ANATOMY OF RESPIRATORY SYSTEM

Arranged By Group IV :

1. A A Istri Revaliana Pradnyandari (193213006)

2. Dewa Ayu Made Febriari (193213009)
3. I Gusti Ayu Made Indri Amanda (193213014)
4. Ni Koman Bunga Triska Yuniari (193213027)
5. Ni Komang Devi Arianti (193213028)

PROGRAM STUDI KEPERAWATAN PROGRAM SARJANA

SEKOLAH TINGGI ILMU KESEHATAN WIRA MEDIKA BALI

DENPASAR

2020
 Foreword

Praise the presence of Tuhan Yang Maha Esa who has bestowed His mercy and grace. so
we can finish the paper assignment about Anatomy Of Respiratory System well and just in time.
In the preparation of the paper there may be a few obstacles. However, thanks to the support of
friends and guidance from supervisors. So we can finish this paper well. With this paper, it is
expected to help the learning process and can increase knowledge for the readers. The author
also does not forget to say thank you to all parties, for his help, support and prayer. Hopefully
this paper can be useful for all parties who read this paper and can know anatomy of respiratory
system. This paper may be less than perfect, for which we expect criticism and suggestions for
the perfection of this paper.

Author
 TABLE OF CONTENTS

Foreword

Table of content

Chapter I Preliminary

1.1 Background
1.2 formulation of the problem
1.3 objectives
1.4 benefits

Chapter II Theory review

2.1 Definition of respiratory system

2.2 anatomy of respiratory system

2.3 physiology of respiratory system

Chapter III Cover

3.1 Conclusion

3.2 Suggestions

References
 CHAPTER I
PRELIMINARY

1.1 Background

Far from self-sustaining, the body depends on the external environment, both as a source
of subtances the body needs to survive and as a catch basin for its wastes. Tre trilions of cells
making up the body require a continuous supply of oxygen to carry out their vital functions.
We cannot do without oxygen for even a little while, as we can without food or water. As
cells use oxygen, they give off carbon dioxide, a waste product the body must get rid of.
They also generate dangerous free radicals, the inescapable by products of living in a world
full of oxygen.
The major function of the respiratory system is to supply the body with oxygen and
dispose of carbon dioxide. To accomplish this function, at least four process, collectively
called respiratory must happen: 1. pulmonary ventilation, movement of air into and out of the
lungs so that gases there are continuously changed abd refresh (commondly called
breathing), 2. External respiration, movement of oxygen from the lungs to the blood and
carbon dioxide from the blood to the lungs, 3. Transport of respiratory gases, transport of
oxygen from the lungs to the tissue cells of the body, and of carbon dioxide from the tissue
cells to the lungs. This transport is accomplished by the cardiovascular system using blood as
the transporting fluid, 4. Internal respiration, movement of oxygen from blood to the tissue
cells and of carbon dioxide from the tissue cells to blood.

1.2 Formulation of the problem

1. What the definition of the respiratory system?

2. How’s anatomy of respiratory system?
3. How’s physiolofy of respiratory system?

1.3 Objectives

1. To know the definition of the respiratory system

2. To know anatomy of respiratory system
3. To know physiology of respiratory system

1.4 Benefits

1. Knowing the definition of the respiratory system

2. Knowing anatomy of respiratory system
3. Knowing physiology of respiratory system

CHAPTER II
 THEORY REVIEW

2.1 Definition of respiratory system

Respiratory system is the integrated system of organs involved in the intake and
exchange of oxygen and carbon dioxide between the body and the environment and
including the nasal passages, larynx, trachea, bronchial tubes, and lungs.

Respiration is a term that is variously applied to: the acts of inhalation and
exhalation; to the movement of gas molecules in the lungs between alveolar air and
blood in the alveolar capillaries; to the exchange of dissolved gases in the tissues
between the systemic capillaries and the surrounding interstitial fluid; and to the
process conducted within the mitochondria of cells that results in the production of
ATP (and CO2) from small organic molecules by using O2. The respiratory system is
a set of tubes that branch to increase in number and decrease in size, within an elastic
structure that is moved by muscles. The lungs and chest wall together act like a
bellows to move air into and out of the alveoli. The epithelial cells of the walls of the
alveoli are part of the respiratory membrane that separates the air in the alveoli from
the blood in the alveolar capillaries. The endothelial cells of the capillary walls are
also part of the respiratory membrane. Air passes through the nostrils, the meatus of
the nasal cavity, the pharynx, the larynx, the glottis, the trachea, the bronchi, then into
the secondary and tertiary (and smaller) bronchi eventually into the bronchioles, then
into smaller airways to finally reach the alveoli. Here oxygen diffuses through the
respiratory membrane from the alveoli to the blood in capillaries and carbon dioxide
diffuses from the blood to the alveoli. Bronchi are held open by the cartilage in their
walls, while bronchioles are without cartilage but may dilate and constrict their
diameter as the smooth muscle in their wall relaxes or contracts. At the end of an
inhalation, the volume of air that is within the respiratory tree but that has not reached
the alveoli, is not in contact with the respiratory membrane and so does not
participate in gas exchange. This volume of “fresh” air is called the anatomical dead
space and is then exhaled. At the end of an exhalation, there is a volume of “stale” air
within the bronchial tree that has yet to pass out of the body. Instead this stale air re-
enters the alveoli, pushed in by the fresh air of the next inhalation. Hence, alveolar air
is not completely refreshed with each inhalation. Carbon dioxide produced in the
tissues dissolves in water to form carbonic acid ( CO2 + H2O ⇌ H2CO3 ). This
reaction is catalysed within the rbc. Then the carbonic acid molecule disassociates to
form the hydronium and bicarbonate ions ( H2CO3 ⇌ HCO3− + H+ ). The
hydronium ions are buffered by haemoglobin in the rbc while the bicarbonate ions
move into the blood plasma. When blood reaches the lungs, carbon dioxide moves
from the blood to the alveoli and the two previous equations proceed from right to
left. Hence, breathing out carbon dioxide causes acid (hydronium ions) to be
converted to water. If the ability to breathe out is impaired, then acid is not excreted,
so blood pH will fall and the body may be in respiratory acidosis.
2.2 Anatomy of respiratory system
Anatomically, the respiratory system can be divided into the upper and
lowerrespiratory tract. The upper respiratory tract includes the organs located outside
of thechest cavity (thorax) area (i.e. nose, pharynx, larynx), whereas the lower
respiratorytract includes the organs located almost entirely within it (i.e. trachea,
bronchi,bronchiole, alveolar duct, alveoli)
1. Nose and nasal cavity
The human nose differs in its anatomy and morphology between different
racial andethnic groups. Therefore, the following anatomical description is a
generalisationand inter-racial variations exist. For completeness, structures
that have synonymsare followed by their alternate names in parentheses and
italicised. Structurally thenose can be divided into the external portion which
is in fact termed as the nose andthe internal portions being the nasal cavities
(nasal fossae; cavum nasi). The nose isthe only visible part of the respiratory
system, protruding from the face, and lying in between the forehead and the
upper lip. It is made up of a bony section and acartilaginous section. The bony
section is located in the superior half and contains apair of nasal bones sitting
together side by side, separated in the middle and fusedposteriorly by the
medial plates of the cheekbones (maxilla bones). The cartilaginous section is
located in the inferior half, consisting of flexiblecartilages in the anterior,
caudal portion of the nose . The cartilages areconnected to each other and to
the bones by a tough fibrous membrane. At the base of the nose are two
openings called the nostrils (anterior nares, sing. naris) andare separated by
nasal septum cartilage (columna). The nostrils are a portal for airand
particulates to enter the nasal cavity. Its shape can be very elliptical to
circularvarying between people from different ethnicity and race.Air enters
the nasal cavity through the nostrils, which opens with a slight dilationinto an
enclosed area called the vestibule. It is enclosed by the greater alar
cartilageand extends as a small recess toward the apex of the nose. The two
nostril openingsand consequently the two vestibules leading to two nasal
chambers or cavities areseparated by the septum. The anterior septum is
primarily made of cartilage (hyalinecartilage) but posteriorly is composed of
the vomer bone and the perpendicular plateof the ethmoid bone. It is a
common occurrence for the septum to be deviated and insevere cases this can
lead to nasal dysfunction requiring surgical procedures. The topof the nasal
cavity is divided from the anterior cranial cavity by the cribiform plateof the
ethmoid bone and the sphenoid bone. The cribriform plate is perforated
withmany small openings that allow the olfactory nerve branches that are
responsible forthe sense of smell to extend through to the brain. The lateral
walls abut on either sidewith the maxillary bones, and the floor of the nasal
cavity is separated from the topof the mouth by the palatal bones. From the
vestibule the air passes through a constricted cross-sectional area whichhas
been termed the anterior nasal valve, before entering the main nasal
 passage.In each cavity there are three passageways (superior, middle, and
inferior meati;singular, meatus) within the main nasal passage, formed by
three correspondingcurled bony plates that project medially into the main
passage way from the septumwall, called the superior, middle and inferior
nasal turbinates or conchae (so-called asthey are shaped like a conch seashell.
At the posterior end of the main nasal passage are the oval-shaped orifices of
the posterior nares, (choanae) approximately1.5–3.0 cm in diameter. The
choanae are openings that allow air to pass from themain nasal passage, into
the nasopharynx. Once air has passed through the posteriornares, it has left the
nasal cavity and enters the next major segment of the upperrespiratory tract—
the pharynx. The paranasal sinuses are four pairs of empty air spaces that open
or drain intothe nasal cavity. They are located in the frontal, sphenoid,
ethmoid, and maxillarybones and as such their names are taken from where
they are located. The frontalsinuses are located just above the orbit (eye
sockets) and don’t develop until aroundthe age of seven. The maxillary, the
largest of the sinuses extends laterally (intothe maxilla) on either side of the
nose and is present at birth and grows with thebody’s development. The
sphenoid sinuses lie in the body of the sphenoid bone,deep in the face just
behind the nose. This sinus does not develop until adolescence.The ethmoid
sinuses are not single large cavities but rather a collection of small airpockets,
located around the area of the bridge of the nose. This sinus is also presentat
birth, and grows with development.
2. Pharynx
The pharynx (throat) is a tubelike structure about 12.5 cm long that
connects theposterior nasal and oral cavities to the larynx and oesophagus. It
extends from thebase of the skull to the level of the sixth cervical vertebrae.
Structurally the phar-ynx can be divided into three anatomical parts according
to its location as shown in, which are the nasopharynx (posterior to the nasal
chambers), the orophar-ynx (posterior to the mouth), and the laryngopharynx
(posterior to the pharynx) The nasopharynx is located between the internal
nares and the soft palate and liessuperior to the oral cavity. At the base of the
nasopharynx are the soft palate and theuvula. At the wall of the nasopharynx
are the auditory (Eustachian) tubes connectedto the middle ear. The
pharyngeal tonsils (adenoids) are located in the nasopharynxon its posterior
wall opposite the posterior internal nares. The oropharynx is locatedposterior
to the mouth, inferior from the soft palate, and superior to the level of
thehyoid bone. At this location the mouth leads into the oropharynx and both
food andinhaled air pass through it. The palatine (faucial) tonsils lie in the
lateral walls ofthe fauces. The laryngopharynx (hypopharynx) extends from
the hyoid bone to theoesophagus. It is inferior to the epiglottis and superior to
the junction where theairway splits between the larynx and the esophagus. The
lingual tonsils are found atthe posterior base of the tongue which is near the
opening of the oral cavity.
3. Larynx
 The larynx is commonly known as the voice box as it houses the vocal
folds that areresponsible for sound production (phonation). It serves as a
sphincter in transmittingair from the oropharynx to the trachea and also in
creating sounds for speech. Itis found in the anterior neck, connecting the
hypopharynx with the trachea, whichextends vertically from the tip of the
epiglottis to the inferior border of the cricoidcartilage At the top of the larynx
is the epiglottis which acts as a flap that closes off the trachea during the act of
swallowing to direct food into the oesopha-gus instead of the trachea. The
laryngeal skeleton consists of nine cartilages, threesingle (thyroid, cricoid, and
epiglottis) and three paired (arytenoid, corniculate, andcuneiform), connected
by membranes and ligaments. The hyoid bone is connectedto the larynx but is
not considered part of the larynx. The single laryngeal cartilagesare:
• The epiglottis—a leaf-shaped piece of elastic cartilage located at the top
of thelarynx. It is inferiorly anchored at one end between the back of the
tongue andthe anterior rim of the thyroid cartilage. The free superior end
bends up and downlike a flap to open and close the opening into the larynx.
• The thyroid cartilage (Adam’s apple)—formed by the fusion of two
cartilageplates and is the largest cartilage of the larynx. It is shaped like a
triangular shieldand is usually larger in males than in females due to male sex
hormones stimulatingits growth during puberty.
• The cricoid cartilage—a signet ring shaped cartilage so-called because
the signetend forms part of the posterior wall of the larynx. It is attached to the
top of tracheaand is the most inferiorly placed of the nine cartilages.
The paired laryngeal cartilages form part of the lateral and posterior walls of
thelarynx, which are:
• The arytenoid cartilages—two upward protrusions located at the back of
thelarynx. The arytenoid cartilages are attached to the cricoarytenoid muscles,
an-chored by the cricoid cartilage and attached to the vocal cords. They are
the mostimportant because they influence the position and tension of the vocal
folds.
• The corniculate cartilages—small and cone-shaped hyaline cartilages that sit
ontop of each of the arytenoid cartilages. During swallowing of food, the
epiglottis bends down and meets the corniculate cartilages to close off the
pathway to thetrachea.
• The cuneiform cartilages—small elongated rod-like elastic cartilages located
atthe apex of each arytenoid cartilage, and at the base of the epiglottis above
andanterior to the corniculate cartilage
The airway cavity of the larynx extends from a triangular shaped inlet at the
epiglot-tis to a circular outlet inferior to the cricoid cartilage where it is
continuous withthe lumen of the trachea. Two pairs of mucous membrane
foldings stretch inwardand horizontally across the larynx. The upper pair of
folds are the vestibular folds(ventricular or false folds) which only play a
minimal role in phonation but protectthe more delicate folds below. The lower
pair of folds are the true vocal folds, whichform a slit-like opening called the
 glottis. This is the narrowest part of the larynx. Thevestibular and vocal folds
divide the larynx into (1) the vestibule (upper chamber),located above the
vestibular folds; (2) the ventricle, the small middle chamber locatedbetween
the vestibular and vocal folds; and (3) the infraglottic cavity, which
extendsfrom the vocal folds to the lower border of the cricoid cartilage . The
vocalcords, are flat triangular bands and white in colour because of their their
lack of bloodsupply (avascular) nature. They are attached posteriorly to the
arytenoid cartilages,and anteriorly to the thyroid cartilage. The interior surface
of the superior portionof the larynx is made up of stratified squamous
epithelium which is an area that issubject to food contact. Below the vocal
folds the epithelium is pseudo stratified cil-iated columnar. Here mucociliary
action directs mucous movement upward towardsthe pharynx, so that the
mucous is continually being moved away from the lungs.
4. Tracheobronchial Tree and Deep Lung Airways
The tracheobronchial tree is the structure from the trachea, bronchi, and
bronchi-oles that forms the upper part of the lung airways. It is referred to as a
tree becausethe trachea splits into the right and left main bronchi, which
further bifurcates orbranches out into more progressively smaller airways. It is
an asymmetric dichoto-mous (splitting of a whole into exactly two non-
overlapping parts) branching pattern,with the daughter bronchi of a parent
bronchus varying in diameter, length, and thenumber of divisions. The
bronchial generation is normally referred to by a number,indicating the
number of divisions from the trachea, which is assigned as generationnumber
0 or 1 as found in the literature.The trachea (windpipe) is a hollow tube about
11–14 cm long connecting from thecricoid cartilage in the larynx to the
primary bronchi of the lungs. Its cross-sectionaldiameter in normal human
adult males is 1.3–2.5 cm in the coronal plane and 1.3–2.7in the sagittal plane,
while for females the diameters are slightly smaller (1.0–2.1 cmand 1.0–2.3
cm for coronal and sagittal diameters respectively) (Breatnach et al.1984). The
variation in the trachea cross-section between the coronal and sagittalplane is
due to its shape being a horse-shoe where the anterior side is made up ofC-
shaped cartilaginous rings, and posteriorly by a flat band of muscle and
connectivetissue called the posterior tracheal membrane, closing the C-shaped
rings. There are16–20 tracheal rings, which hold and support the trachea
preventing it from collaps-ing in on itself but also provides some flexibility for
any neck movement. Furtherdownstream, along subsequent bronchi, the
cartilage support becomes progressivelysmaller and less complete. The
tracheal mucosa consists of pseudo stratified, ciliatedcolumnar epithelium,
while its submucosa contains cartilage, smooth muscle, andseromucous
glands.The trachea divides into the main bronchi (primary bronchi) at the
carina, withthe right bronchus wider, shorter and more vertical than the left
bronchus (Mooreand Dalley 2006) (mean lengths of ∼2.2 cm and ∼5 cm
respectively). This leads toincreased chances of inhaled foreign particles
depositing within the right bronchus.The right main bronchus bifurcates
posterior and inferiorly into the right upper lobebronchus and an intermediate
bronchus. This bifurcation occurs earlier on the rightthan on the left lung in all
models.The left bronchus passes inferolaterally at a greater angle from the
vertical axisthan the right bronchus. It is located anterior to the oesophagus
and thoracic aortaand inferior to the aortic arch. Each main bronchi leads into
the lung on its respectiveside. The right main bronchus subdivides into three
lobar (secondary)bronchi (right upper lobe bronchus, right middle lobe
bronchus, and right lower lobebronchus) while the left main bronchus divides
into two (left upper lobe bronchusand left lower lobe bronchus). Each lobar
bronchus serves as the airway to a specificlobe of the lung.
The lobar bronchi further divides into segmental bronchi (tertiary
bronchi), whichsupply the bronchopulmonary segments of each lobe.A
bronchopulmonary segment may be defined as an area of distribution of
anybronchus (Jackson and Huber 1943). Technically there are ten
bronchopulmonarysegments in each lung, however in the left lung some of
these segments fuse and thereare as few as eight bronchopulmonary segments.
The bronchi continually divide intosmaller and smaller bronchi up to about
23–24 generations of divisions from the mainbronchi. As the bronchi become
smaller, their structure changes:
• the cartilaginous rings that support the branches turn into irregular plates
of car-tilage and eventually disappear by the time bronchioles are reached
(∼1mmindiameter). When the bronchi eventually lose all support (usually
between gen-erations 12–15) the airways are then referred to as bronchioles
(Vanpeperstraete1974);
• the epithelium changes from pseudo stratified columnar to columnar and
then tocuboidal in the terminal bronchioles. There are no cilia or mucous
producing cells in the bronchioles and foreign particles are removed by
macrophages located inthe alveoli instead of mucociliary action;
• The amount of smooth muscle in the tube walls increases as the
passagewaysbecome smaller.
The passageway from the trachea, bifurcating into the right and left main
bronchi,which further divide into lobar, then segmental bronchi and continues
this bifurcatingprocess down to the terminal bronchioles (which are the
smallest airways withoutalveoli) is called the conducting airways. In this area,
gas exchange doesnot take place because no alveoli are present, and it
contributes to the anatomic deadspace which takes up approximately 150 mL
in volume The terminal bronchioles that divide into respiratory bronchioles
are also calledtransitional bronchioles as they have occasional alveoli present
at the walls. Therespiratory bronchioles further divide into alveolar ducts
which are completely linedwith alveoli. This region is the acinus (meaning
berry in Latin) region because of thecluster of cells that resemble a knobby
berry, like a raspberry. It includes all parts dis-tal to a single terminal
bronchiole and on average is beyond the sixteenth generation(Haefeli-Bleuer
and Weibel 1988). The acinus is therefore comprised of respira-tory airways
 and forms the functional tissue of the lung, or, the lung parenchyma.It extends
only a few millimetres for about eight generations with the first three
generations consisting of respiratory bronchioles (Sznitman 2008). In total the
res-piratory zone makes up most of the lung, with its volume being about 2.5–
3 litresduring rest (West 2008) in comparison to the conducting airways that
make up 150 mL(anatomic dead space). The alveolar ducts are short tubes that
are supported by arich matrix of elastic and collagen fibres. The distal end of
the alveolar duct opensinto the alveolar sac, which is made up of an atrium
and the alveoli. Thewalls between adjacent alveoli have tiny holes known as
pores of Kohn that serves asadditional ventilation by allowing in air between
the alveoli. This is the terminatingend of all airway passages in the respiratory
system. Because exchange takes placein the acinus, the area is surrounded by
a rich network of blood capillaries. It hasbeen estimated that each adult lung
has about 300 million alveoli, with a total surfacearea for gas exchange of 70–
80 m2.

2.3 Phsyology of respiratory system

Inhalation is initiated by the contraction of the diaphragm which contracts and de-
scends about 1 cm during normal breathing and up to 10 cm on forced breathing.
Thediaphragm lines the lower part of the thorax, sealing it off air-tight from the
abdom-inal cavity below. Its contraction causes muscles in the thorax to pull the
anteriorend of each rib up and outwards enlarging its volume.As a result, the pressure
insidethe thorax (intrathoracic pressure) and inside the lungs (intrapulmonary
pressure)decreases relative to the outside atmospheric air pressure. The pressure
differenceinduces the inhaled air from a higher pressure to a lower pressure in order
to equalisethe pressure. During exhalation the lung and chest wall return to its
equilibriumposition and shape. The thoracic cavity volume is reduced and the
pressure buildsup to release the air from the lungs. In quiet breathing only the elastic
recoil of thelung and chest walls is needed to return the thorax to equilibrium (a
passive process). However in forceful expiration additional muscles (intercostals) in
the thorax andabdomen are also used to further increase the pressure.A pressure-
volume curve can be used to obtain information about how the lungdeforms during
breathing. It can describe the mechanical behaviour of the lungsand chest walls such
as the elasticity of the lung, and its ability to expand andstretch (distensibilty) through
the slope of the pressure-volume curve. This is re-ferred to as lung compliance (CL)
and has units of mL/cm H2O to reflect the changein lung volume (V) as a result of
a change in the pressure (P) of the lung(e.g. CL=V/P). A pressure-volume
curve from the literature (Harris 2005) isshown in. A high compliance value refers to
a lung that is easily distendedand is reflected with a steep pressure-volume curve. A
low compliance means that the lung is ‘stiff’, and is not easily distended with a flat
pressure-volume curve.When reading the compliance slope the lung volume must be
considered, since atlow lung volumes the lung distends easily, but at high lung
volumes large changesin pressure only produce small changes in lung volume. This is
because at high lungvolumes the all alveolar and airways have been maximally
stretched. To accountfor the variations in volume, specific compliance (compliance
divided by the lungvolume usually FRC) is used.
Gas exchange during the respiration process takes place in the alveolus at its
surfacethat separates the alveolus with the capillary. In addition each alveolus is
smallerthan a grain of salt, in which there are approximately 300 million of them in
thelungs. Each alveolus is optimised for gas exchange by having a thin moist
surfaceand a very large total surface area in total. The surfaces of the alveoli are
coveredwith a network of capillaries which are narrow blood vessels. Oxygen is
passed fromthe alveoli into the surrounding capillaries that contains oxygen deprived,
carbondioxide rich blood passed from the heart. Gas exchange takes place where the
oxygenis dissolved in the water lining of the alveoli before it diffuses into the blood
whilecarbon dioxide is removed from the blood and into the alveoli where it leaves
thebody during exhalation. After leaving the lungs, the refreshed blood is now
oxygen-rich and returns back to the heart before it is redistributed to tissues in the
human body.
 CHAPTER III
COVER

3.1 Conclusions

The primary function of the respiratory system is to supply the body with
oxygenand remove carbon dioxide. During inspiration outside air is inspired into the
bodywhich travels from either the nose or mouth down to the lungs. The organs of
therespiratory system can be divided functionally into the conducting zone and the res-
piratory zone. The conducting zone is the airway from the nose or mouth down tothe
bronchioles and is significant for CFPD as its anatomy and physiology is respon-sible for
transporting air and any foreign particles. The respiratory zone includes therespiratory
bronchioles down to the alveoli, where gas exchange takes place througha diffusion
process.The primary aim of this chapter is to summarise the important features of res-
piration by presenting the anatomy and physiology of the respiratory system. It byno
means is a replacement for comprehensive anatomy and physiology study. How-ever it is
hoped that the reader has gained enough understanding of the anatomyand physiology of
the respiratory system, and the mechanics of breathing, in orderto reconstruct any section
of the respiratory airway. Furthermore the physiology,variations and diseases of the
respiratory organs should be taken into account as itinfluences many settings for
computational modelling. Now that some theory of therespiratory system has been
covered, the first step in CFPD, reconstruction of theairways, is presented in the next
chapter. Techniques in extraction of data from CTor MRI scans and how to create the 3D
model will be given.

3.2 Suggestions