TEST BANK FOR vv vv
PrimaryCare InterprofessionalCollaborative Practice 6th Edition
vv vv vv vv vv vv
|Chapter1-228|Complete TestBank vv vv
Authors:Terry Mahan Buttaro, Patricia Polgar-Bailey, Joanne Sandberg-Cook, JoAnn Trybulski
v vv vv vv vv vv vv vv vv
Chapter 01: Interprofessional Collaborative Practice:
vv vv vv vv
Where We Are Today
vv vv vv vv
Buttaro: Primary Care: A Collaborative Practice, 6th
vv vv vv vv vv vv
Edition
vv
MULTIPLE CHOICE vv
1. v v A small, rural hospital is part of an Accountable Care
vv vv vv vv vv vv vv vv vv
Organization (ACO) and is designated as a Level 1 ACO.
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What is part of this designation?
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a. Bonuses based on achievement of benchmarks vv vv vv vv vv
b. Care coordination for chronic diseases vv vv vv vv
c. Standards for minimum cash reserves vv vv vv vv
d. Strict requirements for financial reporting vv vv vv vv
ANS: v v
A
A Level 1 ACO has the least amount of financial risk and requirements, but receives shared
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
savings bonuses based on achievement of benchmarks for quality measures and expenditures.
vv vv vv vv vv vv vv vv vv vv vv vv
Care coordination and minimum cash reserves standards are part of Level 2 ACO requirements.
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
Level 3 ACOs have strict requirements for financial reporting.
vv vv vv vv vv vv vv vv vv
2. v v What was an important finding of the Advisory Board survey of 2014 about primary care
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
preferences of patients?
vv vv vv
a. Associations with area hospitals vv vv vv
b. Costs of ambulatory care vv vv vv
c. Ease of access to care vv vv vv vv
d. The ratio of providers to patients vv vv vv vv vv
ANS: C v v v v
As part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access to care,
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
walk-in settings and the ability to be seen within 30 minutes, and care that is close to home.
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
Associations with hospitals, costs of care, and the ratio of providers to patients were not part of vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
these results.
vv vv
,MULTIPLE RESPONSE vv
1. Which assessments of care providers are performed as part of the value-based purchasing (VBP)
vv vv vv vv vv vv vv vv vv vv vv vv vv
initiative? (Select all that apply.)
vv vv vv vv vv
a. Appraising costs per case of care for Medicare patients vv vv vv vv vv vv vv vv
b. Assessing patients’ satisfaction with hospital care vv vv vv vv vv
c. Evaluating available evidence to guide clinical care guidelines vv vv vv vv vv vv vv
d. Monitoring mortality rates of all patients with pneumonia vv vv vv vv vv vv vv
e. Requiring advanced IT standards and minimum cash reserves vv vv vv vv vv vv vv
ANS: A, B, D v v v v vv vv
Value-based purchasing looks at five domain areas of processes of care, including efficiency of
vv vv vv vv vv vv vv vv vv vv vv vv vv
care (cost per case), experience of care (patient satisfaction measures), and outcomes of care
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
(mortality rates for certain conditions). Evaluation of evidence to guide clinical care is part of
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evidence-based practice. The requirements for IT standards and financial status are part of
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Accountable Care Organization standards.
vv vv vv vv
Chapter 02: Translating Research into Clinical Practice
vv vv vv vv vv vv
Buttaro: Primary Care: A Collaborative Practice, 6th Edition
vv vv vv vv vv vv vv vv
MULTIPLE CHOICE vv
1. What is the purpose of Level II research?
vv vv vv vv vv vv vv
a. To define characteristics of interest of groups of patients
vv vv vv vv vv vv vv vv
b. To demonstrate the effectiveness of an intervention or treatment
vv vv vv vv vv vv vv vv
c. To describe relationships among characteristics or variables
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d. To evaluate the nature of relationships between two variables
vv vv vv vv vv vv vv vv
ANS: C v v v v
Level II research is concerned with describing the relationships among characteristics or
vv vv vv vv vv vv vv vv vv vv vv
variables. Level I research is conducted to define the characteristics of groups of patients. Level II
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
research evaluates the nature of the relationships between variables. Level IV research is
vv vv vv vv vv vv vv vv vv vv vv vv vv
conducted to demonstrate the effectiveness of interventions or treatments.
vv vv vv vv vv vv vv vv vv
2. Which is the most appropriate research design for a Level III research study?
vv vv vv vv vv vv vv vv vv vv vv vv
a. Epidemiological studies vv
b. Experimental design vv
c. Qualitative studies vv
d. Randomized clinical trials vv vv
ANS: B v v v v
The experimental design is the most appropriate design for a Level III study. Epidemiological
vv vv vv vv vv vv vv vv vv vv vv vv vv
studies are appropriate for Level II studies. Qualitative designs are useful for Level I studies.
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
Randomized clinical trials are used for Level IV studies.
vv vv vv vv vv vv vv vv vv
, 3. What is the purpose of clinical research trials in the spectrum of translational research?
vv vv vv vv vv vv vv vv vv vv vv vv vv
a. Adoption of interventions and clinical practices into routine clinical care
vv vv vv vv vv vv vv vv vv
b. Determination of the basis of disease and various treatment options vv vv vv vv vv vv vv vv vv
c. Examination of safety and effectiveness of various interventions vv vv vv vv vv vv vv
d. Exploration of fundamental mechanisms of biology, disease, or behavior vv vv vv vv vv vv vv vv
ANS: C v v v v
Clinical research trials are concerned with determining the safety and effectiveness of
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interventions. Adoption of interventions and practices is part of clinical implementation.
vv vv vv vv vv vv vv vv vv vv vv
Determination of the basis of disease and treatment options is part of the preclinical research
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
phase. Exploration of the fundamental mechanisms of biology, disease, or behavior is part of the
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
basic research stage.
vv vv vv
Chapter 03: Empowering Patients as Collaborative partners: A New Model for Primary Care
vv vv vv vv vv vv vv vv vv vv vv vv
Buttaro: Primary Care: A Collaborative Practice, 6th Edition
vv vv vv vv vv vv vv
MULTIPLE CHOICE vv
1. Which statement made by a health care provider demonstrates the most appropriate
vv vv vv vv vv vv vv vv vv vv vv
understanding for the goal of a performance report?
vv vv vv vv vv vv vv vv
a. ―This process allows me to critique the performance of the rest of the staff.‖
v vv vv vv vv vv vv vv vv vv vv vv vv
b. ―Most organizations require staff to undergo a performance evaluation yearly.‖
vv vv vv vv vv vv vv vv vv
c. ―It is hard to be personally criticized but that’s how we learn to change.‖
vv vv vv vv vv vv vv vv vv vv vv vv vv
d. ―The comments should help me improve my management skills.‖
vv vv vv vv vv vv vv vv
ANS: D v v v v
The goal of the performance report is to provide guidance to staff in the areas of professional
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
development, mentoring, and leadership development. A peer review is written by others who
vv vv vv vv vv vv vv vv vv vv vv vv vv
perform similar skills (peers). The remaining options may be true but do not provide evidence of
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
understanding of the goal of this professional requirement.
vv vv vv vv vv vv vv vv
MULTIPLE RESPONSE vv
1. Which assessment question would a health care provider ask when engaging in the previsit stage of
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
the new model for primary care? (Select all that apply.)
vv vv vv vv vv vv vv vv vv vv
a. ―Areyou ready to discuss some ofthe community resources that are available?‖
v vv vv vv vv vv vv vv vv vv vv vv
b. ―Are you experiencing any side effects from your newly prescribed medications?‖
vv vv vv vv vv vv vv vv vv vv
c. ―Do you anticipate any problems with adhering to your treatment plan?‖
vv vv vv vv vv vv vv vv vv vv
d. ―Are you ready to discuss the results of your laboratory tests?‖
vv vv vv vv vv vv vv vv vv vv
e. ―Do you have any questions about the lab tests that have been ordered for you?‖
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
ANS: v v v v B, C, E vv vv
, The nursing responsibilities in the previsit stage include assessing the patient’s tolerance of
vv vv vv vv vv vv vv vv vv vv vv vv
prescribed medications, understanding of existing treatment plan, and education about required lab
vv vv vv vv vv vv vv vv vv vv vv vv
testing. The primary care provider is responsible for screening lab data and discussing
vv vv vv vv vv vv vv vv vv vv vv vv vv
community resources during the actual visit.
vv vv vv vv vv vv
Chapter 04: Coordinated Chronic Care
vv vv vv vv
Buttaro: Primary Care: A Collaborative Practice, 6th Edition
vv vv vv vv vv vv vv
MULTIPLE CHOICE vv
1. To reduce adverse events associated with care transitions, the Centers for Medicare and
vv vv vv vv vv vv vv vv vv vv vv vv
Medicaid Service have implemented which policy?
vv vv vv vv vv vv
a. Mandates for communication among primary caregivers and hospitalists vv vv vv vv vv vv vv
b. Penalties for failure to perform medication reconciliations at time of discharge vv vv vv vv vv vv vv vv vv vv
c. Reduction of payments for patients readmitted within 30 days after discharge vv vv vv vv vv vv vv vv vv vv
d. Requirements for written discharge instructions for patients and caregivers vv vv vv vv vv vv vv vv
ANS: C v v v v
As a component of the Affordable Care Act, the Centers for Medicare and Medicaid Service
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
developed the Readmissions Reduction Program reducing payments for certain patients
vv vv vv vv vv vv vv vv vv vv
readmitted within 30 days of discharge. The CMS did not mandate communication, institute
vv vv vv vv vv vv vv vv vv vv vv vv vv
penalties for failure to perform medication reconciliations, or require written discharge
vv vv vv vv vv vv vv vv vv vv vv
instructions.
vv
2. According to multiple research studies, which intervention has resulted in lower costs and fewer
vv vv vv vv vv vv vv vv vv vv vv vv vv
rehospitalizations in high-risk older patients?
vv vv vv vv vv
a. Coordination of posthospital care by advanced practice health care providers vv vv vv vv vv vv vv vv vv
b. Frequent posthospital clinic visits with a primary care provider vv vv vv vv vv vv vv vv
c. Inclusion of extended family members in the outpatient plan of care vv vv vv vv vv vv vv vv vv vv
d. Telephone follow-up by the pharmacist to assess medication compliance vv vv vv vv vv vv vv vv
ANS: A v v v v
Research studies provided evidence that high-risk older patients who had posthospital care
vv vv vv vv vv vv vv vv vv vv vv
coordinated by an APN had reduced rehospitalization rates. It did not include clinic visits with a
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
primary care provider, inclusion of extended family members in the plan of care, or telephone
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
follow-up by a pharmacist.
vv vv vv vv
MULTIPLE RESPONSE vv
1. Which advantages are provided to the chronically ill patient by personal electronic monitoring
vv vv vv vv vv vv vv vv vv vv vv vv
devices? (Select all that apply.)
vv vv vv vv vv
a. Helps provide more patient control their health and lifestyle
vv vv vv vv vv vv vv vv
b. Eliminates need for regular medical and nursing follow-up visits vv vv vv vv vv vv vv vv
c. Helps the early identification of patient health-related problems
vv vv vv vv vv vv vv
d. Helps health care providers in keeping track of the patient’s health status
vv vv vv vv vv vv vv vv vv vv vv
e. Cost is often covered by Medicare vv vv vv vv vv
PrimaryCare InterprofessionalCollaborative Practice 6th Edition
vv vv vv vv vv vv
|Chapter1-228|Complete TestBank vv vv
Authors:Terry Mahan Buttaro, Patricia Polgar-Bailey, Joanne Sandberg-Cook, JoAnn Trybulski
v vv vv vv vv vv vv vv vv
Chapter 01: Interprofessional Collaborative Practice:
vv vv vv vv
Where We Are Today
vv vv vv vv
Buttaro: Primary Care: A Collaborative Practice, 6th
vv vv vv vv vv vv
Edition
vv
MULTIPLE CHOICE vv
1. v v A small, rural hospital is part of an Accountable Care
vv vv vv vv vv vv vv vv vv
Organization (ACO) and is designated as a Level 1 ACO.
vv vv vv vv vv vv vv vv vv vv
What is part of this designation?
vv vv vv vv vv vv
a. Bonuses based on achievement of benchmarks vv vv vv vv vv
b. Care coordination for chronic diseases vv vv vv vv
c. Standards for minimum cash reserves vv vv vv vv
d. Strict requirements for financial reporting vv vv vv vv
ANS: v v
A
A Level 1 ACO has the least amount of financial risk and requirements, but receives shared
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
savings bonuses based on achievement of benchmarks for quality measures and expenditures.
vv vv vv vv vv vv vv vv vv vv vv vv
Care coordination and minimum cash reserves standards are part of Level 2 ACO requirements.
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
Level 3 ACOs have strict requirements for financial reporting.
vv vv vv vv vv vv vv vv vv
2. v v What was an important finding of the Advisory Board survey of 2014 about primary care
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
preferences of patients?
vv vv vv
a. Associations with area hospitals vv vv vv
b. Costs of ambulatory care vv vv vv
c. Ease of access to care vv vv vv vv
d. The ratio of providers to patients vv vv vv vv vv
ANS: C v v v v
As part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access to care,
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
walk-in settings and the ability to be seen within 30 minutes, and care that is close to home.
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
Associations with hospitals, costs of care, and the ratio of providers to patients were not part of vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
these results.
vv vv
,MULTIPLE RESPONSE vv
1. Which assessments of care providers are performed as part of the value-based purchasing (VBP)
vv vv vv vv vv vv vv vv vv vv vv vv vv
initiative? (Select all that apply.)
vv vv vv vv vv
a. Appraising costs per case of care for Medicare patients vv vv vv vv vv vv vv vv
b. Assessing patients’ satisfaction with hospital care vv vv vv vv vv
c. Evaluating available evidence to guide clinical care guidelines vv vv vv vv vv vv vv
d. Monitoring mortality rates of all patients with pneumonia vv vv vv vv vv vv vv
e. Requiring advanced IT standards and minimum cash reserves vv vv vv vv vv vv vv
ANS: A, B, D v v v v vv vv
Value-based purchasing looks at five domain areas of processes of care, including efficiency of
vv vv vv vv vv vv vv vv vv vv vv vv vv
care (cost per case), experience of care (patient satisfaction measures), and outcomes of care
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
(mortality rates for certain conditions). Evaluation of evidence to guide clinical care is part of
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
evidence-based practice. The requirements for IT standards and financial status are part of
vv vv vv vv vv vv vv vv vv vv vv vv vv
Accountable Care Organization standards.
vv vv vv vv
Chapter 02: Translating Research into Clinical Practice
vv vv vv vv vv vv
Buttaro: Primary Care: A Collaborative Practice, 6th Edition
vv vv vv vv vv vv vv vv
MULTIPLE CHOICE vv
1. What is the purpose of Level II research?
vv vv vv vv vv vv vv
a. To define characteristics of interest of groups of patients
vv vv vv vv vv vv vv vv
b. To demonstrate the effectiveness of an intervention or treatment
vv vv vv vv vv vv vv vv
c. To describe relationships among characteristics or variables
vv vv vv vv vv vv
d. To evaluate the nature of relationships between two variables
vv vv vv vv vv vv vv vv
ANS: C v v v v
Level II research is concerned with describing the relationships among characteristics or
vv vv vv vv vv vv vv vv vv vv vv
variables. Level I research is conducted to define the characteristics of groups of patients. Level II
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
research evaluates the nature of the relationships between variables. Level IV research is
vv vv vv vv vv vv vv vv vv vv vv vv vv
conducted to demonstrate the effectiveness of interventions or treatments.
vv vv vv vv vv vv vv vv vv
2. Which is the most appropriate research design for a Level III research study?
vv vv vv vv vv vv vv vv vv vv vv vv
a. Epidemiological studies vv
b. Experimental design vv
c. Qualitative studies vv
d. Randomized clinical trials vv vv
ANS: B v v v v
The experimental design is the most appropriate design for a Level III study. Epidemiological
vv vv vv vv vv vv vv vv vv vv vv vv vv
studies are appropriate for Level II studies. Qualitative designs are useful for Level I studies.
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
Randomized clinical trials are used for Level IV studies.
vv vv vv vv vv vv vv vv vv
, 3. What is the purpose of clinical research trials in the spectrum of translational research?
vv vv vv vv vv vv vv vv vv vv vv vv vv
a. Adoption of interventions and clinical practices into routine clinical care
vv vv vv vv vv vv vv vv vv
b. Determination of the basis of disease and various treatment options vv vv vv vv vv vv vv vv vv
c. Examination of safety and effectiveness of various interventions vv vv vv vv vv vv vv
d. Exploration of fundamental mechanisms of biology, disease, or behavior vv vv vv vv vv vv vv vv
ANS: C v v v v
Clinical research trials are concerned with determining the safety and effectiveness of
vv vv vv vv vv vv vv vv vv vv vv
interventions. Adoption of interventions and practices is part of clinical implementation.
vv vv vv vv vv vv vv vv vv vv vv
Determination of the basis of disease and treatment options is part of the preclinical research
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
phase. Exploration of the fundamental mechanisms of biology, disease, or behavior is part of the
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
basic research stage.
vv vv vv
Chapter 03: Empowering Patients as Collaborative partners: A New Model for Primary Care
vv vv vv vv vv vv vv vv vv vv vv vv
Buttaro: Primary Care: A Collaborative Practice, 6th Edition
vv vv vv vv vv vv vv
MULTIPLE CHOICE vv
1. Which statement made by a health care provider demonstrates the most appropriate
vv vv vv vv vv vv vv vv vv vv vv
understanding for the goal of a performance report?
vv vv vv vv vv vv vv vv
a. ―This process allows me to critique the performance of the rest of the staff.‖
v vv vv vv vv vv vv vv vv vv vv vv vv
b. ―Most organizations require staff to undergo a performance evaluation yearly.‖
vv vv vv vv vv vv vv vv vv
c. ―It is hard to be personally criticized but that’s how we learn to change.‖
vv vv vv vv vv vv vv vv vv vv vv vv vv
d. ―The comments should help me improve my management skills.‖
vv vv vv vv vv vv vv vv
ANS: D v v v v
The goal of the performance report is to provide guidance to staff in the areas of professional
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
development, mentoring, and leadership development. A peer review is written by others who
vv vv vv vv vv vv vv vv vv vv vv vv vv
perform similar skills (peers). The remaining options may be true but do not provide evidence of
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
understanding of the goal of this professional requirement.
vv vv vv vv vv vv vv vv
MULTIPLE RESPONSE vv
1. Which assessment question would a health care provider ask when engaging in the previsit stage of
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
the new model for primary care? (Select all that apply.)
vv vv vv vv vv vv vv vv vv vv
a. ―Areyou ready to discuss some ofthe community resources that are available?‖
v vv vv vv vv vv vv vv vv vv vv vv
b. ―Are you experiencing any side effects from your newly prescribed medications?‖
vv vv vv vv vv vv vv vv vv vv
c. ―Do you anticipate any problems with adhering to your treatment plan?‖
vv vv vv vv vv vv vv vv vv vv
d. ―Are you ready to discuss the results of your laboratory tests?‖
vv vv vv vv vv vv vv vv vv vv
e. ―Do you have any questions about the lab tests that have been ordered for you?‖
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
ANS: v v v v B, C, E vv vv
, The nursing responsibilities in the previsit stage include assessing the patient’s tolerance of
vv vv vv vv vv vv vv vv vv vv vv vv
prescribed medications, understanding of existing treatment plan, and education about required lab
vv vv vv vv vv vv vv vv vv vv vv vv
testing. The primary care provider is responsible for screening lab data and discussing
vv vv vv vv vv vv vv vv vv vv vv vv vv
community resources during the actual visit.
vv vv vv vv vv vv
Chapter 04: Coordinated Chronic Care
vv vv vv vv
Buttaro: Primary Care: A Collaborative Practice, 6th Edition
vv vv vv vv vv vv vv
MULTIPLE CHOICE vv
1. To reduce adverse events associated with care transitions, the Centers for Medicare and
vv vv vv vv vv vv vv vv vv vv vv vv
Medicaid Service have implemented which policy?
vv vv vv vv vv vv
a. Mandates for communication among primary caregivers and hospitalists vv vv vv vv vv vv vv
b. Penalties for failure to perform medication reconciliations at time of discharge vv vv vv vv vv vv vv vv vv vv
c. Reduction of payments for patients readmitted within 30 days after discharge vv vv vv vv vv vv vv vv vv vv
d. Requirements for written discharge instructions for patients and caregivers vv vv vv vv vv vv vv vv
ANS: C v v v v
As a component of the Affordable Care Act, the Centers for Medicare and Medicaid Service
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
developed the Readmissions Reduction Program reducing payments for certain patients
vv vv vv vv vv vv vv vv vv vv
readmitted within 30 days of discharge. The CMS did not mandate communication, institute
vv vv vv vv vv vv vv vv vv vv vv vv vv
penalties for failure to perform medication reconciliations, or require written discharge
vv vv vv vv vv vv vv vv vv vv vv
instructions.
vv
2. According to multiple research studies, which intervention has resulted in lower costs and fewer
vv vv vv vv vv vv vv vv vv vv vv vv vv
rehospitalizations in high-risk older patients?
vv vv vv vv vv
a. Coordination of posthospital care by advanced practice health care providers vv vv vv vv vv vv vv vv vv
b. Frequent posthospital clinic visits with a primary care provider vv vv vv vv vv vv vv vv
c. Inclusion of extended family members in the outpatient plan of care vv vv vv vv vv vv vv vv vv vv
d. Telephone follow-up by the pharmacist to assess medication compliance vv vv vv vv vv vv vv vv
ANS: A v v v v
Research studies provided evidence that high-risk older patients who had posthospital care
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coordinated by an APN had reduced rehospitalization rates. It did not include clinic visits with a
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primary care provider, inclusion of extended family members in the plan of care, or telephone
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follow-up by a pharmacist.
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MULTIPLE RESPONSE vv
1. Which advantages are provided to the chronically ill patient by personal electronic monitoring
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devices? (Select all that apply.)
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a. Helps provide more patient control their health and lifestyle
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b. Eliminates need for regular medical and nursing follow-up visits vv vv vv vv vv vv vv vv
c. Helps the early identification of patient health-related problems
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d. Helps health care providers in keeping track of the patient’s health status
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e. Cost is often covered by Medicare vv vv vv vv vv
