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Valdivia de la Fuente M, Palacios Castañeda DJ, Martínez Sanz N. The human factor and ergonomics in Patient Safety. Med Intensiva 2024:S2173-5727(24)00106-1. [PMID: 38763833 DOI: 10.1016/j.medine.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/29/2024] [Indexed: 05/21/2024]
Abstract
The human condition is linked to error in any activity that is performed, and the healthcare world is no exception. The origin of human error does not lie within the perversity of human nature, instead, it has its origins in latent failures in the healthcare environment and is a consequence of the processes and procedures applied. The science of the Human Factor deals with the application of knowledge to people (capabilities, characteristics and limitations), with the design and the management of the equipment they use and with the environments in which they work and the activities they carry out. Part of the Human Factor are the non-technical skills. These skills greatly influence people's behavior and, therefore, their performance and the quality of healthcare in a very complex socio-technical system.
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Affiliation(s)
- Miguel Valdivia de la Fuente
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain.
| | | | - Nuria Martínez Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
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Rieger T, Manzey D. Human Performance Consequences of Automated Decision Aids: The Impact of Time Pressure. HUMAN FACTORS 2022; 64:617-634. [PMID: 33111557 DOI: 10.1177/0018720820965019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The study addresses the impact of time pressure on human interactions with automated decision support systems (DSSs) and related performance consequences. BACKGROUND When humans interact with DSSs, this often results in worse performance than could be expected from the automation alone. Previous research has suggested that time pressure might make a difference by leading humans to rely more on a DSS. METHOD In two laboratory experiments, participants performed a luggage screening task either manually, supported by a highly reliable DSS, or by a low reliable DSS. Time provided for inspecting the X-rays was 4.5 s versus 9 s varied within-subjects as the time pressure manipulation. Participants in the automation conditions were either shown the automation's advice prior (Experiment 1) or following (Experiment 2) their own inspection, before they made their final decision. RESULTS In Experiment 1, time pressure compromised performance independent of whether the task was performed manually or with automation support. In Experiment 2, the negative impact of time pressure was only found in the manual but not in the two automation conditions. However, neither experiment revealed any positive impact of time pressure on overall performance, and the joint performance of human and automation was mostly worse than the performance of the automation alone. CONCLUSION Time pressure compromises the quality of decision-making. Providing a DSS can reduce this effect, but only if the automation's advice follows the assessment of the human. APPLICATION The study provides suggestions for the effective implementation of DSSs in addition to supporting concerns that highly reliable DSSs are not used optimally by human operators.
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Hayes P, Bearman C, Butler P, Owen C. Non‐technical skills for emergency incident management teams: A literature review. JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT 2020. [DOI: 10.1111/1468-5973.12341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Hayes
- Appleton Institute Central Queensland University Adelaide SA Australia
- Bushfire and Natural Hazards Cooperative Research Centre Melbourne Vic. Australia
| | - Chris Bearman
- Appleton Institute Central Queensland University Adelaide SA Australia
- Bushfire and Natural Hazards Cooperative Research Centre Melbourne Vic. Australia
| | | | - Christine Owen
- Bushfire and Natural Hazards Cooperative Research Centre Melbourne Vic. Australia
- Tasmanian Institute of Law Enforcement Studies University of Tasmania Hobart Tas. Australia
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Carroll MB, Sanchez PL. Decision making with conflicting information: influencing factors and best practice guidelines. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2020. [DOI: 10.1080/1463922x.2020.1764660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Paige L. Sanchez
- College of Aeronautics, Florida Institute of Technology, Melbourne, FL, USA
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Wang X, Gong G, Li N, Ding L. Use of multimodal physiological signals to explore pilots’ cognitive behaviour during flight strike task performance. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2020. [DOI: 10.1016/j.medntd.2020.100030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Burton JW, Stein M, Jensen TB. A systematic review of algorithm aversion in augmented decision making. JOURNAL OF BEHAVIORAL DECISION MAKING 2019. [DOI: 10.1002/bdm.2155] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jason W. Burton
- Department of Psychological SciencesBirkbeck, University of London London UK
| | - Mari‐Klara Stein
- Department of DigitalizationCopenhagen Business School Frederiksberg Denmark
| | - Tina Blegind Jensen
- Department of DigitalizationCopenhagen Business School Frederiksberg Denmark
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Vestjens L, Cramm JM, Birnie E, Nieboer AP. Evaluating an integrated primary care approach to improve well-being among frail community-living older people: A theory-guided study protocol. BMC Geriatr 2018; 18:173. [PMID: 30071842 PMCID: PMC6091022 DOI: 10.1186/s12877-018-0832-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 06/06/2018] [Indexed: 01/21/2023] Open
Abstract
Background A major challenge in primary healthcare is the substantial increase in the proportion of frail community-dwelling older persons with long-term conditions and multiple complex needs. Consequently, a fundamental transformation of current models of primary care by means of implementing proactive integrated care is necessary. Therefore, an understanding of the effects of integrated primary care approaches and underlying mechanisms is essential. This article presents the design of a theory-based evaluation of an integrated primary care approach to improve well-being among frail community-living older adults, which is called “Finding and Follow-up of Frail older persons” (FFF). First, we present a theoretical model to facilitate a sound theory-guided evaluation of integrated primary care approaches for frail community-dwelling older people. The model incorporates interrelated elements of integrated primary care approaches (e.g. proactive case finding and self-management support). Efforts to improve primary care should integrate these promising components to assure productive patient-professional interactions and to improve well-being. Moreover, cognitive and behavioral components of healthcare professionals and patients are assumed to be important. Second, we present the design of the study to evaluate the FFF approach which consists of the following key components: (1) proactive case finding, (2) case management, (3) medication review, (4) self-management support, and (5) working in multidisciplinary care teams. Methods The longitudinal evaluation study has a matched quasi-experimental design with one pretest and one posttest (12 month follow-up) and is conducted in the Netherlands between 2014 and 2017. Both quantitative and qualitative methods are used to evaluate effectiveness, processes, and cost-effectiveness. In total, 250 frail older persons (75 years and older) of 11 GP (general practitioner) practices that implemented the FFF approach are compared with 250 frail older patients of 4 GP practices providing care as usual. In addition, data are collected from healthcare professionals. Outcome measures are based on our theoretical model. Discussion The proposed evaluation study will reveal insight into the (cost)effectiveness and underlying mechanisms of the proactive integrated primary care approach FFF. A major strength of the study is the comprehensive evaluation based on a theoretical framework. The quasi-experimental design presents some challenges.
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Affiliation(s)
- Lotte Vestjens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands.
| | - Jane M Cramm
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands
| | - Erwin Birnie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands
| | - Anna P Nieboer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands
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Walmsley S, Gilbey A. Debiasing visual pilots' weather-related decision making. APPLIED ERGONOMICS 2017; 65:200-208. [PMID: 28802440 DOI: 10.1016/j.apergo.2017.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 06/20/2017] [Accepted: 06/27/2017] [Indexed: 06/07/2023]
Abstract
Pilots who decide to continue a flight into deteriorating weather conditions, rather than turn back or divert, are a significant cause of fatal crashes in general aviation. Earlier research has suggested that cognitive biases such as the anchoring effect and confirmation bias are implicated in many decisions to continue into worsening weather. In this study, we explored whether a simple debiasing technique, 'considering the alternative', reduced the effect of these two potentially fatal biases. Despite the study being adequately powered, our attempts to reduce the effects of biases were both unsuccessful. Negative findings such as these are particularly useful in aviation, as they can provide information on what does not work in this high stakes industry, even though such strategies may work elsewhere.
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Wickens CD, Clegg BA, Vieane AZ, Sebok AL. Complacency and Automation Bias in the Use of Imperfect Automation. HUMAN FACTORS 2015; 57:728-739. [PMID: 25886768 DOI: 10.1177/0018720815581940] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE We examine the effects of two different kinds of decision-aiding automation errors on human-automation interaction (HAI), occurring at the first failure following repeated exposure to correctly functioning automation. The two errors are incorrect advice, triggering the automation bias, and missing advice, reflecting complacency. BACKGROUND Contrasts between analogous automation errors in alerting systems, rather than decision aiding, have revealed that alerting false alarms are more problematic to HAI than alerting misses are. Prior research in decision aiding, although contrasting the two aiding errors (incorrect vs. missing), has confounded error expectancy. METHOD Participants performed an environmental process control simulation with and without decision aiding. For those with the aid, automation dependence was created through several trials of perfect aiding performance, and an unexpected automation error was then imposed in which automation was either gone (one group) or wrong (a second group). A control group received no automation support. RESULTS The correct aid supported faster and more accurate diagnosis and lower workload. The aid failure degraded all three variables, but "automation wrong" had a much greater effect on accuracy, reflecting the automation bias, than did "automation gone," reflecting the impact of complacency. Some complacency was manifested for automation gone, by a longer latency and more modest reduction in accuracy. CONCLUSIONS Automation wrong, creating the automation bias, appears to be a more problematic form of automation error than automation gone, reflecting complacency. IMPLICATIONS Decision-aiding automation should indicate its lower degree of confidence in uncertain environments to avoid the automation bias.
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Kern DJ, Culley KE. How do Submarine Force trainers use computer-based navigation trainer systems? Applying cluster analysis to examine situated objectives in the employment of adaptive CBT. COMPUTERS IN HUMAN BEHAVIOR 2015. [DOI: 10.1016/j.chb.2015.02.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Global warming has not been a major focus of human factors/ergonomics (HF/E), but interest in the problem and in the question of what HF/E professionals might have to contribute to its solution or to the mitigation of undesirable effects appears to be growing. Here I note three ways in which HF/E science is well positioned to contribute: promotion of a systems-approach perspective, development of effective tools for dealing with the problem, and performance of focused behavioral research.
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Taylor J, Sims J, Haines TP. The emergent relevance of care staff decision-making and situation awareness to mobility care in nursing homes: an ethnographic study. J Adv Nurs 2014; 70:2767-78. [PMID: 24735067 DOI: 10.1111/jan.12425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Janice Taylor
- Faculty of Medicine, Nursing and Health Sciences; Monash University; Notting Hill Victoria Australia
| | - Jane Sims
- Faculty of Medicine, Nursing and Health Sciences; Monash University; Notting Hill Victoria Australia
| | - Terry P. Haines
- Allied Health Research Unit; Kingston Centre; Southern Health; Cheltenham Victoria Australia
- Southern Physiotherapy Clinical School; Monash University; Melbourne Victoria Australia
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Hartgerink JM, Cramm JM, de Vos AJBM, Bakker TJEM, Steyerberg EW, Mackenbach JP, Nieboer AP. Situational awareness, relational coordination and integrated care delivery to hospitalized elderly in the Netherlands: a comparison between hospitals. BMC Geriatr 2014; 14:3. [PMID: 24410889 PMCID: PMC3890569 DOI: 10.1186/1471-2318-14-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing integrated care delivery between hospitals. Therefore, this study aims to (i) provide insight into the underlying components 'relational coordination' and 'situational awareness' of integrated care delivery and the role of team and organizational context in integrated care delivery; and (ii) compare situational awareness, relational coordination, and integrated care delivery of different hospitals in the Netherlands. METHODS This cross-sectional study took place in 2012 among professionals from three different hospitals involved in the delivery of care to older patients. A total of 215 professionals filled in the questionnaire (42% response rate).Descriptive statistics and paired-sample t-tests were used to investigate the level of situational awareness, relational coordination, and integrated care delivery in the three different hospitals. Correlation and multilevel analyses were used to investigate the relationship between background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery. RESULTS No differences in background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery were found among the three hospitals. Correlational analysis revealed that situational awareness (r = 0.30; p < 0.01), relational coordination (r = 0.17; p < 0.05), team climate (r = 0.29; p < 0.01), formal internal communication (r = 0.46; p < 0.01), and informal internal communication (r = 0.36; p < 0.01) were positively associated with integrated care delivery. Stepwise multilevel analyses showed that formal internal communication (p < 0.001) and situational awareness (p < 0.01) were associated with integrated care delivery. Team climate was not significantly associated with integrated care delivery when situational awareness and relational coordination were included in the equation. Thus situational awareness acted as mediator between team climate and integrated care delivery among professionals delivering care to older hospitalized patients. CONCLUSIONS The results of this study show the importance of formal internal communication and situational awareness for quality of care delivery to hospitalized older patients.
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Affiliation(s)
- Jacqueline M Hartgerink
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
| | - Jane M Cramm
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
| | - Annemarie JBM de Vos
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
| | - Ton JEM Bakker
- Argos Zorggroep, P.O. Box 4023, Schiedam, GA 3102, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Anna P Nieboer
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
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Hepgul N, Kodate N, Anderson JE, Henderson M, Ranjith G, Hotopf M, Pariante CM. Understanding clinical risk decision making regarding development of depression during interferon-alpha treatment for hepatitis-C: a qualitative interview study. Int J Nurs Stud 2012; 49:1480-8. [PMID: 22889554 DOI: 10.1016/j.ijnurstu.2012.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 07/20/2012] [Accepted: 07/24/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) affects 170 million worldwide. Currently, around 30% of patients receiving interferon-alpha (IFN-α) treatment for HCV experience clinically significant depression. Effective and timely detection of depression is crucial to ensuring appropriate treatment and support. However, little is known about how clinical nurse specialists identify patients at risk of developing interferon-alpha-induced depression, and monitor those receiving antiviral treatment for the occurrence of depression. OBJECTIVE This study aimed to gain an in-depth understanding of staff experience of, and attitudes towards, the identification and monitoring of interferon-alpha-induced-depression and the decision-making process concerning the use of liaison psychiatry and other clinical services. DESIGN A qualitative interview study was conducted among clinical staff involved in the care of patients with hepatitis C, using the perspective of naturalistic decision making. SETTINGS Outpatient liver clinics in three large teaching hospitals in South London, the United Kingdom. PARTICIPANTS All clinical nurse specialists from the three outpatient liver clinics were included. All were involved directly in the care of patients receiving interferon-alpha treatment and had at least one year experience (mean 6.4 years, range 1-11 years) in this field. METHODS Semi-structured face-to-face interviews were conducted between 2010 and 2011. Data collection and analysis were carried out iteratively to ensure the reliability of the analysis using the constant comparison method. RESULTS Staff used verbal and non-verbal cues when assessing risks of patients developing depression before and during IFN-α treatment. Major sources of uncertainty were patient engagement and familiarity, referrals to psychiatrists, language barriers, and distinguishing between psychological and physical symptoms. Good rapport with patients and good communication among multidisciplinary professional groups were key strategies identified to reduce uncertainty. CONCLUSION Current methods of identifying vulnerable patients rely on the availability of clinical experts and good communication within a multidisciplinary team. Detection and management of depression in this population is complex, however, various strategies are employed by nurses to overcome difficulties when making decisions regarding patient welfare. Current clinical practices should be taken into account when developing new tools and methods.
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Affiliation(s)
- Nilay Hepgul
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK
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Parasuraman R, de Visser E, Lin MK, Greenwood PM. Dopamine beta hydroxylase genotype identifies individuals less susceptible to bias in computer-assisted decision making. PLoS One 2012; 7:e39675. [PMID: 22761865 PMCID: PMC3384589 DOI: 10.1371/journal.pone.0039675] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 05/24/2012] [Indexed: 11/23/2022] Open
Abstract
Computerized aiding systems can assist human decision makers in complex tasks but can impair performance when they provide incorrect advice that humans erroneously follow, a phenomenon known as "automation bias." The extent to which people exhibit automation bias varies significantly and may reflect inter-individual variation in the capacity of working memory and the efficiency of executive function, both of which are highly heritable and under dopaminergic and noradrenergic control in prefrontal cortex. The dopamine beta hydroxylase (DBH) gene is thought to regulate the differential availability of dopamine and norepinephrine in prefrontal cortex. We therefore examined decision-making performance under imperfect computer aiding in 100 participants performing a simulated command and control task. Based on two single nucleotide polymorphism (SNPs) of the DBH gene, -1041 C/T (rs1611115) and 444 G/A (rs1108580), participants were divided into groups of low and high DBH enzyme activity, where low enzyme activity is associated with greater dopamine relative to norepinephrine levels in cortex. Compared to those in the high DBH enzyme activity group, individuals in the low DBH enzyme activity group were more accurate and speedier in their decisions when incorrect advice was given and verified automation recommendations more frequently. These results indicate that a gene that regulates relative prefrontal cortex dopamine availability, DBH, can identify those individuals who are less susceptible to bias in using computerized decision-aiding systems.
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Affiliation(s)
- Raja Parasuraman
- Center of Excellence in Neuroergonomics, Technology, and Cognition and Department of Psychology, George Mason University, Fairfax, Virginia, United States of America.
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