Flexiflo QUANTUM User Manual

17558.7910 #50598/#50596 FAN 7116
430-00730-007 LITHO IN USA

No. 50596–Purchase

No. 50598–Lease/Rent

FLEXIFLO®QUANTUM

™

Enteral Pump

OPERATING MANUAL

For Enteral Use Only

Not For Parenteral Use

Rev. 1/97

®

3

PUMP CHARACTERISTICS

The FLEXIFLO®QUANTUM™Enteral Pump is a microprocessor-(computer-) controlled
pump that provides for accurate, controlled enteral feeding in a safe, user-friendly
system. The Quantum Pump is a volumetric pump that uses a specially designed
feeding set, which includes a cassette that delivers measured amounts of enteral
product. As an optional feature, the Quantum Pump will flush the feeding set and
indwelling feeding tube each hour with a 25-mL flush.

PRECAUTION: This pump is designed to deliver only a liquid enteral feeding product
(standard liquid product, infant formula or reconstituted powder product that has
been thoroughly mixed into solution).

The Quantum Pump offers these features:

1. Automatic priming (no manual priming is necessary)

2. Automatic flush feature

3. Dose setting

4. Protection against overdelivery:

•

Motor speed is continuously monitored

•

Senses malfunctions that could result in gravity flow

5. Volume-fed accumulation displays for enteral product and flush solution

6. Flow-rate selection from 1 to 300 mL/hr in 1 mL/hr increments

7. Accuracy to ± 10% (refer to CHECKING PUMP ACCURACY, page 13)

8. 8-hour battery operation at 125 mL/hr, when fully charged

9. Alarms:

•

OCCLUSION

•

EMPTY

•

DOSE COMPLETE

•

TURN TO RUN

•

LOW BATTERY

•

DOOR/CASSETTE

•

SET RATE

10. System self-check

11. Adjustable alarm volume

12. User-friendly operating controls

13. Simple setup (one-hand cassette loading)

14. Memory—Automatic retention of the following values until turned off and
disconnected from AC power:

•

FEED and FLUSH volume accumulations (VOL FED)

•

SET RATE

•

SET DOSE values

TABLE OF CONTENTS PAGE

Pump Characteristics 3

Pediatric Use 4

Precautions 4

Panel Displays 5

Control Dial Settings 6 & 7

Automatic Prime 8

Pump Sets 9 & 10

Instructions For Use 11 & 12

Checking Pump Accuracy 13

Trouble-Shooting 14 & 15

Cleaning 16

Storage 17

Service 17

Flexiflo Quantum Enteral Delivery System 17

Specifications 18

Limited Warranty 19

USER QUALIFICATIONS

© 1997 Ross

The Flexiflo Quantum Enteral Pump is for use at the direction of or under the super­vision of licensed physicians, and by licensed or certified health care professionals who
are trained in the use of the pump and the administration of enteral fluids.

5

PANEL DISPLAYS

Here is a simple explanation of the panel displays. Understanding
them is necessary for successful operation of the pump.

FRONT PANEL

BACK PANEL

BOTTOM VIEW

4

PEDIATRIC USE

Because the Flexiflo® Quantum™ Pump (when FLUSH sets are used in the Optional
FLUSH MODE) will deliver at least 600 mL of additional fluid (flush solution) per day on
continuous feeding, the FLUSH sets must NOT be used for feeding infants

under 12 months of age. In addition, use of the FLUSH feature in all pediatric
patients 12 months of age or older must be carefully evaluated: A physician,

who has training in pediatrics, must take into account the effect of this additional
volume on intestinal tolerance and overall fluid balance of the individual patient and
should, accordingly, determine the maximum amount of flush solution to be hung.

CAUTION

The Quantum Pump can be used on pediatric patients provided the patients can tolerate
a feeding range within the pump operational specifications. Those specifications are:

•

The flow rate range of the Quantum Pump is 1-300 mL/hr in 1 mL increments.

•

The flow rate accuracy of the pump is ± 10% (see page 13 of the Quantum
operating manual for checking pump accuracy).

•

The mean occlusion pressure limit of the Quantum Pump is 15 PSI.

If these specifications are not appropriate for a given patient, the Quantum
Pump should not be used.

All enteral pumps have the potential to bolus-feed or overdeliver, which is an important
consideration in feeding volume-sensitive patients. In these patients, a volume of
product no more than four times the hourly feeding rate should be hung.

PRECAUTIONS

Caution should be exercised in the use of this pump in the Automatic Flush
Mode for patients with volume sensitivity or fluid restriction (ie, cardiac,
renal, pulmonary or pediatric patients). For such patients, the Feed Only
Mode (using the system without automatic flush feature) may be desired.

NOT FOR PARENTERAL USE

Confirm proper placement and function of patient’s enteral feeding tube (nasogastric,
jejunostomy, gastrostomy, etc). Failure to do so may result in vomiting and/or aspira­tion. Verify the following before initiating feeding:

1. A Quantum Pump Set is being used.

2. Cassette is properly seated in pump and door is closed.

3. Flow rate is set at the prescribed mL/hr.

4. Before putting pump in RUN mode, be sure line clamps are fully open.

5. If a pump set with flush bag is used, be sure both line clamps are closed during
setup and when the door on the pump is open. Otherwise, the fluids will mix.

For optimum operation, observe the following precautions: Low level electrical
emissions are commonly observed when fluids are administered using an enteral feed­ing pump. The emissions observed with the QUANTUM pump may create artifacts on
voltage sensing equipment such as ECG, EMG, and EEG monitoring devices if the
monitoring device is not operating correctly or has loose or defective connections to its
sensing electrodes. These artifacts may be mistaken as actual physiologic signals, and
may vary at a rate that is associated with the delivery rate set on the pump. To deter­mine if the abnormality in the monitoring device is caused by the QUANTUM pump,
set the pump so it is temporarily not delivering fluid. Disappearance of the artifact
indicates it was probably caused by the pump. Proper setup and maintenance of the
monitoring device should eliminate the artifact.

FLASH

FEEDING Display

Pump Dial

FLUSH Display

Blue Lever

Light will
when pump is in

RUN mode

HI/LO AUDIO Alarm

Pole Clamp

Ground Test Point

HOSPITAL-GRADE

POWER CORD

BATTERY ACCESS
DOOR

7

CONTROL DIAL SETTINGS (continued)

DIAL: FUNCTION:

HOLD Stops pumping action and audio alarms.

HOLD is used when correcting an alarm con-

dition or whenever temporary cessation of
pumping action is desired (such as when con­necting a new feeding container). If pump
dial is left on HOLD for more than 5 minutes,
an alarm will sound and the message TURN

TO RUN will be displayed.

VOL FED Stops pumping action. The FEEDING display

will show feed volume delivered and the
FLUSH display will show flush volume deliv­ered. Pump accumulates feed volume deliv­ered up to 9999 mL and flush volume up to
999 mL unless these volumes are reset to zero
by turning to CLEAR VOL (or the pump is
unplugged while in the OFF (CHARGE)
mode). Upon exceeding the maximum feed or
flush volume allowed on the display, the value
turns to zero and a new accumulation begins.

CLEAR VOL Stops pumping action and clears to zero both

the feed and flush volume fed. NOTE: The
pump will “beep” four times before erasing
volumes to alert the user that the dial has
been turned to CLEAR VOL. The user must
turn dial away from CLEAR VOL (to any
other setting) the fourth beep to avoid
an unintentional erasure of volume total(s).

CLEAR VOL does not work while pump
is priming.

6

CONTROL DIAL SETTINGS

DIAL: FUNCTION:

OFF Stops all pump functions. Battery charges in
(CHARGE) all dial settings when pump is plugged in.

The pump will retain current RATE, DOSE
and VOL FED values indefinitely the
pump is unplugged from an AC power source
while in the OFF (CHARGE) setting.

SET RATE Allows flow rate to be set (1 to 300 mL/hr in

1-mL increments) by pressing the keypad
arrows when the pump is in the SET RATE
mode. Rate may be set during or after the
automatic priming phase.

SET DOSE Allows dose to be limited (1 to 1999 mL for

Models A, B & C and 1 to 9999 mL for
Model D and higher, in 1-mL increments) by
pressing the keypad arrows. Completion of
this dose triggers DOSE COMPLETE alarm.
Refer to DOSE COMPLETE (page 14).
DOSE may also be set during the automatic
priming phase.

NOTE: If zero dose is entered (0000), this
feature is deactivated.

RUN Only setting that activates feeding. Visual

display shows rate of flow in mL/hr and a
droplet-shaped image will move across the
bottom of the visual display. Also, a small
green light on lower left-hand corner of
pump will flash when pump is in RUN mode.

unless

before

9

PUMP SETS

The Quantum Pump offers a wide choice of feeding sets with either a Pump Set
Without Flush Bag (single inlet cassette) or Pump Set With Flush Bag (dual inlet
cassette).

PUMP SET (WITHOUT FLUSH BAG)—SINGLE INLET CASSETTE

EXAMPLE SHOWN:

FLEXIFLO

®

Top-Fill Enteral Nutrition Bag

With Preattached Quantum

™

Pump Set

IMPORTANT REMINDER WHEN USING A PUMP SET (WITHOUT FLUSH BAG):

• FLUSH display will be blank when a single inlet cassette is used.

8

AUTOMATIC PRIME

System Self-Check Display Priming Display

Automatic Priming is initiated when:

Pump dial is turned from OFF (CHARGE) position to SET RATE, SET DOSE or RUN
position. The system self-check on the pump is followed by automatic priming of the
set. Fluid fills the tubing during this priming sequence. This fluid is not counted in

VOL FED.

NOTE: Automatic priming expels air from the set, which may result in a

small amount of fluid being expelled beyond the adapter on the feeding set.

Automatic Priming does not occur in the following dial settings:

HOLD
VOL FED
CLEAR VOL

SINGLE INLET CASSETTE

From Feeding Container

Pumping Chamber

11

INSTRUCTIONS FOR USE

10

PUMP SETS (continued)

PUMP SET WITH FLUSH BAG—DUAL INLET CASSETTE

EXAMPLE SHOWN:

FLEXIFLO

®

Top-Fill Enteral Nutrition Container

With Preattached Quantum

™

Pump Set With Flush Bag

IMPORTANT REMINDER WHEN USING FEED/FLUSH SETS:

•

Every 60 minutes of continuous feeding before the pump alarms EMPTY,
DOSE COMPLETE or LOW BATTERY, 25 mL of flush solution will be delivered

over 1

1

/2minutes. Flush rate is fixed at 999 mL/hr.

NOTE: The FLUSH cycle will be aborted if the control knob is turned to any
position other than RUN, HOLD or VOL FED.

•

Assure that the clamp on the filled flush bag is open during priming. Otherwise, the
pump will “decide” that a Pump Set (Without Flush Bag) is in place and the FLUSH
display will remain blank.

•

When the door on the pump is open, be sure both clamps are closed. Otherwise,
the fluids will mix.

•

Use of the Quantum Pump replaces the need for flushing procedures
(eg, 20-30 mL of warm water every 3-4 hours during feeding).

•

Flushing with 20-30 mL of warm water (using a 30-mL or greater syringe) before
and after medications is still recommended.

•

If pump feeding is manually stopped or turned off, automatic flushing does not
occur. If pump remains in the OFF (CHARGE) mode (not on HOLD), it is recom­mended to flush with 20-30 mL of warm water (using a 30-mL or greater syringe) to
rinse remaining product from the feeding set.

•

Additional information or action may be included in your facility’s required
procedures.

Before initial use on battery power and after extended storage periods, the
pump must be plugged into an AC power source for a minimum of 8 hours
(pump may be operated during this time). The pump should be operated on
battery power for a minimum of 6 continuous hours at least once every
6 months for best performance and battery life. Use AC power whenever possi­ble. Plug in during storage to assure a fully charged battery for emergencies.

ASSURE THAT ALL CLAMPS ON FEED AND FLUSH SETS ARE CLOSED BEFORE SETUP.

TO ASSEMBLE:

1. Attach pump to stand using pole
clamp. Plug in cord if power is avail­able. If using battery power, do not
let battery run down. When the low
battery message appears, the battery
has approximately 30 minutes of
energy left.

2. Close CAIR

®

Clamp* (flow regulator)

†

on Quantum Pump feeding bag (and
slide clamp on flush bag, if used).

3. Attach the Quantum Pump Set
securely onto a filled enteral nutrition
container, if it is not preattached. Sus­pend container to side or behind and
20 inches above pump. Squeeze sight
chamber

1

/3to 1/2full.

4. Fill flush bag with enteral flush solu­tion (DO NOT USE CARBONATED
SOLUTIONS). Suspend bag to side
or behind and 20 inches above
pump.

5. Lift blue lever on face of pump to
open door. Make sure orange plunger
knob is oriented to the left as you
firmly seat cassette into pump cavity.
Close door on pump by pushing the
blue lever down.

(See illustration top of next column.)

6. Fully open clamp on feeding set (and
slide clamp on flush bag, if used).

TO PRIME:

Pump automatically primes

7. Remove adapter cover.

8. Turn pump dial to SET RATE. Pump
will initiate system self-check
procedure, followed by automatic
priming of the set.

(See illustration top of next page.)

AND

routine

continuous

DANGER: Possible explosion hazard if used in the presence of flammable anesthetics.

DUAL INLET CASSETTE

From Feeding Container

From Flush Bag

Pumping Chamber

13

CHECKING PUMP ACCURACY

Fluid head height and viscosity are two variables that can affect flow rate. To check
flow rate, use the following procedure.

Select a pump set (or fully close clamp on flush bag,
if using a feeding pump set with flush bag). Be sure to use a graduated

cylinder for volume measurement—not an enteral container. Using Ensure

®

Complete, Balanced Nutrition™or Osmolite®Isotonic Liquid Nutrition, fill the
feeding container only and set up pump according to instructions. Suspend bag
to side or behind and 20 inches above pump (see illustration). With a test pump
connected to AC power, start the pump and let it run for 15 minutes. Then run
product into a graduated cylinder for 30 minutes and compare to rate set on pump:

Amount Expected in Graduated Cylinder

Rate Set @ 30 minutes

76 mL/hr = 34.2 mL to 41.8 mL
150 mL/hr = 67.5 mL to 82.5 mL

If flow rate is incorrect, try a new pump set and repeat procedure.

12

INSTRUCTIONS FOR USE (continued)

NOTE: Automatic priming expels air

from the set, which results in a small
amount of fluid being expelled
beyond the adapter.

9. Confirm proper placement and
function of enteral feeding tube.

10. Attach adapter to enteral feeding
tube.

11. Select flow rate, from 1 to 300 mL/hr,
by pressing individual arrows. Never
use sharp objects such as pens, pen­cils, fingernails or paper clips to
depress the keypad arrows.

12. If desired, turn dial to SET DOSE
and select dose by pressing individual
arrows.

NOTE: If zero dose is entered (0000),
this feature is deactivated.

13. Turn dial to RUN to start feeding.

14. To see feeding volume delivered (and
flush volume delivered, if this feature
is used), turn dial to VOL FED.

15. To clear the feeding and flush volume
delivered, turn dial to CLEAR VOL.
(This occurs after four beeps.)

NOTE: If alarm sounds, turn pump
dial to HOLD. Correct alarm condi­tion indicated by visual display, then

turn pump dial to RUN to restart
feeding. (For explanation of alarms,
see pages 14-15.)

16. When desired, disconnect pump-set
tubing from patient’s enteral feeding
tube. Close clamp on feeding bag
(and flush bag, if used). Lift blue
lever on face of pump, remove cas­sette and discard set and container.

17. When feeding is complete, turn
pump dial to OFF.

NOTE: Pump stops and sounds an
alarm automatically when the con­tainer is empty. If the DOSE function
is in use, the pump will stop, sound
the alarm and display the DOSE
COMPLETE message when the
selected dose is reached.
PRECAUTION: The pump set and
container should be replaced as
needed, or at least every 24 hours, to
avoid product-contamination prob­lems. For single-patient use only.

TO GRAVITY FEED OR
MANUALLY PRIME:

1. Completely close CAIR

®

clamp (and

slide clamp, if flush set is used).

2. Remove cassette from pump.

3. Pull out orange plunger knob and
regulate flow with CAIR clamp.

* CAIR®clamp manufactured under license from Adelberg

Laboratories, Inc. Covered by one or more of the following
U.S. Patent Nos: 3,685,787; 3,893,468; 4,013,263; 4,047,694;
4,238,108; 4,181,476.

†

If desired, CAIR clamp may be used to regulate flow rate by
gravity, but all tubing must be completely disconnected
from pump. This set delivers approximately 14 drops
per mL.

without a flush bag

15

TROUBLE-SHOOTING (continued)

VISUAL DISPLAY
OR PROBLEM CORRECTIVE ACTION

LOW BATTERY—Pump has approx-

•

Plug power cord into AC outlet.

imately 30 minutes of battery opera-

•

Turn dial to HOLD, then RUN.

tion before complete shutdown. A Pump will operate normally while
completely blank front panel (no lights, battery is charging.
symbols, message) indicates that the
battery is depleted and the unit is not
plugged into a live AC circuit.
NOTE: Complete shutdown is
preceded by a continuous alarm
for 1 minute.

ERR—System Malfunction.

•

Must turn pump OFF to reset. If
alarm condition persists, pump
requires service.

FLUSH Display Blank with

•

Turn pump OFF.

FEED/FLUSH SET in use—

•

Fill Flush Bag.

Clamp is closed on the Flush Bag or

•

Open clamp.

Flush Bag is empty.

•

Restart pump.

14

TROUBLE-SHOOTING

The Quantum Enteral Pump is designed to be highly reliable. As with any electro­mechanical device, however, problems may occur. The following tips will help correct
minor in-service problems that may arise:

Intermittent audio alarms are accompanied by messages on the front panel indicating
the cause of the alarm for all alarm conditions except LOW AUDIO (visual only),
which indicates low alarm volume has been selected.

VISUAL DISPLAY
OR PROBLEM CORRECTIVE ACTION

OCCLUSION—Flow has stopped.

•

Turn dial to HOLD.

•

Clear obstruction/check for kinked
tubing or closed clamps.

•

Turn dial to RUN to start pump.

EMPTY—Feed or flush bag empty.

•

Turn dial to HOLD.

•

Refill container(s).

•

Turn dial to RUN to start pump.

DOSE COMPLETE—VOL FED is

•

Turn dial to SET DOSE.

equal to the SET DOSE. Pump stops.

•

Press keypad arrows to increase dose
OR to zero dose setting OR turn dial
to CLEAR VOL.

•

To silence alarm, turn dial to HOLD,
then RUN.

SET RATE—Dial turned to RUN with-

•

Select flow rate (1 to 300 mL/hr).

out entering rate.

•

To silence alarm, turn dial to HOLD,
then RUN.

TURN TO RUN—Pump dial in setting

•

Turn the dial to HOLD or RUN to

other than RUN or OFF more than reset.
5 minutes.

DOOR/CASSETTE—Door open,

•

Confirm cassette in place and close
cassette not properly loaded or excess door.
foam or air in cassette.

•

Manually reprime to remove foam or

air from cassette.

•

Replace set.

•

If alarm condition persists, pump

requires service.

17

STORAGE

•

The pump should be stored away from excessive heat, cold or humidity.

•

Be sure pump dial is in the OFF position.

SERVICE

•

The Quantum Enteral Pump is designed to be highly reliable. As with any electro­mechanical device, however, minor problems may occur. In the event of a pump
malfunction, need for technical assistance or parts, please contact Ross.

•

OPERATING INSTRUCTION VIDEOTAPE
An instructional videotape in VHS format assists nursing personnel and other
medical professionals in learning procedures for operating the FLEXIFLO Quantum
Enteral Delivery System. This videotape is available for your use through a
Ross Representative.

FLEXIFLO QUANTUM
Enteral Delivery System

PUMPS

50596 Enteral Pump—Purchase
50598 Enteral Pump—Lease/Rent

PUMP SETS

50600 Pump Set w/Piercing Pin
50602 Pump Set w/40mm Screw Cap
50604 Pump Set w/Piercing Pin With Flush Bag

CONTAINERS WITH PREATTACHED PUMP SETS

50608 1000 mL Top-Fill Bag w/Pump Set
50610 1000 mL Toptainer

®

w/Pump Set
50606 1000 mL Top-Fill Bag w/Pump Set With Flush Bag
50614 1000 mL Toptainer w/Pump Set With Flush Bag

All Quantum pump sets and containers with preattached pump sets can be used in
the gravity mode of feeding.

16

CLEANING

There are no routine calibration or adjustment procedures required with the
Quantum Pump. All servicing or adjustments should be referred to qualified
technical personnel (refer to Service Manual).

For trouble-free operation, check the pump daily and clean immediately after
spills occur.

While cleaning, pump should be turned off and unplugged.
Do not submerge, autoclave, heat, steam, ETO or radiation sterilize the
pump.

THE PUMP CAN BE CLEANED AS FOLLOWS:

HOUSING

•

Clean outside surface with soft cloth and warm, soapy water.

•

For general cleaning, use dishwashing detergent (nonchlorine-based) or isopropyl
alcohol.

•

For general disinfecting, use 70% concentration isopropyl alcohol.

•

For disinfecting after exposure to AIDS or hepatitis, use 10% concentration of 5.25%
sodium hypochlorite (household bleach). This solution may discolor the pole clamp.
DO NOT SPRAY THIS SOLUTION INTO PUMP CAVITY. After exposure to tuber­culosis, use 70% concentration isopropyl alcohol. These recommendations are not
substitutes for official procedures that may differ among institutions.

PUMP CAVITY

To facilitate cleaning, the cassette
receptacle door may be disconnected
from the face of the pump. However,
this should be removed only by a
qualified service technician, in the
following manner:

•

Tilt pump back.

•

Lift blue lever so cassette door is in
open position.

•

Push out on door-release tab to
release cassette door.

•

Allow door to open fully.

•

Lift up on door to remove com­pletely from brown hinge.

Reinstall cassette door by
following above procedures in
reverse order.

•

Do not spray water or cleaning
solution into pump cavity.

•

Clean with a cotton swab, soft brush
or soft cloth and warm soapy water.

•

Dry thoroughly.

•

Be sure no soap film or residue is left
in the pump cavity.

Open
Position

Door

Door-

Release

Tab

Blue Lever

Pump
Cavity

19

LIMITED WARRANTY PLAN

Ross warrants the Flexiflo®Quantum™Enteral Pump
against defects in material and workmanship for a
one (1) year period from date of delivery. This warranty
is valid only to the original purchaser and does not
extend to any product, or part thereof, which has been
subjected to accident, alteration, damage, misuse,
repair by other than Ross authorized representatives, or
has not been operated and maintained in the manner
prescribed in the Operating Manual or which at the
time of pump failure was being used with pump sets
or containers other than Ross pump sets and con­tainers. Examples of damage or misuse include, but
are not limited to, pumps that have been dropped,
have had fluid spilled into or onto the casing or have
been submerged.

In no event shall Ross be liable for any incidental,
indirect or consequential damages in conjunction
with the purchase or use of the pump.

Ross reserves the right to repair or replace (at its
option) any pump that fails to meet the foregoing
warranty.

THE WARRANTIES HEREUNDER ARE IN LIEU OF
ALL OTHER WARRANTIES, EXPRESSED OR IMPLIED,
INCLUDING, WITHOUT LIMITATION, THE WARRAN­TIES OF MERCHANTABILITY AND OF FITNESS FOR
A PARTICULAR PURPOSE.

NOTE:

When repairs on the unit are made under warranty because of
faulty material or workmanship within one year from the date of
delivery to the customer, the customer will not be billed for parts
repaired or replaced. Also, the customer will not be charged for
labor involved in connection with the installation of such parts
furnished under warranty.

Shipping costs for units returned to Ross, including loaners, shall
be paid by the customer. Ross Authorization Forms should be
completed and accompany the returned unit.

18

SPECIFICATIONS

Power

Voltage: 100 to 130 VAC, 47-63 Hz, 1 Phase
Power: 4 watts (average)
Fuse:

1

/2AMP, SB type
Line Cord: Hospital-grade, nondetachable (10 feet)
Leakage: Less than 100 microamps

Mechanical

Height: 8.25 inches
Width: 7.5 inches
Depth: 6.0 inches (8.0 inches with pole clamp)
Weight: 7.2 lbs

Operational Specifications—Flow Rates

Range: 1-300 mL/hr
Increments: 1 mL/hr
Accuracy: ± 10% (refer to CHECKING PUMP ACCURACY, page 13).
Pressure: Pumps against 15 psi (mean) back pressure before occlusion

alarm.

Battery Operation

Type: 2.1 Ah rechargeable sealed lead acid
Voltage: 8V; the pump will fully recharge in a maximum of 8 hours

if turned off, or a maximum of 12 hours if running.

Expected Life: When fully charged, 8 hours at 125 mL/hr.

Standards

Designed and manufactured to meet requirements of UL 544 (1976).