2015 Annual Meeting — Day 4

May 21 2015 :: Published in Annual Meeting


Today is the final day of the 2015 APHL Annual Meeting and Ninth Government Environmental Laboratory Conference. Over the past few days, we have all learned a lot and had some fun along the way. Thank you to APHL members, partners, exhibitors and staff who made our biggest meeting ever a huge success! We hope to see everyone in Albuquerque for the 2016 meeting!


Want to see highlights from the 2015 annual meeting? Check out these daily blog posts:

2015 Annual Meeting — Day 1

2015 Annual Meeting — Day 2

APHL/CDC Laboratory Fellowship Program is Back!

2015 Annual Meeting — Day 3


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2015 Annual Meeting — Day 3

May 20 2015 :: Published in Annual Meeting

Congratulations to all APHL award winners! See the complete list.

The APHL/CDC Laboratory Fellowship is back! Click the link for a few more details along with a list of blog posts written by former fellows.

For more of the day’s top tweets, see our Storify.

Top Tweets


Top Photos


APHL's 2015 award winners

Dr. Chris Portier of the Environmental Defense Fund discusses the exposome and its relationship to our health

Members discuss internet-based laboratory sample submission system at poster session

Willis Gibson, PMP,  of the Texas Department of State Health Services discusses the practical application of cloud computing during the morning plenary session

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APHL/CDC Laboratory Fellowship Program is Back!

May 20 2015 :: Published in Workforce & Professional Development

After a brief hiatus due to funding, the APHL/CDC fellowship program is back! Formerly known as the Emerging Infectious Disease (EID) fellowships, the newly reinstated program will be simply known as the APHL/CDC Laboratory Fellowship program. Over the next few months, APHL and CDC will work closely together to refresh and improve the fellowship program with an initial emphasis on preparedness. A key tool in restructuring the program will be the Competency Guidelines for Public Health Laboratory Professionals featured in the May 15 Morbidity and Mortality Weekly Report (MMWR).

We are thrilled to have this program back on track and hope to begin recruiting in 2016. Resuming the APHL/CDC Laboratory Fellowship program would not have been possible without the hard work of many laboratory leaders at CDC, the CDC director’s office, former fellows and APHL staff.

To learn more about what laboratory fellows do, check out a few blog posts written by former EID fellows:

From The Lorax to the Laboratory

Where are they Now? APHL/CDC Emerging Infectious Disease Fellow Looks Back

HIV Testing Where Ice Melts Fast: EID Fellow Reports from Botswana

Into the Wild: Lab Edition

The Difference between County and State Health Departments (from a Newbie’s Perspective)

The track to becoming a public health laboratory director

Hawaii’s Unique Public Health Challenges



2015 Annual Meeting — Day 2

May 19 2015 :: Published in Annual Meeting

Top Tweets


For more of the day’s top tweets, see our Storify


Top Photos

Attendees rush to the next session

Roxanne Meek of Washington State Public Health Lab presents at plenary on implementation of WGS for foodborne surveillance

Attendees visit the exhibit hall

Ambassador Bonnie Jenkins, US Dept of State; Beth Skaggs, CDC; and Lucy Maryogo-Robinson, APHL discuss laboratory contributions to the Global Health Security Agenda.


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2015 Annual Meeting — Day 1

May 18 2015 :: Published in Annual Meeting

The 2015 APHL Annual Meeting and Ninth Government Environmental Laboratory Conference kicked-off today in Indianapolis, Indiana! We are thrilled to be here in the Hoosier State talking about everything from whole genome sequencing to citizen science to Ebola to marijuana testing. Whether you’re joining us in Indy or not, please follow the live conversation on Twitter using #APHL. You can also catch up here at the end of the day where we’ll feature some of the day’s highlights.

Day 1 Storify

Top 5 Tweets:



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Healthier Communities Thanks to the National Environmental Public Health Tracking Network

Apr 22 2015 :: Published in Environmental Health

By Michelle M. Forman, senior specialist, media, APHL

Your state’s childhood cancer rates are within normal – but what about your community that was once home to a factory?

People suddenly became ill after having a lakeside picnic too close to idling boats – how prevalent is carbon monoxide poisoning from these lesser known sources and does the public understand their risk?

Public health wants to understand the impact of extremely hot temperatures on people’s health – how can they get gather and analyze hospital data so they can properly inform the public of their risks and necessary precautions?

The National Environmental Public Health Tracking Network can provide answers to all of these questions.

Healthier Communities Thanks to the National Environmental Public Health Tracking Network | www.APHLblog.orgBefore CDC launched the Tracking Network in 2002, environmental health data may have been collected at the county or state level but not usually at the community level; and oftentimes public health practitioners, healthcare providers and researchers weren’t sharing data to support one another. Tracking programs around the US are gathering data that better illustrates what may be happening within a particular city, neighborhood and/or demographic; that information is then made available to researchers, healthcare providers and public health practitioners in the form of maps or well-organized databases leading to faster responses.

Here are some real life examples of how the Tracking Network has answered questions like the ones listed above:

Winchester, Massachusetts parents were becoming increasingly concerned about the sediment left in a popular park by an adjacent river’s flood waters. In the same park, an herbicide was used that added to concerns about the park’s safety for kids. Were these things likely to cause childhood cancer? At the request of these citizens, the state tracking program began to investigate. They looked closely at the herbicide and the contaminants from the river, and they reviewed statewide childhood cancer data and compared it to rates in the immediate community. The tracking program’s final report showed that Winchester’s childhood cancer rate was similar to statewide trends – neither the flooding river’s sediment nor the herbicide were causing higher rates of cancer. While this information was reassuring, the Town of Winchester went one step further by deepening the channel of the river to prevent flooding.

At an indoor pool party in a small Kansas town, more than two dozen kids suddenly became ill with headaches and nausea caused by carbon monoxide from the pool’s heater. Following this incident (and a few others), the Kansas tracking program developed an educational program to inform residents of the lesser-known – but equally dangerous – sources of carbon monoxide. The state saw a decrease in carbon monoxide poisonings after the educational program was implemented. Additionally, Kansas is considering regulatory changes that would require hospitals to report all cases of carbon monoxide poisoning giving the tracking program valuable information as they continue to monitor carbon monoxide incidents.

Extreme heat events (aka, heat waves) cause hundreds of hospitalizations and emergency room visits in Minnesota every year. The tracking program analyzed data on hospitalizations and deaths to gain a better understand of high-risk groups, and compiled this data into maps. Using this information, they identified new populations that hadn’t previously been considered high-risk. Health agencies are now able to use this data to develop more targeted prevention and response systems before and during extreme heat events.


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5 Things You Didn’t Know (but Need to Know) about Listeria

Apr 13 2015 :: Published in Food Safety

By Michelle Forman, senior specialist, media, APHL

5 Things You Didn’t Know (but Need to Know) about Listeria | www.APHLblog.org

Listeria has reared its ugly head (and tail – flagella, technically speaking) seemingly quite a bit recently. According to FDA, there have been 14 recalls due to possible Listeria contamination so far this year. (Five of those were linked to the same spinach supplier.) And USDA’s list shows another three. While most of these recalls have not been linked to illnesses*, Listeria is extremely serious and considered a high-priority within the US food safety system. What is this nasty bacteria and why is it so serious? Here are five things that you didn’t know (but need to know) about Listeria.

1. 90% of people who get listeriosis (the infection caused by Listeria monocytogenes) are part of a high-risk group such as pregnant women, adults over 65 years and people with weakened immune systems. In fact, pregnant women are about 10-20 times (depending on the source) more likely and the elderly are four times more likely to get listeriosis than the general population. If you’re part of one of these groups, take Listeria risk very seriously.

2. Listeria has a very high mortality rate. CDC estimates that there are about 1,600 cases each year and 260 die (approximately 16%). By comparison, CDC estimates 19,000 Salmonella cases each year and 380 die (approximately 2%).

5 Things You Didn’t Know (but Need to Know) about Listeria | www.APHLblog.org 3. Listeria is unlike many other foodborne pathogens because it can grow even in the cold temperature of the refrigerator making it extra important to avoid cross contamination from uncooked meat, fish or other high risk foods. Like other foodborne pathogens, proper cooking is the most effective way to kill Listeria that is lurking on your food.

4. The incubation period for Listeria is 3-70 days. That means it could be up to 70 days after Listeria entered your body before you get sick. Many people who get foodborne illness often point to the last thing they ate as the culprit, but that’s often not the case especially with Listeria. For the purposes of an outbreak investigation, epidemiologists will look back even further – as much as 120 days prior to when a person became ill – to be sure they are really looking at every possible suspect. Can you remember what you ate 70 days ago? Or even 120 days ago?

5 Things You Didn’t Know (but Need to Know) about Listeria | www.APHLblog.org

5. The US food safety system takes Listeria extremely seriously. There is an enhanced surveillance system led by CDC called the Listeria Initiative which requires health care providers to report listeriosis cases; requires public health officials to promptly interview anyone with listeriosis to gather information that could help identify the source of infection; and requires clinical labs to send positive samples to public health laboratories for subtyping using PFGE (DNA fingerprinting). The DNA fingerprints are uploaded to PulseNet, the national network of public health and food regulatory agency laboratories that connect foodborne illness cases together to detect clusters of bacteria that make people sick. All of this helps accelerate outbreak detection and surveillance, and decreases the amount of time it takes to stop an outbreak from progressing.

* While there have been 17 recalls due to possible Listeria contamination, most have not been linked to illness. Five national PulseNet clusters of illness have been detected and reported to epidemiologists this year. Four of those clusters have led to epidemiologic investigations. As of now, three of those investigations are still open and active. One of those investigations has led to a confirmed source and is still considered active.

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It is never just a cold

Apr 06 2015 :: Published in Infectious Diseases

By Stephanie Chester, Manager, Influenza Program, APHL

“Oh, it’s just a cold,” seems to be a common phrase heard in office spaces and schools alike during the winter months. But is it just a cold? Are we belittling our coughs and sneezing by grouping them under one tiny umbrella term? While the common cold is, in fact, common it is by no means simple. Your sniffles are never just a cold.

It is never just a cold | www.APHLblog.org

So how common is the cold? The viruses behind the common cold impact all of us at an average of two to three illnesses per year for adults and six to eight illnesses per year for young kids. And despite there being a cold season, these viruses are not actually confined to the winter months. There are differing theories on why people seem to catch colds more frequently during the winter but most agree that the viruses transmit more readily when people are clustered together in schools and offices.  “Environmental conditions may be a factor in which cold viruses are circulating,” said Kirsten St. George, MAppSc, PhD, chief of viral diseases at The Wadsworth Center, the New York State Department of Health’s public health laboratory . “It is not well understood, but certain viruses seem more stable in specific temperature and humidity conditions.”

There are more than two hundred viruses behind the common cold, and there may be many more still that have not been identified. Rhinoviruses are the traditional cause of the common cold, but there are at least 100 rhinovirus serotypes (distinct variations of the virus). A close relative of rhinoviruses are the enteroviruses which you probably heard about with the fall 2014 enterovirus D68 outbreaks; in a normal year they typically cause mild respiratory illness. Other cold causing viruses include human parainfluenza viruses and human metapneumoviruses.

There is a veritable alphabet soup of virus names – but why does the specific virus matter to us if they all just cause a cold?

As you can probably imagine, the fact that there are hundreds of cold-causing viruses, each with several different strains and serotypes, creates many challenges for scientists, healthcare providers and public health practitioners. For starters, it makes it nearly impossible to predict which viruses will be dominant in a given season. “There may be a swell of dominance for one virus, but then it will fade and another will take its place,” explained Dr. St. George.

So if we can’t predict it, why don’t we just prevent it? Why is there not a vaccine for the common cold much like there is for influenza? Again, the sheer volume of viruses and their ability to change and evolve over time is a huge hindrance to this process. To create an effective flu vaccine, said Dr. St. George, researchers must change the vaccine composition annually, or nearly annually, to keep pace with the variants of the virus in circulation. In contrast, she said, “With the cold, there are a myriad of types within a single group, dozens of types circulating all of the time.” This diversity would make the creation of a vaccine very expensive and difficult. It is more likely that researchers will focus on ways to stimulate the immune system to respond more productively to infection and on medications to relieve symptoms.

One area where science is making progress is in the diagnostics and surveillance of the common cold and other respiratory viruses with the advent of new molecular tests. “A lot of these viruses were difficult to identify with classical virology laboratory methods such as culture,” said Dr. St. George. “They just don’t always grow well – or at all – in culture. With new technology, especially the commercially available molecular kits, they are readily detectable.” This advance may not save us from the coughing and congestion, but it provides researchers, physicians and public health practitioners with improved data about what is circulating and causing severe illness. And that information has a multitude of benefits!

For starters, data from these tests may ultimately help researchers and physicians learn if certain demographics or risk factors increase a person’s chance of more severe illness. This may allow for prevention and mitigation strategies, or may lead to a physician being more aggressive with treatment and supportive therapy. Though, as Dr. St. George explained, serious reactions are not limited to those higher risk populations such as those with underlying health conditions. “We have seen very severe manifestations in otherwise healthy people who ended up in intensive care.” Even still, understanding if it is the virus or the host that predisposes a person to more severe illness is incredibly helpful.

Additionally, school officials may decide to cancel classes (or not) if they know the current outbreak of sniffles and coughs is caused by a more troublesome virus. Hospitals can use this data to cluster and isolate patients when needed so respiratory outbreaks don’t spread throughout the entire facility.

While understanding the different viruses that cause the common cold is valuable to public health, we also keep a close eye on how cold treatment may be contributing to a larger health concern: antibiotic resistance. Antibiotics are overprescribed for many things including the common cold. Cold viruses do not respond to antibiotics because they are viruses; antibiotics are only effective for bacterial infections. “Often the thought process is that when you get sick, you should go to the doctor, get some antibiotics and get better,” said Lisa McHugh, MPH, influenza surveillance coordinator and supervisor for the regional epidemiology program at the New Jersey Department of Health. “There is not a clear understanding [among the public] of the difference between bacteriology and virology, and what the standard treatments are for each.” She went on to emphasize that it is critical for the public to understand the difference and that antibiotics are not be the remedy for every ailment. Dr. St. George agreed. “Clinical judgment is important. People need to trust their doctors. They are pretty good at telling when your illness is viral. We are in a time where we need to look carefully at antibiotic use and keep them in reserve.”

Next time you hear someone say, “Oh, it’s just a cold,” you can let them know they may actually be sick from one of hundreds of viruses. Regardless of which one (or several) has struck your family this year, remember to cover your coughs and sneezes with your elbow, wash your hands and stay home when necessary to prevent sharing your virus with others. While scientists work to broaden their understanding of this complex group of viruses, we can help make the common cold a little less common.

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The Tenacity of Tuberculosis: MDR-TB

Mar 24 2015 :: Published in Infectious Diseases

By William A. Murtaugh, MPH, Specialist, TB Program, APHL

“Suddenly she stopped, clutched her throat and a wave of crimson blood ran down her breast… It rendered her even more ethereal.” ~ Edgar Allan Poe describes his wife dying of tuberculosis.

Disturbing, sensational and oddly romanticized — these were the days of tuberculosis past. So what has become of its future?

The Tenacity of TB: How multi-drug resistant tuberculosis will determine global progress in TB elimination | www.APHLblog.org

While recent news stories about en vogue infectious diseases are no less sensational, TB has certainly lost its status at the water cooler. It is far from having the mystique of a zombie apocalypse; it’s not wrapped up in a passionate human rights movement like HIV/AIDS; it doesn’t have the exotic novelty of Ebola; and it hardly provokes the Thought Police like vaccine preventable diseases. With a low burden of disease in the US and case rates continuing to decline annually, TB has all but faded from public consciousness.

But what TB has lost in zeitgeist influence, it has made up for in tenacity. For every major advancement in treatment and control, M. tuberculosis has capitalized on weaknesses and dared the public health system to rest on its laurels. As a result, the US, a country with relatively robust TB control programs, has not achieved TB elimination. Globally, large disparities in resources and infrastructure remain and TB is the second largest cause of mortality of any single pathogen behind HIV.

In the US, TB often persists in marginalized and invisible populations such as homeless or foreign-born communities. With few exceptions, cases of TB are still reported by every state. Occasionally, rare outbreaks breach the imaginary safety bubble of larger communities. It is vital to recognize that our current system is neither infallible nor exclusive of the global TB fight. The TB of today poses a challenge that could take the hot air from the lungs of the most bumptious pathogen pundit. That threat, and this year’s topic for World TB Day, is multi-drug resistant tuberculosis (MDR-TB).

Multi-drug resistant tuberculosis is defined as active disease from infection by M. tuberculosis strains that are resistant to at least rifampin and isoniazid, two of the four drugs in first line drug therapy (collectively and colloquially known by the acronym “RIPE”). The reasons that TB strains develop drug resistance are complicated and derive from a variety of biological and man-made influences. The major concern with MDR-TB is that it renders inadequate an already limited number of drugs, with only prolonged, less effective and more toxic treatment options remaining.

The story of MDR-TB has its roots right here on, or rather in, our soil. Streptomycin, the first drug to treat TB, is an antibiotic produced by bacteria found in the soil, and is a Nobel Prize winning discovery by Selman Waksman of Rutgers University. While blindingly obvious, drug resistance can’t develop without one key component…drugs. But drug resistant TB was unheard of prior to the discovery of streptomycin in 1943. Not to be outdone, M. tuberculosis showed that it could quickly develop resistance. Through the next 20 years this TB tit-for-tat went on with each newly developed drug until a regimen of combination therapy, the RIPE panel of drugs, provided the TKO and is still the primary arsenal used today. This drug regimen was lengthy with harsh side effects, but it was nonetheless effective. US case rates began to decline through the 1970s. However, the silver bullet of antituberculosis drug discovery was a silver lining that encircled a menacing storm cloud of emerging drug resistant TB.

Optimism in new treatment regimens gave way to the reality that global scale-up of effective treatment programs was a long term investment and expensive. Funders wanted the most bang for their buck, and TB didn’t fit the bill. Consequently, global political will eroded and only wealthy countries, like the US, made significant strides toward TB elimination. Low resource, high burden countries faced limited access to antituberculosis drug supplies and deficient healthcare infrastructure. This contributed to the improper use of drugs that consequently encouraged the emergence of resistant TB strains and subsequent outbreaks of multi-drug resistant TB. These factors led to treatment failure and widespread transmission, and paved a road for outbreaks of multi-drug resistant TB.

Not until the 1990s, when TB remained the single largest cause of death from an infectious disease, were advances made in public health economics that supported investment in TB treatment efforts. The World Health Organization implemented a strategy that is the foundation of today’s approach: Directly Observed Therapy short-course (DOTS). DOTS strategy, as the name indicates, involves a high level of accountability for treatment adherence. Unfortunately, drug resistant strains of M. tuberculosis cannot be determined through direct observation or even under a microscope. MDR-TB patients were failed by the original DOTS strategy because it did not include a significant laboratory component to detect drug resistance. This weakness, coupled with comorbidity associated with a mounting HIV epidemic, gave rise to numerous MDR-TB outbreaks here in the US.

Traditional methods for TB drug susceptibility testing in the laboratory greatly improve the ability to properly treat and control MDR-TB, but require weeks of precious time and expertise. This often limits their utility. The Centers for Disease Control and Prevention Division of TB Elimination, in conjunction with APHL and state and local public health laboratory systems in the US, continue to play an important role in maintaining expertise amid overall declining rates of TB. Great strides have been made in the past decade in development and implementation of technologies that can inform treatment decisions within 24 hours and in greater detail than was ever thought possible.

With a bolster to the domestic diagnostic infrastructure, MDR-TB cases are able to be detected and remain rare (95 cases in 2013). But MDR-TB is showing little sign of significant decrease and, as of 2013, nearly 90% of cases were foreign-born. While barely registering in headlines, MDR-TB is nevertheless the next major obstacle to tuberculosis control. Its path will determine global progress toward TB elimination.

Check out APHL’s webinars related to TB:

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University of Oregon outbreak highlights collaboration between public health and clinical care

Mar 12 2015 :: Published in Infectious Diseases

By Michelle Forman, senior specialist, media, APHL

University of Oregon outbreak highlights collaboration between public health and clinical care | www.APHLblog.org

In mid-January, a University of Oregon student was diagnosed with Neisseria meningitidis serogroup B, a rare but serious disease. Within one month, three additional students were diagnosed with the same disease, one of whom died. “I was the first assistant on that autopsy,” said Patrick F. Luedtke MD, MPH, senior public health officer and medical director of the Lane County Department of Health & Human Services Community & Behavioral Health clinics. (He’s also a past APHL president.) “The bacteria were everywhere. Neisseria meningitidis takes over the body and wins every battle.”

College campuses like the University of Oregon are perfect breeding grounds for meningococcal disease. Young adults ages 16-21 have higher rates than others, and it is transmitted through close or lengthy contact such as living in close quarters or kissing. So, yeah… meningococcal disease can make its way across a college campus if it isn’t stopped quickly. In fact, there were similar outbreaks at Princeton University and at University of California, Santa Barbara in 2013.

Meningococcal disease is rare, but if a person gets it they are likely to become very sick. Once it is suspected, clinical laboratories can do a test to confirm meningococcal disease and doctors can quickly begin antibiotic treatment. (Oftentimes prophylactic antibiotic treatment is given anyone who had close contact with the sick individual.) But even with quick and proper treatment, approximately 20% of people will have long-term disabilities and 10-15% of people die. The best way to prevent severe illness is to prevent illness all together – decrease the number of people who can get meningococcal disease in the first place – with vaccines. Here’s the kicker, though… Kids in the US receive a quadrivalent meningococcal vaccine at age 11. However, that vaccine only protects kids from serogroup A, C, Y or W-135. What about B, the serogroup found at the University of Oregon?

In October 2014, the FDA approved the first ever N. meningitidis serogroup B vaccine for use in people 10-25 years of age as a three-dose series. In January 2015, the FDA approved another N. meningitidis serogroup B vaccine for use in the same age group as a two-dose series. Neither vaccine has been recommended for routine use yet, but it has been recommended for controlling outbreaks like the one at the University of Oregon. In order to implement a massive campaign to vaccinate all 22,000 students, CDC needed to know that there had been at least three confirmed serogroup B cases within a three month period. The clinical test that confirmed meningococcal disease in each of the four patients wasn’t enough, though. Not only are clinical laboratories often without the capabilities to serotype meningococcal disease, the serogroup doesn’t affect clinical care. Whether the meningococcal disease was serogroup A, B, C, Y or W-135 didn’t change how they cared for the sick individuals. Further testing was needed to show that all four cases had the exact same strain of serogroup B meningococcal disease.

That was a task for the Oregon State Public Health Laboratory; in an outbreak, it is the public health laboratory’s role to show cases are truly linked. As each case was determined to be meningococcal disease, the public health laboratory was contacted and serotyping began. While the public health lab’s confirmation that the patients were sick with group B meningococcal disease was enough information for CDC to green-light the vaccination effort, the Oregon State Public Health Laboratory dug even deeper. With Neisseria meningitidis cases such as the ones at the university, the Oregon state lab routinely uses pulsed-field gel electrophoresis (PFGE) to isolate the DNA fingerprint of each strain to show that everyone got the disease from the same source. That information could help epidemiologists identify the index case. “Using PFGE to fingerprint meningococcus is considered very risky, and it is very expensive, so many laboratories don’t do it,” explained Robert Vega, general microbiology manager at the Oregon state lab. “The risk associated with this is very real to us. Our staff is vaccinated against groups A, B, C, Y and W-135; we are well equipped and I have highly proficient staff.”

Once it was confirmed that the cases were group B meningococcal disease, CDC approved the Lane County Health Department and the University of Oregon to implement a massive effort to quickly vaccinate 22,000 students. The vaccination effort began on March 2 and within one week over 10,000 students had received the first dose of the vaccination. “We still have more students to reach, but we are working hard to make sure everyone is vaccinated,” said Dr. Luedtke. Quick treatment from clinical care providers and fast, accurate testing by the public health lab will hopefully mean that this is the beginning of the end of this outbreak.

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