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and the older at
-- Jerzy• t 08:04, 7 June 2013 (UTC)
As an aid to later editors studying the edit history, i am adding this documentation of the preceding hard-to-trace events, and saving, prior to an additional edit for the following purpose:
Talking about QTc, how about providing the references to Bazett's and Rautaharju's publications???
JFW |
T@lk
11:15, 7 May 2004 (UTC)
I didn't understand what is the "lead". Does it have anything to do with the chemical element?-- 132.66.16.12 08:44, 26 Aug 2004 (UTC)
In (probably) simpler words, a lead is a PAIR of electrodes, & any electrical disturbance created by the activity of the heart has to "do work" against the potential difference existing between the 2 electrodes. It is not explained in the article, but the electrodes function as if acting from the points of attachment of the limb to the body. Even though potential difference is a scalar, the leads have a direction. For instance, in lead I, the the electrode attached to the left upper limb is it at a higher potential than the opposite arm, so a positive electrical disturbance (generated from the heart) will have to do positive work in travelling from the left to the right side. Hence, this will be registered as a positive deflection. KC Panchal 11:10, 5 February 2007 (UTC)
Why do vawes start with the letter "P"? Why it does not start with, for example, "A"? Why does zero degree of the axis in frontal projection place at "03.00"? Simonnanlohy 17:28, 30 July 2007 (UTC)
like electroencephalography - Omegatron 18:20, Apr 19, 2005 (UTC)
"through the interventricular septum. Very wide and deep Q waves do not have a septal origin, but indicate myocardial infarction."
The Q-wave normally indicates the phase during which the septum depolarises. However, a similar change (but much more pronounced) is seen in the hours after the onset of a heart attack. JFW | T@lk 10:24, 20 Apr 2005 (UTC)
I've heard that electrocardiogram (ECG) is pronounced EKG so it would be easier to differentiate from EEG in speech, it's also phonetic, not because cardio- starts with K in german Prometheus235 14:27, 14 Jun 2005 (UTC)
The article on Willem Einthoven (Nobel Prize winner for his EKG work) is currently quite stubby. Could someone with expertise in this area expand his article a bit? Sayeth 21:21, 6 February 2006 (UTC)
The figure [ [2]] labels the PQ segment as a PR segment. —Preceding unsigned comment added by 194.171.252.100 ( talk • contribs) 19 Sep 2006
I am reading Fundamental Accounting Principles (18 edition, Wild, Larson, Chiapetta, www.mhhe.com/wildFAP18e McGraw-Hill Irwin) and on page 314 it says "There's a new security device -- a person's ECG (electrocardiogram) reading -- that is as unique as a fingerprint and a lot harder to lose or steal than a PIN. ECGs can be read through fingertip touches. An ECG also shows that a living person is actually there, whereas fingerprint and facial recognition software can be fooled." It would be interesting to add this information to the article, and if anyone has any more information reguarding this. I'm not sure how to reference it or where to put it, so if someone else could do it, that would work.— Preceding unsigned comment added by 66.68.213.216 ( talk) 19:21, 22 November 2006
Anything intended to be used as a personal identity mark has to be unique (which your source claims the ECG to be, but is hard to digest), but more than that, it has to be REPRODUCIBLE, which ECG, most certainly, is not. That's because, the tracing keeps on changing not just from minute-to-minute, but even with something as simple as breathing in (heart rate increases) or breathing out. So, I totally agree with John. KC Panchal 11:17, 5 February 2007 (UTC)
It is true that an EKG is probably akin to a fingerprint in a given individual especially if they have an electrical birthmark (many folks do). Transthoracic computational analysis of a standard EKG reads perhaps less than 40% of subjects as normal. Straightforward presentations of recent, evolving or past Myocardial Infarction or Bundle Branch Block immediately identify a given individual. Variability in lead placement probably negates the admissability of this evidence in a court of law. Limb leads may narrow the agreed upon signature. Interventional electrophysiology allows selective changes in the EKG and thus seals the identity beyond question. Anyone who has had an EP study is probably easily later recognizable to the operator that performed the study. Retrieval of an EKG of any quality through the touch of fingertips sounds 50 years out. --lbeben 00:31, 27 March 2010 (UTC)
I have no knowledge or experience of ECG as security devices, but do know that apart from physiological changes affecting ECGs, biochemical disturbances, some medications and a number of disease processes affect ECG tracings (and at times dramatically) thus undermining their reproducibility, as KC Panchal suggests. Could Lbeben or John cite some peer-reviewed primary sources (i.e. experimental data) to support their claims? Kitb ( talk) 02:53, 4 February 2010 (UTC)
So if you're post MI you couldn't access your bank account due to your lengthened QT interval? I really can't see this idea taking off. In cardiac electrophysiology patients are treated all of thetime via RF (or cryo) ablation with the very idea of changing their ECG. Look at pre ablation and post ablation ECGs and you wouldn't know it was the same person. 87.114.241.27 ( talk) 20:56, 12 March 2010 (UTC)
Oxford DNB credits Alexander Muirhead with using an electrocardiogram as early as 1872. I've credited him with this 'first' though others exploited it. Ephebi 16:10, 27 November 2006 (UTC)
The history section is very poorly written and misleading. For example even the date that Einthoven invented the string galvanometer is wrong. I believe the authors have simply reworked secondary publications and have not done the primary research of the dates and people involved in the early years of electrocardiography. I suggest having a look at my extensively researched account on http://www.ecglibrary.com/ecghist.html Dean.jenkins ( talk) 21:14, 7 September 2009 (UTC)
Could we please get an image of an electrocardiograph from after a hundred years ago? I don't want people thinking doctors still use EK graphs that look like they were commissioned to be built by the tsar. VolatileChemical 10:55, 3 January 2007 (UTC)
the lack of a penis on the picture is offensive and odd. I would serously consider changing it.
— Preceding
unsigned comment added by
131.227.105.78 (
talk) 17:57, 11 June 2010
Discussion of posterior leads needed.
— Preceding
unsigned comment added by
147.188.80.202 (
talk) 14:55, 14 February 2007
Gd afternoon sir,
What is the different between physical examination and clinical laboratory ?
< Physical examination : body temp. , BP ,
clinical laboratory : ECG , blood clotting >
In physical examination , body temp. have to be used termometer , Blood pressure have to be used Sphygmomanometer .
Both of them are used equipment to approach. So i think that they should be grouped in the clinical laboratory such like ECG and blood clotting. But why they are grouped in Physical exam ?
thank you ,
protrude from sulcus limitans , k_pinyosamosorn@hotmail.com
— Preceding
unsigned comment added by
Protrude-from-Sulcus-limitans (
talk •
contribs) 10:31, 30 March 2007
Hi, the above named image from this article needs to be changed as there is a slight mistake. The second arrow down is pointing the wrong way, so is identical to the diagram above it. The negative deflection on the ECG should be represented by current moving away from a positive electrode. Thanks. Djsilverspoon 16:01, 3 April 2007 (UTC)
I removed this section from the article:
In my opinion, this gives the concept of an 'ST interval' undue weight. It's an obscure, minority concept in electrocardiography, and not particularly notable. I've heard it referred to as the JT interval (J point to end of the T wave) which is a more precise description. The JT interval is used to estimate the QTc for patients with a baseline intraventricular conduction defect. But no one talks about an ST interval (or JT interval) in common practice. I'd like to see more references to prove this measurement is notable. MoodyGroove 20:31, 10 April 2007 (UTC)MoodyGroove
Moved this section to the bottom of talk page per talk page guidelines. MoodyGroove 02:42, 5 May 2007 (UTC)MoodyGroove
This whole page is confusing except for the history! And I'm a brand new med student too... —Preceding unsigned comment added by Flashpoint145 ( talk • contribs) 23:19, 11 April 2007
Why don't YOU find it confusing? Because you thoroughly understand the topic? I've always thought of Wikipedia to be a great source of education. It is difficult to learn something if you do not understand what is being said. If the medical terms and jargon were to be dumbed down to a middle or high school level, the article would be much easier for the general public to comprehend. Imagine a middle school student having to do a science project on EKG's. Would that student find this article easy to read? Put yourself in the shoes of others. What I'm trying to say here is that the wording of the article is too technical and needs to be fixed in such a way that the article can be understood by people outside of the medical field. With that said, I'm re-tagging the article due to the vocabulary and terminology in these sections:
Flashpoint145 18:32, 4 May 2007 (UTC)
72.40.44.83 11:02, 5 May 2007 (UTC)
![]() | This article may be too technical for most readers to understand.(September 2010) |
My question is: What is the significance of the elevated and depressed ST segment? Apparently it refers to a myocardial infarction, and that seems to be a leading cause of cardiac related death - so should it not have its own sub-heading and discussion? Nitric Oxide 19:32, 14 August 2007 (UTC)
Should the middle image in this diagram not feature the depolarisation moving away from the positive electrode to cause a negatively deflected wave? richard —The preceding unsigned comment was added by 81.129.83.203 ( talk) 09:35, 13 April 2007 (UTC).
I would like to suggest that this article be assessed by an expert for Good Article status. (Reason that I am not adding this directly to WP:GA/N is that I specifically request that the evaluation be done by an expert.) 69.140.164.142 04:48, 19 April 2007 (UTC)
While working with the Electrotridoshagraphy technology [9], which is an Ayurvedic whole body scan and is also used for status quantification of the Ayurvedic basic principles, the inventer of the ETG technology Dr. Desh Bandhu Bajpai have innovated presently ECG machine, which is an advance level achievement of the Electrocardiography. Conventional ECG machine can diagnose whether the sick person is suffering from cardiac disorders or not. But this innovative machine [10]is able to diagnose, if the complaints are due to Thyroid, pulmonary circulation, Muscular or neurogical problems, epigastritis, Pancreatitis, renal problems etc. user:debbe,28 April 2007,11:19 PM IST. — Preceding undated comment added 17:42, :42, & :45, 28 April 2007
I removed this comment from the article:
This is inflammatory, and it simply isn't true.
--
MoodyGroove
21:47, 2 May 2007 (UTC)MoodyGroove
I was reading the chapter in Harrison's on electrocardiography and I wanted to review it in an article on the level of the general reader (which is what Wikipedia is supposed to be).
This entry has a lot of interesting background, particularly the history, but it's pretty difficult reading, for all the reasons people have already given.
I think of a prototypical reader of Wikipedia as a technical person who may not know much about medicine but who just had a diagnosis of heart disease and wanted to understand his EKG. Or it could be an intelligent high school student (or anybody) who's curious. Such a person couldn't understand this article.
For example, if I didn't know what a depolarization vector was, I couldn't figure it out from reading this article. The sections on the limb leads and precordial leads don't clearly explain what the purpose of those leads are (to identify the direction of the vector in the frontal and horizontal plane, respectively, as Harrison's explained it).
The curious thing about this article is that it starts off to explain something, and then goes off on a digression. The section on limb leads starts to explain what they are, and then goes off about Einthoven's buckets of salt water. I realize this is interesting to you (and to me), but an ordinary reader can't follow this if you keep interrupting with historical footnotes.
Richard Feynmann (and others) said that, if you can't explain something to a 12-year-old, you don't understand it yourself. An intelligent high school science student could get through the Harrison's chapter. And there's the idiot's guide to EKGs, Dale Durbin's "Rapid Interpretation of EKG's". It's not an inherently difficult subject. Nbauman ( talk) 00:54, 20 January 2008 (UTC)
Toozdaygirl, instead of saying,
"It is the most painless, inexpensive and quick way to measure and diagnose abnormal rhythms of the heart."
isn't it simpler to say,
"It is the best way to measure and diagnose abnormal rhythms of the heart."
I think that's what the source, Braunwald, says.
Is there a better way to measure and diagnose abnormal rhythms? Is there a better way that is painful? Nbauman ( talk) 15:58, 18 February 2008 (UTC)
Cardiac catheterisation isn't entirely painless but is done under local anisthetic and conscious sedation. This is a much more accurate way to diagnose problems as catheters can be placed inside the heart to record the intracardiac electrograms. This also allows ablation of the problem area with a catheter. Beyond this, the electrical system of the heart can also be mapped with catheters to build a geomemetry and visualise the electrograms moving across the myocardium. There are also a few surgical methods too. 87.114.241.27 ( talk) 21:05, 12 March 2010 (UTC)
It appears that the color coding of the electrodes for the limb leads is different in different countries. And this seems to be just the just the right place to find out more about it. I guess a small table is the easiest way to do so. Feel free to add or not to add a respective link as you see fit. -- Dietzel65 ( talk) 09:34, 7 May 2008 (UTC)
as described in the article.
Note: This appears to be the American Health Association (AHA) recommendation [11]
Used in which countries?
JPINFV ( talk) 20:59, 12 May 2008 (UTC)
Called "traffic light code", at least in Germany.
Note: This appears to be the International Electrotechnical Commission (IEC) recommendation [13]
Used in:
Are there additional color codes used anywhere? If so, please add them.— Preceding
unsigned comment added by
Dietzel65 (
talk •
contribs) 09:34, 7 May 2008
RA=Red, RL= Blue, LL=Green, LA=Yellow — Preceding
unsigned comment added by
117.228.60.17 (
talk)
16:07, 2 August 2011 (UTC)
I have replaced the word salt by electrolytes, because it was just plain wrong. A salt is a compound composed of two differently charged ions (e.g. Sodiumchloride or Potassiumbicarbonate), whereas an electrolyte is an electrically active dissolved ion. I read (and generally agree with) the reasoning above about using as simple as possible words in the introduction as to not discourage readers, but I believe this should not happen at the expense of correctness. Lennert B ( talk) 12:06, 11 May 2008 (UTC)
According to Jaakko Malmivuo & Robert Plonsey: Bioelectromagnetism - Principles and Applications of Bioelectric and Biomagnetic Fields, Oxford University Press, New York, 1995. chapeter 15.1 Clément Ader was the inventor of the string galvanometer. They cite Ader C (1897): Sur un nouvel appareil enregistreur pour cables sousmarins. Compt. rend. Acad. Sci. (Paris) 124: 1440-2 as source for this statement. Which is older than all papers by Einthoven on this subject.
see: [15] —Preceding unsigned comment added by Frodo Muijzer ( talk • contribs) 10:28, 20 October 2008 (UTC)
-- User:OnixWP — Preceding undated comment added 23:53, 29 October 2008
Reading of the above is acknowledged. This is a wonderful, important and (my opinion) confusing article to mostmuch of the Wiki readership out there. I have always enjoyed reading EKGs for many years but cannot for the life of me explain the concept to my (somewhat disinterested) adult sons. I'm I am not certain about the rules on articles, but could it the Electrocardiogram article be edited to an A level of understanding as well as a concurrent B level of understanding in effort to smooth ruffled feathers? The electrocardiogram is actually a very complex and evolving Einthoven opened a keyhole on transthoracic appreciation of organized electrical activity of the heart. Evolution of this concept as evidenced by the contributions is rapidly advancing under the discipline of invasive EP
Invasive Electrophysiology. The readership of the article is probably heavily weighted to the B level of understanding. Perhaps we could better define the readership demographics and edit it the article into two channels.--lbeben 03:58, 20 December 2008 (UTC)— Preceding
unsigned comment added by
User:Lbeben (
talk •
contribs) 01:24 & :26, 19th, & 03:58, 20th December 2008
I did a major edit of a small section just now. I removed a lot of historical info that I didn't think belonged in a section that a lot of people were probably going to view as (a) confusing enough already and (b) the practical "how to" section of the article. See above discussion of readability if you have thoughts of adding technical jargon back into this section. Btw, ELECTRODES go on the body. LEADS are the signals. [1] Walking Softly ( talk) 10:13, 11 May 2009 (UTC), Card Zero ( talk) 14:50, 8 March 2011, & Jerzy• t 06:39, 8 June 2013 (UTC)
References
The diagram is horrendous. The precordial leads aren't even properly placed. I am going to change the caption to make it misleading no longer, but the whole picture needs to go. Can we please have someone do a new diagram? If someone is artistic, please let me know, and I will point you to a proper diagram to "adapt." Walking Softly ( talk) 10:13, 11 May 2009 (UTC)
I have just entered the Biomedical Engineering Technician field and was drawn to this article so that I could have some clarification on ECGs. After reading the article several times, I feel that the limb leads (and below) sections are very 12-leads centric, even though most ECG monitoring doesn't use 12-lead configurations.
Thanx, Ed
The.loquitur ( talk) 03:30, 9 June 2009 (UTC)
The image with the augmented leads is still misleading as the augmented leads do not originate from the Wilson's central termínal, but from the "average" of other two leads. This is not the same !
188.238.152.205 (
talk)
07:36, 6 April 2019 (UTC)
I have added this sentence in brackets, as I did not understand the purpose of Wilson's central terminal was.
(recall that Wilson's central terminal is the average of the four limb leads. This will approximate ground)
I am only a lowly first year medical student, so if it is wrong, please correct it. M0rt ( talk) 07:49, 13 May 2009 (UTC)
ECG should also have info about vector cardiograms —Preceding unsigned comment added by Syeda Fizza Batool ( talk • contribs) 11:05, 30 June 2009 (UTC)
I am not shure, how short the PQ segment can be, but it must not be longer than about 120ms, because the PQ intervall must not be longer than 200ms. —Preceding unsigned comment added by 131.220.35.12 ( talk) 21:52, 28 January 2010 (UTC)
heart is a massive problem —Preceding unsigned comment added by 174.114.236.189 ( talk) 02:35, 12 February 2010 (UTC)
I came looking for some info about EKG machines, but this page seems to be concerned mainly with biology/medicine of EKG. I'd expect at least a block scheme and short text commenting that & linking to respective electronics articles, eg. Instrumentation amplifier, Transient voltage suppressor etc... Would that belong here? VladimirSlavik ( talk) 11:53, 18 November 2010 (UTC)
Same here, I want to know about the engineering and the coding that make an ecg work. I want to know about all that makes an ecg. —Preceding unsigned comment added by 68.19.159.27 ( talk) 04:55, 13 May 2011 (UTC)
I started a section on this...now almost 6 years later. Feel free to spruce it up and include a block diagram. There's a lot that could go into this section though. Cburnett ( talk) 17:23, 24 April 2016 (UTC)
I just cleaned this up. I have not removed the "needs cleanup" template, because the long paragraph starting "the time intervals between consecutive heart beats" has a funny smell. It all seems like useful technical information - I wouldn't know - but it was all added at once, was duplicated in cardiac cycle (I have removed it from there), and spoke gushingly (I have removed the gushing) about this wonderful new process called CZF, then linked to a website which, as well as telling you all about it, will sell it to you. So I don't think it needs a stylistic cleanup any more, but it needs checking out by somebody who knows anything about electrocardiography (not me). Card Zero (talk) 14:47, 8 March 2011 (UTC)
The section on waves explains both waves and segments but leaves out the Q wave and R wave. It would be helpful if someone could break down the reason for the QRS morphology.
AriaNo11 ( talk) 16:49, 30 March 2011 (UTC)
Within the ekg coding, is the tangent function involved in anyway? —Preceding unsigned comment added by 68.19.159.27 ( talk) 23:00, 12 May 2011 (UTC)
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I would like to include more information about the physics of Electrocardiograms, but will probably need to spend a little more time with Partial Differential Equations before I am ready to contribute this material. As such, I am giving this article a "start" rating for physics given that it has very little information about the technical properties of electrocardiography. It is an excellent introduction to ECGs for medicine, but it does not include the physics, just to be clear I mean no insult to the persons who have written this by calling it a "start" rating for the Physics project. Bloomingdedalus ( talk) 17:32, 19 June 2011 (UTC)
The section on ECG graph paper starts by saying it is standards to scale the y axis at 1mm per mV, but ends by saying 1mV must move the stylus 1 cm (i.e. 10 mm per mV). I believe the latter is correct. — Preceding unsigned comment added by 81.129.213.76 ( talk) 12:23, 8 January 2013 (UTC)
According to Ansi AAMI standard (EC 11 standard (1991), "Diagnostic Electrocardiographic devices") the low-pass filter must be set at least at 150Hz for diagnostic purposes. (The American Heart Association recommends that diagnostic ECGs have a frequency response up to 150 Hz.)
This avoids significant distortion on QRS-T transients that arise when low pass cut-off frequency is lower (e.g 100 Hz).
Other editors suggests that "in diagnostic mode, the low pass filter can be set to 40, 100, or 150Hz;"
The second issue is probably true on specific devices but may be misleading since 150 Hz should be set on filter to avoid impact on interpretation.
Suggestions on this issues are welcomed — Preceding unsigned comment added by Cbecc ( talk • contribs) 13:32, 20 September 2013 (UTC)
In the "Waves and Intervals" section it seems to me that the explanation on the 'PR segment' may be wrong, it currently reads:
The PR segment connects the P wave and the QRS complex. The impulse vector is from the AV node to the Bundle of His to the bundle branches and then to the Purkinje fibers. This electrical activity does not produce a contraction directly and is merely traveling down towards the ventricles, and this shows up flat on the ECG. The PR interval is more clinically relevant.
It has always been my understanding that during the PR segment the AV node is delaying transfer of the electrical signal from Atria to Ventricals, were the signal to be traveling down the Bundle of His that would be the very definition of electrical activity the ACG should (and does) detect, flat on ECG is no electrical activity, whether contractions happen or not can't be told from ECG alone (PEA is the perfect example for that). -- Keeper of the Keys ( talk) 00:28, 21 January 2015 (UTC)
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The only grades I feel at all qualified to give out are A, B, Start, and Stub. GA and FA have existing processes in place which I will not try to bypass. Having said that, my only real concerns about the article is the comparative lack of inline citations and the existing structure. I note the ECG graph paper, Leads, Precordial, Ground, Axis, Waves and intervals, P wave, PR interval, QRS complex, ST segment, T wave, Rhythm analysis, and Representation in culture sections each have no inline citations. It is possible that all this information qualifies as Wikipedia:Scientific citation guidelines#Uncontroversial knowledge, and thus not require specific referencing. I am myself not sufficient expert in the field to say one way or another. Also, I question including the "History" section so late in the article. I think generally such sections, explaining the development of the subject, come earlier, generally making it a bit easier for the reader to perhaps see how other items mentioned in the article developed over time. That, however, is just my opinion. I might find the appropriate citations for the sections above, if required, and then nominate the article for Wikipedia:Peer review for what would with any luck be more informed opinion. John Carter 13:51, 4 May 2007 (UTC) |
Last edited at 05:15, 13 March 2009 (UTC). Substituted at 14:18, 29 April 2016 (UTC)
The table in the "Electrodes and leads" section lists 10 electrodes, even though the sentence before the table reads: "The 12 leads in a 12-lead EKG are listed below". The meaning of "lead" is not defined well enough. Can an electrode have more that one lead? If so, what leads are missing from the table of electrodes? EditorAtLarge ( talk) 09:54, 6 September 2016 (UTC)
The article contains the phrase "a conventional 109 ECG", with no explanation given. What does the number refer to? is it part of a larger system of numericlature for procedures, or is it specific to ECGs? I did a quick search but didn't find an answer. MrRK ( talk) 16:11, 7 September 2017 (UTC)
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Hello world! It's been a while since I've edited but here goes. I think the following section of the intro is not accurate and is covered better in the Theory section anyway. Here's my explanation, since this edit removes a substantial chunk I thought I should justify:
"It can also be further broken down into the following:
In summary I have removed this section as it duplicates existing content in the Theory section and does not use standard accepted definitions / descriptions of these terms. It was also unreferenced.
Hope this is ok by more experienced editors! Bron ( talk) 20:28, 31 March 2019 (UTC)
Can someone please explain what a capacitively coupled electrocardiogram, a conventional galvanic reference ECG and their differences in Capacitive ECG Monitoring in Cardiac Patients During Simulated Driving. are? -- 46.83.142.48 ( talk) 15:56, 18 September 2019 (UTC)
The following Wikimedia Commons file used on this page or its Wikidata item has been nominated for deletion:
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Could not somebody add the normal values of the quantities PR, QRS, and QT or else I would.
Ahmad 123456p ( talk) 16:43, 29 January 2021 (UTC)
What is the interpretations of the down stroke in the EKG like the second half of the P wave? And what action of the electrical activity of the heart does it represents? And the same I'm wondering with the T wave? Willing student ( talk) 07:16, 22 December 2021 (UTC)
Description of using of RL electrode for voltage calculation is must be at this article. Or the non-using of it must be indicated explicitly. Voproshatel ( talk) 16:07, 7 October 2023 (UTC)
Edit: Nevermind, my confusion was answered later in the article.