Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Poisoning


Related Terms

  • Drug Overdose
  • Overdosage
  • Substance Intoxication
  • Toxic Effects of a Substance

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Emergency Medicine Physician
  • Gastroenterologist
  • Internal Medicine Physician
  • Medical Toxicologist
  • Nephrologist
  • Pharmacologist
  • Preventive Medicine Specialist

Comorbid Conditions

Factors Influencing Duration

The type and amount of the poisoning agent, when the treatment was instituted, the nature and severity of organ system impairments, and the presence of complications will affect the duration.

Medical Codes

ICD-9-CM:
960.0 - Poisoning by Penicillins
960.1 - Poisoning by Antifungal Antibiotics
960.2 - Poisoning by Chloramphenicol Group
960.3 - Poisoning by Erythromycin and Other Macrolides
960.4 - Poisoning by Tetracycline Group
960.5 - Poisoning by Cephalosporin Group
960.6 - Poisoning by Antimycobacterial Antibiotics
960.7 - Poisoning by Antineoplastic Antibiotics
960.8 - Poisoning by Other Specified Antibiotics
960.9 - Poisoning by Unspecified Antibiotic
961.0 - Poisoning by Sulfonamides
961.2 - Poisoning by Heavy Metal Anti-infectives
961.3 - Poisoning by Quinoline and Hydroxyquinoline Derivatives
961.4 - Poisoning by Antimalarials and Drugs Acting on Other Blood Protozoa
961.5 - Poisoning by Other Antiprotozoal Drugs
961.6 - Poisoning by Anthelmintics
961.7 - Poisoning by Antiviral Drugs
961.8 - Poisoning by Other Antimycobacterial Drugs
961.9 - Poisoning by Other Unspecified Anti-Infectives
962.0 - Poisoning by Adrenal Cortical Steroids
962.1 - Poisoning by Androgens and Anabolic Congeners
962.2 - Poisoning by Ovarian Hormones and Synthetic Substitutes
962.3 - Poisoning by Insulins and Antidiabetic Agents
962.4 - Poisoning by Anterior Pituitary Hormones
962.5 - Poisoning by Posterior Pituitary Hormones
962.6 - Poisoning by Parathyroid and Parathyroid Derivatives
962.7 - Poisoning by Thyroid and Thyroid Derivatives
962.8 - Poisoning by Antithyroid Agents
962.9 - Poisoning by Other and Unspecified Hormones and Synthetic Substitutes
963.0 - Poisoning by Antiallergic and Antiemetic Drugs
963.1 - Poisoning by Antineoplastic and Immunosuppressive Drugs
963.2 - Poisoning by Acidifying Agents
963.3 - Poisoning by Alkalizing Agents
963.4 - Poisoning by Enzymes, Not Elsewhere Classified
963.5 - Poisoning by Vitamins
963.8 - Poisoning by Other Specified Systemic Agents
963.9 - Poisoning by Unspecified Systemic Agent
964.0 - Poisoning by Iron and Its Compounds
964.1 - Poisoning by Folic Acid
964.2 - Poisoning by Anticoagulants
964.3 - Poisoning by Vitamin K
964.4 - Poisoning by Fibrinolysis-affecting Drugs
964.5 - Poisoning by Anticoagulant Antagonists and Other Coagulants
964.6 - Poisoning by Gamma Globulin
964.7 - Poisoning by Natural Blood and Blood Products
964.8 - Poisoning by Other Specified Agents Affecting Blood Constituents
964.9 - Poisoning by Unspecified Agent Affecting Blood Constituents
965.00 - Poisoning by Analgesics, Antipyretics, and Antirheumatics; Opium (alkaloids), unspecified
965.01 - Poisoning by Analgesics, Antipyretics, and Antirheumatics; Heroin; Diacetylmorphine
965.02 - Poisoning by Analgesics, Antipyretics, and Antirheumatics; Methadone
965.09 - Other; Codeine [Methylmorphine]; Meperidine [Pethidine]; Morphine
965.1 - Poisoning by Salicylates
965.4 - Poisoning by Aromatic Analgesics, Not Elsewhere Classified
965.5 - Poisoning by Pyrazole Derivatives
965.61 - Poisoning by Analgesics, Antipyretics, and Antirheumatics; Propionic acid derivatives; Fenoprofen; Flurbiprofen; Ibuprofen; Ketoprofen; Naproxen; Oxaprozin
965.69 - Poisoning by Analgesics, Antipyretics, and Antirheumatics; Other Antirheumatics; Gold Salts; Indomethacin
965.7 - Poisoning by Other Non-narcotic Analgesics
965.8 - Poisoning by Other Specified Analgesics and Antipyretics
965.9 - Poisoning by Unspecified Analgesic and Antipyretic
966.0 - Poisoning by Oxazolidine Derivatives
966.1 - Poisoning by Hydantoin Derivatives
966.2 - Poisoning by Succinimides
966.3 - Poisoning by Other and Unspecified Anticonvulsants
966.4 - Poisoning by Anti-Parkinsonism Drugs
967.0 - Poisoning by Barbiturates
967.1 - Poisoning by Chloral Hydrate Group
967.2 - Poisoning by Paraldehyde
967.3 - Poisoning by Sedatives and Hypnotics; Toxic Effects, Methyl Bromide
967.4 - Poisoning by Methaqualone Compounds
967.5 - Poisoning by Glutethimide Group
967.6 - Poisoning by Mixed Sedatives, Not Elsewhere Classified
967.8 - Poisoning by Other Sedatives and Hypnotics
967.9 - Poisoning by Unspecified Sedative or Hypnotic
968.0 - Poisoning by Central Nervous System Muscle-tone Depressants
968.1 - Poisoning by Halothane
968.2 - Poisoning by Other Gaseous Anesthetics
968.3 - Poisoning by Intravenous Anesthetics
968.4 - Poisoning by Other and Unspecified General Anesthetics
968.5 - Surface (topical) and infiltration anesthetics
968.6 - Poisoning by Peripheral Nerve and Plexus-Blocking Anesthetics
968.7 - Poisoning by Spinal Anesthetics
968.9 - Poisoning by Other and Unspecified Local Anesthetics
969.00 - Poisoning by antidepressant, unspecified
969.01 - Poisoning by monoamine oxidase inhibitors
969.02 - Poisoning by selective serotonin and norepinephrine reuptake inhibitors
969.03 - Poisoning by selective serotonin reuptake inhibitors
969.04 - Poisoning by tetracyclic antidepressants
969.05 - Poisoning by tricyclic antidepressants
969.09 - Poisoning by other antidepressants
969.1 - Poisoning by PheNothiazine-based Tranquilizers
969.2 - Poisoning by Butyrophenone-based Tranquilizers
969.3 - Poisoning by Other Antipsychotics, Neuroleptics, and Major Tranquilizers
969.4 - Poisoning by Benzodiazepine-based Tranquilizers
969.5 - Poisoning by Other Tranquilizers
969.6 - Poisoning by Psychodysleptics (Hallucinogens) and Cannabis
969.70 - Poisoning by psychostimulant, unspecified
969.71 - Poisoning by caffeine
969.72 - Poisoning by amphetamines
969.73 - Poisoning by methylphenidate
969.79 - Poisoning by other psychostimulants
969.8 - Poisoning by Other Specified Psychotropic Agents
969.9 - Poisoning by Unspecified Psychotropic Agent
970.0 - Poisoning by Analeptics
970.1 - Poisoning by Opiate Antagonists
970.81 - Cocaine; Crack
970.89 - Other Central Nervous System Stimulants
970.9 - Poisoning by Unspecified Central Nervous System Stimulant
971.0 - Poisoning by Parasympathomimetics
971.1 - Poisoning by Parasympatholytics
971.2 - Poisoning by Sympathomimetics
971.3 - Poisoning by Sympatholytics
971.9 - Poisoning by Unspecified Drug Primarily Affecting Autonomic Nervous System
972.0 - Poisoning by Cardiac Rhythm Regulators
972.1 - Poisoning by Cardiotonic Glycosides and Drugs of Similar Action
972.2 - Poisoning by Antilipemic and Antiarteriosclerotic Drugs
972.3 - Poisoning by Ganglion-blocking Agents
972.4 - Poisoning by Coronary Vasodilators
972.5 - Poisoning by Other Vasodilators
972.6 - Poisoning by Other Antihypertensive Agents
972.7 - Poisoning by Antivaricose Drugs, Including Sclerosing Agents
972.8 - Poisoning by Capillary-active Drugs
972.9 - Poisoning by Other and Unspecified Agents Primarily Affecting the Cardiovascular System
973.0 - Poisoning by Antacids and Antigastric Secretion Drugs
973.1 - Poisoning by Irritant Cathartics
973.2 - Poisoning by Emollients Cathartics
973.3 - Poisoning by Other Cathartics, Including Intestinal Atonia Drugs
973.4 - Digestants; Pancreatin; Papain; Pepsin
973.5 - Poisoning by Antidiarrheal Drugs
973.6 - Poisoning by Emetics
973.8 - Poisoning by Other Specified Agents Primarily Affecting the Gastrointestinal System
973.9 - Poisoning by Unspecified Agents Primarily Affecting the Gastrointestinal System
974.0 - Poisoning by Mercurial Diuretics
974.1 - Poisoning by Purine Derivative Diuretics
974.2 - Poisoning by Carbonic Acid Anhydrase Inhibitors
974.3 - Poisoning by Saluretics
974.4 - Poisoning by Other Diuretics
974.5 - Poisoning by Electrolytic, Caloric, and Water-Balance Agents
974.6 - Poisoning by Other Mineral Salts, Not Elsewhere Classified
974.7 - Poisoning by Uric Acid Metabolism Drugs
975.0 - Poisoning by Oxytocic Agents
975.1 - Poisoning by Smooth Muscle Relaxants
975.2 - Poisoning by Skeletal Muscle Relaxants
975.3 - Poisoning by Other and Unspecified Drugs Acting on Muscles
975.4 - Poisoning by Antitussives
975.5 - Poisoning by Expectorants
975.6 - Poisoning by Anti-common Cold Drugs
975.7 - Poisoning by Antiasthmatics
975.8 - Poisoning by Other and Unspecified Respiratory Drugs
976.0 - Poisoning by Iodine (Local Anti-infectives and Anti-inflammatory Drugs)
976.1 - Poisoning by Antipruritics
976.2 - Poisoning by Local Astringents and Local Detergents
976.3 - Poisoning by Emollients, Demulcents, and Protectants
976.4 - Poisoning by Keratolytics, Keratoplastics, Other Hair Treatment Drugs and Preparations
976.5 - Poisoning by Eye Anti-infectives and Other Eye Drugs
976.6 - Poisoning by Anti-infectives and Other Drugs and Preparations for Ear, Nose, and Throat
976.7 - Poisoning by Agents Primarily Affecting Skin and Mucous Membrane, Ophthalmological, Otorhinolaryngological, and Dental Drugs; Dental drugs topically applied
976.8 - Poisoning by Other Agents Primarily Affecting Skin and Mucous Membrane
976.9 - Poisoning by Unspecified Agent Primarily Affecting Skin and Mucous Membrane
977.0 - Poisoning by Agents Primarily Affecting Skin and Mucous Membrane, Ophthalmological, Otorhinolaryngological, and Dental Drugs; Poisoning by Dietetics
977.1 - Poisoning by Lipotropic Drugs
977.2 - Poisoning by Antidotes and Chelating Agents, Not Elsewhere Classified
977.3 - Poisoning by Alcohol Deterrents
977.4 - Poisoning by Pharmaceutical Excipients
977.8 - Poisoning by Other Specified Drugs and Medicinal Substances
977.9 - Poisoning by Unspecified Drug or Medicinal Substance
978.0 - Poisoning by BCG Vaccine
978.1 - Poisoning by Typhoid and Paratyphoid Vaccine
978.2 - Poisoning by Cholera Vaccine
978.3 - Poisoning by Plague Vaccine
978.4 - Poisoning by Tetanus Vaccine
978.5 - Poisoning by Diphtheria Vaccine
978.6 - Poisoning by Pertussis Vaccine, Including Combinations with Pertussis Component
978.8 - Poisoning by Other and Unspecified Bacterial Vaccines
978.9 - Poisoning by Mixed Bacterial Vaccines, Except Combinations with Pertussis Component
979.0 - Poisoning by Smallpox Vaccine
979.1 - Poisoning by Rabies Vaccine
979.2 - Poisoning by Typhus Vaccine
979.3 - Poisoning by Yellow Fever Vaccine
979.4 - Poisoning by Measles Vaccine
979.5 - Poisoning by Poliomyelitis Vaccine
979.6 - Poisoning by Other and Unspecified Viral and Rickettsial Vaccines
979.7 - Poisoning by Mixed Viral-rickettsial and Bacterial Vaccines, Except Combinations with Pertussis Component
979.9 - Poisoning by Other and Unspecified Vaccines and Biological Substances

Overview

Poisoning is defined as injury or impairment of organ function or death by any substance capable of producing adverse effects. Poisoning can be acute or chronic. A poison can have local and systemic effects. Poisons can be divided into those intended for human use (foods and their additives, pharmaceuticals, toiletries, and cosmetics) and those that are not (household products, industrial chemicals, and agricultural products). Overdose refers to excessive amounts of the former and any amount of the latter.

Exposure can be from ingestion, inhalation, or absorption through the skin, eyes, or mucous membranes. Poisoning can also occur from bites, stings, and injection of venom from insects, sea creatures (jellyfish, man-of-war, and other fish) and arachnids (spiders, scorpions).

Poison may be taken accidentally (unintentional), for the purpose of committing suicide or as an unexpected complication after intentional drug abuse. Accidental poisonings can also result from acute or chronic exposure in the workplace.

Common over-the-counter pharmaceuticals such as aspirin, acetaminophen or ibuprofen can cause acute or chronic poisoning. Chronic poisoning with these drugs occurs most commonly in elderly persons who regularly take large doses (e.g., for osteoarthritis) or in whom renal failure develops.

Incidence and Prevalence: According to the national Toxic Exposure Surveillance System, there were 2.4 million potential cases of poisoning reported to the poison control centers for the year 2004. Poisonings resulted in 1100 deaths and more than 500,000 hospitalizations. Drug-related exposures were responsible for 38% of the emergency department visits at one hospital and 19.7% of the ICU admissions over a 3 month period at another hospital. Forty percent of poisonings involve pharmaceuticals, with the largest number due to acetaminophen. Most fatalities are due to pain relievers (analgesics) (Mofenson).

Source: Medical Disability Advisor



Diagnosis

History: Any individual presenting with multisystem disorders, a change in mental status, or unconscious (comatose) should be suspected of poisoning or overdose.

A history of exposure to poison may or may not be present. The individual can be asymptomatic or complain of generally feeling ill (malaise). Individuals may report vomiting, diarrhea, blood in stool, difficulty breathing, weakness, GI upset, profuse sweating, or dry skin. Irritability, dizziness and low urine output are additional symptoms. In aspirin (salicylate) poisoning, the individual may complain of ringing in the ears (tinnitus). Ibuprofen overdose is usually characterized by GI upset and dizziness.

Physical exam: The exam can reveal skin irritation, different levels of central and peripheral nervous system impairment, pale blue skin due to lack of oxygen (cyanosis), tachycardia, and coma.

The most common initial manifestation of aspirin poisoning is hyperventilation. Other findings include confusion, and lethargy. Individuals with severe intoxication may experience coma, seizures, elevated temperature (hyperthermia), pulmonary edema, and circulatory collapse.

Early signs of acetaminophen overdose are profuse sweating (diaphoresis), pale complexion, and diminished urine output. Later acetaminophen symptoms (at 24 to 48 hours) include nausea and protracted vomiting, upper right quadrant pain, jaundice, coagulation defects, decreased blood sugar (hypoglycemia), degeneration brain function (encephalopathy), liver failure, kidney (renal) failure, and possible disease of the heart muscle (cardiomyopathy).

Tests: Testing depends on the type of poisoning suspected. Laboratory tests include an arterial blood gas (ABG); serum sodium, potassium, and bicarbonate; BUN; blood glucose; urine pH and specific gravity, and kidney (renal) and liver tests. Electrocardiography (ECG) can reveal arrhythmias. A salicylate or acetaminophen level may be obtained if indicated and should be followed serially during therapy. Chest and abdominal radiographs may be required.

In any individual with altered mental status, CT of the head and lumbar puncture should be considered.

In aspirin poisoning, arterial blood gases usually reveal respiratory alkalosis and underlying metabolic decrease in alkalinity of the blood and tissues (acidosis).

Source: Medical Disability Advisor



Treatment

Once poison has been absorbed through the gastrointestinal tract, skin, or lungs, it can quickly spread throughout the body. Most poisons are eventually detoxified by the liver or excreted in the urine. The goal of treatment is to accelerate detoxification and elimination of poison while simultaneously trying to reverse toxic effects.

If asymptomatic, an individual should have the substance removed from the eye, skin, or gastrointestinal tract and should be observed for potential development of symptoms.

For symptomatic individuals, therapy includes the above measures as well as emergency management with resuscitation and ventilation, use of antidotes, prevention of absorption (activated charcoal), elimination of the absorbed substance (hemodialysis) if possible, and supportive therapy.

Intravenous fluids are given to keep the individual well hydrated and maintain urine output. Mild acids or bases can be added to these fluids to increase the amount of poison excreted through the urine. Chemicals to bind poisons (chelation therapy) may be used to neutralize and eliminate certain poisons. Poisons not readily neutralized or eliminated from the blood may need to be removed through dialysis. When available, a specific antidote is given as quickly as possible. Respiration may need to be assisted by a ventilator. Kidney failure may require dialysis. Cerebral edema requires specific management.

Early gastric emptying may be accomplished by inducing vomiting within 30 minutes of ingestion, unless the mental status of the individual prevents this or there are other contraindications. If the individual presents too late to induce vomiting, if the individual is unconscious, or the poison has already moved past the stomach, activated charcoal may be administered by mouth or by a tube introduced through the nose into the stomach (nasogastric tube) to help absorb the poison. Whole bowel irrigation, in which large volumes of polyethylene glycol solution are administered by mouth or by nasogastric tube, may also be needed in an attempt to flush the poison from the gastrointestinal tract prior to absorption. Adequate hydration and maintenance of kidney function is imperative. Arterial blood gases, serum potassium, and urine pH should be monitored often. Hemodialysis may be required, especially if the individual has impaired kidney function.

Eye exposures should be flushed for 15 to 20 minutes with saline. Skin exposures require removal of any contaminated clothing and flushing the skin for 30 minutes with water and shampooing hair if necessary.

Source: Medical Disability Advisor



Prognosis

The outcome depends on the type of the poison, duration of exposure, individual sensitivity, severity of any organ system impairment, and the effectiveness of the treatment. The prognosis is good when treatment begins early and there are no underlying gastrointestinal problems, such as ulcers, or complications such as liver, kidney, or brain (cerebral) damage.

Source: Medical Disability Advisor



Complications

Poisoning can cause permanent injury after acute or chronic exposures. Complications include cardiovascular collapse, coma, shock, respiratory failure, neurological problems, chronic renal failure, and liver failure requiring transplantation. If transplantation is required, then complications of surgery may occur, including medication reactions, infection, and organ rejection.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations depend on the poisoning agent and the outcome of treatment. No work restrictions may be recommended in the case of uneventful treatment and recovery. If prolonged treatment was required, heavy lifting, extensive walking, or strenuous physical activity may need modification until stamina returns.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual have a history of exposure to a poisonous or toxic substance?
  • Did the individual present with symptoms consistent with poisoning or overdose? Has a diagnosis of a specific substance overdose/poisoning been confirmed?
  • How was detection of toxic levels of substance in blood or tissue conducted?
  • Is there a history of exposure to this toxic substance in the workplace? Could the exposure be occurring outside the workplace (i.e., in the home, in the community, or in recreational activities)?
  • Has the individual recently worked in another organization where exposure to this substance is higher?
  • If the diagnosis is uncertain, have other conditions with similar symptoms been ruled out?
  • Is there pre-existing dysfunction of lung, liver, or kidney slowing elimination of toxic agents?
  • Have underlying medical conditions been identified or ruled out?
  • Are liver or kidney abnormalities, or gastrointestinal disorders evident?
  • Has psychiatric evaluation been performed?

Regarding treatment:

  • How soon after exposure was appropriate treatment initiated?
  • Would individual benefit from additional or continued therapy?
  • Did the individual experience any complications associated with the poisoning? If so, was appropriate intervention for the complications addressed in the treatment plan?
  • Would the individual benefit from consultation with a specialist (medical toxicologist, nephrologist, poison control center personnel, gastroenterologist, psychological counselor)?
  • If there is evidence of purposeful self-overdose, is individual receiving appropriate psychiatric counseling?
  • If accidental overdose, has individual received proper education/clarification?

Regarding prognosis:

  • What was the expected outcome?
  • Did the individual suffer any permanent damage to the brain, kidneys, or liver?
  • Has the source of the toxicity been identified and removed?

Source: Medical Disability Advisor



References

Cited

Mofenson, Howard, et al. "Medical Toxicology: Ingestions, Inhalations, and Dermal and Ocular Absorptions." Conn's Current Therapy. Eds. Robert E. Rakel and Edward T. Bope. 57th ed. Philadelphia: W.B. Saunders, 2004. 1319-1392.

Source: Medical Disability Advisor






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