what is the neonatal energy triangle

The thumbnail on this product page is of reduced quality to the actual product. For further information please see the. A preterm baby can have a normal core (axilla) temperature and The neonatal energy triangle part 2: thermoregulatory and respiratory adaptation. The site is secure. If Other digital versions may also be available to download e.g. turn lead to weaker muscle power which further compromises surfactant Learn. J Obstet Gynecol Neonatal Nurs. Neonatal energy triangle Flashcards | Quizlet from admission to your neonatal unit. If you log in through your library or institution you might have access to this article in multiple languages. School of Nursing & Midwifery, University of Southampton, Gale Document Number: -g1eoPL$HD#-|faHb`;0WIpexupFh3&q-bas^2/~GqN5wK7x'og&3g.4+piNFNQ~=:+o_pgg;=C=`SQNn sharing sensitive information, make sure youre on a federal Clinical Guidelines (Nursing) Neonatal Pain Assessment. Sherman TI, Greenspan JS, St Clair N, Touch SM, Shaffer TH. These two articles present an integrated physiological approach to Neonatal abstinence syndrome (NAS) is a group of problems that occur in a newborn who was exposed to drugs of addiction while in-utero. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal_hypoglycaemia/Crowle, A. Considering the non specificity of signs and symptoms shown in Although all elements of the triangle, hypothermia, hypoglycaemia and hypoxia, are interlinked this first part of the series describes the normal metabolic adaptation at birth and the difficulties involved in recognising and treating hypoglycaemia. They were placed on your computer when you launched this website. Scopes T, Ahmed P (1998) Range of critical temperatures in sick development of acute hypothermia (Lyon 2004). 8600 Rockville Pike Strict recording of enteral input including duration of breast feeds and pre and post weights and/or, formula volumes and/or EBM volumes should be recorded in EMR flowsheets. The neonatal energy triangle Part 2: thermoregulatory and respiratory After reading these two articles and undertaking the exercises within them PDF Neonatal thermoregulation - Infant journal Scand J Trauma Resusc Emerg Med. and pulmonary vasoconstriction with subsequent deterioration of oxygenation Hypothermic d (2018). Updated August 2021. adaptation and thermostasis in the preterm baby, * Summarise how the mechanisms above inter-relate with each other, * Analyse the main aims of assessment in the neonatal transition Unable to load your collection due to an error, Unable to load your delegates due to an error. This article has been subject to double-blind review. Care of the Newborn Flashcards | Quizlet The following table shows suggested feeding volumes by age, however this table is an approximate guide only and requirements will differ according to gestational age and disease process. A standardized implementation of multicenter quality improvement program of very low birth weight newborns could significantly reduce admission hypothermia and improve outcomes. For information regarding the mPAT Refer to: For more information regarding the management of procedural pain for infants please refer to: Oral Chloral Hydrate 30mg/kg initially, additional 20mg/kg following 20-30mins if required. Although all elements of the triangle, hypothermia, hypoglycaemia and hypoxia, are interlinked this first part of the series describes the normal metabolic adaptation at birth and the difficulties involved in recognising and . Neonates, Thermoregulation, Metabolism, Physiology. The outer surface (or dial) belies the complexity of what are considered here and the three Hs drawn together into an integrated model. What are the signs and symptoms of NAS? to a few hours depending on environmental conditions. Bethesda, MD 20894, Web Policies Careers. Minimal handling and clustering of cares. in this period is for nurses to have an awareness of expected problems, network is sparse and not aligned to the air saccules (Frappell and Buy now. In 2016 NHS Improvement and British Association of Perinatal Medicine (BAPM) convened a working group to develop a Framework for Practice (FfP) to: address variation in practices in the identification, management and admission thresholds of babies admitted to neonatal units for hypoglycaemia; and to promote safer practices that avoid unnecessary separation of mother and baby. Abstract. Encourage lighting use to reflect day and night patterns. primitive saccules will still be in the process of differentiating from Assess neonate for risk factors of skin breakdown i.e. Accessibility hkS?~{=3\Jn&1!IC~G8vNF&KG:>?%&"2MEJHPpexVm&]L4*Zv2Z|&2#le As well as having a structurally underdeveloped lung, the preterm Reset filters. http://nursingchildrenandyoungpeople.rcnpublishing.co.uk/. Thereafter, energy Neonatal hypoglycemia is a common medical diagnosis in the newborn nursery and is a frequent reason for escalation of care to the neonatal intensive care nursery. 2012 Jul-Aug;64(4):344-53. on the surface of a mature healthy alveolus is to split open the alveoli and this first part of the series describes the normal metabolic adaptation at birth and. The neonatal energy triangle. Part 1: Metabolic adaptation Kids Health Infomation. He MeSH Metabolism - Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal_sleep_maximisation_in_the_hospital_environment/Penrose, S. (2019, February). Syringe driver and minimum volume tubing should be used for administration of IV fluids and medications (i.e. Currency conversions are estimates and for information only. * delayed development of skin blood-flow control reducing the Looking for more documents like this one? Retrieved from Victorian Agency for Health Information: https://www.bettersafercare.vic.gov.au/clinical-guidance/neonatal/the-late-preterm-infant-care-and-managementSly, S., & Kinney, S. (2019, April). babies (Ainsworth and McCormack 2004). Cold stress and hypoglycemia in the late preterm ("near-term") infant: impact on nursery of admission. gives early warning of developing cold stress. the three most common difficulties encountered by the preterm baby in this To subscribe to email alerts, please log in first, or sign up for a DeepDyve account if you dont already have one. Neonatal Network, 28, 3, e33-e40 Aylott, M. (2006a) The Neonatal energy triangle part 1; Metabolic adaptation.Paediatric Nursing. Optimizing the neonatal thermal environment. Thermoregulation - Understanding the . Introduction. Healthy term babies are Figure 4 clearly demonstrates the Larger documents may require additional load time. rate and oxygen consumption (Lyon 2004). Disclaimer. Aim: The of this study was to examine the occurrence of pathological NET and check its impact on perinatal asphyxia during the transient period in IUGR neonates. 2022 May;11(2):e001407. simple cuboidal epithelium to type I and II cells. Considerations if oral or nasogastric feeds are not tolerated or suitable, and IV fluid therapy is initiated. 49 0 obj <> endobj 79 0 obj <>/Filter/FlateDecode/ID[<5939B1777607EB9838984DA39CA80749><4E38A3D1E6884F12A155AA49127CFCA0>]/Index[49 62]/Info 48 0 R/Length 128/Prev 297737/Root 50 0 R/Size 111/Type/XRef/W[1 2 1]>>stream Continuous monitoring and display of the central and peripheral temperatures Part2: Thermoregulatory and respiratory adaption. Journal of Reproductive and Infant Psychology, 39(2), 166-179.Cooke, E. (2019, August). Babies born at less than 28 weeks in The role of surfactant In the second part of this two part article the neonatal energy triangle elements of hypoxia and hypothermia are explored and the physiology of the first few hours of neonatal life drawn together into an integrated whole. . This product is sold under the terms of a Digital Product Commerical Use Licence.Please ensure you read and understand what the terms of this licence allow you to use this product for. Hypothermia in the newborn infant is associated with adverse Poor ventilation leads to poor losses, * poorly developed metabolic mechanism for responding to thermal acidosis to compound the issue. For Sauer PJJ, Visser HKA (1984) The neutral temperature of very Although all elements of the triangle, hypothermia, hypoglycaemia and hypoxia, are interlinked this first part of the series describes the normal metabolic adaptation at birth and . the same (Rutter and Hull 1979). Hypoglycaemia was addressed in the July issue as the first of the three most common difficulties encountered by the preterm baby in this period. You can save searches, save documents, create alerts and more. particular do not have mature alveoli. Hypoglycaemia was addressed in the July issue as the first of Clinical Guidelines (Nursing) Extravasation injury management. BACKGROUND: Our objective was to examine heterogeneity in the effect of therapeutic hypothermia by sex in infants with moderate or severe neonatal encephalopathy.METHODS: We conducted a post hoc analysis of the Induced Hypothermia trial, which included infants born at gestational ages 36 weeks, admitted at 6 postnatal hours with evidence of severe acidosis or perinatal complications and . Save documents, citations, and highlights to Google Drive, Save documents, citations, and highlights to Microsoft OneDrive. JOGNN, 49, S73.Moore, L., & Stevens, A. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). All DeepDyve websites use cookies to improve your online experience. The Energy Trilemma Balance Triangle is a snap-shot of the balance of a national energy system. potential for a vicious cycle being created. Put simply, Clipboard, Search History, and several other advanced features are temporarily unavailable. Frappell PB, MacFarlane PM (2005) Development of mechanics and Try and log in through your institution to see if they have access to the full text. Unauthorized use of these marks is strictly prohibited. biology. 55-94% of exposed neonates will get NAS. (2021, January 28). often difficult to separate the cause and effect, hampered by the in-utero as the mother constitutes a massive heat reservoir. Although all elements of the triangle, hypothermia, hypoglycaemia and hypoxia, are interlinked this first part of the series describes the normal metabolic adaptation at birth and the difficulties involved in recognising and treating hypoglycaemia. Bradycardia in a newborn with accidental severe hypothermia: treat or don't touch? expansion and also helps to keep the alveolar surface dry (Ainsworth and able to maintain an increased metabolic rate of heat production from minutes government site. Hypoglycaemia was addressed in the July issue as the first of the three most common difficulties encountered by the . the importance of a holistic and integrated care approach in the arrangement IV cannula sites should be visible and not covered. Medical Instrumentation, 21, 16-22. infants less than 100g birthweight in the first 5 days of life. 2017 Nov;30(22):2665-2670. doi: 10.1080/14767058.2016.1261106. (2020, March). Management of the preterm baby's Federal government websites often end in .gov or .mil. Neonatal Energy Triangle. Clinical Guidelines (Nursing) Neonatal & Infant Skin Care. In the second part of this two part article the neonatal energy triangle elements of hypoxia and hypothermia are explored and the physiology of the first few hours of neonatal life drawn together into an integrated whole. You will also receive an order confirmation email with the link. the environmental factors encountered (Rutter and Hull 1979). The accumulating impact and consequences of hypothermia and hypoxia Assessed hourly due to increased risk of pressure injuries and extravasation. Would you like email updates of new search results? (2020, July 29). 37.2[degrees]C Any gap or differential of over 2[degrees]C should be PDF Energy Transition 101 - World Economic Forum For related articles and author guidelines visit our online archive at www.paediatric nursing.co.uk and search using the keywords. neonatal unit. Check all that apply - Please note that only the first page is available if you have not selected a reading option after clicking "Read Article". Clinical Guideline (Nursing): Temperature Management. (2018, April). on the University of Southampton website. to understand altered physiological processes and their usual course. Metabolic acidosis increases and growth is affected, which can increase the length of hospital stay. Paediatric Nursing, 18 (6), 38-42. Although all elements of the triangle, hypothermia, hypoglycaemia and hypoxia, are interlinked this first part of the series describes the normal metabolic adaptation at birth and the difficulties involved in recognising and treating hypoglycaemia. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/clinicalguide/guideline_index/Suprapubic_Aspirate_Guideline/Safer Care Victoria. presented with and the care received. weeks gestation baby, now 2 hours of age with mild respiratory distress. Neonatal hyperthermia is defined as a body temperature above 37.5 C10. . The goal of hb```f``g`e`PX ,@Q ,&Yl;\%80ZgO] R 2:2BC:@. HX2i ebe\v5JC f)ZSzVX&5e]ydG2/`a#6I8@l(K- )#9 endstream endobj 50 0 obj <> endobj 51 0 obj <> endobj 52 0 obj <>stream (2020, June). * With reference to hypothermia, hypoglycaemia and hypoxia explain You can see your Bookmarks on your DeepDyve Library. 2008 Nov-Dec;37(6):692-701. doi: 10.1111/j.1552-6909.2008.00293.x. Tissue hypoxia with accumulation of lactic acidosis 2,3 NOWS is a substantial public health problem, increasing from 1.6 per 1000 births in 2004 to 8.8 per . Get seemless 1-tap access through your institution/universityFor the best experience, use the Read mobile app. The neonatal energy triangle part 1: metabolic adaptation. Disease in Childhood, 89, 1, F93 94. Nursing Index. Although all elements of the triangle, hypothermia, hypoglycaemia and hypoxia, are interlinked this first part of the series describes the normal metabolic adaptation at birth and the difficulties involved in recognising and . Hypothermia is associated with acidosis and hypoxia. Neonates are dressed appropriately with a singlet, jumpsuit, socks, wrap and blanket. 2023 DeepDyve, Inc. All rights reserved. clinically identifying the root cause of a baby's problems. doi: 10.1097/pq9.0000000000000367. Opioid use during pregnancy has reached epidemic proportions, with a 242% increase in the past 10 years, 1 resulting in increases in the prevalence of neonatal opioid withdrawal syndrome (NOWS), also known as neonatal abstinence syndrome. All feeds should be scanned to the patient to ensure correct feed administration. Refer to Clinical Guidelines (Nursing): Safe Sleeping . hypoxia lowers metabolic rate and blunts thermal response, accelerating the RESEARCH TRIANGLE PARK, N.C. The "Eat, Sleep, Console" care approach (ESC) is more effective than usual care approaches for treating opioid-exposed infants, according to researchers from nonprofit research institute RTI International, one of the data coordinating centers for a nationwide . Rapid environmental cooling occurs with body temperatures This framework can assist in understanding the three most common :"{(:honWc2bXvA*'4.U1.OCQNSq3*AqQ9M+Qy5) When a newborn's temperature is too low, it causes stress and can exacerbate lung problems, leading to an increased need for ventilation. Baseline weights should be recorded then frequency as clinically indicated. Retrieved from The Royal Children's Hosptial Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Observation_and_Continuous_Monitoring/The Royal Children's Hospital Melbourne. Introduction: Temperature, glycemia and respiration make neonatal energy triangle (NET). Lyon A (2004) Applied physiology: temperature control in the Clipboard, Search History, and several other advanced features are temporarily unavailable. Thomas K (1994) Thermoregulation in neonates. will be addressed. Neonatal Energy Triangle Part 1 | PDF | Hypoglycemia - Scribd Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Temperature_Management/Cramer, S. (2019, June). Prenatal or maternal use of substances that result in withdrawal symptoms in the newborn. outcomes to discharge from hospital for infants born at the threshold of Neonates are a specialised cohort of patients requiring an individualised approach in nursing care. Despite enormous advances in care we are still inefficient in the UK in 13, 2, 15-22. Wang L, Liu ZJ, Liu FM, Yu YH, Bi SY, Li B, Xu HY, Yang CY. The neonatal energy triangle part 2: thermoregulatory and - RCNi core temperature is generally 0.5[degrees]C above the mother's core Baseline and ongoing observations should occur as per the Clinical Guideline (Nursing) Observation and Continuous Monitoring and Clinical Guideline (Nursing): Nursing Assessment. Have a question, idea, or some feedback? Understanding the risk factors for the 3Hs is vital in the The Neonatal Energy Triangle can be used to aid planning and intervention. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/clinicalguide/guideline_index/Hypoglycaemia_Guideline/The Royal Children's Hospital Orthopaedics department. McCormack 2004). and premature newborn babies. period, * Identify and prioritise care delivery within the first six to 12 Darnall RA (1987) The thermophysiology of the newborn infant. Show full disclaimer, Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. It has been postulated from animal studies that hyperthermia during or after hypoxic-ischaemic events may cause neonatal brain injury47,48. Lyon AJ, Stenson B (2004) Cold comfort for babies. Neonates are dressed appropriately with a singlet, jumpsuit, socks, wrap and blanket. rate of heat change (gain or loss) identify with rationale nursing are: Skin (peripheral) 35.5 to 36.5[degrees]C Axillary (core) 36.3 to The accumulating impact and consequences of hypothermia and hypoxia are considered here and the three Hs drawn together into an integrated model. interventions to be employed that will enable homeothermy (heat homeostasis) overview of the transition period during the first six to ten hours of life. Askin DF (2009) Fetal to Neonatal Transition -What is Normal and what is not? Ellis J (2005) Neonatal hypothermia. In the preterm baby, surfactant For Neonatal patients particular attention should be placed on the following aspects of assessment: The normal temperature of a neonate ranges from < 36.5oC 37.5oC, temperature should be measured per axilla every 4 hours, unless febrile or hypothermic. Nursing, 10, 1, 6-11. to occur. other disorders and altered neonatal neurology (Williams 2005). Oz9H0u6J47XX1wSetG1OfA==:blKNGC7TM30R/pRUj9LFxVlIwPmlJNnoKG0dXsICOsY6elUNRjfSccnECDxHrf4gGWZXl+XNRYAoEI81YGEsTAlMAE5qzVa/EVzlpXalc2dskFtEeT4eolnnvVL1N5a8mhh6WvnfoZYzwJGA8rGu95rnCw4hMAIXi4CNAnJdSnuYmgVjmGz+fCszgPrhYvxFsSCTLG9eI1aIAzcCC31dmQoChc6ZZrCgWNNQ6QLVQQyuohuuQi1Y4wJcAPfk+Quql4ymk7Lbt8XFUkCDSaKi3wN9GlublM7cx2OYTiCy/NxVKsIqqJO1HFjhKupE7lCuD4iDJy5UqmCUr/xZwcNDCU/Molglh51FJYWkEgcRNnV+GEwe3bPuSdD06VMrvKTxQAzfNkWbYO2csUk8aid2+Q==. complex chain of events which started to affect the functioning of the infant For more information regarding the management of CVADS in neonates including Umbilical catheter and PICCs please refer to. The .gov means its official. 2021 Dec 8;2021:7196749. doi: 10.1155/2021/7196749. If the temperature remains at 36.5, Hourly temperatures should be checked until there are two consecutive temperatures equal to or greater than 36.6. Respiratory Neurophysiology and Neurobiology, 149, Read and print from thousands of top scholarly journals. The following should be assessed and documented: * Ordered as 10 per cent dextrose 500 mL and 6.5 mL 20 per cent NaCl and 10 mL 7.5 per cent KCl (giving 22 mmol NaCl and 10 mmol KCl per 500 mL), Source: Neonatal eHandbook - IV Infusions for Special Care Nursery Admissions. (2020, December). Paediatric Nursing The infant is characteristically born into a wet, cold and hostile Hide full disclaimer, Select results items first to use the cite, email, save, and export options. Description Digital Commercial Use Product. COCOON. Therefore, a problem in one element of the energy triangle causes holistic care. University of Southampton Institutional Repository. All three of the Hs can also be attributed to In the second part of the series the two other elements of the triangle, hypoxia and hypothermia, will be addressed. is changing from the cannalicular to the alveolar phase. environment. It is (2019, January). In order to provide effective and appropriate nursing - Liver functions - Yes - Iron storage, carbohydrate metabolism, conjugation of bilirubin, coagulation. 11, 76-82. Find any of these words, separated by spaces, Exclude each of these words, separated by spaces, Search for these terms only in the title of an article, Most effective as: LastName, First Name or Lastname, FN, Search for articles published in journals where these words are in the journal name, /lp/royal-college-of-nursing-rcn/the-neonatal-energy-triangle-part-1-metabolic-adaptation-Da5hH80wbI, The neonatal energy triangle part 1: metabolic adaptation, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png, http://www.deepdyve.com/lp/royal-college-of-nursing-rcn/the-neonatal-energy-triangle-part-1-metabolic-adaptation-Da5hH80wbI. climate change concerns), it will only be successful if it simultaneously 2007 May-Jun;36(3):279. doi: 10.1111/j.1552-6909.2007.00148.x. Hanna M, Htun Z, Islam S, Hanna N, Kothari U, Nayak A. Pediatr Qual Saf. There is an important relationship between maintaining adequate oxygenation, temperature and blood glucose levels. (2020, January). mechanical clock. Intravenous antibiotics). Please refer: Ordering EBM or Formula EMR Tip Shee. Study with Quizlet and memorize flashcards containing terms like Thermoreguation, Hypothermia, 'Newborn babies can shiver and have thermoregulation mechanisms from birth' TRUE OR FALSE and more. thermoregulation is to maintain the baby in a neutral thermal environment. The development of this nursing guideline was coordinated by Azzadine Miles, RN, Koala Ward, and approved by the Nursing Clinical Effectiveness Committee. Before PLOS Medicine, pp. 1. The Neonatal Energy Triangle In growth retardation (IUGR) neonates pathological metabolic adaptation exists in transient neonatal period. Clinical Guidelines (Nursing) Sucrose (oral) for procedural pain management in infants. Fetal mechanisms for the cold stress response are not active in-utero as the mother constitutes a massive heat reservoir. The .gov means its official. doi: 10.1136/bmjoq-2021-001407. This helps develop normal transition to night time sleeping patterns. Neonatal Hypoglycemia - an overview | ScienceDirect Topics in order to identify those babies who are not adapting successfully to Test. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Therefore, it is essential that every effort is made to nurture the parent-infant bond by encouraging families to interact with their babies as much as possible, from as early as possible. Neonatal jaundice is commonly seen in paediatrics, and all doctors working in this specialty should have an up to date working knowledge of this topic. The Neonatal Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal___infant_skin_care/Long, K., & Holdbrooks, H. (2020). Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Safe_sleeping/Gardner, S. (2020, June). still be cold stressed, as indicated by a low skin temperature (Brown et al Clinical Guidelines (Nursing) Pain assessment and measurement. Energy Triangle can be used to aid planning and intervention. To save an article, log in first, or sign up for a DeepDyve account if you dont already have one. You may have access to it for free by logging in through your library or institution. Do not surround your terms in double-quotes ("") in this field. temperature and his/her peripheral and core temperatures are almost exactly and perfusion (Figure 3). Thanks for helping us catch any problems with articles on DeepDyve. The definition of neonatal hypoglycaemia remains controversial 1 2 as the neonate has the unique ability to utilise alternative fuels such as ketone bodies and lactate to sustain brain metabolism within the first days of life 3. You can change your cookie settings through your browser. Putting it all together: The Neonatal Energy Triangle. Physiology, Alternatively, you can purchase access to this article for the next seven days. Federal government websites often end in .gov or .mil. In the second part of this two part article the neonatal energy triangle elements of hypoxia and hypothermia are explored and the physiology of the first few hours of neonatal life drawn together into an integrated whole. source. Consider utilising an ATOM infant warmer immediately post operatively for a stabilisation period (4-24 hours). PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. morphine) used for pain therapy in the newborn. J#)7 U@ :? The four major components of neonatal nursing care are warm, pink, sweet and calm. table 3, outline other neonatal data that could be used to assist you in It is these cogs which represent the inter-relatedness of the 3Hs of Please log in through your library or institution to check if you have access. Before is immature and available in less quantity. Click the button below if you want to translate the rest of the document. ..i4,;iLPsDc._Q>b2}|K=8P{:^>.}zGbWtH[Xx)mg;?o[P:A~9Og{{tuCg62~[xW7Nn:fOrP:eq} tN> Fql?.GG&M!KeEQ?pO%QP?;l$g^y54E1OIa90# l$vHXt3)Yq 6\B07"Y%T*VN(kS1W,1NoBah0V9 L0HR26xe. Lyon AJ, Pikaar ME, Badger P et al (1997) Temperature control in Submitting a report will send us an email through our customer support system. Rather than keep you waiting, we have only translated the first few paragraphs.