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The designations employed and the presentation of the material in this publication do not imply the expression ofanyopinionwhatsoever on thepartoftheWorldHealth Organization concerning thelegal statusofanycountry discount zestril 5mg with amex digital blood pressure monitor,territory discount zestril 5 mg online hypertension thyroid,cityorareaorofitsauthorities generic 2.5mg zestril amex yaz arrhythmia,orconcerningthedelimitationofitsfrontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. This publication contains the collective views of an international group of experts and does not necessarily represent the decisions or the stated policy of the World Health Organization or of the Food and Agriculture Organization of the United Nations. Population nutrient intake goals for preventing diet-related chronic diseases 54 5. Amine, Dean, High Institute of Public Health, Alexandria University, Alexandria, Egypt Dr N. Baba, Chairperson, Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon Dr M. Belhadj, Professor of Internal Medicine and Diabetologia, Centre Hospitalier Universitaire, Oran, Algeria Dr M. Deurenberg-Yap, Director, Research and Information Management, Health Promotion Board, Singapore (Co-Rapporteur) Dr A. Djazayery, Professor of Nutrition, Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran Dr T. Forrester, Director, Tropical Medicine Research Institute, The University of the West Indies, Kingston, Jamaica Dr D. Herman, Senior Researcher, Nutrition Research and Development Centre, Ministry of Health, Bogor, Indonesia Professor W. M’Buyamba Kabangu, Hypertension Unit, Department of Internal Medicine, University of Kinshasa Hospital, Kinshasa, Democratic Republic of the Congo Professor M. Katan, Division of Human Nutrition and Epidemiology, Wageningen University, Wageningen, Netherlands Dr T. Mann, Department of Human Nutrition, University of Otago, Dunedin, New Zealand Dr P. Moynihan, School of Dental Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, England Dr A. Musaiger, Director, Environmental and Biological Programme, Bahrain Centre for Studies and Research, Manama, Bahrain Dr G. Petkeviciene, Institute for Biomedical Research, Kaunas Medical University, Kaunas, Lithuania vi Dr A. Prentice, Director, Human Nutrition Research, Medical Research Council, Cambridge, England Professor K. Reddy, Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Science, New Delhi, India Dr A. Seidell, National Institute of Public Health and the Environment, Bilthoven, Netherlands (Co-Rapporteur) Dr A. Srianujata, Director, Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand Dr N. Steyn, Chronic Diseases of Lifestyle, Medical Research Council, Tygerberg, South Africa Professor B. Swinburn, School of Health Sciences, Deakin University, Melbourne, Victoria, Australia Dr R. Uauy, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile; and Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England (Chairperson) Dr M. Wahlqvist, Director, Asia Pacific Health and Nutrition Centre, Monash Asia Institute, Monash University, Melbourne, Victoria, Australia Professor Wu Zhao-Su, Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China Dr N. Delgado, Director, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala; Dr F. Henry, Director, Caribbean Food and Nutrition Institute, The University of the West Indies, Kingston, Jamaica. Ferro-Luzzi, National Institute for Food and Nutrition Research, Rome, Italy (Temporary Adviser) Dr J. The Consultation recognized that the growing epidemic of chronic disease afflicting both developed and developing countries was related to dietary and lifestyle changes and undertook the task of reviewing the considerable scientific progress that has been made in different areas. For example, there is better epidemiological evidence for determining certain risk factors, and the results of a number of new controlled clinical trials are now available. The mechanisms of the chronic disease process are clearer, and interventions have been demonstrated to reduce risk. Some of the specific dietary components that increase the probability of occurrence of these diseases in individuals, and interventions to modify their impact, have also been identified. Furthermore, rapid changes in diets and lifestyles that have occurred with industrialization, urbanization, economic development and market globalization, have accelerated over the past decade. This is having a significant impact on the health and nutritional status of populations, particularly in developing countries and in countries in transition. While standards of living have improved, food availability has expanded and become more diversified, and access to services has increased, there have also been significant negative consequences in terms of inappropriate dietary patterns, decreased physical activities and increased tobacco use, and a corresponding increase in diet-related chronic diseases, especially among poor people. Food and food products have become commodities produced and traded in a market that has expanded from an essentially local base to an increasingly global one. Changes in the world food economy are 1 reflected in shifting dietary patterns, for example, increased consump- tion of energy-dense diets high in fat, particularly saturated fat, and low in unrefined carbohydrates. These patterns are combined with a decline in energy expenditure that is associated with a sedentary lifestyle --- motorized transport, labour-saving devices in the home, the phasing out of physically demanding manual tasks in the workplace, and leisure time that is preponderantly devoted to physically undemanding pastimes. The overall aim of these recommendations is to implement more effective and sustainable policies and strategies to deal with the increasing public health challenges related to diet and health. The Consultation articulated a new platform, not just of dietary and nutrient targets, but of a concept of the human organism’s subtle and complex relationship to its environment in relation to chronic diseases. The discussions took into account ecological, societal and behavioural aspects beyond causative mechanisms. The experts looked at diet within the context of the macroeconomic implications of public health recommendations on agriculture, and the global supply and demand for foodstuffs, both fresh and processed. Nutrition is coming to the fore as a major modifiable determinant of chronic disease, with scientific evidence increasingly supporting the view that alterations in diet have strong effects, both positive and negative, on health throughout life. Most importantly, dietary adjustments may not only influence present health, but may determine whether or not an individual will develop such diseases as cancer, cardiovascular disease and diabetes much later in life. In many developing countries, food policies remain focused only on undernutrition and are not addressing the prevention of chronic disease. This emphasis is consistent with the trend to consider physical activity alongside the complex of diet, nutrition and health. Energy expenditure through physical activity is an important part of the energy balance equation that determines body weight.

Comparison of the antidandruff efficacy of several zinc pyrithione shampoos versus antidandruff shampoos containing ketoconazole buy zestril 10 mg blood pressure printable chart, coal tar and sulfur buy zestril 10 mg mastercard hypertension blood pressure readings. Clinical investigation comparing 1% selenium sulfide and 2% ketoconazole shampoos for dandruff control order 5mg zestril with mastercard pulse pressure between aorta and capillaries. A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in severe dandruff and seborrheic dermatitis. Results of clinical trial comparing 1% pyrithione zinc and 2% ketoconazole shampoos. The activity in vitro of five different antimycotics against Pityrosporum orbiculare. Propylene glycol in the treatment of seborrheic dermatitis of the scalp: a double- blind study. Short-term treatment of dandruff with a combination of propylene glycol solution and shampoo. The effects of minoxidil, 1% pyrithione zinc and a combination of both on hair density: a randomized controlled trial. Comparative efficacy of various treatment regimens for androgenetic alopecia in men. Dandruff: a condition characterized by decreased levels of intercellular lipids in scalp stratum corneum and impaired barrier function. An open pilot study using tacrolimus ointment in the treatment of seborrheic dermatitis. Pimecrolimus cream, 1%, vs hydrocortisone acetate cream, 1%, in the treatment of facial seborrheic dermatitis: a randomized, investigator-blind, clinical trial. Pilot trial of 1% Pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation. Antifungal activities of tacrolimus and azole agents against the eleven currently accepted Malassezia species. Hordinsky Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, U. To suppress disease activity, physicians commonly prescribe topical or intralesional corticosteroids and, less commonly, oral steroids. There are also many other treatment approaches and several are currently being evaluated in clinical trials. Patients who experience the reticular variant have ongoing disease activity with patches of non-scarring hair loss appearing and disappearing. A scalp biopsy obtained from such patients can show patchy focal peribulbar inflammation. The perinevoid variant is even rarer and is characterized by non-scarring hair loss around nevi. These fibers have a broader distal segment than the proximal end and when these fibers grow they taper down proximally to a pencil point and may break easily, similar to what is seen with hair fibers experiencing anagen arrest as with chemotherapy (Fig. The immune attack on hair follicles tends to spare white fibers; likewise when hair regrowth occurs, fibers are frequently white before coming pigmented, indicating that the hair follicle pigment system is still dysfunctional (Fig. It is relatively easy to diagnose alopecia areata, particularly when there are patches of non-scarring hair loss, skin “bare as a baby’s bottom,” and positive hair-pull tests. However, patchy disease may sometimes be mistaken for tinea capitis, traction alopecia, loose anagen syndrome, aplasia cutis congenita, or pseudopelade (3). Nail abnormalities may precede, follow, or occur concurrently with hair-loss activity. Area of involvement includes the lower occipital scalp and region above both ears. Other abnormalities include koilonychia, longitudinal ridging, brittle nails, onycholysis, onychomadesis, and periungual erythema (4). Common disease associations include atopy (allergic rhinitis, asthma, and atopic dermatitis) up to 40% in some studies, while the prevalence of atopic disease in the popula- tion is estimated to be 20% (7). Other common disease associations include thyroid disease and 94 Hordinsky and Caramori autoimmune diseases, such as thyroiditis and vitiligo. These patients have chronic hypo- parathyroidism, mucocutaeous candidiasis, and autoimmune adrenal insufficiency. Other investigators subsequently confirmed many of her conclusions, but in more recent times this classification system is not commonly used. They ascertained that 30% of patients developed alo- pecia totalis (54% of children, 24% of adults) and that the proportion of patients presenting with alopecia totalis declined with each decade of life. They concluded that although spontaneous resolution is expected in most patients, a small but significant proportion of cases, approxi- mately 7%, may evolve into severe and chronic hair loss (7). From such studies and others, the presence of severe nail abnormalities, atopy (asthma, allergic rhinitis, and atopic dermatitis), and onset of extensive disease at less than five years of age have all been implicated as negative prognostic indicators. Alopecia totalis or universalis lasting more than two years, is also believed to have a particularly low chance of spontaneous regrowth and to be less responsive to therapy. Follicles are small, fibers are dystrophic, and there is minimal perifollicular and peribulbar inflammation. In some, similar prognostic indicators have been reported, but in others different associations have been observed (14–19). The authors con- cluded that their findings were similar to those reported in the Western literature. However, an association of atopy with a younger age at onset and severe alopecia was not confirmed. In Kuwait, 10,000 consecutive new patients were surveyed; 96% of whom were children of Arab descent. A female preponderance (52%) was observed, and infants constituted the largest group (28. Further study of 215 children revealed that 97% of the children were of Arab ancestry and girls outnumbered boys by a 2. The peak age of onset was seen between 2 and 6 years of age with a mean age of onset at 5. A majority of the patients had mild disease, and extensive disease was seen in 13% of the children. The age of onset, a positive family history of alopecia areata, and associated atopic disorders were observed to have no influence on the extent and severity of the disease. In northern India, a prospective, hospital-based study, which lasted for a decade (1983– 1992), evaluated the epidemiology of alopecia areata, including noting associated diseases and risk factors for development of severe alopecia areata. The study evaluated 880 patients (532 men and 276 women) and 509 controls (307 men and 202 women). Onset in childhood was more frequent in females, but the incidence of severe alopecia was higher in males with onset at an earlier age. Atopy was found to be present in 18% of patients, but its reported association with younger age of onset and severe alopecia was not confirmed. However, in our mobile world, an understanding of these differences may be important in discussions with patients and families. The best place to take a biopsy for diagnostic purposes is the active edge of an area of hair loss.

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An absence of the menstrual period can test—analysis of cerebrospinal fluid buy zestril visa prehypertension facts, which is indicate pregnancy or a problem such as a hor- extracted by means of a spinal tap generic zestril 2.5 mg with visa arrhythmia unspecified icd 9 code, also called lum- mone abnormality safe zestril 2.5 mg class 1 arrhythmia drugs. This procedure often causes some discomfort during the fluid extraction and some- microsporidiosis An intestinal infection that times a headache afterward. A clear, but suspected means are unprotected sexual person with bacterial meningitis, which is much activity and consumption of food contaminated more serious, is usually hospitalized for treatment with microspora. Most patients thus far has worked well in treating patients with who receive prompt medical treatment for menin- microsporidiosis. A papule incision shows lesions it causes are benign, and the problem does a white waxy core. Children almost always con- tifies this infection easily, a lesion may be biopsied tract the infection through nonsexual contact. Occasionally the physician adults, the virus is transmitted sexually, resulting in lances a large lesion and expresses its virus contents lesions on the genitals, lower abdomen, buttocks, to confirm diagnosis. For via skin-to-skin contact, but it is also likely that a bumps that do not resolve spontaneously (or for person can contract molluscum contagiosum from people who do not want to wait for resolution), a contact with inanimate objects such as clothing or doctor may use any one of several treatment options: towels. Further, a person can spread the infection liquid nitrogen, salicylic acid, curettage (surgical on the body by touching a lesion and then touch- scraping of the lesions), 30 percent trichloroacetic acid, electrodesiccation, or cantharidin. Prevention Symptoms Molluscum contagiosum can be transmitted to a Molluscum contagiosum results in skin lesions— sex partner by skin-to-skin contact, whether the painless, dimpled bumps that sometimes feel person who is infected has symptoms or not. These dimpled bumps Therefore, maintaining a mutually monogamous show up as shiny, flesh-colored, domelike lesions relationship can help prevent infection with mol- with central umbilication (a “dent”) and spread luscum contagiosum. The rise in sexually those with molluscum contagiosum, the bumps transmitted diseases in the United States has served resolve spontaneously in a few months. Major depression is characterized by a period by this problem, and it may be necessary for other of at least two weeks of significantly low moods, people to recognize the signs and steer the person feelings of overwhelming sadness, loss of interest to professional evaluation and treatment. Basi- anyone else who appears to show the signs of cally, the two traits that are benchmarks of a diag- bipolar disorder or depression, try to arrange for nosis of depression are anhedonia (lack of interest her or him to see a psychiatrist. The doctor can in things once enjoyed) and depressed mood state rule out other illnesses that produce similar (sad, hopeless, teary). Furthermore, a person will symptoms and check whether the mood disorder have some of the following symptoms: sleep dis- is resulting from substance abuse or from a thy- turbances (excessive sleep, insomnia), weight loss roid problem. Treatment for bipolar disorder usu- or gain, agitation, extreme fatigue, feelings of ally involves psychotherapy and medication that worthlessness, suicidal thoughts, impaired ability evens out moods. A per- condition that features recurring cycles of depres- son with depression typically responds well after sion and elation—lows and highs. The person who is in a Dysthymia is a persistent state of mild depres- manic state can make impulsive decisions that are sion with symptoms less severe than those of unwise; also, a manic person may be wildly produc- major depression. The person feels hopeless and sad and has acterized by mood changes, sleep and appetite dis- insomnia, poor appetite, and low energy. Treat- turbances, persistent feelings of hopelessness, ment requires medication and therapy. In some fatigue, difficulty in concentrating, and thoughts of cases, the dysthymic person’s condition turns into suicide. This illness can be serious and debilitat- changes, with times of mild depression and times ing. If bipolar disorder is untreated, it for bipolar disorder (although less aggressively often grows worse. Although the cause of bipolar disorder remains unknown, it is believed that various genetic, environmental, and biological factors work morning-after pill One of two different types of together to trigger episodes. In many cases, a person with bipolar disorder The existence of a morning-after pill that prevents does not recognize the level of dysfunction caused pregnancy remains shrouded in secrecy, and few 144 mucopurulent American women are even aware of it. Proponents could be benefits, but it remains unclear what this believe that, if used properly, this pill could cut means for human beings. Emergency contra- that animals are not exposed in the same way ception consists of a high dose of the hormones (different type of exposure through mucous found in birth control pills. In contrast, emergency contra- sures includes abstinence, sex only with an unin- ception is quicker, can prevent ovulation, or can fected partner, correct and consistent use of prevent implantation of a fertilized egg. The American not be used routinely, nor should it be used when College of Obstetricians and Gynecologists has a low risk of transmission exists or when people asked doctors nationwide to distribute information seek care more than 72 hours after exposure. Pos- on emergency contraception when female patients texposure antiretroviral therapy—if it were indeed have annual well-woman visits. The American effective—would have to be started within an hour Medical Association wants emergency contracep- or two of exposure, and when started later than 24 tives to become an over-the-counter product. This kind of drug therapy is (actually, a drug regimen of pills) in preventing extreme and can have severe side effects. However, doc- postexposure antiretroviral therapy only after tors prescribe it, nonetheless, for patients who informing patients of the experimental nature of indulge in high-risk sex. At the same time, physi- this treatment and the possible risks associated cians are concerned that many people who are sex- with it. Also, it should be prescribed only after the ually active may mistakenly perceive using patient has consulted an expert in the use of anti- morning-after pills and condoms as a surefire way retroviral drugs. Too, there are no human data available on the Cervicitis is also suggested by easily induced cervi- effectiveness of postexposure therapy in reducing cal bleeding. If the young and sexually active get these infections, cause is bacterial, the patient is prescribed an including women who are pregnant, those who antibiotic. When trichomonas or herpesvirus is the take oral birth control pills, and those who do not cause, the physician treats the infection. Extremely use any barrier method of protection against sexu- important in mucopurulent cervicitis is follow-up: ally transmitted diseases. Often symptom- An infected person can infect another during sex- free, mucopurulent cervicitis can be found on ual contact. Condoms are not 100 percent effective physical examination and examination of dis- in preventing any sexually transmitted disease. This disease is trans- person should not try to treat herself or take mitted by sexual contact or contact with sex toys. If a woman douches, Genital rubbing may sometimes transmit muco- that can also make diagnosis difficult in that it purulent cervicitis. Symptoms mucous membranes The mucus-secreting lining An infected person can have yellow vaginal dis- of some tissues of the body such as the vagina, charge, spotting with blood, redness of the cervix, mouth, nose, and eyes. A doctor can diagnose mucopurulent cervicitis by mucus Secreted by mucous membranes, a body observations during a patient’s examination and by secretion that has protective and lubricant action microscopic study of discharge. If symptoms per- University of Pittsburgh, Northwestern University, sist, women should return to the doctor for and the University of California at Los Angeles. One of the earliest breakthroughs was specimens provide the general scientific commu- in 1988, when John P. Although the term myalgia is most com- that results in decreased production of red blood monly used in the medical realm in relation to cells, white blood cells, and platelets. Some med- physical overuse of muscles, myalgia is also a prob- ications cause myelosuppression. For example, lem of those with autoimmune disease and other chemotherapy strongly affects both normal and medical conditions, such as flu.

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Demons Can Enter Through Inheritance We’ve already mentioned that it is possible to be born demonized order zestril 5 mg amex arrhythmia medications. Now we will follow up by saying that rejection is not the only door that can cause someone to be born demonized 10 mg zestril mastercard heart attack bar. A child born to a parent with a spirit of witchcraft may find later in life that she has similar demonic powers discount 2.5mg zestril free shipping blood pressure medication hair growth. Similarly, a demon of cancer or miscarriage or deafness may harass a family line for generations. You will notice an unusual number of people in that family with the same disease or condition. Demons Can Enter Through Environment Another extremely common way in which demons invade our lives is through our environments. A child born to alcoholics may find that although he hates what alcohol has done to his family, he still finds himself strangely drawn to the cursed liquid. What has happened is the child lives in an atmosphere where that particular spirit is allowed to manifest virtually at will. Unless one is incredibly strong, he will most likely fall victim to the same spirit—even though he hates the effects of the spirit. Or if there is another sinful act, attitude, belief, or behavior, that greatly and consistently manifests itself in that home, the person’s natural and spiritual resistance can be weakened to such a degree that demons may find access. I say involuntary because the person just happens to be raised in this atmosphere. Voluntary environmental demonic invasion happens when we deliberately go to places of strong demonic concentration. It’s as though the environment paralyzes their consciences and draws upon their sexual instincts. How many fornications and adulteries just happened simply because someone was overwhelmed by the strong concentration of demon spirits that hang around such places. There are two of the most beautiful bare breasts in the world saying “Howdy, partner! This happened because he deliberately put himself in a place where there is a strong concentration of demon power. If you are in a place where there is a strong concentration of demon power, get away from it as soon as possible. If this is impractical, or if God has called you to serve in such a place, cry out to Him for strength. Casting out demons, or as it is commonly called, deliverance, is nothing more than a Christian making a demon leave a person through the power of the Holy Spirit. Repeatedly we see Jesus making demons leave by issuing verbal commands to the invading spirits. The below scripture is an excellent summary of Jesus’ deliverance ministry: “When the even [evening] was come, they brought unto him many that were possessed with devils: and he cast out the spirits with his word, and healed all that were sick. There was no religious ceremony, no mystical chants, no use of top secret religious formulas. Several places in the gospels we read that Jesus commanded the disciples to cast out demons. They apparently understood this to mean that they were to follow His example in casting out demons through the use of verbal commands. A clear example of this is given in Luke 10:17, when some disciples returned from an evangelistic trip: “And the seventy returned again with joy, saying, Lord, even the devils are subject unto us through thy name. Another clear example is Acts 16:18: “…But Paul, being grieved, turned and said to the spirit, I command thee in the name of Jesus to come out of her…. Thus, we see conclusively that the routine way to cast out a demon is to simply command it to come out. What May Happen Just Prior to the Command for the Demon to Leave Satan is no fool. Also be aware that demons often manifest their functional nature in their victims when they are in the presence of a Christian who is skilled in deliverance ministry. For instance, if I teach a powerful, insightful message that exposes the way Satan does business, he may manifest himself. The way in which he manifests himself may very well be expressed as the function of the demon. Similarly, a demon of fear or pride may cause the person to exhibit those characteristics. Whatever is the spirit’s predominant nature, that is probably the way in which it will manifest itself when it is disturbed by anointed ministry. For instance, a spirit of fear may become so agitated at a particular sermon that it causes a pain or some other discomfort. What to Expect After the Command is Given Fortunately, the Bible has many examples of what happens when demons are commanded to leave people. In Jesus’ ministry we are given very graphic accounts of what happens when demons are challenged. Since many of the several biblical accounts list similar responses, I will list only those that introduce new material. Sometimes in my meetings I have noticed that most of those delivered manifested screaming demons. Other times the predominant demonic manifestation has been great spontaneous coughing. When the command is given for the demon to come out, you may find that it simply leaves. If you do, you probably will sense its departure in one of several ways: (1) You feel something leave a body part; (2) The demon leaves through screams; (3) The demon leaves through yawns; (4) The demon leaves through tears; (5) The demon leaves through coughs; (6) The demon leaves through vomit or spit. I think Satan uses it to scare others away from seeking or ministering deliverance. When they get in the presence of someone who flows in deliverance ministry, they often panic in fear. Therefore, they do everything they can to convince the victim that the problem is not demonic. If this doesn’t work, and the demon is directly challenged through deliverance ministry, it will pretend to not be there. The demon hopes that the deliverance minister will get discouraged or impatient and stop the challenge. However, if the minister—every Christian is a minister—presses the challenge, the demon may desperately defy the deliverance minister in the hope that he can outlast the minister’s faith, love, and patience. Faith that he actually can cast out this demon; love enough to care to press on to victory; and patience to persist in the face of Satan’s defiance. Often I have been in intense battles with demons that desperately and arrogantly refused to leave their victims. Of course, since I knew that Satan is defeated, and that Christians have authority over him, and since I have learned much about this ministry, these antics didn’t stop me. And, second, I know that the demon’s defiance is being empowered by some undisclosed fact.

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