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2.
PLoS One ; 16(4): e0250308, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33909654

RESUMO

OBJECTIVE: To evaluate the evidence of aerosol generation across tasks involved in voice and speech assessment and intervention, to inform better management and to reduce transmission risk of such diseases as COVID-19 in healthcare settings and the wider community. DESIGN: Systematic literature review. DATA SOURCES AND ELIGIBILITY: Medline, Embase, Scopus, Web of Science, CINAHL, PubMed Central and grey literature through ProQuest, The Centre for Evidence-Based Medicine, COVID-Evidence and speech pathology national bodies were searched up until August 13th, 2020 for articles examining the aerosol-generating activities in clinical voice and speech assessment and intervention within speech pathology. RESULTS: Of the 8288 results found, 39 studies were included for data extraction and analysis. Included articles were classified into one of three categories: research studies, review articles or clinical guidelines. Data extraction followed appropriate protocols depending on the classification of each article (e.g. PRISMA for review articles). Articles were assessed for risk of bias and certainty of evidence using the GRADE system. Six behaviours were identified as aerosol generating. These were classified into three categories: vegetative acts (coughing, breathing), verbal communication activities of daily living (speaking, loud voicing), and performance-based tasks (singing, sustained phonation). Certainty of evidence ranged from very low to moderate with variation in research design and variables. CONCLUSIONS: This body of literature helped to both identify and categorise the aerosol-generating behaviours involved in speech pathology clinical practice and confirm the low level of evidence throughout the speech pathology literature pertaining to aerosol generation. As many aerosol-generating behaviours are common human behaviours, these findings can be applied across healthcare and community settings. SYSTEMATIC REVIEW REGISTRATION: Registration number CRD42020186902 with PROSPERO International Prospective Register for Systematic Reviews.


Assuntos
Aerossóis/efeitos adversos , Comportamento Verbal/fisiologia , Aerossóis/metabolismo , Tosse/fisiopatologia , Fonação/fisiologia , Canto/fisiologia , Fala/fisiologia , Patologia da Fala e Linguagem/métodos
3.
Ann Agric Environ Med ; 28(1): 27-43, 2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33775065

RESUMO

INTRODUCTION AND OBJECTIVE: The course of COVID-19 caused by the SARS-CoV-2 may be aggravated by bioaerosols containing other viruses, bacteria, and fungi, occurring mainly in the occupational environment. Hence, the diagnostics and treatment of COVID-19 should address such a possibility in the anamnesis, treatment and final recommendations for avoiding of adverse exposure. ABBREVIATED DESCRIPTION OF THE STATE OF KNOWLEDGE: As SARS-CoV-2 attacks primarily the respiratory system and the severe manifestation of COVID-19 is interstitial pneumonia, diagnostics should include the following clinical and laboratory examinations: chest X-ray; high resolution computed tomography (HRCT); pulmonary function tests; arterial-blood gas test; genetic tests for the presence of SARS-CoV-2, in the future with the use of highly specific and sensitive nano-based biosensors; tests for the presence of specific immunity against the antigens of microorganisms causing other infectious or allergic pulmonary diseases (in the case of anamnestic indications). Because an universally accepted treatment for COVID-19 does not exist, the hitherto prescribed antiviral and immune-modulating drugs should be used be with caution. In many cases, a better alternative could be a safe supportive therapy, such as supplementation of the diet with probiotics, prebiotics, vitamins and microelements. SUMMARY: The most important preventive measures against COVID-19 should include: vaccination; the use of filter or surgical masks; disinfection and sterilization; maintaining of well-functioning ventilation and air conditioning systems; reduction of the community air pollution which has been identified as an important factor increasing the COVID-19 severity. In the choice of preventive measures, the above should be considered for their potential efficacy against other bioaerosols as potential disease-aggravating agents.


Assuntos
/diagnóstico , /terapia , Aerossóis/efeitos adversos , Humanos , Doenças Profissionais/complicações , Doenças Profissionais/prevenção & controle , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Doenças Respiratórias/complicações , /isolamento & purificação
4.
Artigo em Inglês | MEDLINE | ID: mdl-33567665

RESUMO

BACKGROUND: During the SARS-CoV-2 pandemic, there was shortage of the standard respiratory protective equipment (RPE). The aim of this study was to develop a procedure to test the performance of alternative RPEs used in the care of COVID-19 patients. METHODS: A laboratory-based test was developed to compare RPEs by total inward leakage (TIL). We used a crossflow nebulizer to produce a jet spray of 1-100 µm water droplets with a fluorescent marker. The RPEs were placed on a dummy head and sprayed at distances of 30 and 60 cm. The outcome was determined as the recovery of the fluorescent marker on a membrane filter placed on the mouth of the dummy head. RESULTS: At 30 cm, a type IIR surgical mask gave a 17.7% lower TIL compared with an FFP2 respirator. At 60 cm, this difference was similar, with a 21.7% lower TIL for the surgical mask compared to the respirator. When adding a face shield, the TIL at 30 cm was further reduced by 9.5% for the respirator and 16.6% in the case of the surgical mask. CONCLUSIONS: A safe, fast and very sensitive test method was developed to assess the effectiveness of RPE by comparison under controlled conditions.


Assuntos
/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Máscaras/normas , Equipamento de Proteção Individual/normas , Dispositivos de Proteção Respiratória/normas , Aerossóis/efeitos adversos , Humanos , Exposição Ocupacional/prevenção & controle , Ventiladores Mecânicos , Água
5.
PLoS One ; 16(2): e0246543, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33539439

RESUMO

Dental turbines and scalers, used every day in dental operatories, feature built-in water spray that generates considerable amounts of water aerosol. The problem is that it is not exactly known how much. Since the outbreak of COVID-19, several aerosol safety recommendations have been issued-based on little empirical evidence, as almost no data are available on the exact aerosol concentrations generated during dental treatment. Similarly, little is known about the differences in the efficacy of different commercially available aerosol control systems to reduce in-treatment aerosol load. In this in vitro study, we used spectrometry to explore these questions. The time-dependent effect of conventional airing on aerosol concentrations was also studied. Everyday patient treatment situations were modeled. The test setups were defined by the applied instrument and its spray direction (high-speed turbine with direct/indirect airspray or ultrasonic scaler with indirect airspray) and the applied aerosol control system (the conventional high-volume evacuator or a lately introduced aerosol exhaustor). Two parameters were analyzed: total number concentration in the entire measurement range of the spectrometer and total number concentration within the 60 to 384 nm range. The results suggest that instrument type and spray direction significantly influence the resulting aerosol concentrations. Aerosol generation by the ultrasonic scaler is easily controlled. As for the high-speed turbine, the efficiency of control might depend on how exactly the instrument is used during a treatment. The results suggest that scenarios where the airspray is frequently directed toward the air of the operatory are the most difficult to control. The tested control systems did not differ in their efficiency, but the study could not provide conclusive results in this respect. With conventional airing through windows with a standard fan, a safety airing period of at least 15 minutes between treatments is recommended.


Assuntos
Aerossóis/efeitos adversos , Instrumentos Odontológicos/virologia , Odontologia/métodos , Aerossóis/administração & dosagem , Aerossóis/análise , Desenho de Equipamento , Humanos , Tamanho da Partícula , /isolamento & purificação
6.
Indian J Ophthalmol ; 69(3): 734-738, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33595513

RESUMO

Purpose: The study uses principles of liquid and gas mechanics to verify and quantify the generation of aerosols in oculoplastic procedures, namely surgery using a scalpel, electrosurgical device, and a mechanized drill. Methods: Surgical techniques were performed ex vivo using the electrosurgical device, scalpel, and mechanized drill on the muscle and bone of commercially available chicken. The liquid and gas dynamics were observed using a high-speed high-resolution Photron SA5 camera (0.125 to 8 ms temporal resolution, 0.016 to 0.054 mm/pixel spatial resolution) and stroboscopic lighting (Veritas 120 E LED Constellation). The analysis was performed using in-house algorithms and ImageJ software. Results: The use of a mechanized drill at 35000 rpm and a 3 mm fluted burr generated aerosol with particle size 50 to 550 microns with a spread of 1.8 m radius. Surgical smoke was generated by an electrosurgical device in both cutting and coagulation modes. Dispersion of the smoke could be controlled significantly by the use of suction, mean smoke spread ratio being 0.065 without suction and 0.002 with use of suction within 2 cm. Conclusion: The quantification of the aerosol generation will help surgeons take practical decisions in their surgical techniques in the pandemic era.


Assuntos
Aerossóis/efeitos adversos , Diagnóstico por Imagem/métodos , Oftalmopatias/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Cirúrgicos Oftalmológicos/métodos , Pandemias , Equipamento de Proteção Individual , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Medição de Risco/métodos , Comorbidade , Oftalmopatias/diagnóstico , Oftalmopatias/cirurgia , Humanos , Índia
7.
Indian J Ophthalmol ; 69(3): 743-745, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33595516

RESUMO

Type 1 retinopathy of prematurity (ROP) requires emergency intervention and laser is an established modality of treatment. Laser treatment for ROP under topical anesthesia can be considered as an aerosol-generating procedure due to crying that puts health care workers at high risk of COVID-19 transmission. Aerosol containment box (ACB) is known to minimize aerosol transmission and there are reports of ROP laser done through incubator. Combining these two ideas, we describe a new application of ACB with suction for laser treatment of ROP thereby, reducing risk to health care team without compromising timely effective, and safe treatment for ROP.


Assuntos
Aerossóis/efeitos adversos , Transmissão de Doença Infecciosa/prevenção & controle , Fotocoagulação a Laser/efeitos adversos , Pandemias , Retinopatia da Prematuridade/cirurgia , Comorbidade , Humanos , Recém-Nascido , Retinopatia da Prematuridade/epidemiologia
8.
J Glaucoma ; 30(3): 219-222, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394847

RESUMO

PRECIS: Designing and demonstrating an experiment that shows the risk of airborne transmission of COVID-19 between patients having visual fields analyzed is low. PURPOSE: The aim was to investigate the possibility of airborne transmission of COVID-19 during Humphrey visual field testing in a real-world scenario. METHODS: A particle counter was placed within the bowl of Humphrey visual field analyzer (HFA) before and after turning on the machine to ascertain the effect of the air current produced by the ventilation system on aerosols. A second experiment was run where the particle counter was placed in the bowl and recorded particulates, in the air, as a 24-2 SITA standard was performed by a mock patient and then again immediately after the patient had moved away. We measured aerosol particle counts sized ≤0.3 µm, >0.3≤0.5 µm, >0.5≤1 µm, >1≤2.5 µm, >2.5≤5 µm, and >5≤10 µm. RESULTS: Particulates of all sizes were shown to be significantly reduced within the bowl after turning the machine on, demonstrating that the air current produced by the HFA pushes air out of the bowl and it cannot stagnate. There was no significant difference in measurement of aerosol while there was a patient performing the test and immediately after they had moved away, suggesting that aerosols breathed out by the patient are not able to remain in suspension in the bowl because of the ventilation current. CONCLUSION: There is no significant difference between aerosol count in the bowl of a HFA before, during and after testing. This suggests the risk of airborne transmission of COVID-19 is low between subsequent patients. This is in keeping with manufacturer's guidance on Humphrey visual field testing.


Assuntos
Aerossóis/efeitos adversos , Transmissão de Doença Infecciosa/prevenção & controle , Hipertensão Ocular/diagnóstico , Testes de Campo Visual/métodos , Campos Visuais/fisiologia , /epidemiologia , Comorbidade , Humanos , Pressão Intraocular/fisiologia , Hipertensão Ocular/epidemiologia , Hipertensão Ocular/fisiopatologia
11.
Anesthesiology ; 134(1): 61-71, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33125457

RESUMO

BACKGROUND: Disease severity in coronavirus disease 2019 (COVID-19) may be associated with inoculation dose. This has triggered interest in intubation barrier devices to block droplet exposure; however, aerosol protection with these devices is not known. This study hypothesized that barrier devices reduce aerosol outside of the barrier. METHODS: Aerosol containment in closed, semiclosed, semiopen, and open barrier devices was investigated: (1) "glove box" sealed with gloves and caudal drape, (2) "drape tent" with a drape placed over a frame, (3) "slit box" with armholes and caudal end covered by vinyl slit diaphragms, (4) original "aerosol box," (5) collapsible "interlocking box," (6) "simple drape" over the patient, and (7) "no barrier." Containment was investigated by (1) vapor instillation at manikin's right arm with video-assisted visual evaluation and (2) submicrometer ammonium sulfate aerosol particles ejected through the manikin's mouth with ventilation and coughs. Samples were taken from standardized locations inside and around the barriers using a particle counter and a mass spectrometer. Aerosol evacuation from the devices was measured using standard hospital suction, a surgical smoke evacuator, and a Shop-Vac. RESULTS: Vapor experiments demonstrated leakage via arm holes and edges. Only closed and semiclosed devices and the aerosol box reduced aerosol particle counts (median [25th, 75th percentile]) at the operator's mouth compared to no barrier (combined median 29 [-11, 56], n = 5 vs. 157 [151, 166], n = 5). The other barrier devices provided less reduction in particle counts (133 [128, 137], n = 5). Aerosol evacuation to baseline required 15 min with standard suction and the Shop-Vac and 5 min with a smoke evacuator. CONCLUSIONS: Barrier devices may reduce exposure to droplets and aerosol. With meticulous tucking, the glove box and drape tent can retain aerosol during airway management. Devices that are not fully enclosed may direct aerosol toward the laryngoscopist. Aerosol evacuation reduces aerosol content inside fully enclosed devices. Barrier devices must be used in conjunction with body-worn personal protective equipment.


Assuntos
Aerossóis/análise , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle , Equipamento de Proteção Individual , Aerossóis/efeitos adversos , Tosse/prevenção & controle , Tosse/virologia , Pessoal de Saúde , Humanos , Intubação Intratraqueal/efeitos adversos
12.
Am J Otolaryngol ; 42(1): 102829, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33186853

RESUMO

PURPOSE: The COVID-19 pandemic has led to concerns over transmission risk from healthcare procedures, especially when operating in the head and neck such as during surgical repair of facial fractures. This study aims to quantify aerosol and droplet generation from mandibular and midface open fixation and measure mitigation of airborne particles by a smoke evacuating electrocautery hand piece. MATERIALS AND METHODS: The soft tissue of the bilateral mandible and midface of two fresh frozen cadaveric specimens was infiltrated using a 0.1% fluorescein solution. Surgical fixation via oral vestibular approach was performed on each of these sites. Droplet splatter on the surgeon's chest, facemask, and up to 198.12 cm (6.5 ft) away from each surgical site was measured against a blue background under ultraviolet-A (UV-A) light. Aerosol generation was measured using an optical particle sizer. RESULTS: No visible droplet contamination was observed for any trials of mandible or midface fixation. Total aerosolized particle counts from 0.300-10.000 µm were increased compared to baseline following each use of standard electrocautery (n = 4, p < 0.001) but not with use of a suction evacuating electrocautery hand piece (n = 4, p = 0.103). Total particle counts were also increased during use of the powered drill (n = 8, p < 0.001). CONCLUSIONS: Risk from visible droplets during mandible and midface fixation is low. However, significant increases in aerosolized particles were measured after electrocautery use and during powered drilling. Aerosol dispersion is significantly decreased with the use of a smoke evacuating electrocautery hand piece.


Assuntos
Aerossóis/efeitos adversos , Transmissão de Doença Infecciosa/estatística & dados numéricos , Período Intraoperatório , Pandemias , /epidemiologia , Humanos , Mandíbula , Estados Unidos/epidemiologia
15.
Nicotine Tob Res ; 22(Suppl 1): S25-S34, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320255

RESUMO

INTRODUCTION: Flavor aldehydes in e-cigarettes, including vanillin, ethyl vanillin (vanilla), and benzaldehyde (berry/fruit), rapidly undergo chemical reactions with the e-liquid solvents, propylene glycol, and vegetable glycerol (PG/VG), to form chemical adducts named flavor aldehyde PG/VG acetals that can efficiently transfer to e-cigarette aerosol. The objective of this study was to compare the cytotoxic and metabolic toxic effects of acetals and their parent aldehydes in respiratory epithelial cells. AIMS AND METHODS: Cell metabolic assays were carried out in bronchial (BEAS-2B) and alveolar (A549) epithelial cells assessing the effects of benzaldehyde, vanillin, ethyl vanillin, and their corresponding PG acetals on key bioenergetic parameters of mitochondrial function. The potential cytotoxic effects of benzaldehyde and vanillin and their corresponding PG acetals were analyzed using the LIVE/DEAD cell assay in BEAS-2B cells and primary human nasal epithelial cells (HNEpC). Cytostatic effects of vanillin and vanillin PG acetal were compared using Click-iT EDU cell proliferation assay in BEAS-2B cells. RESULTS: Compared with their parent aldehydes, PG acetals diminished key parameters of cellular energy metabolic functions, including basal respiration, adenosine triphosphate production, and spare respiratory capacity. Benzaldehyde PG acetal (1-10 mM) increased cell mortality in BEAS-2B and HNEpC, compared with benzaldehyde. Vanillin PG acetal was more cytotoxic than vanillin at the highest concentration tested while both diminished cellular proliferation in a concentration-dependent manner. CONCLUSIONS: Reaction products formed in e-liquids between flavor aldehydes and solvent chemicals have differential toxicological properties from their parent flavor aldehydes and may contribute to the health effects of e-cigarette aerosol in the respiratory system of e-cigarette users. IMPLICATIONS: With no inhalation toxicity studies available for acetals, data from this study will provide a basis for further toxicological studies using in vitro and in vivo models. This study suggests that manufacturers' disclosure of e-liquid ingredients at time of production may be insufficient to inform a comprehensive risk assessment of e-liquids and electronic nicotine delivery systems use, due to the chemical instability of e-liquids over time and the formation of new compounds.


Assuntos
Aerossóis/efeitos adversos , Aldeídos/efeitos adversos , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Células Epiteliais/patologia , Aromatizantes/efeitos adversos , Mitocôndrias/patologia , Sistema Respiratório/patologia , Aldeídos/química , Células Epiteliais/efeitos dos fármacos , Aromatizantes/química , Humanos , Mitocôndrias/efeitos dos fármacos , Sistema Respiratório/efeitos dos fármacos
18.
BMJ Open ; 10(10): e040321, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33067299

RESUMO

OBJECTIVES: In patient-facing healthcare workers delivering secondary care, what is the evidence behind UK Government personal protective equipment (PPE) guidance on surgical masks versus respirators for SARS-CoV-2 protection? DESIGN: Two independent reviewers performed a rapid review. Appraisal was performed using Critical Appraisal Skills Programme checklists and Grading of Recommendations, Assessment, Development and Evaluations methodology. Results were synthesised by comparison of findings and appraisals. DATA SOURCES: MEDLINE, Google Scholar, UK Government COVID-19 website and grey literature. ELIGIBILITY CRITERIA: Studies published on any date containing primary data comparing surgical facemasks and respirators specific to SARS-CoV-2, and studies underpinning UK Government PPE guidance, were included. RESULTS: Of 30 identified, only 3 laboratory studies of 14 different respirators and 12 surgical facemasks were found. In all three, respirators were significantly more effective than facemasks when comparing protection factors, reduction factors, filter penetrations, total inspiratory leakages at differing particle sizes, mean inspiratory flows and breathing rates. Tests included live viruses and inert particles on dummies and humans. In the six clinical studies (6502 participants) included the only statistically significant result found continuous use of respirators more effective in clinical respiratory illness compared with targeted use or surgical facemasks. There was no consistent definition of 'exposure' to determine the efficacy of respiratory protective equipment (RPE). It is difficult to define 'safe'. CONCLUSIONS: There is a paucity of evidence on the comparison of facemasks and respirators specific to SARS-CoV-2, and poor-quality evidence in other contexts. The use of surrogates results in extrapolation of non-SARS-CoV-2 specific data to guide UK Government PPE guidance. The appropriateness of this is unknown given the uncertainty over the transmission of SARS-CoV-2.This means that the evidence base for UK Government PPE guidelines is not based on SARS-CoV-2 and requires generalisation from low-quality evidence of other pathogens/particles. There is a paucity of high-quality evidence regarding the efficacy of RPE specific to SARS-CoV-2. UK Government PPE guidelines are underpinned by the assumption of droplet transmission of SARS-CoV-2.These factors suggest that the triaging of filtering face piece class 3 respirators might increase the risk of COVID-19 faced by some.


Assuntos
Aerossóis/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Pessoal de Saúde , Controle de Infecções/métodos , Equipamento de Proteção Individual/provisão & distribuição , Pneumonia Viral/transmissão , Triagem/métodos , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia
19.
Crit Care ; 24(1): 571, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32967700

RESUMO

Coronavirus disease (COVID-19) is an emerging viral infection that is rapidly spreading across the globe. SARS-CoV-2 belongs to the same coronavirus class that caused respiratory illnesses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). During the SARS and MERS outbreaks, many frontline healthcare workers were infected when performing high-risk aerosol-generating medical procedures as well as when providing basic patient care. Similarly, COVID-19 disease has been reported to infect healthcare workers at a rate of ~ 3% of cases treated in the USA. In this review, we conducted an extensive literature search to develop practical strategies that can be implemented when providing respiratory treatments to COVID-19 patients, with the aim to help prevent nosocomial transmission to the frontline workers.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , /terapia , Aerossóis/efeitos adversos , Infecções por Coronavirus/transmissão , Humanos , Metanálise como Assunto , Estudos Observacionais como Assunto , Pneumonia Viral/transmissão , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
20.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 55-57, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965357

RESUMO

In the context of the COVID-19 pandemic, endoscopy services must adopt preventive measures to maintain proper functioning due to a high risk of disease contagion. Triage protocols before and after the procedure, personal protective equipment, and environmental contamination control are some of the endoscopy society's recommendations. However, the risk of infection may remain high due to poor control over the source of contamination.Using a combination of standardized supplies and accessories in a hospital, a ventilation mask adapted to be used in endoscopic procedures is proposed to reduce COVID-19 contamination.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Endoscopia , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Desenho de Equipamento , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
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