4338 unit 2 flashcards
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| when are the 4 times Abx combination therapy is necessary? |
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| 1) emergency 2) infection likely to caused by more than one m/o 3) to achieve synergy 4) to prevent /delay development of resistance |
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| Abx combination therapy is necessary in emergency of what? |
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| bacterial meningitis and sepsis |
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| Abx combination therapy is necessary in what infection likely to be caused by more than one m/o? |
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| perianal abscess and burst appendix |
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| what are three ways we prevent and limit the spread of microbes? |
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| prophylactic/prophylaxis, chemoprophylaxis, and immunoprophylaxis |
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| prophylactic/prophylaxis is? |
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| prevent |
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| chemoprophylaxis is? |
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| the use of chemicals to prevent an infection by reducing risk from contact or reduce normal microflora |
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| immunoprophylaxis is? |
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| the use of immune serums to prevent disease -immune serums ~ antigen (microbes) -vaccines |
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| to cause a disease a pathogen must do these 5 things? |
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| 1) contact the host 2) colonize the host 3) infect the host 4) evade host defense system 5) damage host tissues |
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| a pathogen must contact the host to be? |
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| transmissible |
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| a pathogen must colonize the host by? |
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| adhering to and being able to grow on host surfaces |
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| a pathogen must infect the host by? |
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| proliferating in host cells or tissues - grow well |
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| a pathogen must damage the host tissue by? |
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| physical and/or chemical destruction of host cells and tissues |
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| what is immunotherapy? |
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| the use of immune serums (WBC compounds like interferons, interleukins...) for treatment of disease |
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| Immunotherapy is used when? |
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| You knowingly have an infection (chronic) and want to minimize symptoms and risk of spreading |
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| Gamma interferon is used to treat what ? |
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| HCV a chronic viral disease |
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| Immunotherapy is used when? |
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| You knowingly have an infection (chronic) and want to minimize symptoms and risk of spreading |
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| Gamma interferon is used to treat what ? |
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| HCV a chronic viral disease |
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| ________ _________ is a chemical message produced by certain WBC to inhibit virus replication and spreading ("contain" the virus) |
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| gamma interferon |
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| what are the 5 problems with use of antibiotic? |
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| toxicity, hypersensitivity, organism resistance, allows for excessive growth of normal flora, and antibiotic may not be able to penetrate difficult to reach areas |
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| what are 3 places antibiotic cannot penetrate? |
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| bones, sinus, and ears |
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| what antibiotic has the side effect of aplastic anemia? |
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| chloramphenicol which is a static broad spectrum |
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| what is number 1 prevention of infection? |
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| handwashing |
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| with "hospital acquired" infection the greater your _______ the greater your risk |
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| trauma |
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| for prevention of "hospital acquired" infection you use hand washing and what else? |
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| you control the carries and have isolation |
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| nosocomial setting includes? |
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| hospital and nursing homes |
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| medical asepsis is? |
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| removing all pathogens |
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| surgical asepsis is? |
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| sterilization |
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| what are examples of ways to prevent infection? |
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| 1) use face mask and gown for isolation 2)gell in and gell out 3)proper disposal of hazardous material |
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| what is epidemiology? |
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| science that is the study of the occurrence, distribution, and determinants of disease and injuries in human population |
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| what are the various degrees of disease outbreak can occur? |
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| 1) sporadic 2) endemic 3) epidemic 4) pandemic |
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| sporadic disease outbreak is what? |
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| random like 1-2 people out of millions |
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| endemic disease outbreak is what? |
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| low level in geographic region like an acceptable level of disease in a population |
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| epidemic disease outbreak is what? |
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| explosive outbreak in a population explosive # well beyond normal |
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| pandemic disease outbreak is what? |
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| worldwide |
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| water is a major reservoir and vehicle of communicable disease such as _______ and ________ _______ (1849-1856) |
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| cholera and typhoid fever |
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| identification of arthropod vectors for many diseases is a result of what? |
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| epidemiology |
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| malaria, yellow fever. sleeping sickness, and typhus are diseases caused by what? |
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| arthropod vectors |
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| what is arthropod vectors? |
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| insects that spread disease |
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| what is an important vector for typhoid, diptheria, and polio |
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| asymptomatic carrier |
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| what 3 important things we learned from epidemiology? |
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| 1) water as a reservoir (1849-1856) 2) arthropod vectors (1895-1909) 3) asymptomatic carrier (1893-1905) |
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| typhoid Mary is an example of what? |
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| asymptomatic carrier |
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| what is a person who looks and feels fine but harbors a disease? |
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| asymptomatic carrier |
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| what is a communicable disease? |
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| a disease whose agent is directly or indirectly transmitted from host to host |
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| disease that is directly transmitted directly from person to person is? |
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| contagious |
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| what is a medium that provides a pathogen with adequate conditions for survival and opportunity for transmission? |
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| reservoir |
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| an example of an animate reservoir is? |
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| living and zoonoses(animals) |
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| an example of inanimate reservoir is? |
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| non-living (soil, water, foods...) |
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| what two reservoir are there? |
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| animate and inanimate |
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| what two ways does disease originate from microorganisms? |
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| endogenous and exogenous |
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| disease originate from m/o endogenous when? |
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| normal microflora is misplaced or overgrows |
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| disease originate from m/o exogenous when? |
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| the microbe is never normal or common microflora |
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| vaginal candida albicans originate from microorganisms how? |
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| endogenous |
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| what yeast infection develops during antibiotic treatment? |
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| vaginal candida albicans |
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| T. pallidum originate from microorganisms how? |
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| exogenous |
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| N. gonorrhoeae originate from microorganism how? |
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| exogenous |
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| what causes syphilis? |
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| T. pallidum |
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| what causes gonorrhea? |
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| N. gonorrhoeae |
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| what are 6 ways spreading and transmission of disease can occur? |
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| 1)direct contact 2)indirect contact 3)airborne: respiratory droplets 4)oral (fecal-oral)route 5)parenteral (injection) -needle stick; insect bite 6) mucous membrane contact |
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| what is the kissing disease? |
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| Epstein Barr Virus (EBV) |
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| ______ and _________ disease can spread through mucous membrane contact |
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| EBV and chlamydia |
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| small droplet that people cough in the air is know as? |
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| nuclei |
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| true or false after someone cough the disease can stay in the air for 2 hours |
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| true |
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| human microflora is? |
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| relationship with microorganisms |
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| true or false we outnumber bacteria |
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| false |
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| what is the host responses to infectious disease? |
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| immunology |
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| what is studying antibodies |
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| serology |
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| infectious disease can be diagnosed using what technique? |
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| serological |
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| microbes live with their hosts in _________ relationships |
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| symbiotic |
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| symbiosis means what? |
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| to live together |
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| what are 3 examples of symbiosis? |
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| mutualism, parasitism, and commensalism |
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| bacteria in your colon is an example of what type of symbiosis? |
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| mutualism |
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| what produces vitamin K in your colon? |
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| E.coli |
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| yes or no is E.coli part of our normal bowel flora (NBF)? |
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| yes |
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| how much E.coli is there in the intestine? |
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| 1% |
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| what break down food we can't ingest and produces vitamin K, vitamin B, and fatty acids? |
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| E.coli |
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| what is a symbiosis relationship that 2 organisms live together and both members benefit? |
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| mutualism |
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| what is a symbiosis relationship in which one organism grows, feeds and is sheltered on or in a different organism while contributing nothing to the survival of its host? |
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| parasitism |
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| M.tuberculosis in the human lung is an example of what type of symbiosis relationship? |
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| parasitism |
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| what symbiosis relationship is a most concern to health care professionals? |
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| parasitism |
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| what symbiosis relationship has two organisms live together with no apparent benefit or harm to either member of the association? |
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| commensalism |
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| staphylococcus epidermidis on skin is an example of what type of symbiosis relationship? |
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| commensalism |
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| when two microbe live together and have a neutral relationship is what symbiosis relationship? |
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| commensalism |
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| under normal circumstances normal microbial flora is? |
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| good |
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| true or false most members of the normal bacterial flora will colonize any tissue |
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| false |
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| most members of the normal bacterial flora tendency to colonize certain tissues and not other is due to what? |
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| properties of both the host and the bacterium |
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| yes or no oxygen requirement limit when microorganism can grow |
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| yes |
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| when in your life to you establish your normal flora? |
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| during your teenager years |
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| true or false you are not sterile when born |
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| false |
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| yes or no the human microbiome differs slightly with each individual? |
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| yes |
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| the microbes that colonizes your body when your are born are directly related to what 3 factors? |
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| 1) who touches you 2) the food you eat 3) the environment you live in |
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| when two microbe live together and have a neutral relationship is what symbiosis relationship? |
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| commensalism |
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| what are the 4 normal human microflora? |
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| 1) oral and upper respiratory tract flora 2) GI tract flora 3) Urogenital Flora 4) skin |
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| what inhabit the gingival crevice in the oral cavity? |
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| streptococcal anaerobes |
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| what is the point of entry and initial colonization for Neisseria, Bordetella, Corynebacterium, and Streptococcus spp? |
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| nasopharynx |
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| what GI Tract Flora has variety of possible but few numerically; transient? |
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| stomach |
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| where is Helicobacter pylori flora found? |
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| stomach |
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| what GI Tract has flora that is sparse? |
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| duodenal flora |
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| what flora does Ileum/jejunum have? |
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| mixed flora with increase in numbers as you get closer to large intestine |
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| flora of the large intestines are what? |
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| dense |
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| what has predominantly facultative and strict anaerobe? |
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| flora of the large intestine |
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| what flora's organisms participate in bile acid conversion and in vitamin K and ammonia production in the large bowel? |
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| large intestine |
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| what flora can cause intestinal abscesses and peritonitis? |
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| flora of the large intestine |
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| vaginal flora changes with what 3 things? |
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| 1) age of the individual 2) the vaginal pH 3) hormone levels |
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| skin flora is what |
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| variety - transient |
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| is the stomach sterile? |
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| no |
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| 95% of normal flora is where? |
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| large intestine |
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| ___________ and ___________ __________ work together to use up oxygen |
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| facultative & strict anaerobes |
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| why are there few flora in the duodenal? |
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| because there is bile and enzymes changes |
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| the normal gut flora increases from the _______ to the_________ to the __________ |
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| duodenum, jejunum, and ileum |
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| as you move down the small intestine through the large, the number of bacteria and number of different genera/species increases or decreases? |
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| increases |
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| lactobacilli, Enterococci, Streptococci, and Clostidium are found where? |
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| lower digestive tract- jejunum/upper ileum; ileum; large intestines |
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| aerobic and anaerobic microbe mix in what body site? |
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| upper respiratory: nasopharynx region, buccal region, upper trachea |
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| what 5 bacteria are found in the reproductive system? |
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| 1) lactobacillus 2) streptococcus 3) staphylococcus 4) clostridium 5) candida |
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| the eyes have sparse Gram-positive ______ and Gram-negative ______ (possibly Staphylococcus) |
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| cocci and rods |
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| propioniibacterium, Corynebacterium species, some Streptococci, Staphylococci species, Micrococcus, Candida are found in what body site? |
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| the skin |
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| many flora found in large numbers in ___________ many have never been identifies |
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| saliva |
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| Acidic environment of stomach and enzymatic/basic environment of duodenum is not conductive to microorganism survival- which can be altered with what medication? |
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| antacids |
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| does the flow of urine prevents the extensive colonization of urethra/ |
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| yes |
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| what are the 6 axenic locations? |
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| 1) Blood 2) CSF 3) Deep Tissue (Muscle, etc.) 4) Body fluids (such as urine, extracellular fluids- synovial fluid-, intracellular fluid...) 5) urinary tract, from bladder up 6) bronchi of lungs |
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| are sinuses, inner and middle ear, and lower respiratory sterile? |
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| yes |
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| what is called when normally commensal, even mutualistic organisms cause disease? |
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| opportunists |
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| what are 3 "opportunities"? |
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| 1) immune suppression 2) changes in normal microbiota that upset the "balance" in the body 3) relocation - normal microbiota are introduction to an abnormal location in the body |
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| what keeps the normal microflora in check? |
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| immune system |
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| what can suppress the immune system? |
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| HIV, stress, medication (transplant patients), lack of sleep, and lack of nutrients |
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| an example of changes in the normal microbiota that upset the "balance" in the body is? |
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| candida albicans and thrush or yeast |
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| an example of relocation when normal microbiota are introduced to an abnormal location in the body is? |
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| E.coli normal in large intestine found in urethra and bladder |
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| nonspecific defenses are __________ which means "born with" |
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| innate |
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| the 1st line of defense are? |
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| skin, mucous membranes, and chemicals |
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| 2nd line of defense are? |
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| phagocytosis, complement, intergeron, inflammation, and fever |
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| the 1st line and 2nd line of defense are know as? |
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| nonspecific defenses |
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| the 3rd line of defense are? |
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| lymphocytes and antibodies |
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| the 3rd line of defense is know as? |
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| specific defenses |
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| what line of defense is -innate, nonspecific -reacts "the same" to all pathogens -no memory |
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| the 1st line |
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| what line of defense has physical/ chemical barriers which includes 1) skin (dry, keratin-rich) 2)a.secretions (sweat and sebum - acidic pH, salty) b. lysozyme - an enzyme found in tears and saliva that has powerful digestive capabilities 3) mucous membranes, ciliated cells, etc |
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| the 1st line of defense |
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| which line of defense is innate, nonspecific, and reacts (almost) "the same" to all pathogen? |
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| 2nd line of defense |
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| what line of defense has no memory and often works directly with or stimulates the third line of defense (the adaptive/acquired immune system- known as the "memory" system)? |
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| 2nd line of defense |
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| what are the 3 components of the second line of defense? |
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| leukocytes (WBC), chemicals/chemical actions, and processes |
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| what does leukocytes (WBC) have? |
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| granulocytes and agranulocytes |
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| what are the chemicals/ chemical actions of the second line of defense? |
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| a. cytokines - signaling molecules b. opsonins and opsonization c. complement (which can act as opsonins...) d. interferons e. others..... |
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| what are the 3 processes of the second line of defense? |
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| a. phagocytosis b. inflammation c. fever |
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| erythroid stem cell, myeloid stem cell, and lymphoid stem cell came from where? |
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| blood stem cell in bone marrow |
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| platelets, basophil, neutrophil, eosinophil, and monocyte came where? |
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| myeloid stem cell |
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| erythrocyte came from where? |
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| erythroid stem cell |
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| what myeloid stem cell deal with inflammation? |
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| basophil |
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| what myeloid stem cells deal with phagocytosis? |
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| neutrophil, eosinophil, and monocyte |
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| what erythroid stem cell deal with gas transpotion? |
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| erythrocyte |
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| lymphocyte came from what stem cell? |
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| lymphoid stem cell |
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| what is named based on the appearance of visible granules in the cellular cytoplasm? |
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| granulocytes |
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| granulocytes include what 3? |
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| basophils, eosinophils, and neutrophils (polymorphonuclear leukocytes, or PMNs) |
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| what has blue granules and has 0.5-1.0% normally present in cellular cytoplasm? |
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| basophils |
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| what has red-orange granules and has 2-4% normally present in cellular cytoplasm? |
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| eosinophils |
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| what has lilac/lavender granules and 60-70% normally present in cellular cytoplasm? |
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| neutrophils (polymorphonuclear leukocyte, or PMNs) |
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| _______________ has granules filled with histamine (like tissue bound Mast cells) |
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| basophils |
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| what granulocyte function in allergies and inflammation? |
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| basophils |
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| what granulocyte bind IgE antibodies to cause it to degranulate and cannot phagocytose? |
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| basophils |
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| what granulocyte is used to treat helminth (worm) infections, inflammation, can phagocytose; extracellular killing (bind and act on cell (worms) coated with complement? |
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| eosinophils |
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| what granulocyte is a key phagocytic cell and increases in bacterial infections? |
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| neutrophils |
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| lymphocytes, natural killer (NK) cells, and monocytes are what? |
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| agranulocytes |
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| monocytes matures into either ___________ or ____________ cells |
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| macrophages or dendritic cells |
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| _____________ include B cells, T cells both acquired immunity (3rd line) and act specifically |
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| lymphocytes |
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| natural killer (NK) cells bind to virally infected or abnormal cells and releases granules containing _____________ and _______________ |
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| perforin and granzymes |
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| targeted cells are destroyed by natural killer cells via what? |
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| apoptosis |
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| natural killer cells killing is _____________ |
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| extracellular |
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| what 2 types of macrophages are there? |
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| wandering and fixed macrophages |
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| what wander in blood looking for pathogens? |
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| wandering |
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| ___________ ____________ strategically concentrate in specific areas that are more vulnerable to intruders, like the lungs or the intestine |
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| fixed macrophages |
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| natural killer cells bind to virally infected or abnormal cells how? |
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| by detecting cells that have reduced or no class I MHC expression ( which is abnormal) |
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| cells that "hang out" mostly in the skin, nose, lungs, and digestive system are? |
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| dendritic cells |
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| when dendritic cells ingest a foreign particle, they become activated and travel to the lymph nodes where they activate what? |
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| T cells |
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| as a group, all dendritic cells, macrophages + monocytes make up the system known as ____________ which emphasize the microscopic appearance and primary functions of the group of cells |
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| the mononuclear phagocytic system |
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| what are the 3 components of the second line of defense? |
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| 1) leukocytes (WBC) 2) chemicals/chemical actions 3) processes |
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| leukocytes (WBC) component of the second line of defense include ___________ and _____________ |
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| granulocytes and agranulocytes |
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| chemical/chemical actions component of the second line of defense include what four? |
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| cytokines, opsonins and opsonization, complement protein, and interferons |
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| what are a signaling molecules? |
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| cytokines |
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| complement proteins are able to function as what? |
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| opsonins |
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| the processes component of the second line of defense include what 3? |
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| phagocytosis, inflammation, and fever |
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| what 5 steps do WBCs leave blood stream and enter tissues? |
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| 1) circulating lymphocyte enters the high endothelial venule in the lymph node 2) binding of l-selectin to GlyCAM- and CD34 allows rolling interaction 3) LFA-1 is activated by chemokines bound to extracellular matrix 4) activated LFA-1 binds tightly to ICAM-1 5) diapedesis- lymphocyte migrate into the lymph node |
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| a group of small blood proteins that regulate cellular function (predominantly made by WBCs) is called what? |
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| cytokines |
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| cytokines made my lymphocytes are called what? |
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| lymphokines |
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| what cytokines acts as growth regulator of T cells and B cells and produces macrophages, monocytes and B cells also serves as an endogenous pyrogen, which stimulate fever? |
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| interleukin-1 (IL-1) |
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| what cytokines stimulate the proliferation of T cells and activates NK cells? |
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| interleukin-2 (IL-2) |
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| what cytokines kills cells, including tumor cells and is produced by T cells which is activated macrophages? |
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| Tumor Necrosis Factor- (TNF-a and TNF-b) |
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| what cytokines causes phagocytic white cells of all types to differentiate and divide, produces ThI & macrophages and targets phagocytes? |
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| colony stimulating factors (CSF) |
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| what are the 5 cytokines? |
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| 1) interleukin-1 (IL-1) 2) interleukin-2 (IL-2) 3) interleukin-6 (IL-6) 4) tumor necrosis factor (TNF-a & TNF-b) 5) colony stimulating factors (CSF) |
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| key actions that attribute to TNF-alpha are what 4? |
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| macrophages, endothelium, hepatocytes, and synoviocytes |
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| TNFa has macrophages which increase pro-inflammatory cytokines and increase chemokines as a result causes? |
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| increased inflammation |
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| TNFa endothelium has high adhesion molecules and high vascular endothelial growth factor (VEGF) that causes _____________ and __________ |
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| increased cell infiltration and increased angiogenesis |
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| TNFa hepatocytes has high acute phase response which cause what? |
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| increased CRP in serum |
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| TNFa synoviocytes has high metalloproteinase synthesis which causes what? |
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| articular cartilage degradation |
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| ___________ is defined as coating of pathogens by proteins, thus increasing their vulnerability to phagocytes (phagocytosis) |
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| opsonization |
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| what leads to or causes opsonization |
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| opsonins |
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| an example of opsonins are what 2? |
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| complement proteins and antibodies |
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| ___________ is made of series of serum proteins/protein fragments that can act as opsonins, chemotactic factors, and can indirectly trigger inflammation and fever? |
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| complement |
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| inflammatory reaction, and/or phagocytosis, and/or formation of MAC complex and lysis of foreign cells are the end result of what? |
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| complement activation |
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| complement is activated what two ways? |
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| classical pathway and alternative pathway |
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| classical pathway start with antibody and bind with? |
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| antigen |
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| alternate pathway doesn't use antibody but ________ and _________ |
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| C3a and C3b |
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| both classical and alternative complement pathways can result in what 3 actions? |
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| opsonization, inflammation, and membrane attack complex and cell lysis |
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| what are 3 steps that classical complement pathway work? |
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| 1) start with serum protein C1 becoming activated on binding to Ab-Ag complex 2) leads to subsequent binding and activation of additional serum protein in a systematic manner 3) end result is formation of Membrane Attack Complex (MAC) |
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| GN or GP are vulnerable to Membrane Attack Complex (MAC)? |
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| GN |
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| alternative complement pathway is activated by what? |
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| bacterial cell surface molecules |
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| alternative complement pathway is activated by bacterial cell surface including ______________ from GN, ______________ from positive cell walls and some parasite surface molecules |
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| lipopolysaccharide (LPS) and teichoic acid |
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| MAC formation can form with ____________ and ___________ complement pathways |
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| alternative and classical |
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| ________________ makes a pathogen look much more delicious |
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| opsonized |
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| in MAC complex chemoattractants, such as _________, attract phagocyte to organisms to be be ingested |
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| C3a |
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| in MAC complex _____ coats organisms and attaches to C3b receptors on phagocyte |
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| C3b |
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| in MAC complex organism is engulfed into a _____________ |
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| phagosome |
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| in MAC complex phagosome fuses with lysosome to produce ___________ |
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| phagolysosome |
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| in MAC complex organism is killed within the ________________ and digestion & breakdown of organism also occurs there |
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| phagolysosome |
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| bacterium swells and eventually bursts when _________ and _________ diffuse into the bacterium through the holes made by complement protein forming complexes of protein |
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| water and salts |
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| what are the two interferons in the second line of defense? |
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| alpha/beta interferon and gamma interferon (IFN-y) |
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| what interferon act locally, is released hours after infection, last 3-4 days, released by certain WBCs and virally infected cells and stimulate production of anti-viral components in neighboring cells? |
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| alpha and beta interferon |
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| what interferon induce resistance to viral replication in all cells, increase MHC class expression and antigen presentation in all cells, and activate NK cells to kill virus infected cells? |
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| alpha and beta interferon |
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| what is also known as the "neighborhood watch"? |
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| alpha and beta interferon |
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| gamma interferon is produced by ______ T cells, ________, and________ |
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| CD4, CD8 T cells, and NK cells |
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| what interferon activates macrophages (and neutrophils) (solicits their help!), has broader (systemic) effect than alpha and beta? |
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| gamma interferon (or interferon gamma- IFN-y) |
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| what interferon can be thought of as "calling the police or FBI"? |
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| IFN-y |
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| ____________ are often used as treatment for certain viral diseases like HCV and some cancers |
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| interferon |
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| what are the second line of defense 3 processes? |
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| phagocytosis, inflammation, and fever |
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| what are the 4 steps of phagocytosis? |
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| 1) chemotaxis of phagocyte 2) adherence 3) ingestion of microbe by phagocyte 4) digestion of microbe by enzymes 5) elimination (exocytosis) |
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| what are the 4 steps of inflammation? |
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| 1) a cut penetrates the epidermis barrier and bacteria invade 2) damaged cells release prostaglandins, leukotrienes, and histamine including mast cells 3) prostaglandins and leukotrienes make vessels more permeable. histamine causes vasodilation, increasing blood flow to the site 4) macrophages and neutrophils squeeze through walls of blood vessels (diapedesis) |
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| step 5,6,7,8, and 9 of inflammation is what? |
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| 5) increased permeability allows antimicrobial chemicals and clotting proteins to seep into damaged tissue but also results in swelling, pressure on nerve endings, and pain 6) blood clot forms 7) more phagocytes migrate to the site and devour bacteria 8) accumulation of damaged tissue and leukocytes form pus 9) undifferentiated stem cells repair the damaged tissue. blood clot is absorbed or falls off as a scab |
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| ______________ which have become engorged with bacteria usually die and largely make up the material of pus |
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| neutrophils |
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| what are the 4 causes of fever in the second line of defense? |
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| IL-1,IL-2, lipid A (endotoxin), and teichoic acid fragments |
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| what are the 4 steps of fever? |
answer
| 1) IL-1 secreted by phagocytes travel in blood to hypothalamus 2) hypothalamus secrete prostaglandin, which resets hypothalamic thermostat 3) nerve impulses cause shivering, higher metabolic rate, inhibition of sweating, and vasocontriction 4) these increase body temperature to the point set by the hypothalamic thermostat |
question
| what line of defense is known as acquired immunity? |
answer
| 3rd line of defense |
question
| what line of defense is antigen specific, establishes memory, and distinguishes "self from non-self" |
answer
| 3rd line of defense |
question
| what are the 2 divisions of the 3rd line of defense? |
answer
| humoral and cell-mediated |
question
| what division of the 3rd line of defense is comprised of B cells and the antibodies produced by them? |
answer
| humoral |
question
| what division of the 3rd line of defense is helper T cells, cytotoxic T cells, and is critical in the defense against intracellular pathogens and other intracellular abnormalities like cancer? |
answer
| cell-mediated |
question
| what 3rd line of defense division is critical in the defense against "bloodborne pathogens" and is extracellular pathogens? |
answer
| humoral |
question
| in acquired immune system B cells and T cells are involved based on communication with _______ |
answer
| Antigen Presenting Cell |
question
| the 3rd line of defense include what 4 cells? |
answer
| macrophages, dendritic cells, and sometimes T cells and B cells |
