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Gani MO, Kethireddy S, Adib R, Hasan U, Griffin P, Adibuzzaman M. Structural causal model with expert augmented knowledge to estimate the effect of oxygen therapy on mortality in the ICU. Artif Intell Med 2023; 137:102493. [PMID: 36868692 PMCID: PMC9992896 DOI: 10.1016/j.artmed.2023.102493] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
Recent advances in causal inference techniques, more specifically, in the theory of structural causal models, provide the framework for identifying causal effects from observational data in cases where the causal graph is identifiable, i.e., the data generation mechanism can be recovered from the joint distribution. However, no such studies have been performed to demonstrate this concept with a clinical example. We present a complete framework to estimate the causal effects from observational data by augmenting expert knowledge in the model development phase and with a practical clinical application. Our clinical application entails a timely and essential research question, the effect of oxygen therapy intervention in the intensive care unit (ICU). The result of this project is helpful in a variety of disease conditions, including severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) patients in the ICU. We used data from the MIMIC-III database, a widely used health care database in the machine learning community with 58,976 admissions from an ICU in Boston, MA, to estimate the oxygen therapy effect on morality. We also identified the model's covariate-specific effect on oxygen therapy for more personalized intervention.
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Affiliation(s)
- Md Osman Gani
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD, USA.
| | | | - Riddhiman Adib
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA.
| | - Uzma Hasan
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD, USA.
| | - Paul Griffin
- Department of Industrial and Manufacturing Engineering, Penn State University, University Park, PA, USA.
| | - Mohammad Adibuzzaman
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR, USA.
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Lerret SM, Schiffman R, White-Traut R, Medoff-Cooper B, Ahamed SI, Adib R, Liegl M, Alonso E, Mavis A, Jensen K, Peterson CG, Neighbors K, Riordan MK, Semp MC, Vo T, Stendahl G, Chapman S, Unteutsch R, Simpson P. Feasibility and Acceptability of a mHealth Self-Management Intervention for Pediatric Transplant Families. West J Nurs Res 2022; 44:955-965. [PMID: 34154460 PMCID: PMC8688578 DOI: 10.1177/01939459211024656] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Families of pediatric solid organ transplant recipients need ongoing education and support in the first 30 days following hospital discharge for the transplantation. The purpose of this report is to describe the feasibility, acceptability, and preliminary efficacy of a mHealth family-self management intervention, (myFAMI), designed to improve post-discharge outcomes of coping, family quality of life, self-efficacy, family self-management, and utilization of health care resources. We enrolled 46 primary family members. myFAMI was feasible and acceptable; 81% (n=17/21) of family members completed the app at least 24/30 days (goal 80% completion rate). Family members generated 134 trigger alerts and received a nurse response within the goal timeframe of < 2 h 99% of the time. Although there were no significant differences between groups, primary outcomes were in the expected direction. The intervention was well received and is feasible for future post-discharge interventions for families of children who receive an organ transplant.
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Affiliation(s)
- Stacee M Lerret
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rosemary White-Traut
- Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Barbara Medoff-Cooper
- College of Nursing, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sheikh Iqbal Ahamed
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, WI, USA
| | - Riddhiman Adib
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, WI, USA
| | - Melodee Liegl
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Estella Alonso
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alisha Mavis
- Pediatric Gastroenterology, Hepatology and Nutrition, Duke University Medical Center, Durham, NC
| | - Kyle Jensen
- Pediatric Gastroenterology, Hepatology and Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Caitlin G Peterson
- Pediatric Nephrology and Hypertension, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Katie Neighbors
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mary K Riordan
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Melissa C Semp
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Truc Vo
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Gail Stendahl
- Pediatric Heart Transplant Program, Children's Wisconsin, Milwaukee, WI, USA
| | - Shelley Chapman
- Pediatric Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Unteutsch
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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Adib R, Das D, Ahamed SI, Lerret SM. Design and development of myFAMI application framework: a mHealth self-management intervention for family members of pediatric transplant recipients. JMIR Nurs 2021; 5:e32785. [PMID: 34780344 PMCID: PMC8767472 DOI: 10.2196/32785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/01/2021] [Accepted: 11/14/2021] [Indexed: 01/23/2023] Open
Abstract
Background Solid-organ transplantation is the treatment of choice for children with end-stage organ failure. Ongoing recovery and medical management at home after transplant are important for recovery and transition to daily life. Smartphones are widely used and hold the potential for aiding in the establishment of mobile health (mHealth) protocols. Health care providers, nurses, and computer scientists collaboratively designed and developed mHealth family self-management intervention (myFAMI), a smartphone-based intervention app to promote a family self-management intervention for pediatric transplant patients’ families. Objective This paper presents outcomes of the design stages and development actions of the myFAMI app framework, along with key challenges, limitations, and strengths. Methods The myFAMI app framework is built upon a theory-based intervention for pediatric transplant patients, with aid from the action research (AR) methodology. Based on initially defined design motivation, the team of researchers collaboratively explored 4 research stages (research discussions, feedback and motivations, alpha testing, and deployment and release improvements) and developed features required for successful inauguration of the app in the real-world setting. Results Deriving from app users and their functionalities, the myFAMI app framework is built with 2 primary components: the web app (for nurses’ and superadmin usage) and the smartphone app (for participant/family member usage). The web app stores survey responses and triggers alerts to nurses, when required, based on the family members’ response. The smartphone app presents the notifications sent from the server to the participants and captures survey responses. Both the web app and the smartphone app were built upon industry-standard software development frameworks and demonstrate great performance when deployed and used by study participants. Conclusions The paper summarizes a successful and efficient mHealth app-building process using a theory-based intervention in nursing and the AR methodology in computer science. Focusing on factors to improve efficiency enabled easy navigation of the app and collection of data. This work lays the foundation for researchers to carefully integrate necessary information (from the literature or experienced clinicians) to provide a robust and efficient solution and evaluate the acceptability, utility, and usability for similar studies in the future. International Registered Report Identifier (IRRID) RR2-10.1002/nur.22010
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Affiliation(s)
- Riddhiman Adib
- Department of Mathematics, Statistics and Computer Science, Marquette University, MIlwaukee, US
| | - Dipranjan Das
- Department of Mathematics, Statistics and Computer Science, Marquette University, MIlwaukee, US
| | - Sheikh Iqbal Ahamed
- Department of Mathematics, Statistics and Computer Science, Marquette University, MIlwaukee, US
| | - Stacee Marie Lerret
- Department of Pediatrics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, US
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Lerret SM, Johnson NL, Polfuss M, Weiss M, Gralton K, Klingbeil CG, Gibson C, Garnier-Villarreal M, Ahamed SI, Adib R, Unteutsch R, Pawela L, White-Traut R, Sawin K. Using the Engaging Parents in Education for Discharge (ePED) iPad Application to Improve Parent Discharge Experience. J Pediatr Nurs 2020; 52:41-48. [PMID: 32163845 PMCID: PMC10465148 DOI: 10.1016/j.pedn.2020.02.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the use of the Engaging Parents in Education for Discharge (ePED) iPad application on parent experiences of hospital discharge teaching and care coordination. Hypotheses were: parents exposed to discharge teaching using ePED will have 1) higher quality of discharge teaching and 2) better care coordination than parents exposed to usual discharge teaching. The secondary purpose examined group differences in the discharge teaching, care coordination, and 30-day readmissions for parents of children with and without a chronic condition. DESIGN/METHODS Using a quasi-experimental design, ePED was implemented on one inpatient unit (n = 211) and comparison group (n = 184) from a separate unit at a pediatric academic medical center. Patient experience outcome measures collected on day of discharge included Quality of Discharge Teaching Scale-Delivery (QDTS-D) and care coordination measured by Care Transition Measure (CTM). Thirty-day readmission was abstracted from records. RESULTS Parents taught using ePED reported higher QDTS-D scores than parents without ePED (p = .002). No differences in CTM were found between groups. Correlations between QDTS-D and CTM were small for ePED (r = 0.14, p 0.03) and non-ePED (r = 0.29, p < .001) parent groups. CTM was weakly associated with 30-day readmissions in the ePED group. CONCLUSION The use of ePED by the discharging nurse enhances parent-reported quality of discharge teaching. PRACTICE IMPLICATIONS The ePED app is a theory-based structured conversation guide to engage parents in discharge preparation. Nursing implementation of ePED contributes to optimizing the patient/family healthcare experience.
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Affiliation(s)
- Stacee M Lerret
- Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | - Norah L Johnson
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Michele Polfuss
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - Marianne Weiss
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Karen Gralton
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | - Carol G Klingbeil
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - Cori Gibson
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | | | - S Iqbal Ahamed
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Riddhiman Adib
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Rachel Unteutsch
- Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | - Louis Pawela
- Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | | | - Kathy Sawin
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
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Lerret SM, White-Traut R, Medoff-Cooper B, Simpson P, Adib R, Ahamed SI, Schiffman R. Pilot study protocol of a mHealth self-management intervention for family members of pediatric transplant recipients. Res Nurs Health 2020; 43:145-154. [PMID: 31985067 DOI: 10.1002/nur.22010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/16/2019] [Accepted: 12/30/2019] [Indexed: 01/19/2023]
Abstract
Solid-organ transplantation is the treatment of choice for end-stage organ failure. Parents of pediatric transplant recipients who reported a lack of readiness for discharge had more difficulty coping and managing their child's medically complex care at home. In this paper, we describe the protocol for the pilot study of a mHealth intervention (myFAMI). The myFAMI intervention is based on the Individual and Family Self-Management Theory and focuses on family self-management of pediatric transplant recipients at home. The purpose of the pilot study is to test the feasibility of the myFAMI intervention with family members of pediatric transplant recipients and to test the preliminary efficacy on postdischarge coping through a randomized controlled trial. The sample will include 40 family units, 20 in each arm of the study, from three pediatric transplant centers in the United States. Results from this study may advance nursing science by providing insight for the use of mHealth to facilitate patient/family-nurse communication and family self-management behaviors for family members of pediatric transplant recipients.
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Affiliation(s)
- Stacee M Lerret
- Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rosemary White-Traut
- Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | - Pippa Simpson
- Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Riddhiman Adib
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, Wisconsin
| | - Sheikh Iqbal Ahamed
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, Wisconsin
| | - Rachel Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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Hasan MK, Haque MM, Adib R, Tumpa JF, Begum A, Love RR, Kim YL, Sheikh IA. SmartHeLP: Smartphone-based Hemoglobin Level Prediction Using an Artificial Neural Network. AMIA Annu Symp Proc 2018; 2018:535-544. [PMID: 30815094 PMCID: PMC6371334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Blood hemoglobin level (Hgb) measurement has a vital role in the diagnosis, evaluation, and management of numerous diseases. We describe the use of smartphone video imaging and an artificial neural network (ANN) system to estimate Hgb levels non-invasively. We recorded 10 second-300 frame fingertip videos using a smartphone in 75 adults. Red, green, and blue pixel intensities were estimated for each of 100 area blocks in each frame and the patterns across the 300 frames were described. ANN was then used to develop a model using the extracted video features to predict hemoglobin levels. In our study sample, with patients 20-56 years of age, and gold standard hemoglobin levels of 7.6 to 13.5 g/dL., we observed a 0.93 rank order of correlation between model and gold standard hemoglobin levels. Moreover, we identified specific regions of interest in the video images which reduced the required feature space.
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Affiliation(s)
| | | | | | | | - Azima Begum
- Dhaka Medical College and Hospital, Bangladesh
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Abstract
BACKGROUND Open incisional hernia repair is associated with high morbidity and recurrence rates. Laparoscopic approaches offer improved long-term results with low complication rates. METHODS Laparoscopic repair was attempted in 117 consecutive patients (median age 68 (range 31-91) years, 50 men) undergoing 122 operations. A novel mesh centralization technique was employed. Data were recorded prospectively. Follow-up was by clinical review or telephone consultation. RESULTS One hundred and eighteen procedures (96.7 per cent) were completed laparoscopically; four required conversion. Forty-one patients (35.0 per cent) had additional, unsuspected defects. The median mesh size was 225 (range 42-600) cm2. Median follow-up was 42 months. Small bowel enterotomy occurred in six patients. Fourteen postoperative seromas were successfully aspirated. Recurrence was detected in nine patients (7.7 per cent). One patient was readmitted with small bowel obstruction that settled with conservative management. There were no enterocutaneous fistulas. One patient died after operation from myocardial infarction. CONCLUSION Laparoscopic incisional hernia repair using a self-centring suture provides good long-term results with low complication rates.
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Affiliation(s)
- R W Motson
- Department of Surgery, Colchester General Hospital, Turner Road, Colchester CO4 5JL, UK.
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Cartwright RA, Adib R, Appleyard I, Glashan RW, Gray B, Hamilton-Stewart PA, Robinson M, Barham-Hall D. Cigarette smoking and bladder cancer: an epidemiological inquiry in West Yorkshire. J Epidemiol Community Health 1983; 37:256-63. [PMID: 6655413 PMCID: PMC1052920 DOI: 10.1136/jech.37.4.256] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Results are given of a case-control study on bladder cancer in West Yorkshire. The aim of the study was to assess what risks exist for cigarette smoking in the United Kingdom and also to investigate if a dose response effect was present. The study shows for the first time in the United Kingdom a positive but weak relationship between cigarette smoking and bladder cancer. Close examination of the data with regard to this effect shows that a complex set of relationships result when the quantity smoked and the period of smoking are taken into account. A dose response effect is weakly demonstrated when a medium quantity of cigarettes are smoked but it is not present at all in those who smoked most cigarettes for the longest periods. No risk appears to exist for those who have smoked only filter cigarettes. The results are contrasted with similar studies and the significance of the observations are discussed.
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Cartwright RA, Adib R, Appleyard I, Glashan RW, Richards B, Robinson MR, Sunderland E, Barham-Hall D. ABO, MNSs and rhesus blood groups in bladder cancer. Br J Urol 1983; 55:377-81. [PMID: 6411162 DOI: 10.1111/j.1464-410x.1983.tb03326.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Data are presented on a group of cases of primary carcinoma of the bladder detailing their ABO, MNSs and rhesus blood antigenic phenotypes. Differences, either between all cases and controls or between particular stages of presentation and controls, have been found in the ABO red cell system as well as the MNSs red cell system. In the case of the ABO system an excess of the A gene is present but detailed study shows this to be only in patients with T1 and T2 tumours. No excess was seen in patients with carcinoma in situ or T3 or T4 stage disease. The S gene of the MNSs system is also in excess in cases of bladder cancer.
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Cartwright RA, Adib R, Appleyard I, Coxon JG, Glashan RW, Richards B, Robinson MR, Sunderland E, Barham-Hall D. Ten genetic polymorphisms in bladder cancer. J Med Genet 1983; 20:112-6. [PMID: 6221102 PMCID: PMC1049011 DOI: 10.1136/jmg.20.2.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Data are presented on a group of cases of primary carcinoma of the bladder, detailing red cell surface blood group antigenic phenotypes, serum haptoglobin phenotypes, and some red cell isoenzyme phenotypes. Account is taken of the stage of the disease at presentation. The results are compared with corresponding phenotype frequencies in groups of presumed healthy persons originating either in Yorkshire or County Durham. Differences in relative incidences were found in the haptoglobin, phosphoglucomutase (PGM), and some other systems. These are both differences between all cases and controls and between particular stages at presentation and controls.
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Cartwright RA, Adib R, Glashan R, Gray BK. The epidemiology of bladder cancer in West Yorkshire. A preliminary report on non-occupational aetiologies. Carcinogenesis 1981; 2:343-7. [PMID: 7273315 DOI: 10.1093/carcin/2.4.343] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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