Yes. The Privacy Rule allows covered health care providers to share protected health information for treatment purposes without patient authorization, as long as they use reasonable safeguards when doing so.
What type of information is protected by the HIPAA Privacy Rule?The HIPAA Privacy Rule establishes national standards to protect individuals' medical records and other individually identifiable health information (collectively defined as “protected health information”) and applies to health plans, health care clearinghouses.
Is talking on the phone a HIPAA violation?Phone calls to patients are HIPAA compliant provided the nature of the phone call falls within the reasons for which a patient is considered to have given their consent. If a phone call to a patient relates to any other subject, the Covered Entity must have consent from the patient before making the call.
To know more about Privacy visit:-
https://brainly.com/question/29348566
#SPJ1
he nurse is unsure whether the medications in the bottles match what is on the label. What action should the nurse take to help identify the medications?
The nurse is unsure whether the medications in the bottles match what is on the label therefore the action the nurse should take to help identify the medications is to check the color, texture, or smell and if not convinced consult the pharmacist.
Who is a Nurse?This is referred to as a healthcare professional who specializes in taking care of the sick and ensuring that adequate recovery is achieved in other to prevent complications.
In a scenario where the nurse is unsure whether the medications in the bottles match what is on the label then it is best to check the color, texture, or smell and of not convinced consult the pharmacist for prompt advise and assistance in this type of scenario.
Read more about Medications here https://brainly.com/question/26254731
#SPJ1
the community-based nurse is educating expectant parents on inherited genetic diseases. how does the nurse describe the genetic mutation that results in cystic fibrosis
Cystic fibrosis (CF) is a hereditary genetic illness brought on by a change in the CFTR gene. This mutation impairs the transport of chloride across cell membranes and leads to respiratory, digestive, and reproductive problems.
It is usually inherited in an autosomal recessive pattern, meaning both parents must pass on a mutated copy of the CFTR gene for the child to be affected. The nurse should explain this to expectant parents and discuss available options such as genetic testing, preimplantation genetic diagnosis, and prenatal diagnosis.
These options can help them determine if their child is at risk for CF and take steps to ensure the health and wellbeing of their family.
Learn more about Cystic fibrosis visit:
https://brainly.com/question/29486851
#SPJ4
the nurse's forearm is splattered with blood when cleaning a patient's open wound. what action should the nurse take?
a client is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. when a second dose of the pain medication is given, the client develops redness of the skin, itching, and swelling at the site of injection of the drug. the most likely cause of this response is:
The most likely cause of this response is an allergic response.
What is an allergic response?
allergic responses are extremely prevalent. An allergic reaction is caused by an immunological response that is similar to hay fever. The majority of allergic reactions occur shortly after interaction with an allergen.
Many allergic reactions are moderate, but some can be severe and even fatal. They can be localised to a certain part of the body or they can affect the entire body. Anaphylaxis or anaphylactic shock is the most severe kind. People with a family history of allergies are more likely to experience allergic responses.
To know more about Allergic response visit:
https://brainly.com/question/12978002
#SPJ4
what is recommended to minimize interruptions when using an aed
Answer:
continue preforming high level CPR
Explanation:
a client with a fractured femur is being prepared for surgery. the client develops a sudden onset of cyanosis, tachycardia, dyspnea, and restlessness. which action would the nurse take first?
The nurse should take the action first assess the client's airway, breathing and circulation.
The nurse should immediately assess the client's airway, breathing, and circulation to ensure that they are adequate and stable, Notify the healthcare provider: The nurse should immediately notify the healthcare provider of the client's change in condition and report the vital signs, Administer oxygen: The nurse should administer oxygen to the client via a face mask or nasal cannula to maintain the oxygen saturation at a safe level ,Keep the client in a semi-fowler's position: The nurse should keep the client in a semi-fowler's position to improve breathing and decrease the workload of the heart, Prepare for emergency interventions, It's important to note that these symptoms could indicate a Pulmonary Embolism (PE) which is a serious and life-threatening condition that can occur in clients who are immobile or have suffered a fracture.
Learn more about cannula here:
https://brainly.com/question/29056609
#SPJ4
which choice provides the most relevant detail?choose 1 answer:no changesupplement and convert it into gas to use as fuel in electricity production.supplement, while sweet whey is more desirable as a food additive for humans.supplement, which provides an important element of their diet.
Add to it and turn it into gas to use as fuel for creating power. C. Supplement, even if sweet whey is preferred as a human food ingredient.
What is additive?
Food additives are substances that are added to food to preserve or enhance its freshness, safety, flavour, texture, or appearance. Some food additives, like salt (found in meats like bacon or dried fish) or sugar (found in marmalade), have been used for food preservation for generations (in wine).
Food manufacturing requires a wide variety of additives since preparing meals on a large scale vs preparing them on a small scale at home is extremely different. To keep processed food safe and in good condition from factories or industrial kitchens, during transit to warehouses and stores, and ultimately to customers, additives are required.
Read more about additive?
https://brainly.com/question/27568331
#SPJ4
A qualitative review of a health record reveals that the history and physical for a patient admitted on June 26 was performed on June 30 and transcribed on July 1. Which of the following statements regarding the history and physical is true in this situation? Completion and charting of the H&P indicates
A. noncompliance with Joint Commission standards.
B. compliance with Joint Commission standards.
C. compliance with Medicare regulations.
D. compliance with Joint Commission standards for nonsurgical patients.
The following statements regarding the history and physical is true in this situation is noncompliance with Joint Commission standards option - A is correct answer.
For what purposes are health records used?Different healthcare settings have different names for the health record. Whatever name is given to it, the main purpose of the health record is to support and document patient care services.
The process by which a doctor or other practitioner authenticates an entry that he or she is unable to review because it has not yet been transcribed or the electronic entry cannot be displayed is known as auto-attestation. As a method of authentication in a health record, this procedure is categorically prohibited.
To know more about health record visit:
https://brainly.com/question/18258345
#SPJ4
a patient is prescribed of antibiotic for.the antibiotic is available in vials that contain of the drug.how many
According to question, a patient is prescribed of antibiotic for the antibiotic is available in vials that contain 20.0 mg/vial of the drug.
To treat critical, perhaps fatal illnesses like pneumonia and sepsis, the body's severe response to an infection, we rely on antibiotics. People who are at a greater risk for getting infections also need effective antibiotics.
Although most antibiotic medications require a prescription, some topical antibiotics are available over-the-counter (OTC). Ask a doctor for advice if you believe you have a bacterial illness to determine if a prescription or over-the-counter antibiotic is best for you.
To know more about antibiotic visit :
https://brainly.com/question/10868637
#SPJ4
crushing of a stone located within the gallbladder
Answer:
Cholecystolithotripsy
Explanation:
a nurse is preparing a sterile field for the health care provider to perform a biopsy on a client. which actions follow recommended guidelines for maintaining the sterile field for this procedure? select all that apply.
The action that follows the recommended guidelines for maintaining a sterile field for this biopsy procedure is the use of sterile gloves.
What is a biopsy?A biopsy is a procedure for taking samples of body tissue for analysis in a laboratory using a microscope. This condition is often used to diagnose cancer or other conditions that cause changes in tissue. A biopsy is also needed if an X-ray examination is not enough to distinguish the nature of a tumor, benign or malignant.
A biopsy can be done on any part of the body that has abnormal growths, such as the skin, breast, neck, kidney, uterus, heart muscle, bone, liver, thyroid, or bone marrow.
To maintain a sterile field during the biopsy process, sterile gloves are needed because they prevent contamination.
Learn more about biopsy abbreviation here :
https://brainly.com/question/30066661
#SPJ4
when an emt inspects the abdomen of a patient with pain to his right upper quadrant, it appears large and possibly distended. to determine if the abdomen is indeed distended, the emt would ask:
When an EMT inspects the abdomen of a patient having pain to his right upper quadrant, it appears large and possibly distended. To determine if the abdomen is indeed distended, the EMT would ask: is the belly normally appears in that size or not.
EMT stands for Emergence Medical Technician. It is an ambulance technician who provides emergency medical services to the patients. They are skilled workers who have the essential knowledge to provide first hand treatment to the patient.
Abdomen refers to the body part of a human that comprises of stomach, small intestine, large intestine, liver, spleen, gallbladder, pancreas, uterus, fallopian tubes, ovaries, kidneys, ureters, bladder and many blood vessels.
To know more about abdomen, here
brainly.com/question/28433576
#SPJ4
which medication with the nurse identify as a potential cause for the formation of abnormal small eyes
nitrofurantoin medication with the nurse identify as a potential cause for the formation of abnormal small eyes in newborn baby.
Urinary tract infections are treated with nitrofurantoin. The drug nitrofurantoin belongs to the category of drugs known as antibiotics. It functions by eradicating the infection-causing germs.
Colds, the flu, or any other viral infections will not be treated by antibiotics like nitrofurantoin. Antibiotic overuse raises the likelihood that you'll get an infection later on that is resistant to antibiotic therapy.
Both a liquid solution and capsule form of nitrofurantoin are available for oral use. For at least 7 days, nitrofurantoin is often given two or four times day with food. Try to take nitrofurantoin every day at the same times.
know more about flu here
https://brainly.com/question/3774799#
#SPJ4
a client is receiving 250 mg of a drug that has a half-life of 8 hours. how much drug would remain after 24 hours?
If a client is receiving 250 mg of a drug that has a half-life of 8 hours after 24 hours only 31 mg drug would remain .
The half-life of a medicine refers to how long it takes for its active component to break down by half in your body. This depends on how the chemical is processed and excreted by the body. It could linger for a few hours, days, or even weeks.
The half-life of a drug is the amount of time it takes for its plasma concentration to decrease to half of what it was initially. The half-life of a medication tells you how long it takes for it to exit your body. For instance, Ambien has a two-hour half-life.
To know more about drug visit :
https://brainly.com/question/13294633
#SPJ4
a pulmonologist is examining a patient who has been smoking cigarettes for several years. the patient's history includes frequent upper and lower respiratory tract infections. what explains the patient's history?
The patient's history explains that smoking suppresses the innate defenses in the conducting zone of the respiratory system.
Respiratory problems occurs while someone is not able to alter gas exchange, inflicting them to both soak up too little oxygen or expel too little carbon dioxide. Respiratory failure can observe respiration misery, and reasons greater extreme problems with gas exchange. Left untreated, it can be fatal. Emphysema is a lung sickness that effects from harm to the partitions of the alveoli for your lungs. A blockage (obstruction) might also additionally develop, which traps air inner your lungs. Smoking is the principle motive of continual obstructive pulmonary sickness (COPD), a critical contamination that makes respiratory difficult.
To learn more about smoking check the link below:
https://brainly.com/question/1178363
#SPJ4
carter was born with very distinct facial features. he presents with a flat nose and almond shaped eyes. the doctor has informed his parents that he has a congenital heart defect along with poor vision. the doctors have educated his parents on his chromosomal abnormality known as .
Since Carter was born with distinct facial features such as a flat nose and almond shaped eyes, along with congenital heart defect and poor vision, therefore the doctors described this chromosomal abnormality as Noonan syndrome.
What is Noonan syndrome?Noonan syndrome is caused by a defective gene that is generally passed through one of the child's parents. Children with Noonan syndrome are usually normal length at birth. However, at around 2 years old you may notice that they don't grow as quickly as other children of the same age.
What is a syndrome? Is syndrome genetic?A syndrome is really a collection of traits or distinctive features that run together. The traditional definition of syndromic ASD is a disorder with a clinically defined pattern of somatic abnormalities and a neurobehavioral phenotype that may include Autism spectrum disorder (ASD).
To know more about Noonan syndrome visit
brainly.com/question/10659527
#SPJ4
the nurse is administering an antibiotic to a client with a diagnosis of cellulitis of the left leg. which client condition would have the greatest effect on the drug's distribution?
The nurse is giving an antibiotic to a client who has cellulitis in his left leg. As a result, peripheral vascular disease would have the largest impact on medication delivery.
PVD (peripheral vascular disease) is a cardiovascular illness that progresses gradually. PVD can be caused by blood vessel constriction, blockage, or spasm. Other than the heart, PVD can damage any blood vessel, especially arteries, veins, and lymph vessels.
Cellulitis is a prevalent bacterial skin infection that produces skin redness, swelling, and discomfort in the affected region. It can develop and create major health concerns if left untreated. Cellulite prevention requires wound care and cleanliness.
Cellulitis is a common and potentially serious bacterial skin infection. Affected skin is swollen, inflamed, and usually painful and warm to the touch. Cellulite usually occurs on the legs, but it can also appear on the face, arms, and other areas.
For more information on Cellulitis , visit :
https://brainly.com/question/20374090
#SPJ4
a client arrives at the health care clinic and reports taking several pills for a headache and severe cough without relief. which adverse effect should the nurse be aware may develop from this combination?
In this scenario, a adverse effect of gastrointestinal bleeding may occur if the client reports taking several pills for a headache and severe cough without relief.
Hemorrhage in the digestive tract, anywhere from the throat to the rectum, is referred to as gastrointestinal (GI) bleeding. A person may lose a small amount of blood, like when a haemorrhoid bleeds, or they may have a haemorrhage, which results in a significant blood loss.
There have also been reports of short-lived anxiety, excitement, sleeplessness, difficulty concentrating, headaches, epistaxis, and allergies.
After oral intake, this frequently causes headaches, dizziness, stomach pain, and localised numbness. Large doses have been shown to be capable of causing dry, scaly skin, nail discolouration, photosensitivity, and redness of the eye, as well as yellowish discoloration of the skin and nails.
Learn more about headache here :
brainly.com/question/28084240
#SPJ4
a nurse is assessing a client for signs and symptoms of infection. what would the nurse expect to asses? select all that apply.
Lymph node enlargement, increased respiratory rate, and fever nurse assessing a client for signs and symptoms of infection.
Check the skin or mucous membranes for any signs of local infectious processes. Localized swelling, localized redness, discomfort or tenderness, loss of function in the affected area, and palpable heat are some of the warning signs and symptoms. Every patient in a hospital is at risk of acquiring a nosocomial infection. Young children, the elderly, and people with weakened immune systems are more susceptible to contract an illness than other patients.
To make decisions based on the best available information, infection control nurses must collect and analyse infection data. Providing medical and public health workers with information on infection control procedures to help them be more prepared for emergencies.
To know more about Lymph node visit :
https://brainly.com/question/29829253
#SPJ4
the nurse is caring for a diverse group of clients. in which client should the nurse assess for an alteration in drug metabolism?
The nurse is caring for a diverse group of clients the nurse should assess for an alteration in drug metabolism
c) A 50 yr old man with cirrhosis of the liver.
Cirrhosis of the liver, also known as hepatic cirrhosis, is a chronic hepatic disease characterised by hepatic cell destruction and fibrotic regeneration. The disease alters the liver structure and normal vasculature, impairs blood and lymph flow, and eventually causes hepatic insufficiency as necrotic tissues yield to fibrosis. Malnutrition, inflammation (bacterial or viral), and poisons are some of the causes (e.g., alcohol, carbon tetrachloride, acetaminophen). Cirrhosis is the fourth leading cause of death among people aged 35 to 55 in the United States, and it poses a serious threat to long-term health.
Click here to know more about liver :
brainly.com/question/15637828
#SPJ4
Q. the nurse is caring for a diverse group of clients. in which client should the nurse assess for an alteration in drug metabolism?
A. a 35 yr old woman with cervical cancer
B. a 41 yr old man with kidney stones
C. A 50 yr old man with cirrhosis of the liver
D. A 32 yr old women with urosepsis
the nurse is assessing factors that may affect the absorption of a drug that the nurse will soon administer. what factor should the nurse prioritize?
The factor which the nurse must prioritize that may affect the absorption of drug is route of administering the drug into the body.
The medical administration of drugs into the body of the patient is mainly due to the inability of the person to either consume it orally or they are unconscious. It is done in prescribed dosage under the observation of the doctor. Generally, the size of the particle of drug, its composition, dissolution rate, amorphism, and nature of the dosage are the main factors which affect the absorption of drug.
It is important to check the vital signs of the body before directly infusing the drug. The drug is said to be absorbed when it crosses the biological barriers which are the epithelial tissues and the cell membrane.
Learn more about absorption of drug at:
brainly.com/question/23636785
#SPJ4
the nurse is discussing car safety with the mother of a 6-year-old child. the child's mother questions the need for the use of special car seats for her child. what information can be provided to her?
"At the age of 6 your child should be using a booster seat."
This information can be provided to her regarding the need for the use of special car seats for her child.
There are various types of car seat restraints. The kind of seat your child requires is determined by a number of factors, such as their age, size, and developmental requirements. Therefore, it's crucial to read both the car safety seat manual and the owner's manual of the vehicle before installing the seat. To make sure that their child's seat is placed correctly, all parents might profit from seeking installation assistance from a CPST.
When a kid is taller than 4 feet 9 inches and between the ages of 8 and 12, or when they are heavier over the forward-facing weight or height restriction for their car safety seat, they should utilise a belt-positioning booster seat until the vehicle seat belt fits them comfortably. All passengers under the age of 13 should sit in the back seat.
For as long as feasible, up to the utmost weight or height permitted by their car safety seat manufacturer, children who have outgrown the rear-facing weight or height limit for their convertible seat should utilise a forward-facing seat with a harness. Many chairs can support kids weighing up to 65 pounds.
Learn more about booster seat here :
brainly.com/question/29572493
#SPJ4
You are using a resuscitation mask to give ventilations to a child. After you position and seal the mask, which of the following should you do next?Select one:a. Blow into the mask.b. Tilt the victim's head back to open the airway.c. Place the victim's head in a neutral position to maintain an open airway.d. Place the victim in a recovery position.
Option C ; Place the victim's head in a neutral position to maintain an open airway.
After positioning and sealing the resuscitation mask, the next step is to place the victim's head in a neutral position to maintain an open airway. This is done by aligning the axis of the victim's face with the axis of the spine, with the head in a neutral position. This technique is referred to as the "head-tilt, chin-lift" maneuver. This maneuver should be done gently to avoid hyperextending the neck, which can compromise the airway. Blowing into the mask is the next step after the head is in the neutral position and the airway is open. Tilt the head back or placing the victim in a recovery position is not the next step after you position and seal the mask. You should perform these actions only after you have started ventilations and the victim is breathing.
Learn more about airway here:
https://brainly.com/question/1673523
#SPJ4
the nurse is caring for a client following a total abdominal hysterectomy. the nurse anticipates that which postoperative outcome will be the priority in the first 24 hours following surgery?
The postoperative outcome that must be a priority in the first 24 hours following the surgery of a total abdominal hysterectomy is: pain.
Hysterectomy is the surgical removal of the uterus of a female. The menstrual cycle ceases after the removal of the uterus. Also, pregnancy cannot be achieved after the removal. The removal is done through an incision upon the lower abdominal region.
Pain is the feeling of uneasiness that an individual feels due to some tissue damage in the body. It is a form of detection done by the brain that something is wrong with the body. The detection of pain is done by the help of specialized nerve cells called noci-receptors that sense and transmit the information to the brain.
To know more about hysterectomy, here
brainly.com/question/28484468
#SPJ4
the nurse provides dietary education for a client with newly diagnosed diabetes. the instructions include a food exchange list. the nurse determines that the teaching was effective when the client states that, instead of asparagus, broccoli, and mushrooms, the client could eat which food items?
String beans, beets, or carrots. Diabetes is a long- term( chronic) illness that affects how your body converts food into energy. The maturity of the food you consume is converted by your body into sugar( glucose), which is also released into your rotation. Your pancreas releases insulin when your blood sugar situations rise.
What about diabetes?The utmost kinds of diabetes warrant a honored precise etiology.Sugar builds up in the bloodstream in every situation.This occurs as a result of shy insulin production by the pancreas.Diabetes of either type can affect a blend of heritable and environmental causes.There's presently no treatment for type 2 diabetes, but our experimenters are embarking on a groundbreaking weight operation trial to help individuals in putting their condition into absolution.When blood glucose( or blood sugar) situations return to the normal range, this is known as absolution.This doesn't indicate that diabetes is permanently cured.Type 2 diabetes may be cured if you change your diet to a healthy bone , maintain a healthy weight, and borrow good life habits.Type 1 diabetes can not be cured on its own.Diabetes isn't solely brought on by stress.Still, there's some substantiation suggesting that stress and the threat of type 2 diabetes may be related.High quantities of stress hormones may help insulin- producing cells in the pancreas from performing rightly and beget them to produce lower insulin, according to our study.Learn more about diabetes here:
https://brainly.com/question/26666469
#SPJ4
the nurse is providing care for a client who has been prescribed a diuretic to treat hypertension. the client states that the effects of the drug are problematic, causing the client to wake up numerous times during the night to urinate. what assessment question should the nurse prioritize?
"How many times do you usually get up during the night to urinate?" assessment question should the nurse prioritize to a client who has been prescribed a diuretic to treat hypertension
What is hypertension?The force that the body's arteries, which are its main blood vessels, are subjected to as a result of blood flow is known as blood pressure. Blood pressure that is too high is referred to as hypertension.
It takes two numbers to represent blood pressure. Systolic pressure, or the first number, refers to the blood vessel pressure experienced by the heart during each heartbeat. The pressure in the vessels between heartbeats, or diastole, is indicated by the second number.
A diagnosis of hypertension is made if, when the blood pressure is measured on two different days, the systolic and/or diastolic readings are both below 140 millimetres of mercury.
To learn more about hypertension
https://brainly.com/question/29799896
#SPJ4
a nurse is caring for a school-age child who weighs 35 kg. what is the child's daily maintenance fluid requirement? (round the answer to the nearest whole number.)
A nurse is caring for a school-age child who weighs 35 kg. The child's daily maintenance fluid requirement is 1800 ml/day
For infants between 3.5 and 10 kg, the daily fluid requirement is 100 ml/kg. For children between 11 and 20 kg, the daily fluid requirement is 1000 ml + 50 ml/kg for each kg over 10 years of age. Up to 2400ml per day.
To maintain homeostasis, the adult human body needs 2-3 liters (25-30 ml per day) to maintain the balance of nutrients, oxygen and water necessary to maintain a stable and healthy interior. /kg) fluid intake.
For more information on fluid requirement, visit :
https://brainly.com/question/25755348
#SPJ4
a client newly diagnosed with immune thrombocytopenia purpura (itp) is admitted to the medical unit. after the admission assessment, the client asks the nurse to explain the disease. what potential etiology should the nurse explain to this client?
Nursing care for patients diagnosed with thrombocytopenia: There may be decreased platelet production.
Thrombocytopenia is a condition when the number of blood platelets (thrombocytes) is lower or below normal. Platelets play a role in stopping bleeding when an injury or damage occurs in a blood vessel. A low number of platelets can make it difficult for blood to clot.
The normal number of platelets in the blood is 150,000–450,000 cells per microliter of blood. A person can be considered suffering from thrombocytopenia if the platelet count is less than 150,000. People with thrombocytopenia are prone to bleeding, such as easy bruising, nosebleeds, or bleeding gums.
Learn more about thrombocytopenia at https://brainly.com/question/30244347
#SPJ4
what term best describes the confluence of social statuses that shape people’s lives, access to resources and power, justice, health, and well-being?
Inequality
Symbols
Intersectionality
ethnocentrism
The intersection of social statuses that influence people's lives, power and resource access, justice, health, and well-being is described as inequality.
The phenomena of unequal and/or unjust allocation of resources and opportunities among members of a certain society is referred to as inequality. Depending on who you ask and the situation, the definition of inequality may vary. In addition, inequality has separate yet related economic, social, and geographic dimensions. The conflict between the normative concept of "deservingness" and the moral ethics of fairness and social justice complicates discussions concerning inequality even further. Inequalities that may be seen inside social groups as well as those that can be seen across social groups have come to the forefront of public consciousness in recent years.
Learn more about phenomena from here:
https://brainly.com/question/26101594
#SPJ4
after attending the same social function 5 days ago, 50 individuals arrive at the hospital over a 4-day period with fever; an itchy, reddish brown papule; and complaints of nausea, vomiting, and severe abdominal pain. cutaneous anthrax is suspected by the health care team. which is the nurse's priority for client care?
Institute contact precautions is the nurse's priority for client care.
What is reddish brown papule?
Cryosurgery: In this process, the papules are frozen to cause them to vanish. Excisional surgery: A surgeon removes each papule one at a time using standard instruments like a scalpel. The likelihood of scarring with this strategy is higher than with the others.
An inflammatory type of acne is papules. They are not pus-filled at the tip, but they are still observable. They could be irritable, unpleasant, or red and tender.
Papules come in a variety of colours, including flesh, yellow, white, brown, red, blue, and purple. There may be one or many, and they may appear singly or in groups at various locations throughout the body. It is fluidless but has the potential to develop into a pustule or vesicle.
Read more about reddish brown papule:
https://brainly.com/question/8153113
#SPJ4