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Venkatesh KK, Joseph JJ, Swoboda C, Strouse R, Hoseus J, Baker C, Summerfield T, Bartholomew A, Buccilla L, Pan X, Sieck C, McAlearney AS, Huerta TR, Fareed N. Multicomponent provider-patient intervention to improve glycaemic control in Medicaid-insured pregnant individuals with type 2 diabetes: clinical trial protocol for the ACHIEVE study. BMJ Open 2023; 13:e074657. [PMID: 37164461 PMCID: PMC10173964 DOI: 10.1136/bmjopen-2023-074657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) is one of the most frequent comorbid medical conditions in pregnancy. Glycaemic control decreases the risk of adverse pregnancy outcomes for the pregnant individual and infant. Achieving glycaemic control can be challenging for Medicaid-insured pregnant individuals who experience a high burden of unmet social needs. Multifaceted provider-patient-based approaches are needed to improve glycaemic control in this high-risk pregnant population. Mobile health (mHealth) applications (app), provider dashboards, continuous glucose monitoring (CGM) and addressing social needs have been independently associated with improved glycaemic control in non-pregnant individuals living with diabetes. The combined effect of these interventions on glycaemic control among pregnant individuals with T2D remains to be evaluated. METHODS AND ANALYSIS In a two-arm randomised controlled trial, we will examine the combined effects of a multicomponent provider-patient intervention, including a patient mHealth app, provider dashboard, CGM, a community health worker to address non-medical health-related social needs and team-based care versus the current standard of diabetes and prenatal care. We will recruit 124 Medicaid-insured pregnant individuals living with T2D, who are ≤20 weeks of gestation with poor glycaemic control measured as a haemoglobin A1c ≥ 6.5% assessed within 12 weeks of trial randomisation or within 12 weeks of enrolling in prenatal care from an integrated diabetes and prenatal care programme at a tertiary care academic health system located in the Midwestern USA. We will measure how many individuals achieve the primary outcome of glycaemic control measured as an A1c<6.5% by the time of delivery, and secondarily, adverse pregnancy outcomes; patient-reported outcomes (eg, health and technology engagement, literacy and comprehension; provider-patient communication; diabetes self-efficacy; distress, knowledge and beliefs; social needs referrals and utilisation; medication adherence) and CGM measures of glycaemic control (in the intervention group). ETHICS AND DISSEMINATION The Institutional Review Board at The Ohio State University approved this study (IRB: 2022H0399; date: 3 June 2023). We plan to submit manuscripts describing the user-designed methods and will submit the results of the trial for publication in peer-reviewed journals and presentations at international scientific meetings. TRIAL REGISTRATION NUMBER NCT05662462.
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Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Joshua J Joseph
- Deparment of Medicine, Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Columbus, Ohio, USA
| | - Christine Swoboda
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, Ohio, USA
| | - Robert Strouse
- Department of Research Information Technology, The Ohio State University, Columbus, Ohio, USA
| | | | | | - Taryn Summerfield
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Anna Bartholomew
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lisa Buccilla
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - X Pan
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia Sieck
- Department of Pediatrics, Wright State University, Dayton, Ohio, USA
| | - Ann Scheck McAlearney
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, Ohio, USA
- Department of Family and Community Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Timothy R Huerta
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Naleef Fareed
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
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McAlearney AS, Walker DM, Shiu-Yee K, Crable EL, Auritt V, Barkowski L, Batty EJ, Dasgupta A, Goddard-Eckrich D, Knudsen HK, McCrimmon T, Olvera R, Scalise A, Sieck C, Wood J, Drainoni ML. Embedding Big Qual and Team Science into Qualitative Research: Lessons from a Large-scale, Cross-site Research Study. Int J Qual Methods 2023; 22:10.1177/16094069231165933. [PMID: 38666187 PMCID: PMC11044892 DOI: 10.1177/16094069231165933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Background A major part of the HEALing Communities Study (HCS), launched in 2019 to address the growing opioid epidemic, is evaluating the study's intervention implementation process through an implementation science (IS) approach. One component of the IS approach involves teams with more than 20 researchers collaborating across four research sites to conduct in-depth qualitative interviews with over 300 participants at four time points. After completion of the first two rounds of data collection, we reflect upon our qualitative data collection and analysis approach. We aim to share our lessons learned about designing and applying qualitative methods within an implementation science framework. Methods The HCS evaluation is based on the RE-AIM/PRISM framework and incorporates interviews at four timepoints. At each timepoint, the core qualitative team of the Intervention Work Group drafts an interview guide based on the framework and insights from previous round(s) of data collection. Researchers then conduct interviews with key informants and coalition members within their respective states. Data analysis involves drafting, iteratively refining, and finalizing a codebook in a cross-site and within-site consensus processes. Interview transcripts are then individually coded by researchers within their respective states. Results Successes in the evaluation process includes having structured procedures for communication, data collection, and analysis, all of which are critical for ensuring consistent data collection and for achieving consensus during data analysis. Challenges include recognizing and accommodating the diversity of training and knowledge between researchers, and establishing reliable ways to securely store, manage, and share the large volumes of data. Conclusion Qualitative methods using a team science approach have been limited in their application in large, multi-site randomized controlled trials of health interventions. Our experience provides practical guidance for future studies with large, experientially and disciplinarily diverse teams, and teams seeking to incorporate qualitative or mixed-methods components for their evaluations.
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MacEwan SR, Beal EW, Gaughan A, Sieck C, McAlearney AS. Perspectives of hospital leaders and staff on patient education for the prevention of healthcare-associated infections. Infect Control Hosp Epidemiol 2022; 43:1129-1134. [PMID: 34229774 PMCID: PMC10278535 DOI: 10.1017/ice.2021.271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Device-related healthcare-associated infections (HAIs), such as catheter-associated urinary tract infections (CAUTIs) and central-line-associated bloodstream infections (CLABSIs), are largely preventable. However, there is little evidence of standardized approaches to educate patients about how they can help prevent these infections. We examined the perspectives of hospital leaders and staff about patient education for CAUTI and CLABSI prevention to understand the challenges to patient education and the opportunities for improvement. METHODS In total, 471 interviews were conducted with key informants across 18 hospitals. Interviews were analyzed deductively and inductively to identify themes around the topic of patient education for infection prevention. RESULTS Participants identified patient education topics specific to CAUTI and CLABSI prevention, including the risks of indwelling urinary catheters and central lines, the necessity of hand hygiene, the importance of maintenance care, and the support to speak up. Challenges, such as lack of standardized education, and opportunities, such as involvement of patient and family advisory groups, were also identified regarding patient education for CAUTI and CLABSI prevention. CONCLUSIONS Hospital leaders and staff identified patient education topics, and ways to deliver this information, that were important in the prevention of CAUTIs and CLABSIs. By identifying both challenges and opportunities related to patient education, our results provide guidance on how patient education for infection prevention can be further improved. Future work should evaluate the implementation of standardized approaches to patient education to better understand the potential impact of these strategies on the reduction of HAIs.
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Affiliation(s)
- Sarah R. MacEwan
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Eliza W. Beal
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Alice Gaughan
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Cynthia Sieck
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
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Di Tosto G, Walker D, Sieck C, Wallace L, MacEwan S, Gregory M, Scarborough S, Huerta T, McAlearney A. Health Literacy Does Not Explain Patient Portal Use: Results from a Secondary Analysis of a Randomized Controlled Trial. Health Serv Res 2021. [DOI: 10.1111/1475-6773.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Gennaro Di Tosto
- The Ohio State University, College of Medicine Columbus Ohio USA
| | - Daniel Walker
- The Ohio State University, College of Medicine Columbus Ohio USA
| | - Cynthia Sieck
- The Ohio State University, College of Medicine Columbus Ohio USA
| | - Lorraine Wallace
- The Ohio State University, College of Medicine Columbus Ohio USA
| | - Sarah MacEwan
- The Ohio State University, College of Medicine Columbus Ohio USA
| | - Megan Gregory
- The Ohio State University, College of Medicine Columbus Ohio USA
| | - Seth Scarborough
- The Ohio State University, College of Medicine Columbus Ohio USA
| | - Timothy Huerta
- The Ohio State University, College of Medicine Columbus Ohio USA
| | - Ann McAlearney
- The Ohio State University, College of Medicine Columbus Ohio USA
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Menser T, Swoboda C, Sieck C, Hefner J, Huerta T, McAlearney AS. A Community Health Worker Home Visit Program: Facilitators and Barriers of Program Implementation. J Health Care Poor Underserved 2020; 31:370-381. [PMID: 32037337 DOI: 10.1353/hpu.2020.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Home visit programs have long been used as a means of intervention specifically among vulnerable, at-risk populations including: chronically ill, impoverished, rural, or homebound individuals. Understanding barriers and facilitators to the implementation of home visit programs is essential to inform these efforts. Home visit programs led by community health workers (CHWs) are becoming more common and pose specific challenges. The Ohio Infant Mortality Reduction Initiative is a home visit program led by CHWs with the purpose of reducing infant mortality among high-risk populations. The intervention included health education, referrals to health services, and provision of supplies and social support to expectant mothers. This study examined qualitative interviews with program managers and administrators to describe facilitators and barriers associated with this home visit program from a managerial perspective. Findings highlight the importance of initial and ongoing CHW training, appropriate caseloads, effective communication, and adequate funding, which can inform future CHW programs.
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Rizer MK, Sieck C, Lehman JS, Hefner JL, Huerta TR, McAlearney AS. Working with an Electronic Medical Record in Ambulatory Care: A Study of Patient Perceptions of Intrusiveness. Perspect Health Inf Manag 2017; 14:1g. [PMID: 28566996 PMCID: PMC5430115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess patient perceptions of electronic medical record (EMR) intrusiveness during ambulatory visits to clinics associated with a large academic medical center. METHOD We conducted a survey of patients seen at any of 98 academic medical center clinics. The survey assessed demographics, visit satisfaction, computer use, and perceived intrusiveness of the computer. RESULTS Of 7,058 patients, slightly more than 80 percent reported that the physician had used the computer while in the room, but only 24 percent were shown results in the EMR. Most patients were very satisfied or satisfied with their visit and did not find the computer intrusive (83 percent). Younger respondents, those shown results, and those who reported that the physician used the computer were more likely to perceive the computer as intrusive. Qualitative comments suggest different perceptions related to computer intrusiveness than to EMR use more generally. DISCUSSION Patients were generally accepting of EMRs and therefore use of computers in the exam room. However, subgroups of patients may require greater study to better understand patient perceptions related to EMR use and intrusiveness. CONCLUSION Results suggest the need for greater focus on how physicians use computers in the exam room in a manner that facilitates maintaining good rapport with patients.
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Affiliation(s)
- Milisa K Rizer
- Departments of Family Medicine and Biomedical Informatics in the College of Medicine of The Ohio State University and chief medical information officer of the Ohio State University Wexner Medical Center in Columbus, OH
| | - Cynthia Sieck
- Department of Family Medicine in the College of Medicine of The Ohio State University in Columbus, OH
| | - Jennifer S Lehman
- Department of Family Medicine in the College of Medicine of The Ohio State University in Columbus, OH
| | - Jennifer L Hefner
- Department of Family Medicine in the College of Medicine of The Ohio State University in Columbus, OH
| | - Timothy R Huerta
- Departments of Family Medicine and Biomedical Informatics in the College of Medicine of The Ohio State University in Columbus, OH
| | - Ann Scheck McAlearney
- Department of Family Medicine in the College of Medicine of The Ohio State University and research director for the Central Ohio Practice-Based Research Network in Columbus, OH
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Klatt MD, Sieck C, Gascon G, Malarkey W, Huerta T. A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention. Complement Ther Med 2016; 27:139-44. [DOI: 10.1016/j.ctim.2016.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/12/2016] [Accepted: 05/24/2016] [Indexed: 11/25/2022] Open
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McAlearney AS, Hefner JL, Sieck C, Rizer M, Huerta TR. Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence. Int J Med Inform 2014; 83:484-94. [PMID: 24862893 DOI: 10.1016/j.ijmedinf.2014.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/30/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. METHODS We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. RESULTS We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. CONCLUSIONS Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, Ohio State University, United States; Division of Health Services Management and Policy, College of Public Health, Ohio State University, United States; Department of Corporate Strategy and Innovation, École Polytechnique Fédérale de Lausanne, Switzerland.
| | - Jennifer L Hefner
- Department of Family Medicine, College of Medicine, Ohio State University, United States
| | - Cynthia Sieck
- Department of Family Medicine, College of Medicine, Ohio State University, United States
| | - Milisa Rizer
- Department of Family Medicine, College of Medicine, Ohio State University, United States; Department of Biomedical Informatics, College of Medicine, Ohio State University, United States
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, Ohio State University, United States; Department of Biomedical Informatics, College of Medicine, Ohio State University, United States
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Dembe A, Wickizer T, Sieck C, Partridge J, Balchick R. Opioid use and dosing in the workers' compensation setting. A comparative review and new data from Ohio. Am J Ind Med 2012; 55:313-24. [PMID: 22068830 DOI: 10.1002/ajim.21021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Many authorities are concerned about the rising use and the potential overuse of opioid pain medications. A study of opioid prevalence and dosage in Ohio's workers' compensation (WC) system was conducted, with comparisons made to opioid use in other WC and non-WC settings. METHODS Systematic literature reviews of WC and non-WC opioid use and dosage nationally were conducted. Two years of Ohio WC data (2008-2009) were analyzed to determine average daily morphine equivalent dose (MED), opioid costs, pharmacies used per claimant, and extent of long-duration cases. RESULTS Nearly one-fifth (19.2%) of Ohio WC claims involved opioid use, compared to 31.8% in other WC systems and 17.9% in non-WC settings. Mean MED was 57.5 mg, compared to 47.8 mg in other WC systems, and 41.8 mg among non-WC populations. Nearly 10% of WC claims involved relatively high MED exceeding 120 mg/day. CONCLUSION Policy makers need to develop strategies for addressing high opioid use in WC systems.
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Affiliation(s)
- Allard Dembe
- Division of Health Services Management & Policy,The Ohio State University College of Public Health, 1841 Neil Avenue,Columbus, OH 43210, USA.
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Biehler JL, Sieck C, Bonner B, Steumky JH. A survey of health care and child protective services provider knowledge regarding the toe tourniquet syndrome. Child Abuse Negl 1994; 18:987-993. [PMID: 7850607 DOI: 10.1016/s0145-2134(05)80009-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Recent efforts to increase public awareness of child abuse may result in an increased number of inappropriate reports of suspected child abuse. The authors believe that digital hair strangulation should be included among the conditions that may be confused with child abuse. Digital hair strangulation (toe tourniquet syndrome) occurs primarily in infants and is characterized by a constricting band of foreign material that becomes tightly wrapped around a digit or digits (most often the toes). The consensus in the medical literature is that this condition is not the result of intentional injury. As no reference to the toe tourniquet syndrome exists in the child abuse literature, it was hypothesized that child welfare workers would be more likely than physicians and public health nurses to misinterpret this condition as resulting from intentional injury. A survey was conducted to test this hypothesis. Professionals from the fields of medicine, nursing, and child welfare were provided with a history and photographic findings of a child with a typical case of the toe tourniquet syndrome. Participants were surveyed regarding their interpretation of the described injuries. More than 50% of all respondents indicated that they would report this case as suspected abuse. Child welfare workers responded that the injuries were suggestive of abuse (83%), significantly more often than public health nurses did (45%), (chi 2 = 4.55, p = .03).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J L Biehler
- Department of Pediatrics, Miami Children's Hospital, Coral Gables, FL
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