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Aldhouse NVJ, Kitchen H, Al-Zubeidi T, Thursfield M, Winnette R, See Tai S, Zhu L, Freitas C, Garnier N, Baker CL. Development of a Conceptual Model for the Patient Experience of Immunoglobulin A Nephropathy (IgAN): A Qualitative Literature Review. Adv Ther 2024; 41:1325-1337. [PMID: 38363464 PMCID: PMC10960907 DOI: 10.1007/s12325-024-02793-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Immunoglobulin A nephropathy (IgAN) is a kidney disorder that can lead to progressive kidney disease. Currently, there lacks a comprehensive overview of the symptoms and impacts experienced by those living with IgAN that would help inform the selection or development of fit-for-purpose clinical outcome assessments (COA) to be used in clinical trials. The aim of this study was to develop a conceptual model of the adult and pediatric patient experience of IgAN, including disease signs and symptoms, treatment side effects, and impact on functioning and well-being. METHODS This study comprised a systematic review and thematic analysis of qualitative studies with adults and children diagnosed with IgAN. Data sources were identified through an electronic database search of journal articles (MEDLINE, Embase, PsycINFO; June 2021), hand-searching of conference proceedings, patient advocacy group websites, and gray literature. Non-English articles were excluded. Identified data (patient/caregiver quotes, author summaries, and interpretations of patient experiences) were extracted from articles. Extracted data were qualitatively analyzed, aided by ATLAS.ti v7. Codes were applied to data; concepts (i.e., symptoms) were identified, named, and refined. A conceptual model was developed by grouping related concepts into domains. RESULTS In total, five sources were identified for analysis: two journal articles, two online anthologies of patient stories, and one patient organization-sponsored "Voice of the Patient" meeting report. Conceptual model symptom domains included swelling/puffiness (edema), pain/aches/discomfort, fatigue, weight gain, sleep problems, urinary problems, and gastrointestinal problems. Impact domains included emotional/psychological well-being, physical functioning/activities of daily living, social functioning, work/school, and relationships. CONCLUSIONS Secondary analysis of published qualitative literature permitted development of a novel conceptual model depicting the patient experience of IgAN; however, its depth is limited by a lack of available literature. Further qualitative research is recommended to refine and/or confirm the concepts and domains, determine any relationships between them, and explore the outcomes that are most meaningful to patients. The refined model will provide a useful tool to inform the selection, development, and/or amendment of COAs for use in future IgAN clinical trials.
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Stamellou E, Seikrit C, Tang SCW, Boor P, Tesař V, Floege J, Barratt J, Kramann R. IgA nephropathy. Nat Rev Dis Primers 2023; 9:67. [PMID: 38036542 DOI: 10.1038/s41572-023-00476-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
IgA nephropathy (IgAN), the most prevalent primary glomerulonephritis worldwide, carries a considerable lifetime risk of kidney failure. Clinical manifestations of IgAN vary from asymptomatic with microscopic or intermittent macroscopic haematuria and stable kidney function to rapidly progressive glomerulonephritis. IgAN has been proposed to develop through a 'four-hit' process, commencing with overproduction and increased systemic presence of poorly O-glycosylated galactose-deficient IgA1 (Gd-IgA1), followed by recognition of Gd-IgA1 by antiglycan autoantibodies, aggregation of Gd-IgA1 and formation of polymeric IgA1 immune complexes and, lastly, deposition of these immune complexes in the glomerular mesangium, leading to kidney inflammation and scarring. IgAN can only be diagnosed by kidney biopsy. Extensive, optimized supportive care is the mainstay of therapy for patients with IgAN. For those at high risk of disease progression, the 2021 KDIGO Clinical Practice Guideline suggests considering a 6-month course of systemic corticosteroid therapy; however, the efficacy of systemic steroid treatment is under debate and serious adverse effects are common. Advances in understanding the pathophysiology of IgAN have led to clinical trials of novel targeted therapies with acceptable safety profiles, including SGLT2 inhibitors, endothelin receptor blockers, targeted-release budesonide, B cell proliferation and differentiation inhibitors, as well as blockade of complement components.
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Affiliation(s)
- Eleni Stamellou
- Department of Nephrology, School of Medicine, University of Ioannina, Ioannina, Greece
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Claudia Seikrit
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Peter Boor
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
- Department of Pathology, RWTH Aachen University, Aachen, Germany
| | - Vladimir Tesař
- Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Rafael Kramann
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany.
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, Netherlands.
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Cifuentes Ochoa M, Flowers NJ, Pertile MD, Archibald AD. "It becomes your whole life"-Exploring experiences of reciprocal translocation carriers and their partners. J Genet Couns 2023; 32:1057-1068. [PMID: 37186486 DOI: 10.1002/jgc4.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 05/17/2023]
Abstract
Reciprocal translocation carriers are often diagnosed when they are experiencing difficulties conceiving or after a pregnancy affected by an unbalanced set of chromosomes inherited from the balanced carrier parent. Having a reciprocal translocation is not uncommon; carriers can benefit from reproductive options to achieve a healthy, chromosomally balanced, pregnancy. The aim of this study was to explore the lived experience of carriers and their partners. We conducted 13 semi-structured telephone interviews. Participants were recruited through Victorian Clinical Genetics Services and interviews took place between May and September 2020. Interview transcripts were analyzed using thematic analysis. Reciprocal translocation carriers and their partners described long term emotional and reproductive impacts, with carrier status identified at the time of prenatal diagnosis having marked emotional consequences. Couples facing reproductive challenges found the diagnosis created uncertainty for their future. When considering a pregnancy, couples worried about experiencing a miscarriage; during pregnancy, there was a reluctance to have an invasive diagnostic procedure due to fearing the risk of losing an unaffected pregnancy. Adaptation to their new reality involved having access to accurate information, peer support and maintaining hope. Couples valued having the option to know the carrier status of their children. The complex impacts of carrying a reciprocal translocation highlight the importance of access to specialist genetic counseling services to ensure couples are supported in understanding the implications of their translocation.
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Affiliation(s)
- Marta Cifuentes Ochoa
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Victoria, Parkville, Australia
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Nicola Jane Flowers
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Victoria, Parkville, Australia
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Mark Domenic Pertile
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Victoria, Parkville, Australia
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Alison Dalton Archibald
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Victoria, Parkville, Australia
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
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Wynn M, Garwood-Cross L, Vasilica C, Griffiths M, Heaslip V, Phillips N. Digitizing nursing: A theoretical and holistic exploration to understand the adoption and use of digital technologies by nurses. J Adv Nurs 2023; 79:3737-3747. [PMID: 37530425 DOI: 10.1111/jan.15810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 07/04/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND With healthcare undergoing rapid digitalization, the effective integration of new technologies is crucial for nursing professionals, who form the largest group in the healthcare workforce. However, barriers within the nursing profession may impede digitalization efforts, leading to under utilization of available technologies and missed opportunities for enhancing healthcare quality and population health. AIMS This article aims to investigate the adoption and use of digital technologies by nurses, considering how key demographics, such as gender, age, and voluntariness of technology use, interact to influence their acceptance and utilization of these technologies. METHODS Employing the Unified Theory of Acceptance and Use of Technology (UTAUT) as a framework, we conducted a discursive exploration, supplemented by a literature review from diverse academic sources. Keywords related to UTAUT, digitalization, nursing practice and technology adoption were searched on PubMed, CINAHL and Google Scholar. Additionally, UK government and professional regulator reports were examined to understand current recommendations concerning digital technologies in nursing practice and the profession's demography. Searches focused on moderating factor domains, and the last search was conducted on 26 April 2023. RESULTS The study revealed that the successful implementation of digital technologies in nursing practice requires a nuanced understanding of the nursing workforce's characteristics and preferences. Gender, age and voluntariness of technology use were found to intersect and influence nurses' acceptance and utilization of digital tools. DISCUSSION By applying UTAUT in the context of nursing, this study highlights the importance of tailored implementation strategies for digital technologies. A technologically deterministic perspective is insufficient; instead, consideration of social factors specific to nursing is essential for successful adoption. CONCLUSION To maximize the benefits of digitalization in healthcare, it is imperative to address the barriers faced by nursing professionals. A comprehensive understanding of how key demographics impact technology adoption will inform targeted strategies, enhancing the engagement of nurses with digital tools and fostering innovation in healthcare practices. Further research and primary data are needed, but this study lays the foundation for future advancements in digital healthcare integration for nursing professionals. RELEVANCE TO CLINICAL PRACTICE The issues highlighted in this article are relevant to nurse leaders and those responsible for implementing technologies within nursing contexts. They are also relevant to technology developers who may benefit from considering the evidence associated with the moderating demographic factors highlighted in this article. Without a holistic approach to the implementation of technology, challenges associated with the use of digital technology by nurses are likely to persist. By considering the moderating demographic factors highlighted within the UTAUT (age, gender, voluntariness of use and experience) nurse leaders and technology developers may have greater success obtaining greater clinical outcomes from digital technology. This work was completed in 2022. NO PATIENT OR PUBLIC CONTRIBUTION Due to the focus of this article being one on professional challenges within the nursing profession, no involvement from patients or the public was sought.
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Skidmore S, Prior Y, Nester C, Bird S, Vasilica C. Where do you stand?: an exploration of perspectives toward feet, foot health, and footwear using innovative digital methods. J Foot Ankle Res 2023; 16:25. [PMID: 37106384 PMCID: PMC10141949 DOI: 10.1186/s13047-023-00621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The cost of losing foot health is significant to the person, healthcare systems, and economy, with diabetes related foot health issues alone costing over £1 billion annually in the UK. Yet many foot health problems are preventable through alternative health behaviour. It is therefore important to understand how feet, foot health and footwear are conceptualised to gain understanding about how these might influence foot health behaviour and inform health messages that seek to protect or improve foot health through altered health behaviour. This research seeks to explore attitudes and beliefs and identify phenomena that may act as barriers or motivators to the proactive self-management of foot health. METHODS Public conversations involving 2,699 expressions related to feet, footwear or foot health on Facebook, Twitter, and Instagram were extracted. Conversations on Facebook and Twitter were scraped with NVivo's NCapture plugin whereby data is extracted and downloaded to NVivo. Extracted files were uploaded to the Big Content Machine (software developed at the University of Salford) which facilitated the search for keywords 'foot', 'feet', 'footwear', 'shoe', and 'shoes'. Instagram was scraped by hand. Data was analysed using a Thematic Analysis approach. RESULTS Three themes were identified; 1) connections and disconnections derived from social and cultural constructs, 2) phenomena beyond attitudes and beliefs that relate to symbolic representations and the impact when foot health is lost, and 3) phenomena relating to Social Media as a conduit for the exploration of attitudes and beliefs. CONCLUSIONS This novel research exemplifies complex and sometimes incongruous perspectives about feet including their value for what they facilitate, contrasted with negative feelings about the negative impact that can have aesthetically when feet work hard. Sometimes feet were devalued, with expressions of disgust, disconnection, and ridicule. The importance of contextual, social, and cultural phenomena with implications for optimising foot health messages. Knowledge gaps including factors related to children's foot health and development, and how to treat foot health problems. The power of communities with shared experience to influence decisions, theories, and behaviour about foot health was also revealed. While people do talk about feet in some social contexts, it is not always in a way that promotes overt, positive foot health behaviour. Finally, this research demonstrates the benefit of exploring perspectives in uncontrived settings and illuminates the potential utility of social media (SoMe) platforms Facebook, Instagram, and Twitter as vehicles to promote foot health self-management behaviour that is responsive to the social and demographic variances of engagers who inhabit those spaces.
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Affiliation(s)
- Sue Skidmore
- School of Health & Society, University of Salford, Brian Blatchford Building, Frederick Road Campus, Salford, M6 6PU, UK.
| | - Yeliz Prior
- School of Health & Society, University of Salford, Brian Blatchford Building, Frederick Road Campus, Salford, M6 6PU, UK
| | - Christopher Nester
- MacKay Building School of Health and Rehabilitation, Keele University, Keele, ST5 5BG, UK
| | - Sam Bird
- School of Health & Society, University of Salford, Brian Blatchford Building, Frederick Road Campus, Salford, M6 6PU, UK
| | - Cristina Vasilica
- School of Health & Society, University of Salford, Brian Blatchford Building, Frederick Road Campus, Salford, M6 6PU, UK
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Schena FP, Anelli VW, Di Noia T, Tripepi G, Abbrescia DI, Stangou M, Papagianni A, Russo ML, D'Arrigo G, Manno C. Post-hoc analysis of a tool to predict kidney failure in patients with IgA nephropathy. J Nephrol 2023; 36:451-461. [PMID: 36269491 DOI: 10.1007/s40620-022-01463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/01/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recently, a tool based on two different artificial neural networks has been developed. The first network predicts kidney failure (KF) development while the second predicts the time frame to reach this outcome. In this study, we conducted a post-hoc analysis to evaluate the discordant results obtained by the tool. METHODS The tool performance was analyzed in a retrospective cohort of 1116 adult IgAN patients, as were the causes of discordance between the predicted and observed cases of KF. RESULTS There was discordance between the predicted and observed KF in 216 IgAN patients (19.35%) all of whom were elderly, hypertensive, had high serum creatinine levels, reduced renal function and moderate or severe renal lesions. Many of these patients did not receive therapy or were non-responders to therapy. In other IgAN patients the tool predicted KF but the outcome was not reached because patients responded to therapy. Therefore, in the discordant group (prediction did not match the observed outcome) the proportion of patients having or not having KF was strongly associated with treatment (P < 0.0001). CONCLUSIONS The post-hoc analysis shows that discordance in a low number of patients is not an error, but rather the effect of positive response to therapy. Thus, the tool could both help physicians to determine the prognosis of the disease and help patients to plan for their future.
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Affiliation(s)
- Francesco Paolo Schena
- Department of Emergency and Organ Transplantation, Nephrology, University of Bari "Aldo Moro", Bari, Italy.
- Schena Foundation, Polyclinic, Bari, Italy.
| | - Vito Walter Anelli
- Department of Electrical and Information Engineering, Polytechnic of Bari, Bari, Italy
| | - Tommaso Di Noia
- Department of Electrical and Information Engineering, Polytechnic of Bari, Bari, Italy
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Renal Unit, General Hospital, Reggio Calabria, Italy
| | | | - Maria Stangou
- Department of Nephrology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | | | - Graziella D'Arrigo
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Renal Unit, General Hospital, Reggio Calabria, Italy
| | - Carlo Manno
- Department of Emergency and Organ Transplantation, Nephrology, University of Bari "Aldo Moro", Bari, Italy
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Du Y, Dennis B, Ramirez V, Li C, Wang J, Meireles CL. Experiences and disease self-management in individuals living with chronic kidney disease: qualitative analysis of the National Kidney Foundation's online community. BMC Nephrol 2022; 23:88. [PMID: 35246060 PMCID: PMC8894554 DOI: 10.1186/s12882-022-02717-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/24/2022] [Indexed: 12/20/2022] Open
Abstract
Background Self-management of chronic kidney disease (CKD) is one of the keys in improving CKD outcomes and quality of life. There has been an increased use of online health communities to share the experiences of those living with CKD. By analyzing the CKD online forum data, this study aims to: 1) understand the experiences and challenges of individuals living with CKD, and 2) explore how online communities may help CKD patients in improving CKD self-management. Methods Publicly available posts of peer interactions on the National Kidney Foundation’s online community for individuals affected by CKD were extracted in April 2021 using computer programming. A total of 20,436 posts were collected, of which 400 posts were analyzed using inductive thematic analysis, and saturation was reached. Two researchers coded each post independently, and discrepancies were discussed to reach consensus. Results The analysis identified seven themes: 1) Dynamics of CKD status, 2) CKD comorbidities, 3) Managing CKD and symptoms, 4) Life participation and outlook; 5) Navigating healthcare and clinical needs, 6) Medical tests and results; and 7) Support on the forum. The results revealed that comorbidities were common in CKD patients and early-stage CKD was not communicated in a timely manner to patients by the health care community; living with CKD challenged both CKD and caregivers; some common challenges included but were not limited to the management of a diet for CKD and co-morbidities (especially co-morbid diabetes), CKD dynamics and symptoms, and fear of/ways to prevent progression. Individuals living with CKD primarily used the online forum to share and seek information and emotional support for managing CKD (including co-morbidities). Conclusions Challenges of living with CKD were found not only in those with advanced kidney disease and those on dialysis, but also in those with early and middle stages. Information and emotional support from the online forum serve as a platform to empower CKD individuals with the knowledge, skills and confidence for CKD self-management. Proactive and innovative strategies with a combination of virtual and real settings to improve self-management for individuals with all-stage CKD needs to be explored and tailored.
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Affiliation(s)
- Yan Du
- Center on Smart and Connected Health Technology, School of Nursing, UT Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Brittany Dennis
- Center on Smart and Connected Health Technology, School of Nursing, UT Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Valerie Ramirez
- Center on Smart and Connected Health Technology, School of Nursing, UT Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Chengdong Li
- College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - Jing Wang
- College of Nursing, Florida State University, Tallahassee, Florida, USA
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Stevens KI, Melilli E. Navigating social media: how to ensure safe passage. Nephrol Dial Transplant 2021; 37:5-7. [PMID: 34554262 DOI: 10.1093/ndt/gfab273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kate I Stevens
- The Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Edoardo Melilli
- Department of Nephrology, Hospital Universitari de Bellvitge, Barcelona, Spain
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Gaddy A, Topf J. Facebook Groups Can Provide Support for Patients with Rare Diseases and Reveal Truths About the Secret Lives of Patients. Kidney Int Rep 2021; 6:1205-1207. [PMID: 34015065 PMCID: PMC8116909 DOI: 10.1016/j.ekir.2021.03.890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anna Gaddy
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joel Topf
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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