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Schwei RJ, Geiger G, Mirrielees J, Center A, Enemuoh A, Portillo Recinos A, Arias F, Lor M, Shah MN, Wiegmann D, Pulia MS. Characterizing Spanish-speaking patients' patient-centered care experiences in the emergency department. Acad Emerg Med 2024. [PMID: 39248362 DOI: 10.1111/acem.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 08/06/2024] [Accepted: 08/20/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Patient-centered care (PCC) is an essential component of high-quality health, yet patients with non-English language preferences (NELP) experience worse PCC outcomes. Additionally, there are likely unique aspects to PCC for patients with NELP in the emergency department (ED). To inform the development of strategies to improve PCC for NELP in the ED, we sought to understand how Spanish-speaking ED patients experience care and the factors that influenced their perceptions of the patient-centeredness of that care. METHODS We conducted a single-center qualitative study using semistructured interviews with adult, Spanish-speaking patients who had been discharged home from the ED. Interviews were conducted using an interview guide, recorded, transcribed, and analyzed iteratively in Spanish using inductive and deductive thematic analysis. RESULTS We conducted 19 interviews with participants from 24 to 72 years old. Participants were born in seven different Spanish-speaking countries. Participants identified three domains of PCC: patient, medical team's skills, and system. Several of the identified themes such as shared decision making, open communication, compassionate care, and coordination of follow-up care are often incorporated into PCC definitions. However, other themes, including uncertainty leading to fear, use of professional interpreters to promote understanding, receiving equitable care, technical proficiency, and efficiency of care expand upon existing domains in PCC definitions. CONCLUSIONS We now have a more nuanced understanding of how Spanish-speaking patients with NELP experience PCC in the ED and what matters to them. Several of the themes identified in this analysis add details about what matters to patients within the domains of previous PCC definitions. This suggests that the conceptualization of PCC may vary based on the setting where care is provided and the population who is receiving this care. Future work should consider patient population and setting when conceptualizing PCC.
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Affiliation(s)
- Rebecca J Schwei
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Gabriella Geiger
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jenn Mirrielees
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alexandra Center
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alyana Enemuoh
- University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ashley Portillo Recinos
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- 1FLADRC, Gainesville, Florida, USA
- UF Center for Health Equity and Engagement Research (CHEER), Gainesville, Florida, USA
| | - Maichou Lor
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medicine (Geriatrics and Gerontology), School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Zamor RL, Liberman DB, Hall JE, Rees CA, Hartford EA, Chaudhari PP, Portillo EN, Johnson MD. Collecting Sociodemographic Data in Pediatric Emergency Research: A Working Group Consensus. Pediatrics 2024; 154:e2023065277. [PMID: 39044723 PMCID: PMC11291964 DOI: 10.1542/peds.2023-065277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 07/25/2024] Open
Abstract
Understanding and addressing health care disparities relies on collecting and reporting accurate data in clinical care and research. Data regarding a child's race, ethnicity, and language; sexual orientation and gender identity; and socioeconomic and geographic characteristics are important to ensure equity in research practices and reported outcomes. Disparities are known to exist across these sociodemographic categories. More consistent, accurate data collection could improve understanding of study results and inform approaches to resolve disparities in child health. However, published guidance on standardized collection of these data in children is limited, and given the evolving nature of sociocultural identities, requires frequent updates. The Pediatric Emergency Care Applied Research Network, a multi-institutional network dedicated to pediatric emergency research, developed a Health Disparities Working Group in 2021 to support and advance equitable pediatric emergency research. The working group, which includes clinicians involved in pediatric emergency medical care and researchers with expertise in pediatric disparities and the conduct of pediatric research, prioritized creating a guide for approaches to collecting race, ethnicity, and language; sexual orientation and gender identity; and socioeconomic and geographic data during the conduct of research in pediatric emergency care settings. Our aims with this guide are to summarize existing barriers to sociodemographic data collection in pediatric emergency research, highlight approaches to support the consistent and reproducible collection of these data, and provide rationale for suggested approaches. These approaches may help investigators collect data through a process that is inclusive, consistent across studies, and better informs efforts to reduce disparities in child health.
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Affiliation(s)
- Ronine L. Zamor
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Division of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Danica B. Liberman
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Departments of Pediatrics
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeanine E. Hall
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Departments of Pediatrics
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Division of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Emily A. Hartford
- Division of Emergency Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Departments of Pediatrics
| | - Elyse N. Portillo
- Division of Pediatric Emergency medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Michael D. Johnson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Douglas KE, Fox MT, Cheston CC, Behara ML, Schoppel KA. Improving Interpreter Access in the Pediatric Emergency Department: A Quality Improvement Initiative. Pediatr Qual Saf 2024; 9:e748. [PMID: 38993271 PMCID: PMC11236402 DOI: 10.1097/pq9.0000000000000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 06/19/2024] [Indexed: 07/13/2024] Open
Abstract
Background An increasing proportion of the population in the United States have limited English proficiency (LEP). Hospitals that receive federal funding must offer interpreter services. However, access is often lacking for patients. Patients with LEP are at higher risk for adverse events, and the Emergency Department is a particularly high-risk environment for these events. Methods This quality improvement initiative took place from April 2021 to August 2022 in an urban, tertiary care Pediatric Emergency Department. A driver diagram informed four Plan-Do-Study-Act cycles, and data were collected through medical record review, patient surveys, and staff surveys. We tracked outcomes using run and control chart data. Results During the study period, the proportion of patients with LEP reporting "always" having an interpreter was unchanged (no centerline shift-control chart rules). Documentation of interpreter use for encounters with patients with LEP improved. Preferred language documentation and documentation of the need for an interpreter in the electronic medical record showed no change. Process measure data for staff-reported use of professional interpreters significantly increased, and the use of ad hoc interpreters decreased significantly. Length of stay did not change for English or LEP patients. Conclusions This quality improvement initiative improved appropriate documentation of LEP and decreased use of nonqualified interpreters, although no change occurred in the proportion of patients who reported always having an interpreter. Patient satisfaction was unaffected.
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Affiliation(s)
- Katherine E. Douglas
- From the Division of Emergency Medicine, Boston Children’s Hospital, Boston, Mass
| | - Miriam T. Fox
- Division of Cardiology, Boston Children’s Hospital, Boston, Mass
| | - Christine C. Cheston
- Boston University Chobanian and Avedisian School of Medicine, Boston, Mass
- Department of Pediatrics, Boston Medical Center, Boston, Mass
| | - M. Laxmi Behara
- Boston University Chobanian and Avedisian School of Medicine, Boston, Mass
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Jafari K, Burns B, Barry D, Koid C, Tan T, Hartford E. Triage Discordance in an Academic Pediatric Emergency Department and Disparities by Race, Ethnicity, and Language for Care. Pediatr Emerg Care 2024:00006565-990000000-00477. [PMID: 38849118 DOI: 10.1097/pec.0000000000003211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Minoritized patients are disproportionately represented in low-acuity emergency department (ED) visits in the United States in part caused by lack of timely access to primary and urgent care. However, there is also the possibility that implicit bias during triage could contribute to disproportionate representation of minority groups in low-acuity ED visits. Triage discordance, defined as when ED resources used are different from initial triage score predictions, can be used as a proxy for triage accuracy. Recent data suggest that discordant triage may be common, although little is known about the interaction with race, ethnicity, and language for care. OBJECTIVES This study aims to determine the prevalence of discordant triage among moderate- and low-acuity pediatric ED encounters and the interaction with patient race, ethnicity, and language for care. METHODS We performed a retrospective analysis of pediatric ED encounters from 2019 with Emergency Severity Index (ESI) scores of 3, 4, or 5 at an academic referral hospital. The primary outcome was triage discordance, encompassing overtriage (ESI 3 and 4) and undertriage (ESI 4 and 5). Logistic and multinomial regressions were used to assess discordant triage by race, ethnicity, and language group. RESULTS Triage discordance occurred in 47% (n = 18,040) of encounters. Black and Hispanic patients had higher likelihood of undertriage for ESI 5 (adjusted odds ratio 1.21, 95% confidence interval [CI] 1.01-1.46 and 1.27, 95% CI 1.07-1.52, respectively), and Black patients were more likely to be overtriaged in ESI 3 (1.18, 95% CI 1.09-1.27). Those with a language other than English for care had higher proportions of overtriage for ESI 3 (1.08, 95% CI 1.04-1.12) and undertriage for ESI 5 (1.23, 95% CI 1.11-1.37). CONCLUSIONS We found high rates of triage discordance in our pediatric ED, with significant associations with race, ethnicity, and language for care. Future research should evaluate the source of triage discordance and develop quality improvement efforts to improve equitable care.
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Affiliation(s)
| | | | - Dwight Barry
- Clinical Analytics, Seattle Children's Hospital, Seattle, WA
| | | | - Tina Tan
- From the Department of Pediatrics, Division of Emergency Medicine, University of Washington, Seattle, WA
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Gutman CK, Hartford EA, Gifford S, Ford V, Bouvay K, Pickett ML, Tran TT, Molyneaux Slade ND, Piroutek MJ, Chung S, Roach B, Hincapie M, Hoffmann JA, Lin K, Kotler H, Pulcini C, Rose JA, Bergmann KR, Cheng T, St Pierre Hetz R, Yan X, Lou XY, Fernandez R, Aronson PL, Lion KC. Management of race, ethnicity, and language data in the pediatric emergency department. Acad Emerg Med 2024. [PMID: 38808384 DOI: 10.1111/acem.14947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Affiliation(s)
- Colleen K Gutman
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Emily A Hartford
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Sasha Gifford
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, New York, USA
| | - Vanessa Ford
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kamali Bouvay
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Michelle L Pickett
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Theresa T Tran
- Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Neh D Molyneaux Slade
- Department of Emergency Medicine, McGovern Medical School, UT Health Houston, Houston, Texas, USA
| | - Mary Jane Piroutek
- Department of Emergency Medicine, University of California Irvine and Children's Hospital of Orange County, Orange, California, USA
| | - Sunhee Chung
- Department of Emergency Medicine and Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Britta Roach
- Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Mark Hincapie
- Department of Pediatrics, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer A Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karen Lin
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hannah Kotler
- Division of Emergency Medicine, The George Washington University School of Medicine and Health Sciences and Children's National Health System, Washington, DC, USA
| | - Christian Pulcini
- Department of Emergency Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Jerri A Rose
- Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Tabitha Cheng
- Department of Emergency Medicine, Harbor UCLA Medical Center and the David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ryan St Pierre Hetz
- Department of Pediatrics, University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xinyu Yan
- Department of Biostatistics, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville, Florida, USA
| | - Xiang Yang Lou
- Department of Biostatistics, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville, Florida, USA
| | - Rosemarie Fernandez
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Center for Experiential Learning and Simulation, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Paul L Aronson
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - K Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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Schweiberger K, Patel M, Ragavan MI. Promoting Equity in Pediatric Health Care Through Language Services Reimbursement. Pediatrics 2024; 153:e2023064214. [PMID: 38567419 PMCID: PMC11035156 DOI: 10.1542/peds.2023-064214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 04/04/2024] Open
Affiliation(s)
- Kelsey Schweiberger
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children’s Hospital of Pittsburgh, Pennsylvania
| | - Mona Patel
- Department of Pediatrics, Children’s Hospital Los Angeles, California
| | - Maya I. Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children’s Hospital of Pittsburgh, Pennsylvania
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Gmünder M, Gessler N, Buser S, Feuz U, Fayyaz J, Jachmann A, Keitel K, Brandenberger J. Caregivers with limited language proficiency and their satisfaction with paediatric emergency care related to the use of professional interpreters: a mixed methods study. BMJ Open 2024; 14:e077716. [PMID: 38216184 PMCID: PMC10806666 DOI: 10.1136/bmjopen-2023-077716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/14/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Communication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP) with care related to the use of interpreters and to explore underlying and interacting factors influencing satisfaction and self-advocacy. DESIGN A mixed-methods study. SETTING Paediatric emergency department (PED) at a tertiary care hospital in Bern, Switzerland. PARTICIPANTS AND METHODS Caregivers visiting the PED were systematically screened for their language proficiency. Semistructured interviews were conducted with all LLP-caregivers agreeing to participate and their administrative data were extracted. RESULTS The study included 181 caregivers, 14 of whom received professional language interpretation. Caregivers who were assisted by professional interpretation services were more satisfied than those without (5.5 (SD)±1.4 vs 4.8 (SD)±1.6). Satisfaction was influenced by five main factors (relationship with health workers, patient management, alignment of health concepts, personal expectations, health outcome of the patient) which were modulated by communication. Of all LLP-caregivers without professional interpretation, 44.9% were satisfied with communication due to low expectations regarding the quality of communication, unawareness of the availability of professional interpretation and overestimation of own language skills, resulting in low self-advocacy. CONCLUSION The use of professional interpreters had a positive impact on the overall satisfaction of LLP-caregivers with emergency care. LLP-caregivers were not well-positioned to advocate for language interpretation. Healthcare providers must be aware of their responsibility to guarantee good-quality communication to ensure equitable quality of care and patient safety.
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Affiliation(s)
- Myriam Gmünder
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Noemi Gessler
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Sina Buser
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Ursula Feuz
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Jabeen Fayyaz
- Emergency Department, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne Jachmann
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristina Keitel
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Julia Brandenberger
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
- Emergency Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Portillo EN, Ellison A. Language Barriers in Care for Low-Risk Febrile Neonates. JAMA Pediatr 2024; 178:17-18. [PMID: 37955911 DOI: 10.1001/jamapediatrics.2023.4896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Affiliation(s)
- Elyse N Portillo
- Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Angela Ellison
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia
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