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  • Ref 5918

    Cognitive, behavioral, and autonomic correlates of mind wandering and perseverative cognition in major depression

    http://journal.frontiersin.org/artic...00433/abstract

    Autonomic dysregulation has been hypothesized to play a role in the relationships between psychopathology and cardiovascular risk. An important transdiagnostic factor that has been associated with autonomic dysfunction is perseverative cognition (PC), mainly present in Major Depressive Disorder (MDD) in the form of rumination. As the ability to adaptively let our mind wander without ruminating is critical to mental health, this study aimed to examine the autonomic concomitants of functional vs. dysfunctional intrusive thoughts in MDD. Ambulatory heart rate (HR) and variability (HRV) of 18 MDD subjects and 18 healthy controls were recorded for 24 h. Approximately every 30 min during waking hours subjects reported their ongoing thoughts and moods using electronic diaries. Random regression models were performed. Compared to controls, MDD subjects were more often caught during episodes of PC. In both groups, PC required more effort to be inhibited and interfered more with ongoing activities compared to mind wandering (MW) (ps < 0.0001). This cognitive rigidity was mirrored by autonomic inflexibility, as PC was characterized by lower HRV (p < 0.0001) compared to MW. A worse mood was reported by MDD patients compared to controls, independently of their ongoing cognitive process. Controls, however, showed the highest mood worsening during PC compared to being on task and MW. HRV during rumination correlated with self-reported somatic symptoms on the same day and several dispositional traits. MDD subjects showed lower HRV during sleep, which correlated with hopelessness rumination. Results show that PC is associated with autonomic dysfunctions in both healthy and MDD subjects. Understanding when spontaneous thought is adaptive and when it is not may clarify its role in the etiology of mood disorders, shedding light on the still unexplained association between psychopathology, chronic stress, and risk for health.
    Last edited by Jo Bowyer; 11-12-2016, 03:44 PM.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

  • #2
    Attachment, Symptom Severity, and Depression in Medically Unexplained Musculoskeletal Pain and Osteoarthritis: A Cross-Sectional Study

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373893/

    Abstract
    Background

    Attachment insecurity relates to the onset and course of chronic pain via dysfunctional reactions to pain. However, few studies have investigated the proportion of insecure attachment styles in different pain conditions, and results regarding associations between attachment, pain severity, and disability in chronic pain are inconsistent. This study aims to clarify the relationships between insecure attachment and occurrence or severity of chronic pain with and without clearly defined organic cause. To detect potential differences in the importance of global and romantic attachment representations, we included both concepts in our study.

    Methods

    85 patients with medically unexplained musculoskeletal pain (UMP) and 89 patients with joint pain from osteoarthritis (OA) completed self-report measures of global and romantic attachment, pain intensity, physical functioning, and depression.

    Results

    Patients reporting global insecure attachment representations were more likely to suffer from medically unexplained musculoskeletal pain (OR 3.4), compared to securely attached patients. Romantic attachment did not differ between pain conditions. Pain intensity was associated with romantic attachment anxiety, and this relationship was more pronounced in the OA group compared to the UMP group. Both global and romantic attachment anxiety predicted depression, accounting for 15% and 17% of the variance, respectively. Disability was independent from attachment patterns.

    Conclusions

    Our results indicate that global insecure attachment is associated with the experience of medically unexplained musculoskeletal pain, but not with osteoarthritis. In contrast, insecure attachment patterns seem to be linked to pain intensity and pain-related depression in unexplained musculoskeletal pain and in osteoarthritis. These findings suggest that relationship-informed focused treatment strategies may alleviate pain severity and psychological distress in chronic pain independent of underlying pathology.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

    Comment


    • #3
      Social determinants of health – are we doing enough?

      Not a paper, another of Dave Nicholl's blog posts

      http://criticalphysio.me/2015/04/14/...gh/#more-28536
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • #4
        Thanks Jo
        Paul

        Comment


        • #5
          Thanks Jo,

          funny you posted Dave's post as I looked at many of t hem last night ..He has an incredible breadth of knowledge and one of his posts on critical thinkinking was especially good . He must not work much to have the time to do this ??
          As to the post on equality ---its usually put in the corner as social/political and I don't see much medical interest in it . Any pain clinic I have been in the patient population is skewed. Pacing and graded exposure doesnt cut it for the majority (neither does interventional pain treatments ). Interestingly Mick Thacker mentioned Andy Burnham the Labour Health secretary comments on how movement straddles a lot of health related behaviour so perhaps a lot of physios might vote for his party (unless you live n of the border that is....)

          Comment


          • #6
            Hi Ian,

            I left the NHS in the '80s when I started to get too much interference from management and went high end instead. Once or twice a year, I will get an immigrant patient who is living in overcrowded accommodation where most of the household are working several zero hours contracts to make ends meet. These patients tend to be highly motivated and do well.

            I would agree that movement in every sense of the word is key. My last NHS post comprised management of massively understaffed medical wards including treatment of stroke and cystic fibrosis as well as picking up spine and pain related problems that came through A+E, because I needed to maintain my skills. It was not unusual for me to put in many hours unpaid overtime on a daily basis and I couldn't afford to spend much time with people who couldn't or wouldn't give us something back in the way of engagement. It can happen high end as well, I sacked one of my private patients years ago for wasting his money and my time. He still emails and a couple of years ago came in to show me his daughter's wedding pictures, she is also a patient and I have hopes that her children, if any, will be too.

            I saw someone this morning who has managed to down modulate much of his NMSK related pain over the years and has learned to live with the pain in his feet (erythromelagia). He has been in touch recently re head pains and has enjoyed adding the occipital nerve diagrams to his file, but we both agree that someone needs to review his temporal arteritis.

            I have had team members who reluctantly turned up for work in order to fund their real lives outside, and patients who have told me that it's my ******* job to fix them and that they are too busy, too tired or have too many "issues" to do any of it for themselves. As a junior physio I changed paper sheets and served meals when the unions called strikes and tend to bend the ear of the CSP whenever it is suggested that physios take strike action. I am fortunate now to work with some surgeons and physicians who love some of what they do in the NHS, tolerate that which grinds their gears with good humour, and bring what they have learned to their private practice.

            I am currently getting five star NHS management for an eye condition as part of a clinical trial. Conversely, I was reluctant to stay hands off during some of the hospital admissions of my late husband because one or two of the wards to which he was admitted were chaotic. I found myself acting as advocate for other relatives in similar situations when staff appeared to be on autopilot. I have an asthmatic daughter who sometimes needs blue lighting to A+E and who, the following week will be sitting in the same department with a friend telling them either that they don't need to be there and should be at the GP surgery, or that their current behaviour in the waiting area is unacceptable.

            We need adequate funding for housing, schools and social care and we also need to improve our attitude as workers within the NHS and users of it. We need people with money to spare to decide to put something back. In Bedford we have the Primrose Unit for chemo. Primrose herself had her chemo with excellent staff in depressing surroundings. Her husband was determined that others should have what he would have liked for her. Others have furnished and continue to fund rooms in London hospitals where people can be given the news that their loved one has reached the end of the road, or they have funded a rest area for the staff. Imo all of us should take a pride in the NHS and do what we can to make it work. Many of my patients do. They use it responsibly, raise money for their local hospitals and work in them as volunteers.
            Jo Bowyer
            Chartered Physiotherapist Registered Osteopath.
            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

            Comment


            • #7
              Associations between Neuroticism and Depression in Relation to Catastrophizing and Pain-Related Anxiety in Chronic Pain Patients

              http://journals.plos.org/plosone/art...l.pone.0126351

              Abstract

              Several cognitive-affective constructs, including pain catastrophizing and pain-related anxiety, have been implicated in the onset and progression of chronic pain, and both constructs have been identified as key targets for multidisciplinary pain treatment. Both neuroticism and depression have been linked to these constructs (and to each other), but how each may contribute to the pain experience is unknown. This study tested associations between neuroticism, depression, and indices of catastrophizing and pain-related anxiety among persons seeking treatment for chronic non-malignant pain. We hypothesized, as a higher-order personality trait, neuroticism would remain uniquely associated with both pain catastrophizing and pain-related anxiety, even after accounting for current symptoms of depression. A retrospective study design assessed depression (as measured by the Centers for Epidemiologic Studies-Depression scale), neuroticism (measured with the Neuroticism-Extraversion-Openness Personality Inventory), the Pain Catastrophizing Scale, and the Pain Anxiety Symptom Score in a consecutive series of patients (n=595) admitted to a 3-week outpatient pain treatment program from March 2009 through January 2011. Hierarchical regression indicated that neuroticism was independently associated with greater pain catastrophizing and pain-related anxiety, above-and-beyond the contributions of sociodemographic characteristics, pain severity, and depression. A depression by neuroticism interaction was not observed, suggesting that associations between neuroticism and cognitive-affective pain constructs remained stable across varying levels of current depression. These findings represent an early but important step towards the clarification of complex associations between trait neuroticism, current depression, and tendencies toward catastrophic and anxiety-provoking appraisals of pain among persons seeking treatment for chronic pain.
              Jo Bowyer
              Chartered Physiotherapist Registered Osteopath.
              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

              Comment


              • #8
                Updating versus Exposure to Prevent Consolidation of Conditioned Fear

                http://journals.plos.org/plosone/art...l.pone.0122971

                Abstract

                Targeting the consolidation of fear memories following trauma may offer a promising method for preventing the development of flashbacks and other unwanted re-experiencing symptoms that characterise Posttraumatic Stress Disorder (PTSD). Research has demonstrated that performing visuo-spatial tasks after analogue trauma can block the consolidation of fear memory and reduce the frequency of flashbacks. However, no research has yet used verbal techniques to alter memories during the consolidation window. This is surprising given that the most effective treatments for PTSD are verbally-based with exposure therapy and trauma-focused cognitive behavioural therapy gaining the most evidence of efficacy. Psychological therapies aim to reduce the conditioned fear response, which is in keeping with the preliminary finding that an increased propensity for fear conditioning may be a vulnerability factor for PTSD. Our research had two aims. We investigated the degree to which individual differences in fear conditioning predict the development of PTSD symptoms. We also compared the preventative effects of two clinically informed psychological techniques administered during the consolidation window: exposure to the trauma memory and updating the meaning of the trauma. 115 healthy participants underwent a fear conditioning paradigm in which traumatic film stimuli (unconditioned stimuli) were paired with neutral stimuli (conditioned stimuli). Participants were randomly allocated to an updating, exposure or control group to compare the effects on the conditioned fear response and on PTSD symptomatology. The results showed that stronger conditioned responses at acquisition significantly predicted the development of PTSD symptoms. The updating group, who verbally devalued the unconditioned stimulus within the consolidation window, experienced significantly lower levels of PTSD symptoms during follow-up than the exposure and control groups. These findings are consistent with clinical interventions for chronic PTSD and have important implications for identifying those at risk as well as for designing novel early interventions to prevent the development of PTSD.
                I worked with someone who was a trained counsellor as well as a physiotherapist. He had a theory that most "victims" of unexpected trauma, especially when it was not their fault, had a degree of PTSD which complicated their presentation. I have found that NSPBE and a certain amount of deconstruction of what happened and why, prevents catastrophising. I have also found that patients get angry if they feel that I am trivialising what happened to them. It is a fine line to tread until one gets to know the patient well.
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • #9
                  Theta, Mental Flexibility, and Post-Traumatic Stress Disorder: Connecting in the Parietal Cortex

                  http://journals.plos.org/plosone/art...l.pone.0123541

                  Abstract

                  Post-traumatic stress disorder (PTSD) is a mental health injury characterised by re-experiencing, avoidance, numbing and hyperarousal. Whilst the aetiology of the disorder is relatively well understood, there is debate about the prevalence of cognitive sequelae that manifest in PTSD. In particular, there are conflicting reports about deficits in executive function and mental flexibility. Even less is known about the neural changes that underlie such deficits. Here, we used magnetoencephalography to study differences in functional connectivity during a mental flexibility task in combat-related PTSD (all males, mean age = 37.4, n = 18) versus a military control (all males, mean age = 33.05, n = 19) group. We observed large-scale increases in theta connectivity in the PTSD group compared to controls. The PTSD group performance was compromised in the more attentionally-demanding task and this was characterised by 'late-stage' theta hyperconnectivity, concentrated in network connections involving right parietal cortex. Furthermore, we observed significant correlations with the connectivity strength in this region with a number of cognitive-behavioural outcomes, including measures of attention, depression and anxiety. These findings suggest atypical coordination of neural synchronisation in large scale networks contributes to deficits in mental flexibility for PTSD populations in timed, attentionally-demanding tasks, and this propensity toward network hyperconnectivity may play a more general role in the cognitive sequelae evident in this disorder.
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                  Comment


                  • #10
                    Better Safe Than Sorry? The Safety Margin Surrounding the Body Is Increased by Anxiety

                    http://www.jneurosci.org/content/33/35/14225.full

                    Abstract

                    The defensive peripersonal space represents a “safety margin” advantageous for survival. Its spatial extension and the possible relationship with personality traits have never been investigated. Here, in a population of 15 healthy human participants, we show that the defensive peripersonal space has a sharp boundary, located between 20 and 40 cm from the face, and that within such space there is a thin, “highest-risk area” closest to the face (i.e., an “ultra-near” defensive space). Single-subject analysis revealed clear interindividual differences in the extension of such peripersonal space. These differences are positively related to individual variability in trait anxiety. These findings point to the potential for measuring a range of defensive behaviors in relation to individual levels of anxiety. Such measures will allow developing procedures to test risk assessment abilities, particularly in professions that require reacting quickly to aversive stimuli near the body, such as firemen, policemen, and military officers. This may also lead to possible interventions to improve their performance under pressure.
                    Re Dr. Gian Domenico Iannetti, Department of Neuroscience, Physiology and Pharmacology, University College London. :thumbs_up One to watch!
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • #11
                      Second Language Feedback Abolishes the “Hot Hand” Effect during Even-Probability Gambling

                      http://www.jneurosci.org/content/35/15/5983.short

                      Abstract

                      Research into language–emotion interactions has revealed intriguing cognitive inhibition effects by emotionally negative words in bilinguals. Here, we turn to the domain of human risk taking and show that the experience of positive recency in games of chance—the “hot hand” effect—is diminished when game outcomes are provided in a second language rather than the native language. We engaged late Chinese-English bilinguals with “play” or “leave” decisions upon presentation of equal-odds bets while manipulating language of feedback and outcome value. When positive game outcomes were presented in their second language, English, participants subsequently took significantly fewer gambles and responded slower compared with the trials in which equivalent feedback was provided in Chinese, their native language. Positive feedback was identified as driving the cross-language difference in preference for risk over certainty: feedback for previous winning outcomes presented in Chinese increased subsequent risk taking, whereas in the English context no such effect was observed. Complementing this behavioral effect, event-related brain potentials elicited by feedback words showed an amplified response to Chinese relative to English in the feedback-related negativity window, indicating a stronger impact in the native than in the second language. We also observed a main effect of language on P300 amplitude and found it correlated with the cross-language difference in risk selections, suggesting that the greater the difference in attention between languages, the greater the difference in risk-taking behavior. These results provide evidence that the hot hand effect is at least attenuated when an individual operates in a non-native language.
                      Jo Bowyer
                      Chartered Physiotherapist Registered Osteopath.
                      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                      Comment


                      • #12
                        Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease

                        http://journals.plos.org/plosone/art...l.pone.0123861

                        Abstract

                        Introduction

                        Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) can profoundly affect quality of life and are influenced by stress and resiliency. The impact of mind-body interventions (MBIs) on IBS and IBD patients has not previously been examined.

                        Methods

                        Nineteen IBS and 29 IBD patients were enrolled in a 9-week relaxation response based mind-body group intervention (RR-MBI), focusing on elicitation of the RR and cognitive skill building. Symptom questionnaires and inflammatory markers were assessed pre- and post-intervention, and at short-term follow-up. Peripheral blood transcriptome analysis was performed to identify genomic correlates of the RR-MBI.

                        Results

                        Pain Catastrophizing Scale scores improved significantly post-intervention for IBD and at short-term follow-up for IBS and IBD. Trait Anxiety scores, IBS Quality of Life, IBS Symptom Severity Index, and IBD Questionnaire scores improved significantly post-intervention and at short-term follow-up for IBS and IBD, respectively. RR-MBI altered expression of more genes in IBD (1059 genes) than in IBS (119 genes). In IBD, reduced expression of RR-MBI response genes was most significantly linked to inflammatory response, cell growth, proliferation, and oxidative stress-related pathways. In IBS, cell cycle regulation and DNA damage related gene sets were significantly upregulated after RR-MBI. Interactive network analysis of RR-affected pathways identified TNF, AKT and NF-κB as top focus molecules in IBS, while in IBD kinases (e.g. MAPK, P38 MAPK), inflammation (e.g. VEGF-C, NF-κB) and cell cycle and proliferation (e.g. UBC, APP) related genes emerged as top focus molecules.

                        Conclusions

                        In this uncontrolled pilot study, participation in an RR-MBI was associated with improvements in disease-specific measures, trait anxiety, and pain catastrophizing in IBS and IBD patients. Moreover, observed gene expression changes suggest that NF-κB is a target focus molecule in both IBS and IBD—and that its regulation may contribute to counteracting the harmful effects of stress in both diseases. Larger, controlled studies are needed to confirm this preliminary finding.
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • #13
                          Relationships among Trait Resilience, Virtues, Post-traumatic Stress Disorder, and Post-traumatic Growth

                          http://journals.plos.org/plosone/art...l.pone.0125707

                          Abstract

                          The present study aims to examine the relationship between trait resilience and virtues in the context of trauma. A total of 537 participants who attended the preliminary investigation and completed the Life Events Checklist were screened. Of these participants, 142 suffered from personal traumatic experiences in the past year; these individuals were qualified and invited to respond to online questionnaires to assess trait resilience, virtues (i.e., Conscientiousness, Vitality, and Relationship), post-traumatic stress disorder (PTSD) symptoms, and post-traumatic growth (PTG). The following questionnaires were used: Connor-Davidson Resilience Scale-Revised, Chinese Virtues Questionnaire, PTSD Checklist-Specific, and Post-traumatic Growth Inventory-Chinese. Only 95 participants who manifested self-reported PTSD symptoms and PTG were involved in the current analyses. Trauma was positively and significantly correlated with PTSD in the current sample. Results indicated that trait resilience was positively associated with virtues and PTG; by contrast, PTSD scores were negatively but not significantly related to most of these factors. The three virtues contributed to PTG to a greater extent than trait resilience in non-PTSD and PTSD groups. However, trait resilience remained a significant predictor in the PTSD group even when the three virtues were controlled. The relationship between trait resilience and PTG was moderated by PTSD type (non-PTSD group vs. PTSD group). Our results further suggested that trait resilience and virtues were conceptually related but functionally different constructs. Trait resilience and virtues are positively related; thus, these factors contributed variances to PTG in the context of trauma; however, trait resilience is only manifested when virtues are controlled and when individuals are diagnosed as PTSD. Furthermore, implications and limitations of this study are discussed.
                          Last edited by Jo Bowyer; 02-05-2015, 03:13 PM. Reason: incorrect title
                          Jo Bowyer
                          Chartered Physiotherapist Registered Osteopath.
                          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                          Comment


                          • #14
                            The Moderating Role of Autonomous Motivation on the Relationship between Subjective Well-Being and Physical Health

                            http://journals.plos.org/plosone/art...l.pone.0126399

                            Abstract

                            The purpose of this study was to investigate the moderator effects of autonomous motivation on the relationship between subjective well-being and physical health. Using a cluster sampling approach 486 students (403 female and 83 male students) were included in this study. Subjective well-being, physical health and autonomous motivation were determined by self-report measures. Data were analysed using hierarchical regression analysis and analysis of variance. The results show that high self-determination moderates the relationship between high subjective well-being and physical health. Accordingly, the best physical health was reported by participants who had high level of subjective well-being and whose behaviours were self-determined. Additional analyses have shown that the moderating effect of self-determination is based on the moderational impact of autonomous motives and not the controlling ones. Additionally, whether autonomous motivation moderates the relationship between components of subjective well-being and physical health was also tested. The findings have shown that autonomous motives moderate relationship between physical health and one component of well-being, positive affect. Consequently, a good physical health was found among participants with high positive affect and behaviours regulated by high degree of autonomous motives. Conclusion which can be drawn from these findings is that if an individual behaves autonomously then it can contribute to positive mind—body influences and support their own health.
                            Jo Bowyer
                            Chartered Physiotherapist Registered Osteopath.
                            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                            Comment


                            • #15
                              Mindfulness-Based Therapies in the Treatment of Somatization Disorders: A Systematic Review and Meta-Analysis

                              http://journals.plos.org/plosone/art...l.pone.0071834

                              Abstract

                              Background

                              Mindfulness-based therapy (MBT) has been used effectively to treat a variety of physical and psychological disorders, including depression, anxiety, and chronic pain. Recently, several lines of research have explored the potential for mindfulness-therapy in treating somatization disorders, including fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome.

                              Methods

                              Thirteen studies were identified as fulfilling the present criteria of employing randomized controlled trials to determine the efficacy of any form of MBT in treating somatization disorders. A meta-analysis of the effects of mindfulness-based therapy on pain, symptom severity, quality of life, depression, and anxiety was performed to determine the potential of this form of treatment.

                              Findings

                              While limited in power, the meta-analysis indicated a small to moderate positive effect of MBT (compared to wait-list or support group controls) in reducing pain (SMD = −0.21, 95% CI: −0.37, −0.03; p<0.05), symptom severity (SMD = −0.40, 95% CI: −0.54, −0.26; p<0.001), depression (SMD = −0.23, 95% CI: −0.40, −0.07, p<0.01), and anxiety (SMD = −0.20, 95% CI: −0.42, 0.02, p = 0.07) associated with somatization disorders, and improving quality of life (SMD = 0.39, 95% CI: 0.19, 0.59; p<0.001) in patients with this disorder. Subgroup analyses indicated that the efficacy of MBT was most consistent for irritable bowel syndrome (p<0.001 for pain, symptom severity, and quality of life), and that mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MCBT) were more effective than eclectic/unspecified MBT.

                              Conclusions

                              Preliminary evidence suggests that MBT may be effective in treating at least some aspects of somatization disorders. Further research is warranted.
                              Jo Bowyer
                              Chartered Physiotherapist Registered Osteopath.
                              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                              Comment

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