BIOLOGICAL BASIS OF BEHAVIOR
Psychology 321
Spring, 2005 HGH 225
Dr. John M. Morgan MWF, 8am to 9:00
Martin Overstreet
Michael Butterfield
Roslyn McCoy
V5 Area Damage
Introduction
The V5 area of the brain, also known as the medial
temporal (MT) is primarily responsible for motion perception.
This paper will address V5 neurology, neurosurgery,
neuropsychology, the effects of V5 lesions on patient
behavior, and family and community interactions.
Neurology and Neurosurgery
By Martin Overstreet
Neurology Overview
Although our primary interest is with the Medial
Temporal Lobe, also called the V5 area, a discussion of the
entire motion perception pathway is instructive. Motion
perception actually begins with the specialized visual
receptors in the retina known as M-cells (from the Latin word
magnus, for large). As the name implies, the M-cells are
relatively large, located in the peripheral retina, and
respond quickly to transient visual stimulation making them
ideally suited for motion detection. By contrast, P-cells are
smaller, located in the fovea, react more slowly to stimuli,
and are suited to fine-detail vision. Impulses from the
retina then travel via the optic nerve to the optic chiasm
where fibers of the optic nerve from the inner (nasal) half
of each retina cross while those from the outside (temporal)
half of each retina stay on the same side. This partial
crossing is a feature of mammals, whereas for most
vertebrates below mammals, all the fibers cross. It must be
pointed out that no motion processing is actually done in the
optic chiasm. About 20% of the axons leaving the optic chiasm
go to the Superior Colliculus, which is responsible for
certain eye movements and spatial localization. The
remaining 80% of the axons go to the Lateral Geniculate
Nucleus, LGN (Schiffman, 2000, p. 71-73).
The LGN represents the next motion processing step
after the M-cells in the retina. The Magnocellular Division
of the LGN specifically processes the impulses from the M-
cells in the retina and is uniquely suited to distinguishing
small contrasts between light and dark areas thereby
enhancing three-dimensionality and motion effects (Schiffman,
2000, p. 78). The Parvocellular path that receives its
inputs from the P-cells, is important for detecting the
disparity from the left and right eyes and is therefore key
to depth perception and distance judgment (Kalat, 2004, p.
172). From the LGN, impulses go to the Primary Visual Cortex
(also called V1) where three specialized cell types (Simple,
Complex, and Hyper Complex) process stimulations as to their
orientation, length, motional speed and direction. Impulses
are further processed in the V2 area in terms of shape and
form, in the V3 area for detail acuity plus some additional
shape and form processing, the V4 area for color information
(Schiffman, 2000, p. 74), and the Medial Superior Temporal
(MST) and the Medial Temporal (MT), also called the V5 area
(Kalat, 2004. P. 171-172). The MST also receives impulses
relating to eye movement and using a form of feedback
processing, it accounts for the near constant movement of the
eyes themselves and differentiates that information from the
actual object movement. The MT area proper is more involved
with the processing of continuous motion. To illustrate the
differences between the MT and the MST, we can use the
example of pouring a cup of coffee. A person suffering a
lesion to the MST will perceive stationary objects to be in
near constant motion, and pouring from the perceived as
moving coffee pot into the also perceived as moving cup is an
extremely difficult task requiring adaptive behaviors just to
perform it. A lesion to the MT would result in the
sufferer's inability to see the fluid being poured as moving
at all, nor would they perceive the rising fluid level in the
cup, consequently they can not judge when to stop pouring
(Kalat, 2004. P. 174).
It must not be assumed, however, that these pathways are
in any way sequential. The fact that the vision areas were
named V1 through V5 was actually based on the mistaken belief
that visual processing was perfectly orderly and traveled
neatly from one area to the next. In truth, visual processing
is highly interactive between areas and extraordinarily
complex. There are numerous unique and separate pathways that
have so far been identified, if incompletely understood. For
example, the dorsal stream that is important for spatial
location extends from V1, making intermediate contact with V2
and V3, and is then processed in V5, but the ventral stream
used for object identification goes from V1, with
intermediate connections to V2 and V4, and finally to the
Interior Temporal (IT) area (Schiffman, 2000, p. 74).
V5 Neurology
The Medial Temporal (MT or V5) and the somewhat smaller
Medial Superior Temporal (MST) are jointly known as MT+ and
are located in the dorsolateral occipitotemporal junction.
The two structures are adjacent to one another and are highly
connected neurally, sharing many processing features, but
having some interesting differences. For example, the MST
neurons are especially sensitive to the coherence of visual
motion, as demonstrated by experimenters using a set of
radially expanding dots as opposed to randomly moving dots.
Interestingly, this motion mimics the common visual
experience of moving though space (optic flow) and may assist
in the visual navigation of space through the MST's
processing based on the direction of heading with respect to
the direction of gaze (Ulbert et al, 2001, p. 227). As
mentioned previously, the MST compares eye movement with
respect to object motion (supplied by the MT) to calculate
true motion. Lesions in the MST can cause extreme
disorientation for the observer with respect to the
environment, and has been described by sufferers as a
"kaleidoscopic disintegration of visible objects (Vaina et
al, 2002, p. 464). The MT itself uses slight differences in
illumination values to detect boundary motion by correlating
luminance displacements over both space and time (Nawrot et
al, 2000, p. 3436), and MT neurons are highly specialized for
detecting the direction, orientation, and speed of stimulus
movement (Naikar et al,1996,p. 1042). At this point, it
should be mentioned that the functions of the MT and MST are
not completely differentiated and much interaction and shared
processing occurs between them. For example, the MT shows
much less selectivity to coherent motion than the MST, but
some MT cells do exhibit that property (Ulbert,2001,p. 227).
V5 Neurosurgery Results
We will be discussing the singular case of S.F. whose
epileptic seizures were determined by EEG to be caused by a
lesion in the right hemisphere MT+ (both MT proper and MST)
and consequently underwent a topectomy to remove a section of
this area. A battery of motion perception tests were given to
S.F. both before and after the surgery, and focused on two
basic types of motion perception, namely, first order effects
which are the detection of luminance displacements (primarily
MT function), and second order effects which involve mental
rotation and orientation (primarily MST functions). Following
are the results of the various tests (Nawrot,2000,p.3436).
The first test was based on random dot cinematograms
(RDC) and was used to assess both first and second order
effects, and requires the subject to detect local dot
movements (first order) and integrate them into a global
motion percept (second order). Immediate post-surgery testing
compared to the pre-surgery baseline showed marked decreases
in both the ability to discern discreet motion (first order)
and global motion (second order). Interestingly, the
patient's performance in the RDC test improved to pre-surgery
levels within two weeks of the surgery (Nawrot, 2000,p.3439),
suggestive of collateral dendritic sprouting, or that the
undamaged MT area in S.F.'s opposite brain hemisphere was
compensating for the impaired functioning (Kalat,2004,p.131).
To test any change to S.F.'s ability to perceive shape
from motion, a 5AFC letter identification task was
administered. This test uses dots to portray standard letters
from the alphabet shown against a background of random dots
under three conditions, 1. dot movement within the letter
shape against a static background,2. dot movement in
different directions within the letter shape and the
background, and 3. differing dot densities within the letter
shape and the background. The results of the pre-surgery
testing showed S.F. was within the normal range, however,
immediately after the surgery, S.F. showed detection
thresholds that were 7 standard deviations higher (worse
performance) than normal. Again, as with the dot
cinematograms test, S.F's measured performance improved after
the surgery so that by 18 days after the surgery, her
detection of shape from motion was back to pre-surgery levels
(Nawrot, 2000,p.3440).
To test mental rotation, the Cooper and Shepherd test
was given. In this test, a single letter "R" is displayed in
seven different orientations and the subject's ability to
recognize the letter is assessed by measuring the elapsed
time it take to identify the letter in normal versus backward
orientation. The results of this test showed S.F.'s response
times increased 380 percent during the first 5 days following
the surgery. Again, as with all the other tests, the poorer
performance was transitory and pre-surgery performance was
again normal by the 18th day following surgery
(Nawrot,200,p.3443), suggestive of either dendritic sprouting
or opposite hemisphere compensation.
References
Kalat, J. W. (2004). Biological Psychology (8th ed.).
Belmont, CA: Thompson-Wadsworth.
Naikar, N. (1996). Perception of apparent motion of colored
stimuli after commissurotomy. Neuropsychologia, 34(11),1041-
1049.
Nawrot, M., Rizzo, M., Rockland, K.S., Howard, M. (2000). A
transient deficit of motion perception. Vision Research,
(40),3435-3446.
Schiffman, H.R. (2000). Sensation and Perception (5th ed.).
New York: John Wiley & Sons.
Ulbert, I., Karmos, G., Heit, G., & Halgren, E. (2001). Early
discrimination of coherent versus incoherent motion by
multiunit and synaptic activity in human putative MT+. Human
Brain Mapping, 13(4),226-238.
Vaina, L.M., Cowey, A., LeMay, M., Bienfang, D.C., & Kikinis,
R. (2002). Visual deficits in a patient with kaleidoscopic
disintegration of the visual world. European Journal of
Neurology, (9),463-477.
V5 Neuropsychology,Patient Impact
And Family Considerations
By Michael Butterfield
Neuropsychology
After an individual damages the MT/v5 area of the
occipital lobe, it can be very beneficial for the
individual to go through neuropsychological evaluations to
assess their perceptual and cognitive abilities post-trauma
or surgery. A Neuropsychologist determines what tests are
appropriate to adequately identify the extent of the
cognitive and behavioral consequential effects associated
with the damage sustained by the MT/v5 area.
In the example of SF, the epileptic mentioned earlier
by (Nawrot et al, 2000), SF had a series of motion
perception test administered to determine the effects of
her surgery. In the case of SF, pre and post-surgery tests
were given to measure how the removal of the lesion in the
MT+ area of her occipital lobe effected her perceptual
abilities. The random dot cinematograms (RDC) test, was
selected to measure SF perception and the consequential
effects of damage sustained to her occipital lobe areas.
After these tests were administered, the Neuropsychologist
is able to rank the patients test score against the mean
scores that represent normal performance range. In the
case of SF, the perception tests were able to show the
amount of time it took for her MT/v5 area to adapt to its
new conditions. The Neuropsychologist then compares SF's
perceptual performance to her pre-surgery ranges. These
results helped (Nawrot et al, 2000) suggest that either
dendritic sprouting or the opposite hemisphere compensation
occurred in order to compensate for damage of SF MT/v5
area. The importance of these tests, are to help the
Neuropsychologist determine the necessary steps needed for
the rehabilitation of the patient. In the case of SF,
these results helped conclude that the removal of lesion in
the MT to reduce her seizures was worth it. The amount of
seizures was greatly reduced post surgery and the visual
and perceptual deficits experienced by SF after the surgery
were short lived.
Another example of the types of tests used by
Neuropsychologist to identify the effects of head trauma,
are illustrated in the case study of BC, a 45 year old
women with visual-perceptual deficits. (Vaina et al, 2002,
p. 465) The Performance part of the Wechsler Adult
Intelligence Scale-Revised (WAIS-R) was administered by the
Neuropsychologist to assess BC's perceptual and cognitive
abilities. Three tests in the Performance IQ set were
administered, Picture Completion, Block Design, and Object
Assembly. The results of BC's scores on these three tests
showed that her perceptual ability was impaired in
comparison to the normal scores of age-matched control
subjects. (Vaina et al, 2002, p. 465) Another test the
Neuropsychologist gave to BC, in addition to the
Performance IQ set, to determine her ability to interpret
complex pictures or visual fields. BC was shown a postcard
size picture of the Telegraph Boy from the Binet Scale at
normal reading distance. The results indicated BC's ability
to accurately portray complex pictures was greatly reduced
when the scene involved movement. (Vaina et al, 2002, p.
466). The significance of this test was to help the
Neuropsychologist identify whether or not BC would
experience problems with object recognition, which can be
illustrated through BC's interpretation to the Telegraph
Boy.
Patient Impact
There are a vast variety of determinant factors that
can influence the way a patient responds to head trauma.
The specific location of the brain trauma plays an
important role in the behavioral side effects. Trauma to
the MT/v5 area of the occipital lobe as earlier discussed
would usually only cause temporary problems with visual
perception, especially in motion perception. Lesions
within area MT, improve or even completely recover their
previous perceptual abilities within a few days after the
lesion (Vaina et al, 2001, p.315). Therefore, probably most
people who experience damage to the v5/MT area do not have
to worry about permanent side effects to their vision.
However beyond the effects experienced as a result of
damaging the occipital cortex, whose main function is to
process things that your eyes see, there can be a number of
potential emotional and other side effects that can develop
as a result of head injury.
Dr. Dell Orto and Dr. Power's theorized in their book
Head Injury And The Family some of the potential
determining factors, in how an individual's might react to
a head injury. The Personality type of an individual
before the trauma seems to be the first important factor in
how an individual responds. Dependent personality types
are usually more inclined to become even more dependent on
others and social support post-trauma, than independent
personality types. The second significant factor in how an
individual reacts is the patient's conception of body image
and related factors impacted by the trauma. Anyone who was
concerned about their body image might have a hard time
with the way they see themselves post-trauma that could
lead to symptoms of depression. Other possible related
factors that could influence an individual's reaction to
occipital lobe damage, is how important visual processing,
especially motion, is for the patients job. A taxi driver,
bus driver, or even a waitress would probably be more
impacted by a v5 trauma than a retired person who does not
drive motor vehicles, instead spends most of the day
observing the clouds in the sky. A third factor that
influences a patient's reaction is their previous
satisfaction with selected activities. In the case of v5
trauma, a person who was blind or had limited visual
processing is probably going to be less likely than a
person who had 20/20 vision, to freak out after the affects
of v5 trauma. The fourth factor that can be a determinant
in a patient's reaction to the v5 trauma is presence or
absence of therapeutic intervention. The best example of
this is if the patient has the resources to see a
Neuropsychologist. The Neuropsychologist can give tests to
the patient to see the extent of the trauma and give
potential rehabilitative activities for the patient to
practice. Beyond the test to see the extent of the trauma,
a Neuropsychologist can also identify potential emotional
effects and potential solutions for such trauma. The fifth
factor that impacts a patients reaction to head trauma is
familial and societal reactions to the injury. Family
members can have profound influence on how an individual
will react to his/her head injury. Different roles within
the family quickly can change as a result of head injury.
It is theorized that individuals often adapt and develop
emotional responses, like frustration, guilt, and
depression, from the families and societies reaction to the
head trauma. My personal experiences with head injury
concur with this idea. After I realized the financial
consequences of my condition I experienced these emotions
of guilt, depression, and especially inadequacy. These
feelings go far beyond the biological symptoms of my brain
injury. I believe that most of these emotions were
personally derived from my perception of how my family
regarded my condition and what they felt should be done
about it.
Family Considerations
The Family usually plays a significant role in how a
patient is going to react to the head injury. Personally
my head injury initially got more concern from my family
than myself. This is usually the case for individuals who
are not yet adults which leaves the family responsible for
the minors well being. I believe that for me this was a
good thing because I needed the social support to ensure
that I would not live in denial of my condition and not
apply treatment. However the negative consequences of my
condition were easily observed through my family members
thoughts and actions. I knew that although my condition
caused a great financial burden on my parents, they wanted
to do everything they could to make my life easier. This
thought although very flattering did not make me feel good,
it made me feel guilty because it made my parents life
harder. I developed feelings that made me think that I my
parents did not deserve that kind of emotional and
financial suffering. As a result I adapted the behavior of
not taking my prescription medication, along with not
seeking any medical attention because of the absurd cost of
medical care. In addition to those feelings my parents
said something to me once that forever imprinted me with
feeling of worthlessness. As a young boy my father
constantly reinforced the idea if I was ever put on life
support my parents would pull the plug, because of the
financial costs of treatment, resulting in my death. After
I heard this I felt as though my life was worth little to
my parents. Even though their love for me was evident
through their concern the reality of such statement gave me
the impression that my life and condition was not their
blessing but an inconvenience. As a result of such reality
imprinted upon me by my parents reactions to my condition,
I began to deny the severity of such condition, a typical
response of head trauma patients as discussed in Dr. Dell
Orto and Dr. Power's book. This denial involved not taking
my medicine with the hope of not being a financial burden
on my parents. The denial also led me to lie to the
neurologist when discussing the extent of my seizures
resulting from my head trauma. I guess I felt like I would
rather die than live with this condition that has caused
great pain and suffering to my family as well as myself.
References:
Del Orto, A. E. & Power, P. W. (1994) Head Injury And The
Family. Winter park, Florida: PMD
Kalat, J. W. (2004). Biological Psychology (8th ed.).
Belmont, CA: Thompson-Wadsworth.
Nawrot, M., Rizzo, M., Rockland, K.S., Howard, M. (2000). A
transient deficit of motion perception. Vision Research,
(40),3435-3446.
Vaina, L.M., Cowey, A., LeMay, M., Bienfang, D.C., &
Kikinis, R. (2002). Visual deficits in a patient with
kaleidoscopic disintegration of the visual world. European
Journal of Neurology, (9),463-477.
Vaina, L.M., Cowey, A., Eskew Jr, R.T., LeMay, M., & Kemper
T. (2001). Regional cerebral correlates of global motion
perception, Evidence from unilateral cerebral brain damage.
Brain, (124), 310-321.
Family and Community
By Roslyn McCoy
The family will become experts in services for traumatic
brain injuries(TBI); Social Security, Medicare, Medicaid,
and Department of Rehabilitation regulations, while trying
to adjust to a family member who has had a TBI. Many times
this beloved family member had been hanging on the edge of
death for unending hours, days, weeks, or even months.
When they come out of the coma, they are not the same as
they were. In most cases they are not able to do what they
used to do, and their behavior may be dramatically changed.
This will cause significant stress in the family structure;
statistics show that 90% of families facing TBI are not
able to stay together. The community involvement will also
change dramatically for these individuals because many in
the community will view them as having psychological
impairments comparative to schizophrenia; such impairments
are widely misunderstood and discriminated against in our
communities (Loudon).
Research has shown that the quality of life of individuals
that live with TBI is significantly lower in many areas, such
as marital comfort, close friends, parenting, understanding
self, socializing, and work, than their nondisabled
counterparts. Individuals experiencing a mild form of TBI
seem to become hyperaware of and hyperreactive to the
challenge introduced into their lives as a consequence of
TBI. This recognition of contrast in quality of life issues
before the injuries and after may provide rationale for their
experience that the quality of life plummets after injury.
This can be compared with other individuals with severe
injuries who do not focus on the contrast between their "old"
and "new" lives allowing these individuals to be more
subjective about the quality of their lives (Brown).
Social worker
An individual and family receive support from various
government services such as the Social Security Department,
Department of Rehabilitations, Medicare and Medi-Cal.
To qualify for Social Security the individual and family if
they are financially responsible, cannot have more than $2000
in resources as a single, or $3000 in resources for a couple.
This doesn't include the home they live in or the car(within
limits) they use to go back and forth to the doctor. For
most Americans, we would see this as totally destitute, but
currently this is the requirement. In California, SSDI, the
minimum cash aid, is around $800 and it will go up depending
on the amount the consumer contributed to the federal
program.
Here in California, the consumer would be qualified for
Medicare and Medi-Cal which involves a maze of paperwork and
regulations. Under this program there is a $2000 a year cap
on Durable Medical Equipment (DME), which has to cover the
expanse of assistive technology like reachers(devices that
grab items out of reach) to bladder bags. These are not
luxuries, but items that can change the quality of life for
an individual and their families who have just experienced
the traumatic incident of a brain injury.
There are different social services available to individuals
and families that have been involved in a TBI such as
Occupational Therapists (also called OT). OT services mainly
focus on activities that an individual needs to do in
everyday life. OTs will also work with the consumer on high-
level thinking skills necessary to return to home and work
successfully. They may help with work related behaviors, but
usually they are totally out of the picture before an
individual is able to return to the work
environment(Johnson).
Occupational therapy is strictly controlled by Medicare/
Medi-Cal, approving two to four weeks of therapy to an
individual that needs help with 100% of their ADL (Activities
of Daily Living) such as dressing, walking, and social
interaction. If they don't progress within this time period
to the moderate level of need, rated at 50% of ADL is
provided by OT , they are terminated from the program. If
they are successful moving into the moderate level, then they
are provided with another two to three weeks of assistance;
again, if they do not advance into the minimum level within
this time period they will be terminated off the program.
The minimum level of instruction the individual is capable of
75% of their ADL activities, and this training only lasts for
one week. Most rehabilitation services are terminated within
three months after the brain injury had occurred, or the
consumer came out of their coma. We have seen from the prior
research that brain injury recovery takes much longer than
three months, so any further services will come directly out
of the pocket of the consumer and their families. $2-$3000
does not go far because the consumer will not receive
services until the consumer reaches this level of
resources(Hildreth).
Other services that may be available to a client are physical
therapy, psychiatrist, vocational rehabilitation counselor,
and social worker. Physical therapy focuses on returning the
person to the highest level of their physical ability, such
as walking. The psychiatrist will be called to help the
individual with TBI cope with their emotional or behavioral
problems. They can provide medication to assist people
experiencing intense emotions and behavioral distress.
During the early phases of hospitalization, the TBI patient
may be confused and agitated to the point where they become
combatant. Later in the recovery process, people can become
depressed requiring antidepressants to help them cope
(Johnson).
In many hospitals, social workers will assist individuals
with discharge plans and assist family members to cope with
their medical problems. Brain injury associations are
available online and in many communities such as Making
Headway, Inc, in Eureka, who will provide legal advocacy, and
social support to individuals and families affected by
TBI.(London)
Work
Vocational Rehabilitation (DOR) counselors assist the
consumer with returning to work, providing support for
retraining in school or placing them in volunteer positions.
They will provide support for their clients by setting up job
coaching, job strategies, school strategies,and maximizing
their client's ability to live independently in their
communities. DOR also provides ADA technical assistance and
training and funds 29 Independent Living Centers
which offer information
and referral services to assist individuals with disabilities
live active, independent lives.Vocational Rehabilitation
services are designed to get Californians with disabilities
prepared for employment and can include training, education,
transportation and job placement. The counselor will locate
jobs, school programs, and volunteer sites that best match
the consumer's needs(Johnson).
The Department of Rehabilitations web site provides
information about assistive technology and resources; this
includes links to other web sites related to assistive
technology that may
help individuals seeking solutions to assistive technology
needs. The AT Network is funded by a federal grant through
the Department of
Rehabilitation(http://www.rehab.cahwnet.gov/)
If you wish to receive any more than a basic level of
service, you will need to know the law intimately. There are
many laws governing how these programs such as Medicare,
Medicaid, and the Department of Rehabilitations are to be
implemented. The regulations for the Department of
Rehabilitations is called Title Nine; this can be found in
the California regulations web site http://www.calregs.com.
You will find in the state and federal regulations that it
states that the clients are to be fully informed about the
services that the Department will provide. But over the last
seven years of asking many DR counselors, I have only found
one Department of Rehabilitation counselor in Michigan that
was willing to give any more information than "it is a
personalized program." They will not tell you that
regulations state that they could help you with medical
expenses, or relocation expenses for access to training and
work. To receive many of these services, you will probably
have to take them to court which is called a Fair Hearing.
To receive help you can contact The Client Assistance program
(CAP) which will help prepare and present your case.
"The Protection and Advocacy (P&A) System and Client
Assistance Program (CAP) comprise the nationwide network of
congressionally mandated, legally-based disability rights
agencies. P&A agencies have the authority to provide legal
representation and other advocacy services, under all federal
and state laws, to all people with disabilities (based on a
system of priorities for services). All P&As maintain a
presence in facilities that care for people with
disabilities, where they monitor, investigate and attempt to
remedy adverse conditions. These agencies also devote
considerable resources to ensuring full access to inclusive
educational programs, financial entitlements, health care,
accessible housing and productive employment opportunities."
The ticket to work program is also available, providing
services to any disabled person who is receiving Social
Security. This program provides services to gain self-
sufficiency in an employment program for people with
disabilities. This program was developed as the Work
Incentives Improvement Act of 1999, removing many of the
barriers that have previously influenced and discouraged
people from returning to work because of concerns over losing
their health-care coverage(MAXIMUS).
References
Brown, Margaret & DavidVandergoot. 1998 Quality of Life for
Individuals with Traumatic Brain Injury: comparison with
other living in the community. Head Trauma Rebabil: 13(4):1-
23
California Code of Regulations http://www.calregs.com April
28, 2005
Department of Rehabilitation, April 28, 2005 Retrieved May,
28 2005 http://www.rehab.cahwnet.gov/
TBI survivor D. Hildreth (personal communication April, 28.
2005)
Johnson,Glen April 28, 2005 TRAUMATIC BRAIN INJURY SURVIVAL
GUIDE. Retrieved May, 28 2005 www.tbiguide.com
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