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DHS-8-PGSSC-Men_and_Women-Template [message #16789] Mon, 04 March 2019 16:42 Go to next message
PGSSC is currently offline  PGSSC
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Thank you for reviewing our proposal for new indicators within the Demographic and Household Survey (DHS) regarding emergency and essential surgical care. The collection of these indicators is a critical step towards the delivery of safe, affordable, equitable access to surgical services as a component of universal health coverage and we consider the DHS as the best forum to derive these data points.

The questions we propose are a product of the Lancet Commission on Global Surgery (LCoGS), a body of work spanning three years involving 25 commissioners and a diverse group of academic, governmental and civil society collaborators from 110 countries. Of the six indicators proposed by the LCoGS, four were published in the World Development Indicators by the World Bank and all six are included in the World Health Organization's Global Reference List of 100 Core Health Indicators. Nevertheless, there currently are no mechanisms in place to collect the data required for these indicators, creating a critical gap in knowledge for surgical care strengthening.

The new indicators in this proposal span four existing DHS modules. For clarity, they are listed in the table below. Of particular interest are the questions on out-of-pocket expenditure and household expenditure to enable the calculation of financial risk protection for all medical interventions captured by the DHS (both surgical and medical), a core component of Sustainable Development Goal 3.8. The remaining questions were taken from a successful pilot DHS survey in Zambia. In the development of this application, we have been fortunate to count on a number of international partners to provide expert review and the indicators proposed are a culmination of these consensus building discussions. Please refer to Appendix A for a full list of international stakeholders who support this application.

Proposed Indicators:
1. Surgical Unmet need
2. Surgical volume

Data Utility:
1. Inform and guide national surgical planning
2. World Bank: World Development Indicators

[Updated on: Mon, 04 March 2019 17:07]

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Re: DHS-8-PGSSC-Men_and_Women-Template [message #16991 is a reply to message #16789] Thu, 14 March 2019 20:11 Go to previous messageGo to next message
taylorwurdeman is currently offline  taylorwurdeman
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Data on unmet surgical need is sparse, as it requires a large statistical infrastructure to collect. DHS is well suited to these types of problems, and is likely the only way this data will be collected. Through understanding unmet surgical need, better policy can be crafted to augment surgical systems.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17077 is a reply to message #16789] Fri, 15 March 2019 10:56 Go to previous messageGo to next message
Scott Corlew is currently offline  Scott Corlew
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Determining the unmet need as well as the actual usage of surgical care within the purview of Universal Health Care is critical for LMICs to be able to develop and implement initiatives that can improve access and quality. Current data regarding this are largely from the perspective of the health care system rather than that of the people who are actually affected. Consequently, unmet need is almost entirely currently found through modeled data. The human level at which DHS can learn about needed but not accessed as well as accessed surgical care as well as accessed care is a major step forward for LMICs in their pursuit of adequate UHC. The questions suggested here for DHS are well-crafted and should be included in the survey tool.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17095 is a reply to message #16789] Fri, 15 March 2019 13:11 Go to previous messageGo to next message
Peacemaker is currently offline  Peacemaker
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Please see attachment for question flow
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17125 is a reply to message #17095] Fri, 15 March 2019 14:31 Go to previous messageGo to next message
djumbam is currently offline  djumbam
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It seems to me that most of the data on unmet need of surgical care in the world we have right now is modeled. While this is helpful to get a sense of what the unmet need is, it is not enough. This is also true of surgical volume. These indicators go hand in hand and should be strongly considered for inclusion in the DHS work.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17141 is a reply to message #16789] Fri, 15 March 2019 14:57 Go to previous messageGo to next message
Aboatin is currently offline  Aboatin
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The DHS provides the best platform to systematically collect standardized data on surgical volume and and unmet need. This is critically needed data to inform efforts to provide universal health care. I fully support the inclusion of these questions in the DHS
Adeline Boatin
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17148 is a reply to message #17141] Fri, 15 March 2019 15:05 Go to previous messageGo to next message
dominiquevervoort is currently offline  dominiquevervoort
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The poorest third of the world's population, according to estimates, only receives 6% of all surgical procedures. Understanding which populations and where are receiving which procedures allows us to intervene where needed: are people in need receiving life-saving or life-changing surgical care, for post-partum complications, congenital malformations, road traffic incidents, cancer, etc.? Integrating this component within DHS allows for properly helping the people in need by highlighting the exact areas and scope of need.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17151 is a reply to message #17148] Fri, 15 March 2019 15:08 Go to previous messageGo to next message
ptruche is currently offline  ptruche
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Data on unmet surgical needs is a core component of understanding the scope of noncommunicable diseases on developing countries. This would provide a broad indicator that would be useful for a variety of applications in health systems research and should be added to the DHS survey.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17170 is a reply to message #17151] Fri, 15 March 2019 15:26 Go to previous messageGo to next message
anm156 is currently offline  anm156
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Reliable epidemiological data on surgical care is sparse, and the data that does exist is often not collected in a standardized manner. DHS efforts to collect this data would go a long way to address this and create a systematic, widespread process to assess unmet surgical need around the world. In order to properly assess surgical systems, overall health systems, and ability of countries to achieve Universal Health Coverage, this data should be collected.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17183 is a reply to message #17170] Fri, 15 March 2019 15:31 Go to previous messageGo to next message
Vicente Gracias is currently offline  Vicente Gracias
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Endeavors to better characterize overall surgical expenditures and their related effects, good and bad, are essential to better codify unmet needs of noncommunicable disease
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17186 is a reply to message #17183] Fri, 15 March 2019 15:44 Go to previous messageGo to next message
Jordan Pyda is currently offline  Jordan Pyda
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The DHS provides the best approach for systematically collecting standardized data on surgical volume and and unmet surgical need. This is incredibly important data. I fully support the inclusion of these questions in DHS. Jordan Pyda MD MPH jpyda@bidmc.harvard.edu
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17187 is a reply to message #16991] Fri, 15 March 2019 15:44 Go to previous messageGo to next message
Adelina Mazhiqi is currently offline  Adelina Mazhiqi
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Data on surgical volume remains limited. Being closely related to unmet surgical need where data is mainly modeled the DHS can offer a solution in collecting accurate and representative data on these indicators. Subsequently, this information can be utilized for improving access to surgical services and prioritizing surgical health policy on national health agendas.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17188 is a reply to message #17183] Fri, 15 March 2019 15:45 Go to previous messageGo to next message
RPatterson is currently offline  RPatterson
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Governments are currently limited in their ability to develop context-specific policy interventions and care delivery structures due to the paucity of surgical data in many countries. By supporting collection of surgical data through these questions, the DHS will be able to help international and national bodies to develop the most effective interventions to address areas with the highest unmet need.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17190 is a reply to message #17183] Fri, 15 March 2019 15:48 Go to previous messageGo to next message
tjpease is currently offline  tjpease
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Surgical system development is the next frontier of public health. Development must be driven by data, and the DHS program is uniquely able to supply necessary baseline data on surgical volume and need.

Tyler Pease
Medical Student
Rutgers - Robert Wood Johnson
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17205 is a reply to message #17190] Fri, 15 March 2019 16:08 Go to previous messageGo to next message
ocahearn is currently offline  ocahearn
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Data on surgical volume and unmet need should absolutely be incorporated into the DHS survey in order to obtain internationally comparable data and improve access to safe surgical care.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17210 is a reply to message #16789] Fri, 15 March 2019 16:09 Go to previous messageGo to next message
JohnMeara is currently offline  JohnMeara
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It is absolutely critical to collect data on surgical volume and unmet need in order for countries to make strategic and tactical decisions around health system strengthening. I full support these indicators.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17211 is a reply to message #16789] Fri, 15 March 2019 16:10 Go to previous messageGo to next message
rachelne is currently offline  rachelne
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Indicators are necessary to have a common language, objectives and variables to discuss research and data that is collected. This is needed to further advance care
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17221 is a reply to message #17210] Fri, 15 March 2019 16:16 Go to previous messageGo to next message
blakealkire is currently offline  blakealkire
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We cannot achieve UHC without surgery, anesthesia, and obstetrics, and thus we cannot know if UHC has been achieved if we cannot describe basic metrics such as unmet need for surgery.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17228 is a reply to message #17221] Fri, 15 March 2019 16:19 Go to previous messageGo to next message
Cstrader1 is currently offline  Cstrader1
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Unmet surgical need is an increasingly visible issue. Questions such as these are vital to inform and guide national surgical planning globally. As resources are finite, collecting this information will certainly help to allocate resources where they are needed most.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17237 is a reply to message #17228] Fri, 15 March 2019 16:21 Go to previous messageGo to next message
shehnaz Alidina is currently offline  shehnaz Alidina
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I fully support these indicators:
1. Surgical Unmet need
2. Surgical volume
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17249 is a reply to message #16789] Fri, 15 March 2019 16:26 Go to previous messageGo to next message
Haitham.Shoman is currently offline  Haitham.Shoman
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It is about time the right questions are being asked at the right time to the right people! Thank you everyone for bringing this on the table.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17260 is a reply to message #16789] Fri, 15 March 2019 16:29 Go to previous messageGo to next message
cjuillard is currently offline  cjuillard
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I support the addition of these questions to help Ministries of Health and other agencies understand how to improve access to surgical care. These data will set the foundation for estimates of unmet need and other critical information necessary to strengthen surgical systems globally.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17268 is a reply to message #17260] Fri, 15 March 2019 16:34 Go to previous messageGo to next message
kgarringer is currently offline  kgarringer
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Efforts by the DHS to collect data regarding surgical volume and unmet surgical need would be unprecedented. It is exciting to see both proposed as indicators, which both would impact policy decisions regarding UHC and surgery worldwide.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17275 is a reply to message #17148] Fri, 15 March 2019 16:39 Go to previous messageGo to next message
Cstrader1 is currently offline  Cstrader1
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Exactly right - we need to fix this!
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17281 is a reply to message #17210] Fri, 15 March 2019 16:43 Go to previous messageGo to next message
AlexPetersMD is currently offline  AlexPetersMD
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As a general surgeon and public health researcher, we currently have little data to truly understand the burden of surgical diseases and the surgical capacity in many countries around the world. We need to understand the surgical volume and unmet need in countries around the world in order to make effective policy and implementation decisions in line with WHA Resolution 68.15.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17282 is a reply to message #17190] Fri, 15 March 2019 16:43 Go to previous messageGo to next message
Cstrader1 is currently offline  Cstrader1
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So great to see medical students aware of this important issue. Education = improvement!
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17284 is a reply to message #17281] Fri, 15 March 2019 16:45 Go to previous messageGo to next message
Yves Jacket Nsavyimana is currently offline  Yves Jacket Nsavyimana
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In the developing country, we miss a lot of data related to surgical care knowing that the demand for surgical care is increasing every year in the world. A DHS survey is so important.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17285 is a reply to message #17275] Fri, 15 March 2019 16:46 Go to previous messageGo to next message
SebastianShu is currently offline  SebastianShu
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Surgery is an essential component of health care. Despite this fact, there is not enough efforts. Data in regard surgical volume and unmet need is urgently needed to take action now.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17287 is a reply to message #16789] Fri, 15 March 2019 16:47 Go to previous messageGo to next message
gmenon is currently offline  gmenon
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Much of the surgical care, particularly in rural parts of LMIC's, is provided 'off the record'. Even less is known about those who never seek surgical care. Having accurate data on surgical volume and the unmet need is critical to planning sustainable interventions.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17288 is a reply to message #17287] Fri, 15 March 2019 16:47 Go to previous messageGo to next message
Ulrick Sidney is currently offline  Ulrick Sidney
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Surgery is part and parcel of healthcare yet more than two thirds of the world's population does not have access to safe and affordable surgical care. Many obstacles to safe surgical care have been identified like out-of-pocket expenditure, low surgical volume and low surgical workforce density. What is tragic is that of the very small percentage that has access to surgical care, a considerable proportion either die, become poor or become poorer. This means that access to surgery alone is not enough but it equally needs to be safe and affordable. In order to make this possible we need to collect more data. This data can help us better comprehend the situation on a global, continental, regional, national and provincial level. This is important because we now have proof from Brazil and India that access to safe and affordable surgical care can vary tremendously even at the national level. Getting this data will equally help us evaluate the impact of national and international public health policies. Why is this important? It is important because you cannot evaluate what you do not measure.

For these reasons, I believe that it is capital for the DHS program to incorporate global surgery related indicators. Fortunately, the Lancet Commission on Global surgery did an amazing job defining six indicators that equally have the benefit of falling in line with the sustainable development goals.


Ulrick Sidney
InciSioN International Team
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17292 is a reply to message #16789] Fri, 15 March 2019 16:52 Go to previous messageGo to next message
SBari is currently offline  SBari
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These are very informative indicators that are important to collect regularly, systematically, and globally. DHS is a great fit.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17305 is a reply to message #16789] Fri, 15 March 2019 17:17 Go to previous messageGo to next message
CLReddy is currently offline  CLReddy
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I fully support the inclusion of these survey questions and indicators into DHS 8. Surgical unmet need is currently based on modeled data. If we are going to make any progress on the global health goals, namely: UHC, improved PHC and the WHO's triple billion goals, we must be able to better quantify surgical unmet need if health systems are to be able to respond to the epidemiological shifts that come with "modernity".
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17314 is a reply to message #16789] Fri, 15 March 2019 17:30 Go to previous messageGo to next message
PGSSC is currently offline  PGSSC
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We would like to thank everyone who have been supporting our submission. We have read all your replies and we are delighted to see such support and commitment from the Global Surgery and Global Health community.

Attached is a list of signatories who also have provided their support towards our submission:

1. Professor Chris Lavy - University of Oxford
2. Mr. Andrew Leather - Kings College London
3. Dr. Lars Hagander - Lund University
4. Dr. Hampus Holmer - Lund University
5. Dr. Martin Veller - University of Witwatersrand
6. Dr. Emannuel Ameh - Abuja National Hospital
7. Dr. Margaret Kruk - Harvard TH Chan School of Public Health

The Program in Global Surgery and Social Change (PGSSC)
Harvard Medical School
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17321 is a reply to message #16789] Fri, 15 March 2019 17:33 Go to previous messageGo to next message
Rachel Koch is currently offline  Rachel Koch
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It is critical to collect data regarding surgical volume and the unmet need in order for governments to build stronger healthcare systems to meet the needs of their specific populations.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17335 is a reply to message #17321] Fri, 15 March 2019 17:49 Go to previous messageGo to next message
Kee Park is currently offline  Kee Park
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Surgical unmet need and volume inform the necessary workforce and service delivery gaps critical for policymakers and healthcare workers in planning for capacity building to sustainably meet the need.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17338 is a reply to message #16789] Fri, 15 March 2019 17:51 Go to previous messageGo to next message
Dr. Ernest Barthélemy is currently offline  Dr. Ernest Barthélemy
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Unmet need for surgical care, and surgical volume, are both fundamental elements of health system performance. Including these two indicators in the DHS would empower health systems to collect and track data that will enable health system strengthening and development, especially in low- and middle-income countries. I fully support the inclusion of these indicators in the DHS.

PGSSC wrote on Mon, 04 March 2019 16:42
Thank you for reviewing our proposal for new indicators within the Demographic and Household Survey (DHS) regarding emergency and essential surgical care. The collection of these indicators is a critical step towards the delivery of safe, affordable, equitable access to surgical services as a component of universal health coverage and we consider the DHS as the best forum to derive these data points.

The questions we propose are a product of the Lancet Commission on Global Surgery (LCoGS), a body of work spanning three years involving 25 commissioners and a diverse group of academic, governmental and civil society collaborators from 110 countries. Of the six indicators proposed by the LCoGS, four were published in the World Development Indicators by the World Bank and all six are included in the World Health Organization's Global Reference List of 100 Core Health Indicators. Nevertheless, there currently are no mechanisms in place to collect the data required for these indicators, creating a critical gap in knowledge for surgical care strengthening.

The new indicators in this proposal span four existing DHS modules. For clarity, they are listed in the table below. Of particular interest are the questions on out-of-pocket expenditure and household expenditure to enable the calculation of financial risk protection for all medical interventions captured by the DHS (both surgical and medical), a core component of Sustainable Development Goal 3.8. The remaining questions were taken from a successful pilot DHS survey in Zambia. In the development of this application, we have been fortunate to count on a number of international partners to provide expert review and the indicators proposed are a culmination of these consensus building discussions. Please refer to Appendix A for a full list of international stakeholders who support this application.

Proposed Indicators:
1. Surgical Unmet need
2. Surgical volume

Data Utility:
1. Inform and guide national surgical planning
2. World Bank: World Development Indicators
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17354 is a reply to message #17338] Fri, 15 March 2019 18:21 Go to previous messageGo to next message
LukeCaddell is currently offline  LukeCaddell
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I fully endorse this inclusion. These are key data elements that will help to guide the development of national and provincial surgical planning. As countries worldwide begin to undertake these measures, they need quality data that addresses the components of unmet surgical need and current surgical volume. The powerful mechanism of DHS is perfectly suited for capturing this data.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17363 is a reply to message #16789] Fri, 15 March 2019 19:13 Go to previous messageGo to next message
LRoa is currently offline  LRoa
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Unmet surgical need and surgical volume are not consistently tracked in most LMIC. In order to address diseases amenable to surgical management and avert mortality and morbidity it is essential to obtain data on number of surgical procedure done and unmet surgical need
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17370 is a reply to message #16789] Fri, 15 March 2019 20:13 Go to previous messageGo to next message
hfoster is currently offline  hfoster
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I support the inclusion of these indicators. Both indicators-surgical unmet need and surgical volume- will help guide appropriate decisions regarding health system strengthening.
Re: DHS-8-PGSSC-Men_and_Women-Template [message #17374 is a reply to message #16789] Fri, 15 March 2019 21:09 Go to previous messageGo to previous message
vsanthirapala is currently offline  vsanthirapala
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Collection of surgical volume indicator is a key recommendation of the Lancet Commission on Global Surgery. With the provision of surgery, it is estimated 16.9 million deaths annually could be minimized owing to surgery's place as a core component of the healthcare system. Yet data to track surgical volume is woefully lacking. Unmet surgical need is essential for assessing the barriers to care which may be financial, social/cultural, geographical and so forth. The unmet need data set will enable ministries to strengthen their surgical system in a targeted fashion. The sheer magnitude of death and disability associated with not having a surgical system means it is entirely appropriate that these indicators are placed in the core modules.
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