# Translation, Cross-Cultural Adaptation, and Validation of the

Authors: Marcos  Campos; Carlos Henrique A. de Rezende; Virgilio da C. Farnese; Carlos Henrique M. da Silva; Nívea Macedo de O. Morales; Rogério de Melo C. Pinto
Journal: ISRN Neurology
 (2011)

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## Abstract

Translate, culturally adapt, and validate the “Parkinson's Disease Quality
of Life” (PDQL) BR, into Brazilian Portuguese. Fifty-two patients
answered the PDQL-BR. Twenty-one patients answered the PDQL-BR again 14 days
later. The UPDRS and HY scale was applied. Validation was evaluated using
psychometric properties, checking the quality of the data, reliability, and
validity. Quality of the data was evaluated based on occurrence of ceiling and
floor effects. Reliability was evaluated based on: internal consistency of an
item, homogeneity, and reproducibility. Validation was checked through the
evaluation of convergent and discriminatory validation. There was no ceiling and
floor effect. When evaluating reliability, items 20, 30, and 37 showed
correlation of 0.34, 0.26, and 0.37, respectively, to your scale; the other
items was higher than 0.4. The alpha Cronbach coefficient was higher than 0.7
for most domains. There was good reproducibility. There were no meaningful
changes in the PDQL-BR translation and cross-cultural adaptation.


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## Body

## 1. Introduction

Parkinson’s disease (PD) is a neurodegenerative disease characterized by the
occurrence of motor and nonmotor symptoms. Motor symptoms include arrest tremors,
stiffness, bradykinesia, and instabilities in posture and gait. Nonmotor symptoms
include autonomic dysfunctions that result in changes in blood pressure control and
intestinal function. The disease shows an inevitably progressive course and an
increasing number of other symptoms. Frequently, Parkinson’s disease patients
go through periods of depression and dementia. In more advanced stages,
complications caused by treatment with dopaminergic drugs result in fluctuations in
motor function [1]. The symptoms,
comorbidities, and complications of treatment restrict the autonomy and the welfare
of affected individuals, leading to prejudices in their professional, social, and
emotional lives [2].In order to evaluate multidimensional features such as those described above,
recently special attention has been given to evaluating the quality of life (QL)
and, more specifically the perception of welfare in light of the state of the
patient health, which has lead to the development of the Health-Related Quality of
Life (HRQL) surveys [3]. The development of
the HRQL has allowed health care providers to determine a better approach to caring
for the patient; the HRQL also places more value on considering the needs and the
expectations of the patient and provides a comparison among different groups [3]. The HRQL instruments are divided into two
groups: generic and specific. The generic instruments determine general features of
health and have advantages, such as wide applicability, that allow them to be used
in different groups of patients and allowing comparisons among the groups. The
specific surveys may be used in specific situations, such as PD, and their advantage
is an approach to specific aspects of the disease being studied, allowing the
comparison of individuals in the same group [4].Four instruments of HRQL have been developed and validated specifically for PD:
Parkinson’s Disease Questionnaire 39 (PDQ-39), Parkinson’s disease
quality of life (PDQL), Parkinson’s Impact Scale (PIMS), and
Parkinson’s Lebens Qualitat (PLQ). Among them, the PDQ-39 is considered the
most appropriate; however, it has shortcomings in the evaluation of self-image sleep
disturbance and sexuality of patients. Because the PDQL takes into account these
problems, it has become an alternative to PDQ-39 [5]. For these reasons, the PDQL has generated more interest, and there
has been an increase in translation and validations for several languages and
cultures [5].The simple translation of HRQL instruments into the language of countries or cultures
different from the ones in which they were developed is insufficient, because the
influence of culture and linguistics may necessitate conceptual changes [6, 7].
While there is no universal agreement about how these instruments must be translated
and culturally adapted, back translation is thought to be the most appropriate
mechanism. After translation and cross-cultural adaptation, the instrument should be
validated in order to determine if the translation process changed the psychometric
properties of the original instrument [7].
The aim of this study was to translate, culturally adapt, and validate PDQL into
Brazilian Portuguese.


## 2. Materials and Methods

### 2.1. Ethics

The study was approved by the Ethics in Research Committee of the Federal
University of Uberlandia (UFU). All of the patients agreed to participate in the
study (consent term). The use of the PDQL is in accordance with the norms of use
of MAPI Trust Research [8].


### 2.2. Instrument

Following the international recommendations for translation and cross-cultural
adaptation [6–8], the original instrument was initially translated into
Brazilian Portuguese by two English language teachers that were born in Brazil
and are fluent in the English language. Both versions were compared by a
neurology professor who is a Brazilian native and who consolidated the first
version. This version was then translated into the original language
(backtranslation) [7] by an English
language teacher from the United Kingdom who is fluent in Brazilian Portuguese.
This version was compared to the original version before being accepted for
cultural adaptation. For cultural adaptation, the instrument was applied given
to a group of patients with PD in order to consolidate the final version to be
validated, the PDQL-BR.The PDQL-BR, like the original, is composed of thirty-seven items divided into
four domains: parkinsonian symptoms (14 items), systemic symptoms (9 items),
emotional function (7 items), and social function (7 items). Each item is scored
from 1 to 5, and the total score of the instrument is given by the sum of the
averages of the scores from each domain. Higher scores represent a better
perception of HRQL by the patient [9].


### 2.3. Patients

A convenience sample, composed of patients diagnosed with PD according to the UK
Parkinson’s Disease Society brain bank criteria, came from the movement
disturbances ambulatory clinic of the UFU, the association of patients with
parkinson’s disease in Uberlandia, and private neurology clinics.
Patients that were unable to participate in everyday activities due to
comorbidities other than PD and patients with serious cognitive damage who
scored less than eighteen points on the Miniexam for mental state [10] were excluded from the study.


### 2.4. Procedures

All of the patients went through a clinical evaluation by a neurologist. The
disease was staged according to the modified classification of Hoehn and Yahr
(HY) [11] and then patients were
classified into phases. The initial phase was composed of HY stages 1.0, 1.5,
and 2.0, the moderate phase HY stage 2.5, and the advanced phase HY stages 3.0,
4.0, and 5.0. A global evaluation of functional damage was done for each patient
using the Unified Parkinson’s Disease Rating Scale (UPDRS) [12]. After clinical evaluation, the
patients answered a social-demographic questionnaire by interview, the PDQL-BR
and the Beck Depression Inventory (BDI) [13], and were invited to return within 14 days to answer the PDQL-BR
again.


### 2.5. Validation

The PDQL-BR was validated by checking the psychometric properties of the
instrument and the quality of the data; reliability and validity were analyzed.
The quality of the data was verified by checking the occurrence of floor and
ceiling effects and the percentage of lost data. The presence of floor or
ceiling effects indicates that the instrument has difficulty detecting
differences in the perception of welfare among individuals with the lowest
possible score (floor effect) or with the highest possible score (ceiling
effect). Lost data are data which could not be used in the evaluation and
interpretation of the application of the instrument, and a loss of less than
10% of the data obtained was considered reasonable [14].The reliability of the instrument was evaluated by determining the internal
consistency of the item, the reliability of the internal consistency, and
reproducibility. The internal consistency of an item evaluates the ability of
each item to contribute to the creation of a basis for the scale that it
represents [15]. It was determined by
correlating each item to its domain and evaluating the percentage of items that
correlate in a satisfactory way to their domain (success rate) [14]. The reliability of the internal
consistency or homogeneity of data of a domain or scale is the extent to which
all of their data define different aspects of the same attribute [15]. The reliability of internal
consistency is guaranteed when the items are moderately correlated to each other
and when each item correlates to the total score [15]. Reliability was calculated for each domain and for the
PDQL-BR. Reproducibility is the capacity of the instrument, in stable
conditions, to reproduce the same results obtained from an initial evaluation
[15]. Reapplication of PDQL-BR
occurred within a period of 14 days after the first test.Validity determines if the tool really measures the concepts it is supposed to
measure, and that it does not measure what it isn’t intended to measure
[16]. Discriminatory validity and
convergent validity were studied. Discriminatory validity verifies the capacity
of the instrument to discriminate among subgroups of patients in different
clinical states [9] and was determined by
comparing the PDQL-BR scores and the parkinsonian symptoms domain and the
systemic symptoms among the groups of patients in initial, moderate, and
advanced phases of the disease. Convergent validity determines the amount of
association between two measures of the same construct [9]. It was determined by correlating scores from the
parkinsonian symptoms domain of the PDQL-BR and scores of the UPDRS III and
among emotional function scores from the PDQL-BR and UPDRS I and the BDI
scores.


### 2.6. Statistics

Descriptive statistics were used for the characterization of the sample. For
correlation tests, the Spearman correlation coefficient was used because it is
considered a satisfactory correlation when it is over 0.4. For the evaluation of
internal consistency of an item, the success rate was considered satisfactory
when it was greater than 80%. For the reliability evaluation of internal
consistency, the alpha-Cronbach coefficient was used, and values over 0.7 were
considered satisfactory internal consistency for comparison among groups. For
the evaluation of reproducibility of the instrument and discriminatory validity,
the Mann-Whitney test was used. The level considered significant wasP<0.05.


## 2.1. Ethics

The study was approved by the Ethics in Research Committee of the Federal
University of Uberlandia (UFU). All of the patients agreed to participate in the
study (consent term). The use of the PDQL is in accordance with the norms of use
of MAPI Trust Research [8].


## 2.2. Instrument

Following the international recommendations for translation and cross-cultural
adaptation [6–8], the original instrument was initially translated into
Brazilian Portuguese by two English language teachers that were born in Brazil
and are fluent in the English language. Both versions were compared by a
neurology professor who is a Brazilian native and who consolidated the first
version. This version was then translated into the original language
(backtranslation) [7] by an English
language teacher from the United Kingdom who is fluent in Brazilian Portuguese.
This version was compared to the original version before being accepted for
cultural adaptation. For cultural adaptation, the instrument was applied given
to a group of patients with PD in order to consolidate the final version to be
validated, the PDQL-BR.The PDQL-BR, like the original, is composed of thirty-seven items divided into
four domains: parkinsonian symptoms (14 items), systemic symptoms (9 items),
emotional function (7 items), and social function (7 items). Each item is scored
from 1 to 5, and the total score of the instrument is given by the sum of the
averages of the scores from each domain. Higher scores represent a better
perception of HRQL by the patient [9].


## 2.3. Patients

A convenience sample, composed of patients diagnosed with PD according to the UK
Parkinson’s Disease Society brain bank criteria, came from the movement
disturbances ambulatory clinic of the UFU, the association of patients with
parkinson’s disease in Uberlandia, and private neurology clinics.
Patients that were unable to participate in everyday activities due to
comorbidities other than PD and patients with serious cognitive damage who
scored less than eighteen points on the Miniexam for mental state [10] were excluded from the study.


## 2.4. Procedures

All of the patients went through a clinical evaluation by a neurologist. The
disease was staged according to the modified classification of Hoehn and Yahr
(HY) [11] and then patients were
classified into phases. The initial phase was composed of HY stages 1.0, 1.5,
and 2.0, the moderate phase HY stage 2.5, and the advanced phase HY stages 3.0,
4.0, and 5.0. A global evaluation of functional damage was done for each patient
using the Unified Parkinson’s Disease Rating Scale (UPDRS) [12]. After clinical evaluation, the
patients answered a social-demographic questionnaire by interview, the PDQL-BR
and the Beck Depression Inventory (BDI) [13], and were invited to return within 14 days to answer the PDQL-BR
again.


## 2.5. Validation

The PDQL-BR was validated by checking the psychometric properties of the
instrument and the quality of the data; reliability and validity were analyzed.
The quality of the data was verified by checking the occurrence of floor and
ceiling effects and the percentage of lost data. The presence of floor or
ceiling effects indicates that the instrument has difficulty detecting
differences in the perception of welfare among individuals with the lowest
possible score (floor effect) or with the highest possible score (ceiling
effect). Lost data are data which could not be used in the evaluation and
interpretation of the application of the instrument, and a loss of less than
10% of the data obtained was considered reasonable [14].The reliability of the instrument was evaluated by determining the internal
consistency of the item, the reliability of the internal consistency, and
reproducibility. The internal consistency of an item evaluates the ability of
each item to contribute to the creation of a basis for the scale that it
represents [15]. It was determined by
correlating each item to its domain and evaluating the percentage of items that
correlate in a satisfactory way to their domain (success rate) [14]. The reliability of the internal
consistency or homogeneity of data of a domain or scale is the extent to which
all of their data define different aspects of the same attribute [15]. The reliability of internal
consistency is guaranteed when the items are moderately correlated to each other
and when each item correlates to the total score [15]. Reliability was calculated for each domain and for the
PDQL-BR. Reproducibility is the capacity of the instrument, in stable
conditions, to reproduce the same results obtained from an initial evaluation
[15]. Reapplication of PDQL-BR
occurred within a period of 14 days after the first test.Validity determines if the tool really measures the concepts it is supposed to
measure, and that it does not measure what it isn’t intended to measure
[16]. Discriminatory validity and
convergent validity were studied. Discriminatory validity verifies the capacity
of the instrument to discriminate among subgroups of patients in different
clinical states [9] and was determined by
comparing the PDQL-BR scores and the parkinsonian symptoms domain and the
systemic symptoms among the groups of patients in initial, moderate, and
advanced phases of the disease. Convergent validity determines the amount of
association between two measures of the same construct [9]. It was determined by correlating scores from the
parkinsonian symptoms domain of the PDQL-BR and scores of the UPDRS III and
among emotional function scores from the PDQL-BR and UPDRS I and the BDI
scores.


## 2.6. Statistics

Descriptive statistics were used for the characterization of the sample. For
correlation tests, the Spearman correlation coefficient was used because it is
considered a satisfactory correlation when it is over 0.4. For the evaluation of
internal consistency of an item, the success rate was considered satisfactory
when it was greater than 80%. For the reliability evaluation of internal
consistency, the alpha-Cronbach coefficient was used, and values over 0.7 were
considered satisfactory internal consistency for comparison among groups. For
the evaluation of reproducibility of the instrument and discriminatory validity,
the Mann-Whitney test was used. The level considered significant wasP<0.05.


## 3. Results

### 3.1. Instrument

During the process of cross-cultural adaptation, item 20 of the scale referred to
“períodos de liga/desliga” was modified
to “períodos de trava/destrava (momentos
com/sem ação dos remédios)” to improve the
understanding of the phase.


### 3.2. Patients

Fifty-eight patients were invited to participate in the study. Five were excluded
because they had cognitive damage, and one did not fit the criteria for
diagnosis of PD. Thirty-six (69.2%) were male. The patients’ ages
varied from 37 to 88 years (average: 64.83 PD 11.81). Forty-five (86.5%) of
the patients were Caucasian, and 33 (63.5%) were married. The clinical
characteristics are presented in Table1.Table 1
Clinical characteristics of patients.
Clinical characteristics
(N)
(%)
Duration of illness
Up to 5 years
25
48.1
From 6 to 10 years
13
25.0
More than 10 years
13
25.0
Unknown
1
1.9
Staging
Initial phase (HY 1/1.5/2)
8
15.3
Moderate phase (HY 2.5)
23
44.2
Advanced phase (HY 3/4/5)
21
40.4


### 3.3. Validation

#### 3.3.1. Quality of Data

Floor and ceiling effects were not observed for any of the PDQLBR domains,
and the rate of lost data varied among domains from 0.3 to 0.6%.


#### 3.3.2. Reliability

For internal consistency of items, all of the items in both the systemic
symptoms and social function domains had correlations greater than 0.4 with
their respective scales (success rate of 100%). In the parkinsonian
symptoms domain, the items 20 and 30 had correlations of 0.34 and 0.26,
respectively, but the other items had correlations that were greater than
0.4 (success rate of 85.71%). In the emotional function domain, item 37
had a correlation of 0.37. The other items had correlations that were
greater than 0.4 (success rate of 88.89%). For evaluation of the
reliability of internal consistency, the alpha Cronbach coefficient of the
tool and for each domain was higher than 0.65 and can be seen in Table2. Twenty-one patients answered the
PDQLBR again for the evaluation of reproducibility. The second occurrence
was fourteen days after the first application of the instrument. There were
no statistically significant differences between the average scores of the
two PDQL-BR applications.Table 2
Comparison of the alpha-Cronbach coefficients among studies.
De Boer et al. [9]
Hobson et al. [2]
Serrano-Dueñas et al. [19]
Present study
PDQL
0.94
0.95
0.92
0.93
Parkinsonian symptoms
0.86
0.87
0.85
0.83
Systemic symptoms
0.80
0.77
0.69
0.65
Emotional function
0.87
0.87
0.78
0.79
Social function
0.82
0.85
0.81
0.80


#### 3.3.3. Validity

In the evaluation of discriminatory validity of the PDQL-BR, the parkinsonian
symptoms and the systemic symptoms scores showed differences among all the
phases of the disease because the average scores of the patients in each
phase differed, with lower scores as the disease advanced. For convergent
validity, correlation between the parkinsonian symptoms domain of the
PDQL-BR and UPDRS III was 0.78. For the emotional function domain of the
PDQL-BR, correlations with the UPDRS I and the DBI were 0.59 and 0.57,
respectively, with significance level of 0.01.


## 3.1. Instrument

During the process of cross-cultural adaptation, item 20 of the scale referred to
“períodos de liga/desliga” was modified
to “períodos de trava/destrava (momentos
com/sem ação dos remédios)” to improve the
understanding of the phase.


## 3.2. Patients

Fifty-eight patients were invited to participate in the study. Five were excluded
because they had cognitive damage, and one did not fit the criteria for
diagnosis of PD. Thirty-six (69.2%) were male. The patients’ ages
varied from 37 to 88 years (average: 64.83 PD 11.81). Forty-five (86.5%) of
the patients were Caucasian, and 33 (63.5%) were married. The clinical
characteristics are presented in Table1.Table 1
Clinical characteristics of patients.
Clinical characteristics
(N)
(%)
Duration of illness
Up to 5 years
25
48.1
From 6 to 10 years
13
25.0
More than 10 years
13
25.0
Unknown
1
1.9
Staging
Initial phase (HY 1/1.5/2)
8
15.3
Moderate phase (HY 2.5)
23
44.2
Advanced phase (HY 3/4/5)
21
40.4


## 3.3. Validation

### 3.3.1. Quality of Data

Floor and ceiling effects were not observed for any of the PDQLBR domains,
and the rate of lost data varied among domains from 0.3 to 0.6%.


### 3.3.2. Reliability

For internal consistency of items, all of the items in both the systemic
symptoms and social function domains had correlations greater than 0.4 with
their respective scales (success rate of 100%). In the parkinsonian
symptoms domain, the items 20 and 30 had correlations of 0.34 and 0.26,
respectively, but the other items had correlations that were greater than
0.4 (success rate of 85.71%). In the emotional function domain, item 37
had a correlation of 0.37. The other items had correlations that were
greater than 0.4 (success rate of 88.89%). For evaluation of the
reliability of internal consistency, the alpha Cronbach coefficient of the
tool and for each domain was higher than 0.65 and can be seen in Table2. Twenty-one patients answered the
PDQLBR again for the evaluation of reproducibility. The second occurrence
was fourteen days after the first application of the instrument. There were
no statistically significant differences between the average scores of the
two PDQL-BR applications.Table 2
Comparison of the alpha-Cronbach coefficients among studies.
De Boer et al. [9]
Hobson et al. [2]
Serrano-Dueñas et al. [19]
Present study
PDQL
0.94
0.95
0.92
0.93
Parkinsonian symptoms
0.86
0.87
0.85
0.83
Systemic symptoms
0.80
0.77
0.69
0.65
Emotional function
0.87
0.87
0.78
0.79
Social function
0.82
0.85
0.81
0.80


### 3.3.3. Validity

In the evaluation of discriminatory validity of the PDQL-BR, the parkinsonian
symptoms and the systemic symptoms scores showed differences among all the
phases of the disease because the average scores of the patients in each
phase differed, with lower scores as the disease advanced. For convergent
validity, correlation between the parkinsonian symptoms domain of the
PDQL-BR and UPDRS III was 0.78. For the emotional function domain of the
PDQL-BR, correlations with the UPDRS I and the DBI were 0.59 and 0.57,
respectively, with significance level of 0.01.


## 3.3.1. Quality of Data

Floor and ceiling effects were not observed for any of the PDQLBR domains,
and the rate of lost data varied among domains from 0.3 to 0.6%.


## 3.3.2. Reliability

For internal consistency of items, all of the items in both the systemic
symptoms and social function domains had correlations greater than 0.4 with
their respective scales (success rate of 100%). In the parkinsonian
symptoms domain, the items 20 and 30 had correlations of 0.34 and 0.26,
respectively, but the other items had correlations that were greater than
0.4 (success rate of 85.71%). In the emotional function domain, item 37
had a correlation of 0.37. The other items had correlations that were
greater than 0.4 (success rate of 88.89%). For evaluation of the
reliability of internal consistency, the alpha Cronbach coefficient of the
tool and for each domain was higher than 0.65 and can be seen in Table2. Twenty-one patients answered the
PDQLBR again for the evaluation of reproducibility. The second occurrence
was fourteen days after the first application of the instrument. There were
no statistically significant differences between the average scores of the
two PDQL-BR applications.Table 2
Comparison of the alpha-Cronbach coefficients among studies.
De Boer et al. [9]
Hobson et al. [2]
Serrano-Dueñas et al. [19]
Present study
PDQL
0.94
0.95
0.92
0.93
Parkinsonian symptoms
0.86
0.87
0.85
0.83
Systemic symptoms
0.80
0.77
0.69
0.65
Emotional function
0.87
0.87
0.78
0.79
Social function
0.82
0.85
0.81
0.80


## 3.3.3. Validity

In the evaluation of discriminatory validity of the PDQL-BR, the parkinsonian
symptoms and the systemic symptoms scores showed differences among all the
phases of the disease because the average scores of the patients in each
phase differed, with lower scores as the disease advanced. For convergent
validity, correlation between the parkinsonian symptoms domain of the
PDQL-BR and UPDRS III was 0.78. For the emotional function domain of the
PDQL-BR, correlations with the UPDRS I and the DBI were 0.59 and 0.57,
respectively, with significance level of 0.01.


## 4. Discussion

The clinical characteristics of the evaluated patients were similar to the
characteristics observed in other studies of translations and validation of PDQL.
The population of the study was similar with regard to the evolution of the disease
[17–19]. The data obtained were satisfactory for analysis. The data
collection by interview minimized the loss of data, and the absence of floor or
ceiling effects indicated that, according to theory, the translated version of the
instrument kept its capacity to determine changes. It is possible that the patients
did not have a good understanding of item 20 “períodos de
trava/destrava (momentos com/sem ação dos
remédios),” because this item had been translated as
“períodos liga/desliga” in the translation process and then had
generated incapacity of understanding by the patients. Even after a change in the
translation, it is possible that patients still did not fully understand the
symptom, causing low correlation with the domain that it represents. However, the
low correlations of items 30 “movimentos repentinos e não
controlados” and 37 “sente-se preocupado (a) com as
possíveis consequências de uma operação por causa de sua
doença” are possibly associated with the inner
characteristics of the studied population. In the first item, patients from
nonspecialized ambulatory clinics before the inclusion of the disturbance movement
ambulatory clinic of the Federal University of Uberlandia were medicated with low
doses of levodopa and, consequently, had low frequencies of motor fluctuation, the
symptom referred to in item 30. However, they indicated that they had significantly
damage from the disease due to the use of very low doses of levodopa. Item 37 does
not depend on the clinical condition of the patient. Surgical procedures for
treatment of PD are not routinely performed at the clinics from which the patients
were recruited, which may not mean anything for most patients. The instrument showed
itself to be reliable, because the alpha Cronbach coefficient for most domains was
higher than 0.7. Only in the systemic symptoms domain was it 0.65. However, great
correlation was observed among the principal studies of validation of the instrument
in different cultures, according to Table 2.The translated version of the instrument demonstrated good reproducibility because
there were no significant variations in the scores obtained from the first and the
second application. For the validity evaluation, we observed that the instrument had
a good convergent validity and showed good association between the parkinsonian
symptoms domain and the UPDRS III motor evaluation and also among the emotional
function domain and the evaluation for UPDRS I and BDI scores. We also observed that
the tool had a good capacity to discriminate among patients in the initial,
moderate, and advanced stages.


## 5. Conclusions

We conclude that the translated version of PDQL (PDQL-BR) did not undergo meaningful
changes in the process of translation and cross-cultural adaptation and keeps its
psychometric proprieties well preserved. A careful interpretation of the evaluation
of answers to items 20, 30, and 37 is recommended.The current study showed that PDQL-BR is a valid instrument for use in Brazil;
however, the validation process is dynamic and goes through changes over time. Only
frequent use of the instrument will result in more consistent theoretical
evaluations. Thus, we understand that more studies using the instrument will be
fundamentally important for increasing the knowledge of it.



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*Source: 954787-2011-07-28.xml*