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López-Pintor E, Grau J, González I, Bernal-Soriano MC, Quesada JA, Lumbreras B. Impact of patients' perception of COPD and treatment on adherence and health-related quality of life in real-world: Study in 53 community pharmacies. Respir Med 2020; 176:106280. [PMID: 33302143 DOI: 10.1016/j.rmed.2020.106280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimize disease management. We aimed to assess the impact of patients' perception of their treatment and disease on adherence and Health-Related Quality of Life (HRQL) in patients attending a community pharmacy, where usually subjects have a better condition than those in clinical settings. METHODS We performed a cross-sectional study of 318 patients with COPD in treatment with inhalers in the last 3 months from 53 community pharmacies. We assessed HRQL with St George's Respiratory Questionnaire (SGRQ). Persistence was assessed from the three previous refills and adherence through the Test of Adherence to Inhalers test. RESULTS Persistence was achieved by 78.6% of the patients and 58.5% had good adherence. Patients having a multidose DPI and those with MDI showed a 2.8-fold and 4.1-fold increased association, respectively, with intermediate/poor adherence in comparison with those having a single dose DPI. Those patients who did not have knowledge about COPD (aOR 2.106, p = 0.006) and those who thought that the inhaler effectiveness was fair/poor (aOR 2.361, p = 0.006) were more likely to have intermediate/poor adherence. Overall SGRQ score was significantly worse in patients with intermediate/poor adherence (p = 0.036) and in those who thought the inhaler's effectiveness was fair/poor (p < 0.001). CONCLUSIONS The type of inhaler and patients' knowledge and perceptions of their disease and treatment were associated with good adherence and higher HRQL. Clinicians should promote shared-decision making in the choice of inhaler depending on patients' individual abilities and beliefs.
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Affiliation(s)
- E López-Pintor
- Department of Engineering, Area of Pharmacy and Pharmaceutical Technologies, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain.
| | - J Grau
- Pneumology Department, General Hospital of Elche, Alicante, Spain.
| | - I González
- Community Pharmacist in Alicante, Spain, Spanish Society of Community Pharmacy, SEFAC, Spain.
| | - M C Bernal-Soriano
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University and CIBER en Epidemiología y Salud Pública, Crtra Alicante-Valencia km 81, Sant Joan d'Alacant, 03550, Alicante, Spain.
| | - J A Quesada
- Department of Clinical Medicine. Miguel Hernandez University, San Juan de Alicante, Alicante, Spain.
| | - B Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University and CIBER en Epidemiología y Salud Pública, Crtra Alicante-Valencia km 81, Sant Joan d'Alacant, 03550, Alicante, Spain.
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Abstract
OBJECTIVE To assess the level of adherence to angiotensin receptor blockers (ARBs) in patients regularly attending a community pharmacy and the influence of a change in patients' adherence to pharmacological treatment. DESIGN Retrospective cohort study of a random sample of consecutive patients collecting their medication. SETTING 40 community pharmacies in Alicante (Southeast Spain). PARTICIPANTS 602 consecutive ≥18 years old patients following treatment with ARBs at least 3 previous refills were included. MAIN OUTCOME MEASURES Prevalence of uncontrolled blood pressure (BP) and adherence to prescribed pharmacological treatment (measured through both the Batalla and the Morisky-Green tests). A multivariate Poisson regression model was used to estimate the adjusted risk ratio (RRa) for non-adherence to pharmacological treatment by the presence of a change in patient's adherence and other significant variables. RESULTS 161/602 (13.7%) patients presented uncontrolled BP. According to the Morisky test, 410/602 (68.2%) patients were considered adherent to pharmacological treatment and 231/602 (38.4%) patients according to the Batalla test. According to the Morisky-Green test, in the multivariable analysis, patients with a previous change in pill appearance were less likely to be adherent than those patients with no change in their pharmacological treatment (RRa 0.45; CI 95% 0.22 to 0.90; p=0.024). Systolic BP was higher in patients with a change in pill appearance in the previous 3 refills (median BP 142 mm Hg; IQR 136-148) than in those who did not have a change (median BP 127 mm Hg; IQR 118-135; p<0.001). CONCLUSIONS There was a low percentage of adherence and nearly 15% of uncontrolled BP in patients who regularly collected their medication. Switching between pills of different appearances was associated with lower patient adherence to pharmacological treatment and a higher uncontrolled BP than no change in pharmacological treatment or change only in package but not in pill appearance.
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Affiliation(s)
- B Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - E López-Pintor
- Department of Engineering, Area of Pharmacy and Pharmaceutical Technologies, Miguel Hernández University, Alicante, Spain
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Lumbreras B, Vilar J, González-Álvarez I, Guilabert M, Parker LA, Pastor-Valero M, Domingo ML, Fernández-Lorente MF, Hernández-Aguado I. Evaluation of clinicians' knowledge and practices regarding medical radiological exposure: findings from a mixed-methods investigation (survey and qualitative study). BMJ Open 2016; 6:e012361. [PMID: 27799242 PMCID: PMC5093629 DOI: 10.1136/bmjopen-2016-012361] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/26/2016] [Accepted: 09/13/2016] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To assess the impact of initiatives aiming to increase clinician awareness of radiation exposure; to explore the challenges they face when communicating with patients; to study what they think is the most appropriate way of communicating the long-term potential risks of medical radiological exposure to patients. DESIGN A quantitative and qualitative evaluation through a survey and focal groups. SETTING San Juan Hospital and Dr Peset Hospital (Southeast Spain) and clinicians from Spanish scientific societies. PARTICIPANTS The surveys were answered (a) in person (216: all the radiologists (30), urologists (14) and surgeons (44) working at both participant hospitals; a sample of general practitioners from the catchment area of one hospital (45), and a consecutive sample of radiologists attending a scientific meeting (60)) or (b) electronically through Spanish scientific societies (299: radiologists (45), pneumologists (123), haematologists (75) and surgeons (40)). Clinicians were not randomly selected and thus the results are limited by the diligence of the individuals filling out the survey. PRIMARY AND SECONDARY OUTCOME MEASURES Clinicians' knowledge and practices regarding medical radiological exposure, and what they considered most appropriate for communicating information to patients. RESULTS Nearly 80% of the clinicians surveyed had never heard of the European recommendations. Fewer than 20% of the clinicians surveyed identified correctly the radiation equivalence dose of intravenous urography or barium enema. It was reported by 31.7% that they inform patients about the long-term potential risks of ionising radiation. All participants agreed that the most appropriate way to present information is a table with a list of imaging tests and their corresponding radiation equivalence dose in terms of chest X-rays and background radiation exposure. CONCLUSIONS Medical radiological exposure is frequently underestimated and rarely explained to patients. With a clear understanding of medical radiological exposure and proper communication tools, clinicians will be able to accurately inform patients.
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Affiliation(s)
- B Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, and CIBER en Epidemiología y Salud Pública, Alicante, Spain
| | - J Vilar
- Radiodiagnostic Department, Peset Hospital, Valenciana, Spain
| | | | - M Guilabert
- Psychology Department, Miguel Hernández University, Alicante, Spain
| | - L A Parker
- Public Health Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiología y Salud Pública, Spain
| | - M Pastor-Valero
- Public Health Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiología y Salud Pública, Spain
| | - M L Domingo
- Radiodiagnostic Department, Peset Hospital, Valenciana, Spain
| | | | - I Hernández-Aguado
- Public Health Department, Miguel Hernández University, Alicante, Spain
- CIBER en Epidemiología y Salud Pública, Spain
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Gómez-Sáez N, González-Álvarez I, Vilar J, Hernández-Aguado I, Domingo ML, Lorente MF, Pastor-Valero M, Parker LA, Picazo N, Calbo J, Lumbreras B. Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study. Eur Radiol 2014; 24:2174-82. [PMID: 24962823 PMCID: PMC4126995 DOI: 10.1007/s00330-014-3249-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 05/06/2014] [Accepted: 05/15/2014] [Indexed: 12/19/2022]
Abstract
Objective To determine the prevalence of solitary pulmonary nodules (SPNs) in chest radiology studies and patient’s features associated with malignancy in a non-high-risk clinical population. Methods Patients ≥35 years were referred for thoracic imaging in two hospitals (2010-2011). Eight radiologists determined the presence and characteristics of SPN. Selected variables were collected from radiological register and medical records. Observer agreement in the diagnosis of SPN was assessed. Results 25,529 patients were included: 23,102 (90.5 %) underwent chest radiograph and 2,497 (9.5 %) a CT. The prevalence of SPN was 2.1 % (95 % CI 1.9 – 2.3) in radiographs and 17.0 % (95 % CI 15.5 – 18.5) in CT. In patients undergoing chest radiograph, detection of SPN with an irregular border was more frequent among smokers. In patients who had a CT, larger SPNs appeared to be associated with 60 years of age or over, diagnosis of a respiratory illness, or male gender. In addition, an irregular border was also more common among men. Conclusions The prevalence of SPNs detected by both radiograph and CT was lower than that shown in screening studies. Patient characteristics such as age, sex, respiratory disease, or smoking habit were associated with nodule characteristics that are known to be related with malignancy. Key Points • There is a lower SPN prevalence in the clinical population than in screening studies. • SPN prevalence is associated with some patient characteristics: sex, age, imaging test. • Nodule characteristics related to malignancy were associated with some patient characteristics.
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Affiliation(s)
- N. Gómez-Sáez
- Public Health Department, Miguel Hernández University, Alicante, Spain
| | | | - J. Vilar
- Radiodiagnostic Department, Peset Hospital, Valencia, Spain
| | - I. Hernández-Aguado
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
| | - M. L. Domingo
- Radiodiagnostic Department, Peset Hospital, Valencia, Spain
| | - M. F. Lorente
- Radiodiagnostic Department, San Juan Hospital, Alicante, Spain
| | - M. Pastor-Valero
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
| | - L. A. Parker
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
| | - N. Picazo
- Radiodiagnostic Department, San Juan Hospital, Alicante, Spain
| | - J. Calbo
- Radiodiagnostic Department, San Juan Hospital, Alicante, Spain
| | - B. Lumbreras
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
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Lumbreras B, Gonzalez-Alvarez I, Vilar J, Parker LA, Pastor MA, Gomez-Saez N, Lorente F, Domingo ML, Perez L, Picazo N. P1-489 Prevalence and determinants of solitary pulmonary nodules detected using thoracic imaging tests during routine clinical practice. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976g.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
The objective of this review is to summarise the available evidence on the frequency and management of incidental findings in imaging diagnostic tests. Original articles were identified by a systematic search of the MEDLINE, EMBASE and Cochrane Library Plus databases using appropriate medical headings. Extracted variables were study design; sample size; type of imaging test; initial diagnosis; frequency and location of incidental findings; whether clinical follow-up was performed; and whether a definitive diagnosis was made. Study characteristics were assessed by one reviewer and checked by a second reviewer. Any disagreement was solved by consensus. The relationship between the frequency of incidental findings and the study characteristics was assessed using a one-way ANOVA test, as was the frequency of follow-up of incidental findings and the frequency of confirmation. 251 potentially relevant abstracts were identified and 44 articles were finally included in the review. Overall, the mean frequency of incidental findings was 23.6% (95% confidence interval (CI) 15.8-31.3%). The frequency of incidental findings was higher in studies involving CT technology (mean 31.1%, 95% CI 20.1-41.9%), in patients with an unspecific initial diagnosis (mean 30.5, 95% CI 0-81.6) and when the location of the incidental findings was unspecified (mean 33.9%, 95% CI 18.1-49.7). The mean frequency of clinical follow-up was 64.5% (95% CI 52.9-76.1%) and mean frequency of clinical confirmation was 45.6% (95% CI 32.1-59.2%). Although the optimal strategy for the management of these abnormalities is still unclear, it is essential to be aware of the low clinical confirmation in findings of moderate and major importance.
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Affiliation(s)
- B Lumbreras
- Departament of Public Health, University Miguel Hernandez, Alicante, Spain.
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van der Wal WM, Prins M, Lumbreras B, Geskus RB. A simple G-computation algorithm to quantify the causal effect of a secondary illness on the progression of a chronic disease. Stat Med 2009; 28:2325-37. [PMID: 19499549 DOI: 10.1002/sim.3629] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Progression of a chronic disease can lead to the development of secondary illnesses. An example is the development of active tuberculosis (TB) in HIV-infected individuals. HIV disease progression, as indicated by declining CD4 + T-cell count (CD4), increases both the risk of TB and the risk of AIDS-related mortality. This means that CD4 is a time-dependent confounder for the effect of TB on AIDS-related mortality. Part of the effect of TB on AIDS-related mortality may be indirect by causing a drop in CD4. Estimating the total causal effect of TB on AIDS-related mortality using standard statistical techniques, conditioning on CD4 to adjust for confounding, then gives an underestimate of the true effect. Marginal structural models (MSMs) can be used to obtain an unbiased estimate. We describe an easily implemented algorithm that uses G-computation to fit an MSM, as an alternative to inverse probability weighting (IPW). Our algorithm is simplified by utilizing individual baseline parameters that describe CD4 development. Simulation confirms that the algorithm can produce an unbiased estimate of the effect of a secondary illness, when a marker for primary disease progression is both a confounder and intermediary for the effect of the secondary illness. We used the algorithm to estimate the total causal effect of TB on AIDS-related mortality in HIV-infected individuals, and found a hazard ratio of 3.5 (95 per cent confidence interval 1.2-9.1).
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Affiliation(s)
- W M van der Wal
- Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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Lumbreras B, Garte S, Overvad K, Tjonneland A, Clavel-Chapelon F, Linseisen JP, Boeing H, Trichopoulou A, Palli D, Peluso M, Krogh V, Tumino R, Panico S, Bueno-De-Mesquita HB, Peeters PH, Lund E, Martinez C, Dorronsoro M, Barricarte A, Chirlaque MD, Quiros JR, Berglund G, Hallmans G, Day NE, Key TJ, Saracci R, Kaaks R, Malaveille C, Ferrari P, Boffetta P, Norat T, Riboli E, Gonzalez CA, Vineis P. Meat intake and bladder cancer in a prospective study: a role for heterocyclic aromatic amines? Cancer Causes Control 2008; 19:649-56. [DOI: 10.1007/s10552-008-9121-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
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Jarrin I, Lumbreras B, Ferreros I, Pérez-Hoyos S, Hurtado I, Hernández-Aguado I. Effect of education on overall and cause-specific mortality in injecting drug users, according to HIV and introduction of HAART. Int J Epidemiol 2006; 36:187-94. [PMID: 17085455 DOI: 10.1093/ije/dyl231] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We assessed the impact of education on long-term overall and cause-specific mortality among 6575 injecting drug users (IDUs) according to HIV status and introduction of highly active antiretroviral therapy (HAART). METHODS Community-based cohort study of IDUs recruited in three AIDS prevention centres (1987-1996). Causes of death were ascertained in clinical centres and Mortality Registry and classified as AIDS, drug use related, injuries, or liver diseases. Poisson regression models including education and calendar period interaction and adjusted by sex, age, and HIV were used. RESULTS In 73 901 person-years of follow-up, there were 1493 deaths (20.2/1000 person-years): 761 related to AIDS, 234 to drug use, 179 to injuries, and 93 to liver diseases. IDUs with university studies had a lower risk of death (RR 0.52; 95% CI 0.36-0.77) than those without studies: this difference was higher after (RR 0.45; 95% CI 0.25-0.80) than before 1997 (RR 0.68; 95% CI 0.41-1.13). Compared to before 1997, while decreases in the risk of AIDS mortality were seen during 1997-2004 for both lower (RR 0.49; 95% CI 0.41-0.58) and higher (RR 0.33; 95% CI 0.23-0.48) educated, only those higher educated experienced a reduction in drug-use mortality (RR 0.54; 95% CI 0.28-1.05) and death from injuries (RR 0.52; 95% CI 0.23-1.21). CONCLUSIONS Independently of HIV status, lower education predicts a higher risk of death in IDUs and its impact is stronger after 1997. Education has a protective effect on most causes of death and it cannot be entirely attributable to the access or use of HAART.
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Affiliation(s)
- I Jarrin
- Department of Public Health, History of Medicine and Gynaecology, Facultad de Medicina, Universidad Miguel Hernández, Carretera de Valencia Km 8,7, 03550 San Juan de Alicante, Spain.
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Lumbreras B, Pascual E, Frasquet J, González-Salinas J, Rodríguez E, Hernández-Aguado I. Analysis for crystals in synovial fluid: training of the analysts results in high consistency. Ann Rheum Dis 2005; 64:612-5. [PMID: 15769916 PMCID: PMC1755440 DOI: 10.1136/ard.2004.027268] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Identification of monosodium urate (MSU) and calcium pyrophosphate dehydrate (CPPD) crystals in synovial fluid samples is diagnostic of gout and CPPD crystal related arthropathy. Various studies have shown poor consistency in results of crystal analysis. OBJECTIVE To determine whether training of the analysts increases the consistency. METHODS An expert rheumatologist gave a course on crystal detection and identification. The four trained observers then blindly and independently examined synovial fluid samples previously classified by the expert which had been obtained from patients with both crystal arthropathies and other non-crystal related inflammatory joint conditions. RESULTS 194 observations were made on 64 synovial fluid samples: 96 without crystals (49.4%), 55 with CPPD crystal (28.4%), and 43 with MSU crystals (22.2%). For crystal detection (presence or absence of crystals), sensitivity was 95.9% and specificity 86.5%. For identification of MSU crystals, sensitivity was 95.3% and specificity 97.2%. For identification of CPPD crystals, sensitivity was 92.7% and specificity 92.1%. The kappa index of agreement with the reference standard between the observers was 0.84 for any crystal detection, 0.93 for MSU crystal sample identification, and 0.79 for CPPD crystal sample identification. CONCLUSIONS For trained observers, the detection and identification of crystals in synovial fluid is a consistent procedure.
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Affiliation(s)
- B Lumbreras
- Department of Clinical Analysis, Hospital General Universitario de Alicante, Spain
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Cascales P, Fernandez V, Tomas A, Sanchez del Campo F, Gonzalez F, Tascon E, Lumbreras B, Gonzalez J. Comparison of UW and Celsior solutions in experimental liver preservation by assessment of alpha-glutathione sulfotransferase. Transplant Proc 2002; 34:53. [PMID: 11959182 DOI: 10.1016/s0041-1345(01)02663-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- P Cascales
- Department of Human Anatomy, School of Medicine, University Miguel Hemández, San Juan, Alicante, Spain
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