"Discount clonidine 0.1mg on line, blood pressure chart explained."
By: Jeffrey T. Wieczorkiewicz, PharmD, BCPS
- Assistant Professor, Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove
- Clinical Pharmacy Specialist—Acute Care Internal Medicine, Edward Hines Jr. VA Hospital, Hines, Illinois
The exhaustion of traditional disposal websites blood pressure iphone discount clonidine 0.1mg visa, stricter environmental controls governing waste disposal and rising portions of extra persistent wastes hypertension signs and symptoms treatment clonidine 0.1 mg with visa, particularly in industrialized nations arteria thoracica interna purchase clonidine 0.1mg mastercard, have all contributed t o a rapid improve in the cost of waste disposal services hypertension herbs clonidine 0.1mg online. As the economics of waste disposal services change, waste recycling and useful resource recovery have gotten increasingly price-efficient. Future waste administration programmes should take maximum benefit of useful resource-efficient approaches to the control of wastes. These activities ought to be carried out at the side of public education programmes. It is essential that markets for products from reclaimed supplies be identified within the development of reuse and recycling programmes. To strengthen and improve national waste reuse and recycling techniques; To create a mannequin inside waste reuse and recycling programme for waste streams, including paper, inside the United Nations system; To make obtainable information, techniques and appropriate coverage instruments to encourage and make operational waste reuse and recycling schemes. By the year 2000, promote enough monetary and technological capacities on the regional, national and native ranges, as appropriate, to implement waste reuse and recycling insurance policies and actions; By the year 2000, in all industrialized nations, and by the year 2010, in all creating nations, have a national programme, including, to the extent attainable, targets for efficient waste reuse and recycling. Develop and strengthen national capability to reuse and recycle an rising proportion of wastes; Review and reform national waste insurance policies to provide incentives for waste reuse and recycling; Develop and implement national plans for waste administration that take advantage of, and provides precedence to, waste reuse and recycling; Modify existing requirements or buy specifications to avoid discrimination towards recycled supplies, bearing in mind the saving in energy and uncooked supplies; Develop public education and consciousness programmes to promote the use of recycled products. Information and research is required to determine promising socially acceptable and value-efficient forms of waste reuse and recycling relevant to every country. For example, supporting activities undertaken by national and native governments in collaboration with the United Nations and different worldwide organizations may include: a. Undertaking an intensive review of options and techniques for reuse and recycling all forms of municipal solid wastes. Policies for reuse and recycling ought to be made an integral element of national and native waste administration programmes; Assessing the extent and follow of waste reuse and recycling operations currently undertaken and figuring out ways by which these could possibly be increased and supported; Increasing funding for research pilot programmes to take a look at various options for reuse and recycling, including the use of small-scale, cottage-based recycling industries; compost manufacturing; handled waste-water irrigation; and energy recovery from wastes; Producing guidelines and finest practices for waste reuse and recycling; Intensifying efforts, at collecting, analysing and disseminating, to key target teams, relevant information on waste points. Special research grants could possibly be made obtainable on a aggressive basis for progressive research initiatives on recycling techniques; Identifying potential markets for recycled products. States, through bilateral and multilateral cooperation, including through the United Nations and different relevant worldwide organizations, as appropriate, should: a. The Conference secretariat has estimated that if the equal of 1 per cent of waste-associated municipal expenditures was dedicated to safe waste reuse schemes, worldwide expenditures for this function would quantity to $eight billion. The secretariat estimates the whole annual price (1993-2000) of implementing the activities of this programme area in creating nations to be about $850 million on grant or concessional terms. Actual prices and monetary terms, including any which might be nonconcessional, will depend upon, inter alia, the particular programmes proposed by worldwide institutions and approved by their governing bodies. The transfer of know-how should help waste recycling and reuse by the following means: a. Including the transfer of recycling technologies, such as equipment for reusing plastics, rubber and paper, inside bilateral and multilateral technical cooperation and help programmes; Developing and enhancing existing technologies, particularly indigenous technologies, and facilitating their transfer beneath ongoing regional and interregional technical help programmes; Facilitating the transfer of waste reuse and recycling know-how. Countries may think about the following options to encourage trade, institutions, business establishments and people to recycle wastes as a substitute of disposing of them: a. Offering incentives to native and municipal authorities that recycle the maximum proportion of their wastes; Providing technical help to informal waste reuse and recycling operations; Applying economic and regulatory instruments, including tax incentives, to help the precept that mills of wastes pay for his or her disposal; Providing authorized and economic situations conducive to investments in waste reuse and recycling; Implementing specific mechanisms such as deposit/refund techniques as incentives for reuse and recycling; Promoting the separate collection of recyclable components of family wastes; g. Providing incentives to enhance the marketability of technically recyclable waste; Encouraging the use of recyclable supplies, particularly in packaging, the place feasible; Encouraging the development of markets for recycled items by establishing programmes. Training shall be required to reorient current waste administration practices to include waste reuse and recycling. Governments, in collaboration with United Nations worldwide and regional organizations, should undertake the following indicative record of actions: a. Capacity-constructing to help increased waste reuse and recycling should focus on the following areas: a. Making operational national insurance policies and incentives for waste administration; Enabling native and municipal authorities to mobilize community help for waste reuse and recycling by involving and aiding informal sector waste reuse and recycling operations and undertaking waste administration planning that incorporates useful resource recovery practices. Even after treatment, all discharges of wastes have some residual influence on the receiving setting. In creating nations, the issue is of a extra basic nature: lower than 10 per cent of city wastes obtain some type of treatment and solely a small proportion of treatment is in compliance with any acceptable quality standard. Faecal matter treatment and disposal ought to be accorded due precedence given the potential threat of faeces to human health. The goal on this area is to treat and safely eliminate a progressively rising proportion of the generated wastes. By the year 2000, establish waste treatment and disposal quality criteria, objectives and requirements based on the character and assimilative capability of the receiving setting; By the year 2000, establish enough capability to undertake waste-associated pollution influence monitoring and conduct regular surveillance, including epidemiological surveillance, the place appropriate; By the year 1995, in industrialized nations, and by the year 2005, in creating nations, make sure that no less than 50 per cent of all sewage, waste waters and solid wastes are handled or disposed of in conformity with national or worldwide environmental and health quality guidelines; By the year 2025, eliminate all sewage, waste waters and solid wastes in conformity with national or worldwide environmental quality guidelines. Governments, institutions and non-governmental organizations, together with industries, in collaboration with appropriate organizations of the United Nations system, should launch programmes to enhance the control and administration of waste-associated pollution.
Health impact of "reduced yield" cigarettes: a important assessment of the epidemiological evidence heart attack upper back pain buy generic clonidine 0.1 mg on line. Smoking and Health: Report of the Advisory Committee to blood pressure medication interactions cheap 0.1 mg clonidine mastercard the Surgeon General of the Public Health Service prehypertension wiki discount 0.1 mg clonidine overnight delivery. The Health Consequences of Smoking: the Changing 22 Chapter 1 E-Cigarette Use Among Youth and Young Adults Cigarette blood pressure medication natural clonidine 0.1mg line. Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1981. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1988. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994. Stakeholder letter: regulation of e-cigarettes and other tobacco merchandise, 2011; <. Deeming tobacco merchandise to be subject to the Federal Food, Drug, and Cosmetic Act, as amended by the Family Smoking Prevention and Tobacco Control Act, 2016; <. Nielsen: Tobacco "All Channel" Data Cig Pricing Remains Strong; E-Cig $ Sales Growth Re-Accelerates. Electronic cigarettes: incorporating human factors engineering into risk assessments. Four hundred and sixty manufacturers of e-cigarettes and counting: implications for product regulation. Introduction, Conclusions, and Historical Background Relative to E-Cigarettes 23 Chapter 2 Patterns of E-Cigarette Use Among U. Youth and Young Adults Introduction 27 Sources of Data 27 Other Literature 27 Key Findings 28 Youth 28 Current Prevalence 28 Trends in Prevalence 28 Young Adults 37 Current Prevalence 37 Trends in Prevalence 37 E-Cigarette Use and Use of Other Tobacco Products Cross-Sectional Studies 37 Longitudinal Studies fifty three E-Cigarette Use and Other Substance Use fifty seven E-Cigarettes and Marijuana fifty eight Use of Flavored E-Cigarettes fifty eight Consumer Perceptions of E-Cigarettes 59 Perceived Harm of E-Cigarettes 59 Reasons for Use and Discontinuation 75 Evidence Summary Conclusions References 88 89 86 37 25 E-Cigarette Use Among Youth and Young Adults Introduction this chapter paperwork patterns and trends in awareness of digital cigarettes (e-cigarettes), their use, and perceptions about these units amongst youth and young adults within the United States. Both the notice of e-cigarettes and levels of their use have elevated quickly all through the U. This chapter summarizes the patterns of use of e-cigarettes, identifies subgroups at greater risk for using them, highlights the ways during which e-cigarettes are used with other tobacco merchandise, and identifies correlates of e-cigarette use, together with data, attitudes, beliefs, and sociodemographic characteristics. Because e-cigarettes only became prevalent within the tobacco product market lately, minimal data can be found on their use before 2011. Given the paucity of surveillance info on e-cigarettes and the low prevalence of their use within the early years of their availability within the United States, peer-reviewed studies with smaller subnational samples are used in this chapter to complement national surveillance data. Surveillance of e-cigarette use presents a novel set of challenges, given the emerging and dynamic market particular to these merchandise (see Chapter 4 for extra on the latter subject). Other Literature this chapter additionally summarizes findings from peerreviewed literature on e-cigarettes that have been recognized by way of a scientific evaluation of studies of those merchandise from the United States and abroad. The search was subsequently updated in November 2015, January 2016, and March 2016 throughout continued development of the report. For consistency, the same search strategy and databases have been employed always. Studies on patterns of e-cigarette use behaviors for each youth and young adults are reviewed within the textual content and tables that observe. All other studies not explicitly described within the textual content are summarized in Appendix 2. Sources of Data Data summarized in this chapter come from nationally representative datasets that have been federally funded and peer-reviewed literature of subnational and worldwide surveillance studies of e-cigarette use that have been mostly cross-sectional in design. More lately, the Youth Risk Behavior Surveillance System and other surveys from the National Center for Health Statistics have added measures of e-cigarette use to their surveys, but only one data level was out there on the time this report was prepared. Only 5 longitudinal studies have been out there on this subject on the time this report was prepared (Leventhal et al. Among middle college students, use was comparable between boys and girls, however it was greater amongst Hispanics compared with other racial/ ethnic groups (Table 2. For highschool students, use was additionally comparable between boys and girls, but greater amongst each White and Hispanic youth compared with Black youth (Table 2. Sociodemographic variations in past-30-day use for middle and highschool students had the same patterns as these for ever use (Tables 2. Due to smaller pattern sizes, confidence intervals have been too extensive to determine sociodemographic variations in these measures. Among highschool seniors who used no less than 1 e-cigarette in the past 30 days, the frequency of e-cigarette use was virtually twice as excessive (10.
Among all known pandemic pathogens heart attack enrique lyrics purchase 0.1 mg clonidine with visa, influenza poses the principal menace because of its potential severity and semiregular incidence since a minimum of the 16th century (Morens and others 2010) blood pressure medication and juice clonidine 0.1mg otc. The West Africa Ebola virus outbreak occurred from 2013 to blood pressure medication and fruit juice discount 0.1 mg clonidine mastercard 2016 arrhythmia cure buy clonidine 0.1 mg mastercard, but the peak and international response efforts began in 2014. Its severity displays partly the limited health technologies of the period, when no antibiotics, antivirals, or vaccines have been available to scale back transmission or mortality (Murray and others 2006). Origin of Pandemics Most new pandemics have originated via the "zoonotic" transmission of pathogens from animals to humans (Murphy 1998; Woolhouse and 318 Disease Control Priorities: Improving Health and Reducing Poverty Gowtage-Sequeria 2005), and the subsequent pandemic is more likely to be a zoonosis as nicely. Zoonoses enter into human populations from each domesticated animals (corresponding to farmed swine or poultry) and wildlife. Many traditionally vital zoonoses have been introduced via increased human-animal interplay following domestication, and probably excessive-threat zoonoses (including avian influenzas) proceed to emerge from livestock production methods (Van Boeckel and others 2012; Wolfe, Dunavan, and Diamond 2007). Some pathogens (including Ebola) have emerged from wildlife reservoirs and entered into human populations via the hunting and consumption of wild species (corresponding to bushmeat), the wild animal trade, and other contact with wildlife (Pike and others 2010; Wolfe, Dunavan, and Diamond 2007). These episodes of "viral chatter" improve pandemic threat by providing opportunities for viruses to become higher tailored to spreading within a human population. Pandemic Risk Factors Pandemic threat, as noted, is pushed by the combined results of spark threat and spread threat. Spark Risk A zoonotic spark may arise from the introduction of a pathogen from either domesticated animals or wildlife. Zoonoses from domesticated animals are concentrated in areas with dense livestock production methods, including areas of China, India, Japan, the United States, and Western Europe. Key drivers for spark threat from domesticated animals embody intensive and extensive farming and livestock production methods and reside animal markets, as well as the potential for contact between livestock and wildlife reservoirs (Gilbert and others 2014; Jones and others 2008). Wildlife zoonosis threat is distributed much more broadly, with foci in China, India, West and Central Africa, and the Amazon Basin (Jones and others 2008). Risk drivers embody behavioral components (corresponding to bushmeat hunting and use of animal-based traditional medicines), pure useful resource extraction (corresponding to sylviculture and logging), the extension of roads into wildlife habitats, and environmental components (including the degree and distribution of animal variety) (Wolfe and others 2005). Spread Risk After a spark or importation, the chance that a pathogen will spread within a population is influenced by pathogenspecific components (including genetic adaptation and mode of transmission) and human population-degree components (such because the density of the population and the susceptibility to an infection; patterns of motion pushed by journey, trade, and migration; and velocity and effectiveness of public health surveillance and response measures) (Sands and others 2016). Pandemics: Risks, Impacts, and Mitigation 319 Dense concentrations of population, especially in urban facilities harboring overcrowded informal settlements, can act as foci for disease transmission and accelerate the spread of pathogens (Neiderud 2015). Moreover, social inequality, poverty, and their environmental correlates can improve individual susceptibility to an infection considerably (Farmer 1996). Collectively, all these components suggest that marginalized populations, including refugees and people residing in urban slums and informal settlements, likely face elevated dangers of morbidity and mortality during a pandemic. The index illustrates global variation in institutional readiness to detect and reply to a big-scale outbreak of infectious disease. Well-ready international locations have effective public institutions, sturdy economies, and enough investment in the health sector. They have built specific competencies crucial to detecting and managing disease outbreaks, including surveillance, mass vaccination, and threat communications. Poorly ready international locations might undergo from political instability, weak public administration, inadequate resources for public health, and gaps in basic outbreak detection and response methods. A geographic analysis of preparedness exhibits that some areas of excessive spark threat also are the least ready. However, geographic areas with excessive spark threat from wildlife species (including Central and West Africa) have a few of the lowest preparedness scores globally, indicating a probably dangerous overlap of spark threat and spread threat. National earnings alone offers an incomplete and probably deceptive metric of preparedness. Although earnings is correlated with epidemic preparedness, many international locations are substantially higher or worse ready than expected, given their gross nationwide earnings per capita. Burden of Pandemics Quantifying the morbidity and mortality burden from pandemics poses a major problem. To overcome these gaps in estimating the frequency and severity of pandemics, probabilistic modeling strategies can augment the historical document with a big catalog of hypothetical, scientifically plausible, simulated pandemics that characterize a variety of potential scenarios.
Administration of 30 mg ivermectin following a excessive-fat meal resulted in an approximate 2 blood pressure chart omron purchase clonidine 0.1 mg online. Microbiology Ivermectin is a member of the avermectin class of broad-spectrum antiparasitic agents which have a novel mode of action arrhythmia grand rounds purchase clonidine 0.1 mg overnight delivery. Compounds of the category bind selectively and with excessive affinity to blood pressure chart poster 0.1mg clonidine amex glutamate-gated chloride ion channels which occur in invertebrate nerve and muscle cells blood pressure chart omron clonidine 0.1mg lowest price. Ivermectin is active towards numerous life-cycle levels of many but not all nematodes. It is active towards the tissue microfilariae of Onchocerca volvulus but not towards the adult type. Its activity towards Strongyloides stercoralis is restricted to the intestinal levels. Clinical Studies Strongyloidiasis Two controlled medical research using albendazole because the comparative agent were carried out in international websites the place albendazole is permitted for the therapy of strongyloidiasis of the gastrointestinal tract, and three controlled research were carried out within the U. Efficacy, as measured by remedy rate, was outlined because the absence of larvae in at least two comply with-up stool examinations three to 4 weeks submit-remedy. Therefore, at least three stool examinations must be performed over the three months following therapy to ensure eradication. Concentration strategies (corresponding to using a Baermann equipment) must be employed when performing these stool examinations, because the variety of Strongyloides larvae per gram of feces could also be very low. A marked discount of >90% was maintained for as much as 12 months after the only dose. As with other microfilaricidal medicine, there was an increase within the microfilariae depend within the anterior chamber of the eye at day three after therapy in some patients. In a separate open study involving pediatric patients ages 6 to thirteen (n=103; weight range: 17-41 kg), comparable decreases in pores and skin microfilariae counts were observed for as much as 12 months after dosing. This indication is based on medical research of each comparative and open-label designs, by which sixty four-100% of contaminated patients were cured following a single 200-mcg/kg dose of ivermectin. This indication is based on randomized, double-blind, placebo-controlled and comparative research performed in 1427 patients in onchocerciasis-endemic areas of West Africa. The adult parasites reside in subcutaneous nodules which are sometimes palpable. Surgical excision of these nodules (nodulectomy) could also be thought-about within the management of patients with onchocerciasis, since this process will remove the microfilariae-producing adult parasites. These reactions are in all probability because of allergic and inflammatory responses to the dying of microfilariae. Oral hydration, recumbency, intravenous regular saline, and/or parenteral corticosteroids have been used to deal with postural hypotension. In these patients, the next antagonistic experiences have additionally been reported: pain (together with neck and back pain), red eye, conjunctival hemorrhage, dyspnea, urinary and/or fecal incontinence, problem in standing/walking, psychological status changes, confusion, lethargy, stupor, seizures, or coma. In individuals who warrant therapy with ivermectin for any purpose and have had vital publicity to Loa loa-endemic areas of West or Central Africa, pretreatment assessment for loiasis and careful submit-therapy comply with-up must be implemented. Ivermectin had no antagonistic results on the fertility in rats in research at repeated doses of as much as three occasions the maximum really helpful human dose of 200 mcg/kg (on a mg/m2/day foundation). Pregnancy, Teratogenic Effects Pregnancy Category C Ivermectin has been proven to be teratogenic in mice, rats, and rabbits when given in repeated doses of zero. Teratogenicity was characterised within the three species examined by cleft palate; clubbed forepaws were moreover observed in rabbits. These developmental results were discovered solely at or close to doses that were maternotoxic to the pregnant female. Treatment of mothers who intend to breastfeed should solely be undertaken when the chance of delayed therapy to the mom outweighs the possible threat to the new child. Other reported medical experience has not identified differences in responses between the elderly and younger patients. In common, therapy of an elderly patient must be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac operate, and of concomitant disease or other drug remedy. Control of extra-intestinal strongyloidiasis in these patients is troublesome, and suppressive remedy, i. Changes observed were primarily deterioration from baseline three days submit-therapy. Most changes both returned to baseline situation or improved over baseline severity at the month three and 6 visits.
The present chapter also needs to be learn at the side of chapter 5 (Demographic dynamics and sustainability) blood pressure chart male cheap clonidine 0.1 mg overnight delivery. Focusing on unsustainable patterns of production and consumption Basis for motion 4 blood pressure during exercise buy clonidine 0.1 mg without prescription. While poverty results in certain kinds of environmental stress heart attack chords purchase 0.1 mg clonidine visa, the most important cause of the continued deterioration of the global setting is the unsustainable pattern of consumption and production hypertension jnc 8 classification buy 0.1mg clonidine visa, notably in industrialized nations, which is a matter of grave concern, aggravating poverty and imbalances. Measures to be undertaken on the international stage for the protection and enhancement of the setting should take totally into account the present imbalances in the world patterns of consumption and production. Special attention should be paid to the demand for natural assets generated by unsustainable consumption and to the environment friendly use of those assets consistent with the aim of minimizing depletion and lowering air pollution. This results in excessive calls for and unsustainable lifestyles among the richer segments, which place immense stress on the setting. The poorer segments, in the meantime, are unable to meet food, health care, shelter and educational wants. Changing consumption patterns will require a multipronged technique specializing in demand, meeting the basic wants of the poor, and lowering wastage and the use of finite assets in the production process. Growing recognition of the significance of addressing consumption has additionally not yet been matched by an understanding of its implications. Some economists are questioning conventional ideas of financial growth and underlining the significance of pursuing financial objectives that take account of the full worth of natural resource capital. More needs to be known in regards to the function of consumption in relation to financial growth and population dynamics to be able to formulate coherent international and national insurance policies. Activities (a) Management-associated actions Adopting a global method to attaining sustainable consumption patterns 4. In precept, nations should be guided by the next basic objectives of their efforts to tackle consumption and lifestyles in the context of setting and development: a. All nations ought to strive to promote sustainable consumption patterns; Developed nations ought to take the lead in attaining sustainable consumption patterns; Developing nations ought to search to achieve sustainable consumption patterns of their development process, guaranteeing the provision of basic wants for the poor, whereas avoiding those unsustainable patterns, notably in industrialized nations, usually recognized as unduly hazardous to the setting, inefficient and wasteful, of their development processes. This requires enhanced technological and other help from industrialized nations. To promote patterns of consumption and production that reduce environmental stress and can meet the basic wants of humanity; To develop a better understanding of the function of consumption and how to result in extra sustainable consumption patterns. In the comply with-up of the implementation of Agenda 21 the evaluate of progress made in attaining sustainable consumption patterns should be given excessive precedence. In order to support this broad technique, Governments, and/or private analysis and coverage institutes, with the help of regional and international financial and environmental organizations, ought to make a concerted effort to: a. Expand or promote databases on production and consumption and develop methodologies for analysing them; Assess the relationship between production and consumption, setting, technological adaptation and innovation, financial growth and development, and demographic elements; Examine the influence of ongoing modifications in the construction of recent industrial economies away from material-intensive financial growth; Consider how economies can develop and prosper whereas lowering the use of energy and materials and the production of harmful materials; Identify balanced patterns of consumption worldwide which the Earth can support in the long run. This should be reflected in the evolution of new techniques of national accounts and other indicators of sustainable development. While international evaluate processes exist for examining financial, development and demographic elements, extra attention needs to be paid to points associated to consumption and production patterns and sustainable lifestyles and setting. In the comply with-up of the implementation of Agenda 21, reviewing the function and influence of unsustainable production and consumption patterns and lifestyles and their relation to sustainable development should be given excessive precedence. Developing national insurance policies and strategies to encourage modifications in unsustainable consumption patterns Basis for motion 4. Achieving the goals of environmental quality and sustainable development will require efficiency in production and modifications in consumption patterns to be able to emphasize optimization of resource use and minimization of waste. In many cases, it will require reorientation of existing production and consumption patterns which have developed in industrial societies and are in turn emulated in a lot of the world. Progress could be made by strengthening constructive tendencies and instructions which are rising, as a part of a process aimed toward attaining vital modifications in the consumption patterns of industries, Governments, households and individuals. In the years forward, Governments, working with appropriate organizations, ought to strive to meet the next broad objectives: a. To promote efficiency in production processes and reduce wasteful consumption in the means of financial growth, taking into account the event wants of developing nations; To develop a home coverage framework that may encourage a shift to extra sustainable patterns of production and consumption; To reinforce each values that encourage sustainable production and consumption patterns and insurance policies that encourage the switch of environmentally sound technologies to developing nations. Activities (a) Encouraging greater efficiency in the use of energy and assets 4. Reducing the amount of energy and materials used per unit in the production of goods and services can contribute each to the alleviation of environmental stress and to greater financial and industrial productivity and competitiveness. Governments, in cooperation with trade, ought to therefore intensify efforts to use energy and assets in an economically environment friendly and environmentally sound method by: a.
0.1 mg clonidine for sale. Audio Enhanced Blood Pressure Practice #5.