integrated approach coordinated by the Government but with the details of policy determined at a local level by new drug action teams. Statutory and voluntary sectors would work together and health and social care would be linked to the criminal justice system. The main focus of the strategy was problematic drug users, which included those who injected drugs and those using opioid drugs and crack cocaine. The 2008 drugs strategy Drugs: protecting families and communities28 maintained the focus on problematic drug users and the links between drugs and crime but laid a greater emphasis on the impact of problematic drug use on others in the user’s circle, especially children and families. As described in the previous section, the number of people in drug treatment increased by 129. This focus on outcomes and an emphasis on recovery is mirrored in the most recent Government strategy, Drug strategy 2010. Reducing demand, restricting supply, building recovery: supporting people to lead a drug free life. A subsequent Government document, Putting full recovery first, provides more detail of the Government’s aim of establishing a treatment system approach that puts more emphasis on people in drug treatment achieving recovery, rather than aiming to simply engage and retain them in treatment. A payment by results model is to be developed to incentivise reaching outcomes that include being free of dependence and not involved in crime and being in employment. Local areas will be supported to move local commissioning structures toward recovery- and abstinence-based support.

Color cheap effexor xr 150mg without prescription," "Artificial Color Added effexor xr 150 mg lowest price," or "Color (1) A color additive or the lake of a Added" (or by an equally informative term color additive subject to certification that makes clear that a color additive has under 721(c) of the act shall be declared been used in the food) generic 150 mg effexor xr otc. Alternatively, such color additives may be declared as "Colored by the name of the color additive listed with llllllll" or "llllllll in the applicable regulation in part 74 color," the blank to be filled in with the or part 82 of this chapter, except that name of the color additive listed in the ap- it is not necessary to include the plicable regulation in part 73 of this chapter. Manufacturers may for foods purporting to be bev- parenthetically declare an appropriate erages that contain fruit or vege- alternative name of the certified color table juice. Alternatively, the label percent juice" or "less than 1 percent may declare "Containing (or contains) lll juice" with the blank filled in no lll juice", or "no lll juice", or with the name of the particular fruit or "does not contain lll juice", the vegetable. I (4–1–10 Edition) name, logo, or universal product code; 100 and Juice percent juice1 (2) In easily legible boldface print or type in distinct contrast to other Guava........................................................................ Any (b)(2)-dietary ingredients tion labeling in accordance with this that are not present, or that are regulation unless an exemption is pro- present in amounts that can be de- vided for the product in paragraph (h) clared as zero in §101. Protein shall not shall contain the following informa- be declared on labels of products that, tion, using the subheadings and the other than ingredients added solely for format specified in paragraph (e) of technological reasons, contain only in- this section. Serving size for die- column, the heading may be centered tary supplements shall be expressed over a column of quantitative using a term that is appropriate for the amounts, described by paragraph form of the supplement, such as "tab- (b)(2)(ii) of this section, if space per- lets," "capsules," "packets," or "tea- mits. I (4–1–10 Edition) Other appropriate terms, such as cap- parentheses following the percent sule, packet, or teaspoonful, also may statement (e. The quantitative amounts by for vitamins and minerals: Vitamin A, weight shall represent the weight of vitamin C, vitamin D, vitamin E, vita- the dietary ingredient rather than the min K, thiamin, riboflavin, niacin, vi- tamin B , folate, vitamin B biotin, weight of the source of the dietary in- 6 12, pantothenic acid, calcium, iron, phos- gredient (e. When urement and the levels of significance "Calories from fat" or "Calories from given in §101. The quantitative lactating women, for total fat, satu- amount by weight of each dietary in- rated fat, cholesterol, total carbo- gredient in this calculation shall be the hydrate, dietary fiber, vitamin K, sele- unrounded amount, except that for nium, manganese, chromium, molyb- total fat, saturated fat, cholesterol, so- denum, chloride, sodium, or potassium, dium, potassium, total carbohydrate, a symbol (e. The symbol that is placed at the bottom of numerical value shall be followed by the nutrition label, below the last the symbol for percent (i. When there are no other titative amount of the dietary ingre- (b)(2)-dietary ingredients listed for dient by weight is great enough to re- which a value must be declared in the quire that the dietary ingredient be "% Daily Value" column, the column listed, but the amount is so small that may be omitted as shown in paragraph the "% Daily Value" when rounded to (e)(10)(vii) of this section. Where the name of the this section (hereinafter referred to as solvent used is not included in the nu- "other dietary ingredients") shall be trition label, it is required to be listed declared by their common or usual in the ingredient statement in accord- name when they are present in a die- ance with §101. When the weight per serving of other dietary in- constituents of a dietary ingredient de- gredients shall be presented in the scribed in paragraph (b)(3)(i) of this same manner as the corresponding in- section are listed, all other dietary in- formation required in paragraph gredients shall be declared in a col- (b)(2)(ii) of this section or, when a lin- umn; however, the constituents them- ear display is used, shall be presented selves may be declared in a column or immediately following the name of the in a linear display. The quan- titative amount by weight shall be the (iv) Other dietary ingredients shall weight of the other dietary ingredient bear a symbol (e. Information on the of dietary ingredients described in condition of the starting material shall paragraph (b)(3)(i) of this section and be indicated when it is fresh and may identified by the term "Proprietary be indicated when it is dried. Informa- Blend" or other appropriately descrip- tion may be included on the concentra- tive term or fanciful name and may be tion of the dietary ingredient and the highlighted by bold type. The title and all headings shall be (d) The source ingredient that sup- bolded to distinguish them from other plies a dietary ingredient may be iden- information. When a source ingredient is (iii) Upper- and lowercase letters, ex- identified in parentheses within the nu- cept that all uppercase lettering may trition label, or when the name of the be utilized for packages that have a dietary ingredient or its synonym is total surface area available to bear la- the source ingredient, it shall not be beling of less than 12 square inches, required to be listed again in the ingre- (iv) At least one point leading (i. I (4–1–10 Edition) paragraph (i)(2) of this section, infor- tion and be clearly identified by appro- mation other than the title, headings, priate headings. Type size tion is made in other parts of the label no smaller than 6 point may be used for that a dietary supplement be consumed column headings (e. Daily Value of each dietary ingredient (5) A hairline rule that is centered may be presented on a "per day" basis between the lines of text shall separate in addition to the "per serving" basis each dietary ingredient required in required by paragraphs (b)(2)(ii) and paragraph (b)(2) and (b)(3) of this sec- (b)(2)(iii) of this section for (b)(2)-die- tion from the dietary ingredient above tary ingredients and (b)(3)(ii) and and beneath it, as shown in paragraph (b)(3)(iv) of this section for other die- (e)(10) of this section. If "per day" informa- (6) A heavy bar shall be placed: tion is provided, it must be presented (i) Beneath the subheading "Servings in additional columns to the right of Per Container" except that if the "per serving" information and be clearly identified by appropriate head- "Servings Per Container" is not re- ings and/or be presented in a parenthet- quired and, as a result, not declared, ical statement as part of the "Serving the bar shall be placed beneath the sub- Size" declaration. A sample illustra- heading "Serving Size," tion for "per day" information in a col- (ii) Beneath the last dietary ingre- umn format is provided in paragraph dient to be listed under paragraph (e)(11)(viii) of this section. As illus- (b)(2)(i) of this section, if any, and trated, the additional "Per Day" col- (iii) Beneath the last other dietary umn heading is followed parentheti- ingredient to be listed under paragraph cally by the number of servings rec- (b)(3) of this section, if any. When the paragraph in individual nutrition la- parenthetical statement format fol- bels or in one aggregate nutrition label lowing the "Serving Size" declaration as illustrated in paragraph (e)(10)(iii) of is used in addition to the column for- this section. I (4–1–10 Edition) (f)(1) Compliance with this section a composite of 12 subsamples (con- will be determined in accordance with sumer packages) or 10 percent of the §101. Reason- shipped in bulk form that are not for able excesses of these other dietary in- distribution to consumers in such form gredients over labeled amounts are ac- and that are for use solely in the man- ceptable within current good manufac- ufacture of other dietary supplements turing practice. I (4–1–10 Edition) (iv) When it is not possible for a vide nutrition information, as provided small or intermediate-sized package in §101. If re- comply with these type size require- tailers choose to provide such informa- ments, the type size of the nutrition tion, they should do so in a manner label on the primary (inner) container that conforms to the guidelines in may be as small as needed to accom- §101. To be in compli- sockeye, chum/pink), scallops, shrimp, ance, the nutrition labeling shall: swordfish, tilapia, and tuna. The nu- type and size, for raw fruit and vegeta- trition labeling information may also bles and for raw fish. The heading vided for individual raw fruits, vegeta- "Nutrition Facts" must be in a type bles, or fish on packages or on signs, size larger than all other print in the posters, brochures, notebooks, or leaf- nutrition label. Pro- lowing footnote is used, "Fish provide posed quantitative label declarations negligible amounts of trans fat, dietary may be included. Approval requests shall be raw fruits, vegetables, and fish that are submitted in accordance with the pro- not among the 20 most frequently con- vision of §101. Except as Nutrition Labeling Manual: A Guide provided in paragraph (e) of this sec- for Developing and Using Data Bases. Approvals will be in effect for (b)(1) of this section may be used on a limited time, e. I (4–1–10 Edition) (ii) The label or labeling clearly iden- dish products as defined in §101.

In: Kirk-Othmer Encyclopedia of cleavage by a protoberberine alkaloid generic effexor xr 37.5mg line, berberrubine buy 75 mg effexor xr mastercard. Mode of Kobayashi Y cheap effexor xr 37.5mg fast delivery, Yamashita Y, Fujii N, Takaboshi K, Kawakami binding of the cytotoxic alkaloid berberine with the T, Kawamura M et al. Adulterants causing and coadministration with oryzanol in rabbits and false negatives in illicit drug testing. Toxicology and carcinogenesis studies of gold- patients with severe congestive heart failure. Drug Metab Dispos, 36(11):2159– absorption mechanisms of berberine, palmatine, jate- 65. It has survived for more than (a) Nomenclature 200 million years and has become popular as an ornamental tree in parks, gardens and city Botanical name: Ginkgo biloba L. Tey have also been Common names: Fossil tree; Kew tree; adopted in traditional Chinese medicine for Japanese silver apricot; Maidenhair tree many years. Nowadays, ginkgo leaf extracts Ginkgo is a perennial plant with little inva- are promoted for the improvement of memory, sive potential, which is resistant to insects and to treat or help prevent Alzheimer disease and disease. Gingko grows slowly up to a height of other types of dementia, and to decrease inter- about 40 m. Te ginkgo plant is deciduous, with mittent claudication (Kleijnen & Knipschild, green leaves that turn golden in autumn. Other important constit- Solubility: Soluble in water (O’Neil, 2013) uents found in ginkgo include bifavonoids and traces of alkylphenols, such as ginkgolic acids (Wagner & Bladt, 1996; DeFeudis, 1991; Schötz, (b) Minor favonoids 2002; Siegers, 1999; van Beek & Montoro, 2009). Te favonoids present 7b, 11 -tetrahydroxy-8-methyl-, [1R-(1α,2α,3 in ginkgo are primarily in the glycoside form β,3aS*,4β,6aα,7aα,7bα,8α,10aα,11α,11aR*)]-) (Ding et al. Description: White crystalline substance Te most widely used quality assurance assays (Ding et al. Addition of cheaper plant mate- lactones includes toluene, ethyl acetate, acetone rial containing large amounts of rutin or other and methanol (20:10:10:1. Ginkgo biloba leaf extract is required to prepared through a complex series of extractions have a ratio of crude plant material to powdered and back-extractions using diferent solvents. A mobile phase Te purpose is to purify the favonol glycosides composed of methanol, water, and phosphoric and to remove unwanted compounds (Harnly acid (100:100:1) is used for the content of favonol et al. Quantitative chemical content varied between products, in determination of the major components of ginkgo some cases dramatically (as for the ginkgolic acid have also been reported using combination content). A standardized developing supplement or food products, so it is difcult to solvent system for favonoids includes ethyl evaluate the composition of marketed non-drug acetate, anhydrous formic acid, glacial acetic products. Te spraying reagents include 5 mg/mL of 2-aminoethyl diphenylborinate in methanol and 50 mg/mL of polyethylene glycol 400 in alcohol. Dried extracts of leaves in the form of tablets, standardized to Ginkgo leaves and fruit are used medici- contain 24% favone glycosides and 6% terpenes, nally for a variety of conditions. Among the uses are available commercially (Brestel & Van Dyke, reported for ginkgo are treatment of asthma, 1991; McKenna et al. Te World Health a steady decline in the prevalence of use in men Organization and the German Commission E and women from 1999–2002 (3. According to the 2012 Nutrition Business peripheral arterial occlusive disease, and vertigo Journal Annual report (Nutrition Business and tinnitus of vascular and involutional origin 96 Ginkgo biloba Journal, 2012), ginkgo was the 37th best-selling 1. Te product Fify-six individuals per 1000 reported using label must declare prominently that the claims natural health products containing ginkgo in a have not been evaluated by the Food and Drug Canadian survey in 2006 (Singh & Levine, 2006). Commission E approved diferent types of ginkgo preparations for human consumption (Diamond et al. In Europe, most herbal products, cally in pharmaceutical or dietary-supplement including ginkgo, were marketed as medic- formulations (Hänsel, 1991; Brestel & Van Dyke, inal products. Many medicinal prod- also noted that besides the use in medicinal ucts did not satisfy those requirements and were products and supplements, ginkgo has also been nevertheless marketed as food supplements, ofen used in Europe as ingredient in foods, as in the just changing the label. Workers on ginkgo plantations and in ginkgo and cancer consisted of one rand- ginkgo-processing plants are probably exposed. Te study fndings were difcult to skin) was evaluated as a secondary outcome, and interpret since the sites with statistically signif- identifed from hospital admission and discharge cant associations were not consistent in diferent records. Furthermore, the generalizability of the tion to treat beginning at randomization and at fndings was limited by the clinical trial design. Dose information was not lung and combined leukaemia and lymphoma obtained because of lack of accurate information were close to unity (see Table 2. No statistically signifcant increase or decrease in the occurrence of any of the cancers examined was observed in these studies. Cancer in Experimental Animals ratios were near unity for all associations reported, except cancer of the colorectum and any use of 3. Te major limitations were use of bw), 200, 600, or 2000 mg/kg bw by gavage, self-reported exposure information, which was 5 days per week, for 104 weeks. Mean body weights of males at tries and tumour boards) and 721 age- and 600 and 2000 mg/kg bw were less (10% or more) residence-matched general population controls. Intake of ginkgo 2000 mg/kg bw were generally less (10% or more) and other herbal remedies, dietary information than those of the controls between weeks 17 and and other factors was assessed via in-person 69, and afer week 93. However, the reduced the lowest, intermediate, and highest dose, and risk was restricted to women with non-mucinous had a signifcant positive trend. Te respiratory epithelium adenoma (0 out of 49, 0 incidence of hepatocellular carcinoma was out of 49, 2 out of 50, 0 out of 46) in the dosed signifcantly higher in the group receiving the groups were higher than the ranges for histor- highest dose, and had a signifcant positive ical controls (all routes: 8 out of 1186 [0–2%], trend. Te incidence of hepatoblastoma could have reduced the tumour incidence, and was signifcantly higher at the intermediate and that nose respiratory epithelium adenomas are highest dose, and had a signifcant positive trend rare spontaneous tumours in F344/N rats. Excretion of quercetin pharmacokinetics of ginkgolide B, the main or its conjugates in human urine ranged from active ingredient in G.

Respiratory: Respiratory disorder generic 75mg effexor xr, dyspnea discount 37.5mg effexor xr with amex, pleural effusion purchase effexor xr 37.5 mg mastercard, asthma, cough increased, lung edema. Urogenital system: Dysuria, kidney failure, vaginal moniliasis, urinary incontinence. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people. Rapidly induced hypertensive responses have been reported to cause acute pulmonary oedema, arrhythmias, cerebral haemorrhage, or cardiac arrest. Monoamine oxidase inhibitors or tricyclic antidepressants may potentiate the action of sympathomimetic amines. Therefore, when initiating pressor therapy in patients receiving these drugs, the initial dose should be small and given with caution. Cardiovascular: Hypertension, tachycardia, bradycardia, pulmonary oedema, atrial or ventricular arrhythmia. Its pharmacologic mechanisms of action are different from other classes of oral antihyperglycaemic agents. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. High concentrations convert the ferrous iron of reduced haemoglobin to ferric iron which results in the formation of methaemoglobin. Methylene Blue is thought to reduce vasoplegia through actions involving nitric oxide. When reconstituted with water for injection use immediately and discard any unused solution. For prophylaxis against laryngeal oedema in high risk patients, the recommended dose is 20mg 4 hourly for 4 doses beginning 12 hours prior to planned extubation. The use of methylprednisolone sodium succinate sterile powder is contraindicated in premature infants because the 40, 125, 500, 1 g, and the accompanying diluent for the 500 mg and 2 g vials contain benzyl alcohol. Benzyl alcohol has been reported to be associated with a fatal "Gasping Syndrome" in premature infants. Corticosteroids may mask some signs of infection, and new infections may appear during their use. This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted. Since mineralocorticoid secretion may be impaired, salt and/or a mineralocorticoid should be administered concurrently. There is an enhanced effect of corticosteroids on patients with hypothyroidism and in those with cirrhosis. Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids. An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (e. This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Clinical improvement or recovery after stopping corticosteroids may require weeks to years. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin may increase the clearance of methylprednisolone and may require increases in methylprednisolone dose to achieve the desired response. Musculoskeletal: Muscle weakness, aseptic necrosis of femoral and humeral heads, steroid myopathy, loss of muscle mass, pathologic fracture of long bones, severe arthralgia, osteoporosis, vertebral compression fractures, tendon rupture (particularly of the Achilles tendon). Gastrointestinal: Peptic ulcer with possible perforation and haemorrhage, abdominal distention, ulcerative oesophagitis, pancreatitis. These changes are usually small, not associated with any clinical syndrome and are reversible upon discontinuation. Dermatologic: Impaired wound healing, facial erythema, thin fragile skin, increased sweating, petechiae and ecchymoses, may suppress reactions to skin tests. Neurological: Increased intracranial pressure with papilloedema (pseudo-tumour cerebri) usually after treatment, convulsions, vertigo, headache. Endocrine: Development of Cushingoid state, menstrual irregularities, suppression of growth in children, decreased carbohydrate tolerance, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery or illness), manifestations of latent diabetes mellitus, increased requirements for insulin or oral hypoglycaemic agents in diabetics. Metoclopramide stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. These usually are seen during the first 24-48 hours of treatment with metoclopramide, occur more frequently in paediatric patients and adult patients less than 30 years of age and are even more frequent at the higher doses used in prophylaxis of vomiting due to cancer chemotherapy. These symptoms may include involuntary movements of limbs and facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus, or dystonic reactions resembling tetanus. Rarely, dystonic reactions may present as stridor and dyspnea, possibly due to laryngospasm. If these symptoms should occur, Benztropine, 1-2 mg intramuscularly, may be used to reverse these reactions. Tardive Dyskinesia Tardive dyskinesia, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements, may develop in patients treated with metoclopramide. Additive sedative effects can occur when metoclopramide is given with alcohol, sedatives, hypnotics, narcotics, or tranquilizers. Haematologic neutropaenia, leukopaenia, or agranulocytosis, methaemoglobinaemia Allergic Reactions A few cases of rash, urticaria, or bronchospasm, especially in patients with a history of asthma.

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