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{\phpg\posx1080\pvpg\posy8356\absw10297\absh758\f5\fs22 \fi287 Things to consider: Pre-bedtime routines will prepare a child physiologically and behaviorally for bed. Calming activities can be identified and learned at school, then practiced at home during the bedtime sequence and at other times.\par}

{\phpg\posx1080\pvpg\posy9508\absw4643\absh505\f9\i\fs22 \li333 \fi-333 2. Graduated Extinction \par\sb0\fi0 \i0 Problem: Bedtime resistance and night wakings\par}

{\phpg\posx1080\pvpg\posy10264\absw10163\absh505\f5\fs22 \fi287 Goal: To gradually withdraw the consequences maintaining a problem behavior and help a child accept change calmly through \ldblquote progressive learning.\rdblquote \par}

{\phpg\posx1413\pvpg\posy10984\absw1100\absh275\f5\fs24 Procedure:\par}

{\phpg\posx1413\pvpg\posy11416\absw3875\absh252\f5\fs22 1. Implement good sleep hygiene practices\par}

{\phpg\posx1413\pvpg\posy11848\absw3803\absh252\f5\fs22 2. Determine when child should go to bed\par}

{\phpg\posx1413\pvpg\posy12280\absw9823\absh241\f5\fs21 3. Put child to bed; if tantrums persist after 1 to 2 minutes, provide neutral reassurance; repeat as often as necessary\par}

{\phpg\posx1413\pvpg\posy12712\absw8513\absh252\f5\fs22 4. Over time, ignore tantrums for increasingly longer intervals, up to a maximum of 20 minutes\par}

{\phpg\posx1413\pvpg\posy13144\absw4010\absh252\f5\fs22 5. Respond consistently within each episode\par}

{\phpg\posx1413\pvpg\posy13576\absw8431\absh252\f5\fs22 Things to consider: A calm child will return to sleep more easily than one who becomes upset.\par}

{\phpg\posx1080\pvpg\posy14224\absw4643\absh505\f9\i\fs22 \li333 \fi-333 3. Extinction \par\sb0\fi0 \i0 Problem: Bedtime resistance and night wakings\par}

{\phpg\posx6180\pvpg\posy14946\absw300\absh275\f5\fs24 12\par}

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{\shp{\*\shpinst\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpz1\shpleft11859\shptop4340\shpright11859\shpbottom7899{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 1}}{\sp{\sn lineWidth}{\sv 25907}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineDashing}{\sv 0}}}}

{\shp{\*\shpinst\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpz1\shpleft11360\shptop7899\shpright11859\shpbottom7899{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 1}}{\sp{\sn lineWidth}{\sv 25907}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineDashing}{\sv 0}}}}

{\shp{\*\shpinst\shpleft11520\shptop4710\shpright11888\shpbottom7385\shpz0\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt0{\sp{\sn fLine}{\sv 0}}{\sp{\sn shapeType}{\sv 202}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn txflTextFlow}{\sv 3}}{\shptxt \f10\b\fs32 PROGRAMMING\par}}}

{\phpg\posx5820\pvpg\posy14946\absw300\absh275\f5\fs24 13\par}

{\phpg\posx1053\pvpg\posy748\absw9458\absh252\f5\fs22 Goal: To totally withdraw the consequences that maintain a problem behavior through \ldblquote planned ignoring\rdblquote \par}

{\phpg\posx1053\pvpg\posy1180\absw1100\absh276\f5\fs24 Procedure:\par}

{\phpg\posx1053\pvpg\posy1612\absw3875\absh252\f5\fs22 1. Implement good sleep hygiene practices\par}

{\phpg\posx1053\pvpg\posy2044\absw3803\absh252\f5\fs22 2. Determine when child should go to bed\par}

{\phpg\posx1053\pvpg\posy2476\absw3535\absh252\f5\fs22 3. Put child to bed and ignore tantrums\par}

{\phpg\posx1053\pvpg\posy2908\absw7542\absh252\f5\fs22 4. If child gets out of bed, direct child to return with minimal attention or interaction\par}

{\phpg\posx1053\pvpg\posy3340\absw3704\absh252\f5\fs22 5. Respond consistently in every episode\par}

{\phpg\posx720\pvpg\posy3988\absw10408\absh758\f5\fs22 \fi287 Things to consider: Extinction may work with some children, especially those who are younger, nonambulatory, and/or not \ldblquote fighters.\rdblquote Other children might continue struggling, then become physiologically agitated and difficult to calm.\par}

{\phpg\posx720\pvpg\posy5140\absw4253\absh505\f9\i\fs22 \li333 \fi-333 4. Scheduled Awakening \par\sb0\fi0 \i0 Problem: Night arousals and night wakings\par}

{\phpg\posx1053\pvpg\posy5968\absw8558\absh252\f5\fs22 Goal: To retrain a child who regularly wakes up spontaneously to awaken under new conditions\par}

{\phpg\posx1053\pvpg\posy6400\absw1100\absh275\f5\fs24 Procedure:\par}

{\phpg\posx1053\pvpg\posy6832\absw4164\absh252\f5\fs22 1. Determine time(s) child routinely wakes up\par}

{\phpg\posx1053\pvpg\posy7264\absw3705\absh252\f5\fs22 2. Awaken child 15 to 30 minutes earlier\par}

{\phpg\posx1053\pvpg\posy7696\absw7732\absh252\f5\fs22 3. Follow a routine procedure with awakened child (hold, console, change diaper, etc.)\par}

{\phpg\posx1053\pvpg\posy8128\absw2765\absh264\f5\fs23 4. Return sleepy child to bed\par}

{\phpg\posx720\pvpg\posy8776\absw10505\absh758\f5\fs22 \fi287 Things to consider: A child who associates waking up with reinforcing consequences (parents come, play, snack, etc.) is conditioned to be awakened by parents. After the initial retraining, time intervals between awakenings are gradually increased.\par}

{\phpg\posx720\pvpg\posy9928\absw4631\absh505\f9\i\fs22 \li333 \fi-333 5. Bedtime Fading \par\sb0\fi0 \i0 Problem: Bedtime resistance and night arousals\par}

{\phpg\posx1053\pvpg\posy10756\absw8197\absh252\f5\fs22 Goal: To shift a child\rquote s natural bedtime to a more acceptable time and reduce night arousals\par}

{\phpg\posx1053\pvpg\posy11188\absw1100\absh275\f5\fs24 Procedure:\par}

{\phpg\posx1053\pvpg\posy11620\absw4335\absh252\f5\fs22 1. Eliminate all daytime sleep (sleep restriction)\par}

{\phpg\posx1053\pvpg\posy12052\absw4990\absh252\f5\fs22 2. Determine child\rquote s natural bedtime within 15 minutes\par}

{\phpg\posx1053\pvpg\posy12484\absw9616\absh252\f5\fs22 3. Follow positive bedtime routine sequence. Begin the sequence 20 minutes before child\rquote s natural bedtime\par}

{\phpg\posx1053\pvpg\posy12916\absw8494\absh229\f5\fs20 4. If child falls asleep within 15 minutes, begin the sequence 15 to 30 minutes earlier the following night\par}

{\phpg\posx1053\pvpg\posy13348\absw9937\absh505\f5\fs22 \li252 \fi-252 5. If child does not fall asleep within 15 minutes, begin the sequence 15 to 30 minutes later the following night, then return to step 4 when child begins sleeping\par}

{\phpg\posx720\pvpg\posy14284\absw10515\absh505\f5\fs22 \fi287 Things to consider: External circumstances and habits can help build associations about going to sleep. It\rquote s impor- tant to continue increasing the percentage of successful bedtime experiences.\par}

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{\phpg\posx6180\pvpg\posy14946\absw300\absh275\f5\fs24 14\par}

{\phpg\posx1080\pvpg\posy748\absw10202\absh758\f5\fs22 \fi287 Whatever intervention strategy is attempted, it\rquote s important to negotiate a level of cooperation acceptable to both child and adult, then slowly increase expectations. Mutual support between adults is also essential for maintaining perspective, confidence and calm.\par}

{\phpg\posx1080\pvpg\posy1900\absw10141\absh482\f3\b\fs21 \li287 \fi-287 Medication and Chemical Intervention \par\sb0\fi0 \b0 If all other attempts at finding a solution through behavioral intervention have been unsuccessful, the use of medica-\par}

{\phpg\posx1080\pvpg\posy2584\absw10359\absh1689\f5\fs21 tion may be appropriate as a final resort. Medication alone is of limited benefit. It might be a short term solution that provides temporary or intermittent relief from insomnia, or may be used in combination with a more permanent behav- ioral retraining approach that changes a persistent pattern. When administered over a long period of time, medication can sometimes actually be counterproductive to sleep. It may cause \ldblquote rebound\rdblquote insomnia, impede or impair the quality of a person\rquote s sleep, and/or produce adverse side effects. Tolerance to medication might also develop, making in- creased dosages necessary for achieving desired results. Before experimenting with medications or nutritional approaches such as vitamins and herbal remedies, consult with a neurologist, psychiatrist, or physician familiar with sleep disorders.\par}

{\phpg\posx1080\pvpg\posy4888\absw1686\absh275\f3\b\fs24 CONCLUSION\par}

{\phpg\posx1080\pvpg\posy5296\absw10501\absh505\f5\fs22 \fi287 While learning to get a good night\rquote s sleep may be a slow, labor intensive process for you and your child, the results will be well worth the effort. Good luck, good night and sweet dreams!\par}

{\phpg\posx1080\pvpg\posy6280\absw1671\absh275\f3\b\fs24 REFERENCES\par}

{\phpg\posx1080\pvpg\posy6688\absw10423\absh529\f5\fs23 \fi287 Adams, L. A. & Rickert, V. I. (1989) Reducing bedtime tantrums: comparison between positive routines and graduated extinction. {\i Pediatrics}, 84, 756-761.\par}

{\phpg\posx1079\pvpg\posy7552\absw10429\absh529\f5\fs23 \fi288 Durand, V. M. & Mindell, J. A. (1990) Behavioral treatment of multiple childhood sleep disorders. {\i Behavior} \i Modification{\i0 , 14, 37-49.}\par}

{\phpg\posx1367\pvpg\posy8416\absw8174\absh264\f5\fs23 Ferber, R. (1985) {\i Solve Your Child\rquote s Sleep Problems}. New York: Simon and Schuster.\par}

{\phpg\posx1367\pvpg\posy8992\absw10192\absh252\f5\fs22 Finnie, N. R. (1975) {\i Handling the Young Cerebral Palsied Child at Home}. 2nd Edition. New York: E. P. Dutton.\par}

{\phpg\posx1079\pvpg\posy9568\absw10244\absh505\f5\fs22 \fi287 Nakagawa, H. Sack, R. L. & Lewy, A. J. (1992) Sleep propensity free-runs with the temperature, melatonin, and cortisol rhythms in a totally blind person. {\i Sleep}, 15(4), 330-336.\par}

{\phpg\posx1079\pvpg\posy10432\absw10345\absh505\f5\fs22 \fi287 Palm, L., Blennow, G. & Wetteberg, L. (1991) Correction of non-24-hour sleep/wake cycle by melatonin in blind retarded boy. {\i Annals of Neurology}, 29(3), 336-339.\par}

{\phpg\posx1079\pvpg\posy11296\absw10136\absh505\f5\fs22 \fi287 Piazza, C. C. & Fisher, W. (1991) A faded bedtime response cost protocol for treatment of multiple sleep prob- lems in children. {\i Journal of Behavioral Analysis}, 24, 129-140.\par}

{\phpg\posx1079\pvpg\posy12160\absw10208\absh505\f5\fs22 \fi287 Rickert, V. I. & Johnson, M. C. (1988) Reducing nocturnal awakening and crying episodes in infants and young children: A comparison between scheduled awakenings and systematic ignoring. {\i Pediatrics}, 81, 203-212.\par}

{\phpg\posx1080\pvpg\posy13024\absw10270\absh529\f5\fs23 \fi287 Stores, G. (1992) Annotation: sleep studies in children with a mental handicap. {\i Journal of Psychology and} \i Psychiatry{\i0 , 33,1303-1317.}\par}

{\phpg\posx1080\pvpg\posy13888\absw10309\absh505\f5\fs22 \fi287 Tzischinsky, O., Skene, D., Epstein, R. & Lavie, P. (1991) Circadian rhythms in 6-sulphatoxymelatonin and noc- turnal sleep in blind children. {\i Chronobiology International}, 8(3), 168-175.\par}

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{\shp{\*\shpinst\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpz1\shpleft11859\shptop4340\shpright11859\shpbottom7899{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 1}}{\sp{\sn lineWidth}{\sv 25907}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineDashing}{\sv 0}}}}

{\shp{\*\shpinst\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpfblwtxt1\shpz1\shpleft11360\shptop7899\shpright11859\shpbottom7899{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 1}}{\sp{\sn lineWidth}{\sv 25907}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineDashing}{\sv 0}}}}

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{\phpg\posx5820\pvpg\posy14946\absw300\absh275\f5\fs24 15\par}

{\phpg\posx2169\pvpg\posy758\absw7940\absh690\f4\b\fs30 \fi2572 A \ldblquote Cheat Sheet\rdblquote for \par\sb0\fi0 New Teachers of the Visually Impaired Working with Infants\par}

{\phpg\posx1147\pvpg\posy1519\absw9568\absh620\f7\fs27 \li1838 \fi-1838 By Nancy Toelle, Coordinator, Quality Programs for Students with Visual Impairments and Ann Rash, Teacher Trainer, TSBVI, VI Outreach\par}

{\phpg\posx720\pvpg\posy2476\absw10539\absh1010\f5\fs22 \fi287 One of the factors that makes working with students with visual impairments an interesting undertaking is the range With the help of the animal trainer, of ages we serve in Texas. Teacher of the Visually Impaired\rquote s (TVI) work with visually impaired students from birth to age 22. Each age has its own considerations, rewards, and concerns. This article will outline a beginning approach to providing services for infants.\par}

{\phpg\posx720\pvpg\posy3916\absw10386\absh1689\f5\fs21 \fi321 The first step in providing educational services for any student is determining eligibility. Eligibility criteria differ for infants. They are eligible based on the existence of a documented eye condition and suspicion of future VI needs rather than on current demonstrated needs. Eligibility is decided by the Individualized Family Service Plan (IFSP) team \par\sb0\fi0 based on assessments and the wishes of the family. IFSP = Individualized Family Service Plan and is equivalent to the IEP, but differs radically in content. If an infant is eligible for vision services, be sure to go through the typical enrollment procedure for your district. It is important for your district\rquote s funding that they are included in PEIMS and are on the TEA Annual Registration of Students who are Visually Impaired.\par}

{\phpg\posx720\pvpg\posy6220\absw4003\absh264\f3\b\fs23 The TVI\rquote s role in determining eligibility\par}

{\phpg\posx1053\pvpg\posy6688\absw7718\absh252\f5\fs22 {\f0\bullet} Receive the screening for visual impairment and current eye exam report from ECI.\par}

{\phpg\posx1053\pvpg\posy7120\absw9962\absh758\f5\fs22 \li252 \fi-252 {\f0\bullet} Perform the FVE and LMA (Functional Vision Exam and Learning Media Assessment), address the need for an O&M evaluation, functional blindness, a low vision evaluation, assistive technology and devices, other services, and identify appropriate learning media.\par}

{\phpg\posx1053\pvpg\posy8128\absw9900\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Assist with developmental assessment and share with the ECI assessment staff information about the impact blindness/low vision has on normal development.\par}

{\phpg\posx1053\pvpg\posy8848\absw5731\absh252\f5\fs22 {\f0\bullet} Ensure that screening for deafness is performed by ECI staff.\par}

{\phpg\posx1053\pvpg\posy9280\absw8906\absh252\f5\fs22 {\f0\bullet} Ensure that a Texas Commission for the Blind children\rquote s caseworker is involved with the family.\par}

{\phpg\posx1053\pvpg\posy9712\absw3993\absh241\f5\fs21 {\f0\bullet} Maintain an eligibility folder in the district.\par}

{\phpg\posx720\pvpg\posy10360\absw10441\absh505\f5\fs22 \fi287 Working in coordination with ECI agencies, TVIs participate in the referral process, and are part of the IFSP team. We work within their system as an adjunct to their services.\par}

{\phpg\posx720\pvpg\posy11224\absw8894\absh264\f3\b\fs23 How the role of the TVI working with infants differ from the role with students aged 3-22\par}

{\phpg\posx1053\pvpg\posy11692\absw9723\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Time considerations: The calendar for this process moves very quickly. Service cannot be interrupted for more than 2 weeks{\b }at a time during the course of a calendar year, unless parent requests it.\par}

{\phpg\posx1053\pvpg\posy12412\absw9403\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Year-round service: service continues at the same frequency decided upon at the annual IFSP meeting through the summer months unless a change is requested by parents.\par}

{\phpg\posx1053\pvpg\posy13132\absw9787\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Documentation: Service must be documented according to ECI requirements, with copies provided to ECI and the parent.\par}

{\phpg\posx1053\pvpg\posy13852\absw9913\absh1010\f5\fs22 \li252 \fi-252 {\f0\bullet} Transition: The process for transitioning to post ECI programming goes according to a fixed schedule and sequence and starts 90 days before the child\rquote s third birthday. The child may or may not transition to a PPCD program (Preschool Program for Children with Disabilities - a public school program). The program that\rquote s selected should best meet the child\rquote s needs.\par}

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{\phpg\posx6225\pvpg\posy14946\absw300\absh275\f5\fs24 16\par}

{\phpg\posx1079\pvpg\posy748\absw3744\absh264\f3\b\fs23 The TVI\rquote s role in developing an IFSP\par}

{\phpg\posx1413\pvpg\posy1216\absw8171\absh252\f5\fs22 {\f0\bullet} The TVI helps analyze and share the results of the child\rquote s FVE and LMA with ECI staff.\par}

{\phpg\posx1413\pvpg\posy1648\absw8329\absh252\f5\fs22 {\f0\bullet} It\rquote s important to provide ECI staff with information on early intervention related to vision.\par}

{\phpg\posx1413\pvpg\posy2080\absw3870\absh252\f5\fs22 {\f0\bullet} The TVI must attend all IFSP meetings.\par}

{\phpg\posx1413\pvpg\posy2512\absw9953\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} In an IFSP meeting, parents select and prioritize what they want for their child. The IFSP is not based solely on assessed educational needs.\par}

{\phpg\posx1079\pvpg\posy3448\absw5618\absh264\f3\b\fs23 The TVI\rquote s role in providing services to family and infant\par}

{\phpg\posx1413\pvpg\posy3916\absw10159\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Bring in information and resources related to the child\rquote s visual impairment, act as part of the instructional team to implement IFSP, enable parents and other caregivers to follow through with child by \ldblquote role releasing.\rdblquote \par}

{\phpg\posx1413\pvpg\posy4636\absw6121\absh252\f5\fs22 {\f0\bullet} Observe child with caregivers to see what\rquote s currently being done.\par}

{\phpg\posx1413\pvpg\posy5068\absw10122\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Stress from the beginning that change/learning occurs in direct relation to the frequency of the infant\rquote s instruc- tion/opportunity to learn and use new information and skills.\par}

{\phpg\posx1413\pvpg\posy5788\absw9852\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Share with the team members the relationship between concept development and opportunities to move and actively interact with the environment and community.\par}

{\phpg\posx1413\pvpg\posy6508\absw9617\absh482\f5\fs21 \li252 \fi-252 {\f0\bullet} Work as a team with ECI staff serving the student, including the occupational therapist, physical therapist, speech therapist, instructional staff and case manager. Provide them with your expertise and learn from theirs.\par}

{\phpg\posx1413\pvpg\posy7228\absw9911\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Coordinating team time can be difficult, but working together will promote a holistic approach to the child\rquote s needs. This should include anything from feeding issues to problems with sleep habits and growth.\par}

{\phpg\posx1413\pvpg\posy7948\absw9827\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Research the child\rquote s eye condition if it is unfamiliar, so you can inform the team of current or future educa- tional or medical implications.\par}

{\phpg\posx1413\pvpg\posy8668\absw9833\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} As needed, attend eye medical appointments and/or low vision clinical visits to learn more and help parents understand their child\rquote s eye condition.\par}

{\phpg\posx1079\pvpg\posy9712\absw2721\absh275\f3\b\fs24 Resources helpful to TVIs\par}

{\phpg\posx1413\pvpg\posy10180\absw9931\absh1263\f5\fs22 \li252 \fi-252 {\f0\bullet} INSITE Developmental Checklist Instructional Manual: This checklist assesses all areas of development. It contains illustrations based on normal development with adaptations for children with sensory impairments and multiple disabilities. The checklist can be used by teachers and caregivers to develop appropriate goals and activities for the parent. Call Hope, Inc. at (435) 245-2888 or check their website at .\par}

{\phpg\posx1413\pvpg\posy11764\absw9962\absh758\f5\fs22 \li252 \fi-252 {\f0\bullet} Blind Children\rquote s Center Publications: These educational booklets are written for teachers and parents. They cover topics on nurturing, feeding, movement, etc. Call them at (800) 222-3566 or check their website at .\par}

{\phpg\posx1413\pvpg\posy12772\absw9892\absh1010\f5\fs22 \li252 \fi-252 {\f0\bullet} Visit the TSBVI website, , and conduct searches for topics you need. From there, you can access links that contain pertinent, infant-specific information. You may also want to search the archives of the {\i SEE/HEAR} Newsletter for topics such as potty training, communication, Little Rooms, and concept development.\par}

{\shp{\*\shpinst\shpleft523\shptop4726\shpright891\shpbottom7401\shpz0\shpfhdr0\shpbxpage\shpbypage\shpwr3\shpwrk0\shpfblwtxt0{\sp{\sn fLine}{\sv 0}}{\sp{\sn shapeType}{\sv 202}}{\sp{\sn dxTextLeft}{\sv 0}}{\sp{\sn dxTextRight}{\sv 0}}{\sp{\sn dyTextTop}{\sv 0}}{\sp{\sn dyTextBottom}{\sv 0}}{\sp{\sn txflTextFlow}{\sv 2}}{\shptxt \f10\b\fs32 PROGRAMMING\par}}}



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