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Lim M, Bohorquez NG, Mitchell R, Cramb S, Bradford N, Naicker S, Kularatna S, Senanayake S. Financial Aid in Children, Adolescents and Young Adult's Cancer Care: A Scoping Review. J Adolesc Young Adult Oncol 2024. [PMID: 38451723 DOI: 10.1089/jayao.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background: The financial burden resulting from cancers on families is higher when it arises in young people compared with older adults. Previous research has provided insight into the financial toxicities associated with childhood cancer, but less is known about the efficacy of financial aid systems in reducing the financial burden on families. We conducted a scoping review to identify the determinants of success and failure of financial aid. Methods: Five databases were searched for articles published between January 1, 2000 and December 1, 2022. Dual processes were used to screen and select studies. Through thematic content analysis, we identified barriers and enablers of financial aid, categorised by country income level. Results: From 17 articles, which were evenly split between high-income countries and upper middle- to low-income countries, four major themes emerged: (1) accessibility of support, (2) delivery of support, (3) administration, and (4) psychosocial factors. Within these themes, the enablers identified were (1) support navigators, (2) establishing a direct contact between donors and beneficiaries, (3) implementation of digital solutions to improve outreach, and (4) using cultural and community values to encourage donor engagement. Conclusions: This scoping review identified the determinants of success and failure of financial aid in supporting families in the context of childhood, adolescent, and young adult (CAYA) cancers. By understanding the barriers and enablers identified in this review, organizations could develop pragmatic evidence-based care models and policies to ensure access to assistance is equitable and appropriate for families experiencing CAYA cancers.
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Affiliation(s)
- Megumi Lim
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Natalia Gonzalez Bohorquez
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Remai Mitchell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre at the Centre for Children's Health Research, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
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Alam A, Kumar A. Impact of financial support and focussed group counselling on treatment abandonment in children with acute lymphoblastic leukaemia. Experience over 22 years from North India. Psychooncology 2018; 28:372-378. [DOI: 10.1002/pon.4951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/29/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Areesha Alam
- Division of Pediatric Hematology‐Oncology, Department of PediatricsKing George's Medical University Lucknow India
| | - Archana Kumar
- Division of Pediatric Hematology‐Oncology, Department of PediatricsKing George's Medical University Lucknow India
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Alam A, Kumar A. Prevalence, predictors, causes of treatment refusal and abandonment in children with acute lymphoblastic leukaemia over 18 years in North India. Treatment phase affecting factors: A step towards better focussed counselling. Cancer Epidemiol 2018; 57:53-59. [DOI: 10.1016/j.canep.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/05/2018] [Accepted: 07/18/2018] [Indexed: 11/28/2022]
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Pediatric oncology-hematology outreach: Evaluation of patient consultations by teleconferences between Indonesian and Dutch academic hospitals. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2018. [DOI: 10.1016/j.phoj.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Aristizabal P, Fuller S, Rivera-Gomez R, Ornelas M, Nuno L, Rodriguez-Galindo C, Ribeiro R, Roberts W. Addressing regional disparities in pediatric oncology: Results of a collaborative initiative across the Mexican-North American border. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26387. [PMID: 28000395 PMCID: PMC5608088 DOI: 10.1002/pbc.26387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cancer is emerging as a major cause of childhood mortality in low- and middle-income countries. In Mexico, cancer is the number one cause of death in children aged 5-14. Until recently, many children with cancer from Baja California, Mexico, went untreated. We reasoned that an initiative inspired by the St. Jude Children's Research Hospital (SJCRH) "twinning" model could successfully be applied to the San Diego-Tijuana border region. In 2008, a twinning project was initiated by Rady Children's Hospital, SJCRH, and the General Hospital Tijuana (GHT). Our aim was to establish a pediatric oncology unit in a culturally sensitive manner, adapted to the local healthcare system. PROCEDURE An initial assessment revealed that despite existence of basic hospital infrastructure at the GHT, the essential elements of a pediatric cancer unit were lacking, including dedicated space, trained staff, and uniform treatment. A 5-year action plan was designed to offer training, support the staff financially, and improve the infrastructure. RESULTS After 7 years, accomplishments include the opening of a new inpatient unit with updated technology, fully trained staff, and a dedicated, interdisciplinary team. Over 700 children have benefited from accurate diagnosis and treatment. CONCLUSIONS Initiatives that implement long-term partnerships between institutions along the Mexican-North American border can be highly effective in establishing successful pediatric cancer control programs. The geographic proximity facilitated accelerated training and close monitoring of project development. Similar initiatives across other disciplines may benefit additional patients and synergize with pediatric oncology programs to reduce health disparities in underserved areas.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego, La Jolla, CA, USA,Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA, USA,Reducing Cancer Disparities Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Spencer Fuller
- School of Medicine, University of California San Diego, La Jolla, CA, USA; Johns Hopkins Bloomberg School of Public Health
| | - Rebeca Rivera-Gomez
- Hospital General de Tijuana, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
| | - Mario Ornelas
- Hospital General de Tijuana, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
| | - Laura Nuno
- Hospital General de Tijuana, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine and International Outreach Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Raul Ribeiro
- Department of Oncology, Leukemia and Lymphoma Division, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - William Roberts
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego, La Jolla, CA, USA,Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA, USA,Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
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Acute lymphoblastic leukemia in low and middle-income countries: disease characteristics and treatment results. Curr Opin Oncol 2015; 26:650-5. [PMID: 25202926 DOI: 10.1097/cco.0000000000000125] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Acute lymphoblastic leukemia is the most common pediatric cancer. The cure rate of this disease is over 80% in developed countries utilizing protocols with very tolerable toxicity. Several factors contributed to this success, including the implementation of large collaborative clinical trials and the better understanding of disease biology allowing for risk-stratified treatment. We will review the current state of the treatment of acute lymphoblastic leukemia in low-income and medium-income countries. RECENT FINDINGS The picture differs from country to country, but recent advances have been made in many countries and the cure rates have improved significantly. Tackling problems such as access to care, abandonment of treatment and toxicity of protocols and the development of centers of excellence are critical for continued improvement. Twinning with programs in developed countries and the creation of regional collaborative groups will allow the implementation of risk-directed therapy and better supportive care. SUMMARY The experience in low-income countries shows that a structured approach to the treatment of acute lymphoblastic leukemia results in improved survival.
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Aristizabal P, Fuller S, Rivera R, Beyda D, Ribeiro RC, Roberts W. Improving Pediatric Cancer Care Disparities Across the United States-Mexico Border: Lessons Learned from a Transcultural Partnership between San Diego and Tijuana. Front Public Health 2015; 3:159. [PMID: 26157788 PMCID: PMC4476311 DOI: 10.3389/fpubh.2015.00159] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/27/2015] [Indexed: 11/13/2022] Open
Abstract
In 2007, the 5-year survival rate for children with acute leukemia in Baja California, Mexico was estimated at 10% (vs. 88% in the United States). In response, stakeholders at St. Jude Children’s Research Hospital, Rady Children’s Hospital San Diego, and the Hospital General de Tijuana (HGT) implemented a transcultural partnership to establish a pediatric oncology program. The aim was to improve clinical outcomes and overall survival for children in Baja California. An initial needs assessment evaluation was performed and a culturally sensitive, comprehensive, 5-year plan was designed and implemented. After six years, healthcare system accomplishments include the establishment of a fully functional pediatric oncology unit with 60 new healthcare providers (vs. five in 2007). Patient outcome improvements include a rise in 5-year survival for leukemia from 10 to 43%, a rise in new cases diagnosed per year from 21 to 70, a reduction in the treatment abandonment rate from 10% to 2%, and a 45% decrease in the infection rate. More than 600 patients have benefited from this program. Knowledge sharing has taken place between teams at the HGT and Rady Children’s Hospital San Diego. Further, one of the most significant outcomes is that the HGT has transitioned into a regional referral center and now mentors other hospitals in Mexico. Our results show that collaborative initiatives that implement long-term partnerships along the United States–Mexico border can effectively build local capacity and reduce the survival gap between children with cancer in the two nations. Long-term collaborative partnerships should be encouraged across other disciplines in medicine to further reduce health disparities across the United States–Mexico border.
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Affiliation(s)
- Paula Aristizabal
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, University of California San Diego , San Diego, CA , USA ; Reducing Cancer Disparities Program, University of California San Diego Moores Cancer Center , La Jolla, CA , USA
| | - Spencer Fuller
- University of California San Diego School of Medicine , La Jolla, CA , USA
| | - Rebeca Rivera
- Pediatric Hematology/Oncology, General Hospital de Tijuana , Tijuana , Mexico
| | - David Beyda
- Global Health Program, University of Arizona College of Medicine , Phoenix, AZ , USA
| | - Raul C Ribeiro
- Department of Oncology, St. Jude Children's Research Hospital , Memphis, TN , USA
| | - William Roberts
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, University of California San Diego , San Diego, CA , USA ; University of California San Diego Moores Cancer Center , La Jolla, CA , USA
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Mostert S, Njuguna F, van de Ven PM, Olbara G, Kemps LJPA, Musimbi J, Strother RM, Aluoch LM, Skiles J, Buziba NG, Sitaresmi MN, Vreeman RC, Kaspers GJL. Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya. Pediatr Blood Cancer 2014; 61:913-8. [PMID: 24347434 DOI: 10.1002/pbc.24896] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 11/15/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kenyan national policies for public hospitals dictate that patients are retained on hospital wards until their hospital bills are paid, but this payment process differs for patients with or without access to National Hospital Insurance Fund (NHIF) at diagnosis. Whether these differences impact treatment outcomes has not been described. Our study explores whether childhood cancer treatment outcomes in Kenya are influenced by health-insurance status and hospital retention policies. PROCEDURE This study combined retrospective review of medical records with an illustrative case report. We identified children diagnosed with malignancies at a large Kenyan academic hospital between 2007 and 2009, their treatment outcomes, and health-insurance status at diagnosis. RESULTS Between 2007 and 2009, 222 children were diagnosed with malignancies. Among 180 patients with documented treatment outcome, 54% abandoned treatment, 22% had treatment-related death, 4% progressive/relapsed disease, and 19% event-free survival. Health-insurance status at diagnosis was recorded in 148 children: 23% had NHIF and 77% had no NHIF. For children whose families had NHIF compared with those who did not, the relative risk for treatment abandonment relative to event-free survival was significantly smaller (relative-risk ratio = 0.31, 95% CI = 0.12-0.81, P = 0.016). The case report illustrates difficulties that Kenyan families might face when their child is diagnosed with cancer, has no NHIF, and is retained in hospital. CONCLUSIONS Children with NHIF at diagnosis had significantly lower chance of abandoning treatment and higher chance of survival. Childhood cancer treatment outcomes could be improved by interventions that prevent treatment abandonment and improve access to NHIF. Hospital retention of patients over unpaid medical bills must stop.
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Affiliation(s)
- S Mostert
- Department of Pediatric Oncology-Hematology and Doctor 2 Doctor Program, VU University Medical Center, Amsterdam, The Netherlands
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Denburg AE, Knaul FM, Atun R, Frazier LA, Barr RD. Beyond the bench and the bedside: economic and health systems dimensions of global childhood cancer outcomes. Pediatr Blood Cancer 2014; 61:572-6. [PMID: 24249518 DOI: 10.1002/pbc.24858] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 10/18/2013] [Indexed: 11/11/2022]
Abstract
Globally, the number of new cases of childhood cancer continues to rise, with a widening gulf in outcomes across countries, despite the availability of effective cure options for many pediatric cancers. Economic forces and health system realities are deeply embedded in the foundation of disparities in global childhood cancer outcomes. A truly global effort to close the childhood cancer divide therefore requires systemic solutions. Analysis of the economic and health system dimensions of childhood cancer outcomes is essential to progress in childhood cancer survival around the globe. The conceptual power of this approach is significant. It provides insight into how and where pediatric oncology entwines with broader political and economic conditions, and highlights the mutual benefit derived from systems-oriented solutions.
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Affiliation(s)
- Avram E Denburg
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Dana-Farber Children's Cancer Center, Boston, Massachusetts; Harvard Global Equity Initiative, Harvard University, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
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Mostert S, Gunawan S, van Dongen JAP, van de Ven PM, Sitaresmi MN, Wolters EE, Veerman AJP, Mantik M, Kaspers GJL. Health-care providers' perspectives on childhood cancer treatment in Manado, Indonesia. Psychooncology 2013; 22:2522-8. [DOI: 10.1002/pon.3314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 04/26/2013] [Accepted: 04/28/2013] [Indexed: 11/09/2022]
Affiliation(s)
- S. Mostert
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - S. Gunawan
- Department of Pediatric Oncology-Hematology; Prof Dr RD Kandou Hospital; Manado Indonesia
| | - J. A. P. van Dongen
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - P. M. van de Ven
- Epidemiology and Biostatistics; VU University Medical Center; Amsterdam The Netherlands
| | - M. N. Sitaresmi
- Department of Pediatrics, Dr Sardjito Hospital; Gadjah Mada University; Yogyakarta Indonesia
| | - E. E. Wolters
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - A. J. P. Veerman
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - M. Mantik
- Department of Pediatric Oncology-Hematology; Prof Dr RD Kandou Hospital; Manado Indonesia
| | - G. J. L. Kaspers
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
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Tsimicalis A, Stevens B, Ungar WJ, McKeever P, Greenberg M, Agha M, Guerriere D, Naqvi A, Barr R. A mixed method approach to describe the out-of-pocket expenses incurred by families of children with cancer. Pediatr Blood Cancer 2013; 60:438-45. [PMID: 23015413 DOI: 10.1002/pbc.24324] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/21/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Families of children with cancer are confronted with a broad range of direct costs (out-of-pocket expenses), but the nature of these costs is poorly understood. This study aimed to disaggregate and describe these costs. PROCEDURE A prospective, mixed method, cost-of-illness design was utilized. Starting in the fourth week following their child's diagnosis, parents recorded resources consumed, and costs incurred for 1 week per month for 3 consecutive months. Any additional costs not captured in this typical 1 week period were added for the remainder of the month. Parents also discussed their costs in an audio-taped interview at the end of the 3 months. Descriptive statistics and qualitative content analyses were performed to disaggregate and describe families' costs. RESULTS In total, 99 families reported utilizing 16 cost categories and 74 cost items. Nearly three quarters of these costs were attributed to travel (56%) and food (18%). Costly items included acquisition of a car ($CAD35,000), relocation of a family ($CAD6,000), and purchase of a wheelchair ($CAD6,800). Parents described facing significant out-of-pocket expenses to ensure that their children had access to cancer treatment, to cope with the clinical treatment side effects of treatment, and to maintain the family household. CONCLUSION Families of children with cancer experience a wide range of costs. Our understanding of the nature of their costs and resource use may formulate the basis for future cost assessments and provide insight into practice and policy changes aimed at lessening the economic impact of this burden.
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Arora RS, Pizer B, Eden T. Understanding refusal and abandonment in the treatment of childhood cancer. Indian Pediatr 2011; 47:1005-10. [PMID: 21220796 DOI: 10.1007/s13312-010-0172-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Treatment refusal and abandonment is the principal cause of therapy failure in children with cancer in the developing world. A complex interplay of biological, socio-economic and treatment-related factors underlies this problem. Interventions are likely to succeed when they try and address all of these issues simultaneously, as exemplified by the success of twinning programs linking resource-rich and resource-limited countries. Hitherto, there has been no systematic attempt to understand and address this problem in India. Based on the knowledge gained from research in other parts of the developing world, we offer suggestions for dealing with this problem.
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Affiliation(s)
- R S Arora
- Cancer Research UK Paediatric and Familial Cancer Research Group, University of Manchester, Manchester, UK.
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