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Energist UltraPlus VPL™ System

User Manual

SD1-43 Issue 3 (CCF 296)

17

2.8 Administrative & Procedure Control

The practical use of high powered optical systems in cosmetic medicine
means that additional administrative controls are necessary to provide safe
working conditions. The extent to which these, and additional procedures,
must be implemented depends on the local registering authority. More
information on the guidelines that are pertinent to your clinic must be obtained
from the relevant authority and implemented as required.

Every Energist UltraPlus system is to have a set of simple operational rules
which govern its use. A generic set of rules that may be adapted for each
individual clinic is included in this manual.

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Содержание UltraPlus VPL System

Страница 1: ...nts 10 1 10 Electromagnetic Compatibility 10 1 11 Transport and Storage 10 1 12 Manufacturer 10 SECTION 2 IMPORTANT SAFETY INFORMATION 11 2 1 Symbol Glossary 11 2 2 Introduction to Safety 13 2 3 Defin...

Страница 2: ...ator 20 4 5 To Turn On the system 21 4 6 To Shut Down the System 21 4 7 User Interface 22 4 8 Logging On 23 4 9 Logging Off 24 4 10 Main Menu 24 4 11 Hair Removal Treatment 26 4 13 Thread Vein Treatme...

Страница 3: ...15 What to expect following treatment 48 SECTION 7 INTRODUCTION TO SKIN THERAPIES 49 7 1 Introduction 49 7 2 Photo Damaged Skin 50 7 3 Acne Vulgaris 50 7 4 Laser Techniques for Skin Rejuvenation 51 7...

Страница 4: ...TMENT SETTING GUIDELINES 65 9 1 Introduction 65 9 2 Hair Reduction 66 9 3 Skin Therapies 68 SECTION 10 INFORMATION ON DRUG INDUCED PHOTOSENSITIVITY 72 SECTION 11 CLINICAL RESEARCH SYNOPSES 74 11 1 Int...

Страница 5: ...this pulsed light system This device is intended solely for the purpose of cosmetic treatments Any information supplied herein is meant as a reference and should not be used to replace any treatment p...

Страница 6: ...system is 51 J cm2 The system has been designed to be versatile and safe with an in built safety feature that will identify which handpiece has been attached The output of the Energist UltraPlus syste...

Страница 7: ...en patients Refer to Section 3 for cleaning and disinfection instructions Any electrical outlet to which the Energist UltraPlus system is connected MUST incorporate an effective earth GROUND connectio...

Страница 8: ...s System 800 001 1 530nm Applicator 800 073 1 610nm Applicator 800 074 1 415 630 Applicator 800 075 1 Protective Eyewear F3 600 012 1 Protective Eyewear F5 600 013 6 Energist Optical Coupling Gel 250m...

Страница 9: ...ece up to 51 J cm2 610nm Handpiece up to 45 J cm2 Acne Handpiece up to 25 J cm2 Energy densities accurate to 20 Interface Control Panel Full Colour LCD display with Touchscreen Windows XP Electrical 1...

Страница 10: ...01 1 2 2002 These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment This system like all similar equipment ge...

Страница 11: ...cooler will be immediately switched off and any energy stored will be safely discharged Rotate buttons in the direction indicated to release Caution Indicates that the User manual should be read thoro...

Страница 12: ...ange IPX0 The system is not protected against the ingress of liquids and should be used only in a clean dry environment Type BF Applied Part This symbol indicates that when the end user wishes to disc...

Страница 13: ...se can be defined as WARNING Denotes that if the safety procedures as advised are ignored then the risk to either the Operator or the Patient is known to be severe and potentially fatal CAUTION Denote...

Страница 14: ...ve a frequency of either 50 or 60 Hertz Hz To protect all users from this supply the Energist UltraPlus system is earthed through the mains cable To avoid any possibility of electric shock the mains c...

Страница 15: ...l flooring Do ensure that there is a gap of approximately 50cm 18 inches between the Energist UltraPlus system and any wall or major appliance 2 6 2 CABLES There are various cables associated with the...

Страница 16: ...he system Do not push fingers into fan vents 2 7 Optical Safety WARNING The Energist UltraPlus system emits a high intensity flash of light that has the potential to damage unprotected eyes Both Opera...

Страница 17: ...onditions The extent to which these and additional procedures must be implemented depends on the local registering authority More information on the guidelines that are pertinent to your clinic must b...

Страница 18: ...ary Remove any residue with a clean damp cloth and wipe dry Sterilise the waveguide using a proprietary sterilising fluid or wipe Dispose of tissue or wipe in an appropriate manner DO NOT USE any abra...

Страница 19: ...at rear of the system is off 2 Open side panel middle right where handpiece connections are located 3 Remove required handpiece from case and gently rock the head to and fro to remove any air bubbles...

Страница 20: ...elease lock and pull firmly out 4 4 Changing the Applicator If the system is ON the applicator may be changed by 1 Select Change below the Applicator information top right hand side 2 Tap Yes to confi...

Страница 21: ...this procedure 1 Ensure required handpiece is attached 2 Ensure emergency stop button is out Rotate button in direction of arrows to release 3 Plug mains lead into rear of system 4 Plug mains lead in...

Страница 22: ...wn then turn off the main switch at the rear once the screen has gone black 4 7 User Interface As you will see the Energist UltraPlus system has been designed with the user in mind The touchscreen tec...

Страница 23: ...ser Id and Password The default User ID for the system is USER2 Please ensure that the exact password for the appropriate User ID is entered To log on 1 Type in your Password as supplied 2 Press the O...

Страница 24: ...OK to confirm The log in screen should now appear See 4 8 4 10 Main Menu If you have successfully logged on you will now be on the main treatment menu The main menu supplies information regarding app...

Страница 25: ...ttached to the system Shots Indicates how many shots are remaining on the applicator Change Change button allows you to change the applicator while the system is on See 4 4 Change the Applicator Sessi...

Страница 26: ...eft on the applicator to complete the treatment If the applicator shot count is below 1000 it is advisable to order a refurbishment 4 Reset Session 5 Select Hair Epilation from the Treatment section 6...

Страница 27: ...pplicator to complete the treatment If the applicator shot count is below 1000 it is advisable to order a refurbishment 4 Reset Session 5 Select Skin Therapies from the Treatment section 6 Select Skin...

Страница 28: ...tor to complete the treatment If the applicator shot count is below 1000 it is advisable to order a refurbishment 4 Reset Session 5 Select Thread Vein Face Body from the Treatment section 6 Select Ski...

Страница 29: ...is below 1000 it is advisable to order a refurbishment 4 Reset Session 5 Select Acne Vulgaris from the Treatment section 6 Select Skin Type of client based on Fitzpatrick I V scale 7 Select Degree of...

Страница 30: ...nted Lesions from the Treatment section 6 Select Skin Type of client based on Fitzpatrick I V scale 7 Select Depth of lesion 8 The system now calibrates the preferred pulse settings and a safe startin...

Страница 31: ...andby mode by tapping Standby 3 The system will go into Standby mode 4 The energy density or Fluence can now be increased or decreased as desired by dragging the bar on the scale or by tapping the up...

Страница 32: ...her increase the energy it is advised that you increase the number of pulses by 1 2 or 3 Additionally the user may also alter the ON time for the pulse and the OFF time between pulses This gives flexi...

Страница 33: ...ue 3 CCF 296 33 Load To load the preferred program setting Tap the Load icon Select the Program number where you have save the required configuration PROGRAM 1 2 3 4 5 6 7 or 8 Press Yes to load the d...

Страница 34: ...not be easily rectified please contact your local distributor or Energist Ltd on 44 1792 798768 To help the engineer diagnose the system fault please have the following information available 1 The sys...

Страница 35: ...lus VPL System User Manual SD1 43 Issue 3 CCF 296 35 5 1 System will not power up If the system will not power up after approximately 5 seconds please work through the following flowchart to help reso...

Страница 36: ...Summary Fault Action Switch off the system and restart If the fault persists call your distributor Message 2 Charge Fault Action Switch off the system and restart If the fault persists call your distr...

Страница 37: ...erted Restart system If the fault persists replace with a different Energist applicator If this does not work call your distributor Message 11 Unknown Applicator Type Do you wish to change applicator...

Страница 38: ...ystem and restart If the fault persists try the following Switch off the system and attach a different applicator and restart system If the fault persists call your distributor Message 21 Unable to op...

Страница 39: ...Switch off the system and restart If the fault persists call your distributor Message 29 Self Test Flow Fault Detected Please Reset Machine Action Switch off the system and restart If the fault persis...

Страница 40: ...ults may vary from Client to Client due to many interrelated physiological factors so Operators need to be capable of working closely with Clients in order to achieve desired results The most common s...

Страница 41: ...ot sheath that has three layers Henley s layer is one cell thick and lies to the outer root sheath Huxley s layer is two or three cells thick and is in the middle of the sheath The cuticle of this inn...

Страница 42: ...n phase the hair shaft is now only held in place mechanically and can be shed by brushing or combing The hair shaft remaining in place at the end of its growth cycle is called a club hair and it is no...

Страница 43: ...f the hair follicles are in telogen Stimulation can come from cuts scrapes heat including sun burn and some forms of skin irritation 6 5 How does VPL WORK The technical term for the VPL process is sel...

Страница 44: ...ypes The Energist UltraPlus system is designed to be very flexible in its operation thereby allowing safe treatments to all Clients from Operators with only a basic knowledge of skin and hair types Op...

Страница 45: ...shaft and secondly reducing the flow of blood will desensitise the nerves in the treatment area thereby reducing any Client discomfort during treatment After firing the first treatment pulse the area...

Страница 46: ...the treatment 6 11 Number of shots for each treatment area The following tables can be used as an approximate guide as to the number of shots required for treating different areas of the body The exac...

Страница 47: ...ll follicles It is only during the growth stage with the hair present that the follicles can be successfully treated It is recommended that each treatment be performed once when the next phase of hair...

Страница 48: ...t to pick at these as this may increase the risk of superficial scarring and to use preparations which have good antiseptic properties 6 15 What to expect following treatment The immediate after effec...

Страница 49: ...e skin from the signs of ageing and sun damage to thread veins pigmentary abnormalities and cosmetic imperfections In addition VPL treatment is known to reduce pore size and leave a smooth revitalised...

Страница 50: ...ather treating each of the different components of photo damaged skin will result in a more dramatic visible improvement 7 3 Acne Vulgaris Early inflammatory acne lesions are characterised by the pilo...

Страница 51: ...ontrolled scar to evolve that shrinks over time a process called contracture This controlled contracture is what gives the appearance of reduced wrinkling of the skin Laser Resurfacing involves the us...

Страница 52: ...ntation following treatment Hormonal changes during pregnancy can also vary the amount of pigmentation The Fitzpatrick description of skin types and known as the Fitzpatrick Skin Type Classification i...

Страница 53: ...owing Reduce redness and flushing Reverse sun damage by reducing fine wrinkles freckles and irregular pigmentation Smooth skin by reducing pore size Treat thread veins and rosacea symptoms Use followi...

Страница 54: ...take place and the client is not sensitive to the treatment It is highly unlikely that permanent pigmentation changes will occur following a single treatment at the recommended system settings However...

Страница 55: ...reated area treatment can be repeated at higher energy levels provided all the precautions given in this guide are adhered to g Remove the gel from the treated area and apply Aloe Vera to reduce any t...

Страница 56: ...oor and outdoor for 24 hours Use of a good sunscreen for at least 5 days for facial sun damage treatments Smoking 2 hours pre post treatment Keep well hydrated Use a good range of active skin products...

Страница 57: ...hange in colour of pigmentation speckly and darker should be present Vascular Lesions Reactions to look for Stinging sensation for client Mild erythema in treated area Change in look of vessel immedia...

Страница 58: ...ts feel appreciated The above guidelines will ensure that you build up a rapport with your client and fully understand their needs However in any undertaking of an elective cosmetic procedure the prep...

Страница 59: ...ient s needs but also inform them of the procedures that you offer From this exchange you should obtain information about The name of the client Their address Contact number What treatment s they are...

Страница 60: ...fusal to listen to the information that is presented to them Over identification with a specific look Obsessive about minor blemishes Negativity i e has tried everything but nothing works History of c...

Страница 61: ...t As clients see themselves every day they have a tendency to forget how dense the hair growth was initially thus the photographs provide the opportunity to review a visual record of the area side by...

Страница 62: ...are to be taken using a camera with a macro facility in the same position and same lighting to ensure parity at the review stage of the treatment The clinical photographs are to be kept with the clien...

Страница 63: ...bodies capacity to carry oxygen and due to its vaso constricting properties Ensure the client is well hydrated 8 7 Client Management Adverse Reactions It is very rare that severe adverse reactions oc...

Страница 64: ...to Accident Emergency unit in local hospital Fill in an adverse incident report including all details Inform manufacturer Anaphylaxis Contact recognised first aid person Seek Emergency Medical Advice...

Страница 65: ...y relative contraindicating factors effect of previous treatment methods emotional stability of Client Physical examination e g ascertaining skin colour assessing degree of photo ageing presence of ke...

Страница 66: ...st UltraPlus system is capable of a wide range of pulse and pulse delay settings deviating from the following recommended settings should only be carried out by an experienced Operator and with the co...

Страница 67: ...Thin 5 3 1 24 II Two Thin 5 3 2 24 III Three Thin 5 3 4 22 IV Four Thin 5 3 6 16 V Five Thin 5 3 8 14 I One Medium 5 5 1 26 II Two Medium 5 5 2 26 III Three Medium 5 5 4 24 IV Four Medium 5 5 6 18 V...

Страница 68: ...d increased or decreased as necessary to gain the required end point Skin Therapy Skin Type Degree of Damage Pulse Train Energy J cm2 I One Low 7 5 2 18 II Two Low 7 5 3 18 III Three Low 7 5 4 17 IV F...

Страница 69: ...ne Thin 5 3 1 26 II Two Thin 5 3 2 26 III Three Thin 5 3 3 26 IV Four Thin 5 3 4 22 V Five Thin 5 3 5 20 I One Medium 5 5 1 28 II Two Medium 5 5 2 28 III Three Medium 5 5 3 28 IV Four Medium 5 5 4 24...

Страница 70: ...One Thin 5 3 1 28 II Two Thin 5 3 2 28 III Three Thin 5 3 3 28 IV Four Thin 5 3 4 24 V Five Thin 5 3 5 22 I One Medium 5 5 1 30 II Two Medium 5 5 2 30 III Three Medium 5 5 3 30 IV Four Medium 5 5 4 26...

Страница 71: ...2 7 4 23 V Five Sub surface 2 7 5 22 Using the 415 630nm Applicator The following table provides the system pre set pulse options for a successful treatment however the energies quoted should be used...

Страница 72: ...and can be seen to slight degree in people who are exposed to sunlight Photo allergic Reactions these involve the immune system and may be similar to other allergic reactions such as swelling rashes a...

Страница 73: ...lus others Piroxicam Feldene Diphenahydramine Benadryl Benylin plus others Prochlorperazine Compazine Enoxacin Penetrex Promethazine Phenergan Fluoracil 5 FU Protryptyline Vivactil Glyburide Diabeta M...

Страница 74: ...ed Light VPL using the Energist Ultra VPL Published Asthetische Dermatologie Issue 3 2006 This study was conducted in a very successful working medical aesthetic clinic in Southern Germany Dr Gramlich...

Страница 75: ...ulsed Light VPL system Energist Limited UK was used with indications on multiple body sites ranging from face chest extremities to other locations in 102 otherwise healthy volunteers The minimum follo...

Страница 76: ...o other acne treatment was permitted within 4 weeks of the study Results With an average frequency of approximately 5 treatments per patient altogether 80 64 of the cases achieved at least 70 improvem...

Страница 77: ...e scalp Methyl aminolevulinate MAL Metvix Galderma France was applied on the targeted area for 3 hrs subsequently one side received an illumination with a LED light source and the contra lateral side...

Страница 78: ...elieving pain by pressing down on an area of the body Adrenal a gland that affects certain types of hair growth AHA see alpha hydroxy acid Alcohol a liquid sometimes used for disinfecting skin before...

Страница 79: ...blood vessel also produce molecules that support the growth of tissues In females angiogenesis also occurs each month in the ovaries and in the uterus as part of the reproductive menstrual cycle In vi...

Страница 80: ...some types of hair removal Also called hypopigmentation Bleach a method used to disguise not remove hair by lightening its colour Blend a modality of electrolysis which uses both thermolysis and galv...

Страница 81: ...gative electrode in a cell or circuit Chemical Depilatories powder or cream preparations that dissolve hair above the surface of the skin Some find these products very irritating to the skin Cherry An...

Страница 82: ...method in which the client is distracted by something during treatment music etc Cortisone an anti inflammatory sometimes linked to hair growth when taken internally Cosmetics certain types of cosmeti...

Страница 83: ...ce Dermatologist a doctor specializing in skin and hair conditions Dermis the deepest layers of the skin where blood vessels lymph channels nerve endings sweat glands sebaceous glands fat cells hair f...

Страница 84: ...ften affect hormonal levels Consult a physician if a drug seems to be causing increased hair growth Dynamic Cooling a method of epidermal cooling which cools the skin with supercooled liquid immediate...

Страница 85: ...ystem include the pituitary thyroid parathyroid adrenal pancreas ovaries and testes Epidermis the thin outer layer of skin on top of the thicker and deeper dermis Epilation the removal of hair below t...

Страница 86: ...series of cycles known as Anagen growing phase Catagen resting phase and Telogen dormant phase Haemangioma Superficial to deep collection of tortuous vessels that is raised above the skin surface May...

Страница 87: ...skin Melanocytes Pigment cells which produce melanin that are found in the lower part of the epidermis Melanoma a form of skin cancer Occurs when the melanocytes become malignant Often the first sign...

Страница 88: ...lt of excess melanin Commonly known as Caf au Lait stains birthmarks age spots and freckles Port Wine Stain Vascular birthmark that ranges in colour from pale pink to dark purple Primarily located on...

Страница 89: ...skin T Telangiectasia Acquired chronic sun exposure or congenital permanent dilatation of the capillaries marked by superficial vessels that range in colour from red to purple Most frequently seen on...

Страница 90: ...rts Benign tumours of epidermal cells induced by the human papillomavirus They occur in about 10 of adults and children Vesiculation Blister formation caused by thermal damage W Wrinkles Due to decrea...

Страница 91: ...of the forms that you may require to provide safe and effective treatment procedures These can be adapted and customised to suit your clinic and provide the basis for a comprehensive client managemen...

Страница 92: ...the machine is to be used on a person This includes treatments on other members of your staff family friends and members of the public A test patch must be completed before treatment Please tick and d...

Страница 93: ...r Yes No 7 Do you have any allergies Yes No If Yes what type 8 Do you take any medicine for allergies Yes No If Yes what type 9 Are you taking any other medication not mentioned above Yes No If Yes wh...

Страница 94: ...Freckles Acne Psoriasis Eczema Shingles Herpes Keloid Formation Wound healing issues Vitiligo Pigmented Patches Prone to Pigmentation Other What other cosmetic procedures have you undertaken Face Lift...

Страница 95: ...serious illness Yes No If Yes what type Do you have any medical conditions Yes No If Yes what type Do you have a personal or family history of skin cancer Yes No Do you have any allergies Yes No If Y...

Страница 96: ...be treated Abdomen Armpits Back Bikini Buttocks Cheeks Chest Chin Ears Eyebrows Feet Fingers Forearms Full Arms Full Legs Hands Lower Legs Neck Shoulders Thighs Upper Arms Upper Lip Other Expectations...

Страница 97: ...y occur causing the skin to appear paler or hyperpigmentation of the area being treated may occur causing the skin to appear dark These symptoms if they occur are usually temporary and slight but the...

Страница 98: ...e treated Abdomen Armpits Back Bikini Buttocks Cheeks Chest Chin Ears Eyebrows Feet Fingers Forearms Upper Arms Upper Lip Hands Lower Legs Neck Shoulders Thighs Other Expectations 1 What are your real...

Страница 99: ...antee that all normal pigment returns I understand that there is a very slight risk of scarring with any skin treatment but in this case it is extremely small 6 I confirm that I have provided the clin...

Страница 100: ...Energist UltraPlus VPL System User Manual SD1 43 Issue 3 CCF 296 100 Area Treated Date Settings...

Страница 101: ...Energist UltraPlus VPL System User Manual SD1 43 Issue 3 CCF 296 101 Area Treated Date Settings Anatomical Location for Hair Removal Skin Rejuvenation please delete as applicable Patient name...

Страница 102: ...Energist UltraPlus VPL System User Manual SD1 43 Issue 3 CCF 296 102 Treatment Record Treatment Description and Location Patient Name Consult Date Treatment Date Area 1st 5th 2nd 6th 3rd 7th 4th 8th...

Страница 103: ...n promotion advertising or trade 3 It is understood that the use of the photographs is for illustrating cosmetic procedures and demonstration of benefits It is also understood that the use of the phot...

Страница 104: ...hen dry or rubbing the area treated 6 Avoid tanning beds or sunbathing for at least 7 days after the treatment 7 If you are unsure about anything after the treatment please contact the clinic for furt...

Страница 105: ...eated than was previously possible How does it work Depending upon the treatment being carried out light emitted from the ULTRA System is preferentially absorbed by the specific structure in the skin...

Страница 106: ...sun and away from tanning beds for at least 6 weeks prior to any treatment to ensure that your skin is as close as possible to its natural colour You must ensure that all cosmetics are removed from t...

Страница 107: ...bjects into the system 7 Due to derived high voltages DO NOT TOUCH bare connectors wires or terminals 8 Warning signs must be clearly displayed on all entrances to the controlled area to indicate clea...

Страница 108: ..._________________________________________________________ _________________________________________________________ _________________________________________________________ Action Taken _____________...

Страница 109: ...ements as required 3 To report any adverse incidents to the Clinic Managers 4 Ensure that all users of the system are adequately trained and understand all procedures related to using the ULTRA System...

Страница 110: ...prior to treatment The pulse types energies and number of shots given below are purely a guide to the setting ranges that are commonly used for each area they are not absolute parameters and may be va...

Страница 111: ...apparent Very rarely 100 clearance Will take time to see the result Will reduce frequency of waxing plucking or other epilation Will reduce visible presence of hairs Wear loose clothing around the tre...

Страница 112: ...see the result Will reduce inflammation of follicles Will reduce frequency of shaving Will reduce visible presence of hairs Will not permanently damage lymph nodes Use deodorant formulated for sensit...

Страница 113: ...l see reduction in in growing hairs between treatments 1 2 Will reduce inflammation of follicles Will reduce frequency of waxing shaving or other epilation Will reduce congestion in back Will reduce v...

Страница 114: ...l reduce frequency of shaving Will take time to see results Treated area will be smoother Will help with PFB pseudofolliculitis barbae Very rarely 100 clearance Treatment issues Perifollicular erythem...

Страница 115: ...in growing hairs between treatments 1 2 Will reduce inflammation of follicles Will reduce frequency of waxing shaving or other epilation Will reduce visible presence of hairs Treatment issues Ensure g...

Страница 116: ...00 clearance Will take time to see the result Will reduce frequency of waxing plucking or other epilation Will reduce visible presence of hairs Treatment issues Ensure gel covers complete area of wave...

Страница 117: ...sues There will always be some hair apparent Very rarely 100 clearance Will take time to see the result Will reduce frequency of waxing Will reduce visible presence of hairs Treatment issues May exper...

Страница 118: ...apparent Very rarely 100 clearance Will take time to see the result Will reduce frequency of waxing shaving or other epilation Will reduce visible presence of hairs Treatment issues Ensure gel covers...

Страница 119: ...nflammation of follicles Will reduce frequency of waxing shaving or other epilation Will reduce visible presence of hairs Treatment issues Ensure gel covers complete area of waveguide and not just hai...

Страница 120: ...cking or other epilation Will reduce visible presence of hairs Do not apply make up to area for 12 24 hours Use products formulated for sensitive skin for 2 3 days post treatment Treatment issues Ensu...

Страница 121: ...sult Will see reduction in in growing hairs between treatments 1 2 Will reduce inflammation of follicles Will reduce frequency of waxing shaving or other epilation Will reduce visible presence of hair...

Страница 122: ...harge ESD IEC 61000 4 2 6kV contact 8kV air 6kV contact 8kV air Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 30...

Страница 123: ...gths from fixed RF transmitters as determined by an electromagnetic site surveya should be less than the compliance level in each frequency rangeb Interference may occur in the vicinity of equipment m...

Страница 124: ...imum output power of transmitter W Separation distance according to frequency of transmitter m 150kHz to 80MHz P d 2 1 80MHz to 800MHz P d 2 1 800MHz to 2 5GHz P d 3 2 0 01 0 12 0 12 0 23 0 1 0 38 0 3...

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