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1.
PLoS One ; 15(10): e0240009, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002052

RESUMO

OBJECTIVE: Brighter Bites is a school-based health promotion program that delivers fresh produce and nutrition education to low-income children and families. Due to COVID-19-related school closures, states were under "shelter in place" orders, and Brighter Bites administered a rapid assessment survey to identify social needs among their families. The purpose of this study is to demonstrate the methodology used to identify those with greatest social needs during this time ("high risk"), and to describe the response of Brighter Bites to these "high risk" families. METHODS: The rapid assessment survey was collected in April 2020 across Houston, Dallas, Washington DC, and Southwest Florida. The survey consisted of items on disruption of employment status, financial hardship, food insecurity, perceived health status and sociodemographics. The open-ended question "Please share your greatest concern at this time, or any other thoughts you would like to share with us." was asked at the end of each survey to triage "high risk" families. Responses were then used to articulate a response to meet the needs of these high risk families. RESULTS: A total of 1048 families completed the COVID-19 rapid response survey, of which 71 families were triaged and classified as "high risk" (6.8% of survey respondents). During this time, 100% of the "high risk" participants reported being food insecure, 85% were concerned about their financial stability, 82% concerned about the availability of food, and 65% concerned about the affordability of food. A qualitative analysis of the high-risk group revealed four major themes: fear of contracting COVID19, disruption of employment status, financial hardship, and exacerbated food insecurity. In response, Brighter Bites pivoted, created, and deployed a framework to immediately address a variety of social needs among those in the "high risk" category. Administering a rapid response survey to identify the immediate needs of their families can help social service providers tailor their services to meet the needs of the most vulnerable.


Assuntos
Infecções por Coronavirus/epidemiologia , Características da Família , Determinação de Necessidades de Cuidados de Saúde , Pneumonia Viral/epidemiologia , Pobreza , Betacoronavirus , Criança , District of Columbia , Emprego , Florida , Alimentos/economia , Abastecimento de Alimentos , Promoção da Saúde , Humanos , Renda , Pandemias , Serviço Social , Inquéritos e Questionários , Texas
2.
Yale J Biol Med ; 93(4): 579-585, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33005122

RESUMO

Not only do epidemics such as HIV/AIDS, Ebola Virus Disease (EVD), and the current Coronavirus Disease (COVID-19) cause the loss of millions of lives, but they also cost the global economy billions of dollars. Consequently, there is an urgent need to formulate interventions that will help control their spread and impact when they emerge. The education of young girls and women is one such historical approach. They are usually the vulnerable targets of disease outbreaks - they are most likely to be vehicles for the spread of epidemics due to their assigned traditional roles in resource-limited countries. Based on our work and the work of others on educational interventions, we propose six critical components of a cost-effective and sustainable response to promote girl-child education in resource-limited settings.


Assuntos
Doenças Transmissíveis Emergentes , Infecções por Coronavirus , Identidade de Gênero , Saúde Global , Educação em Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , Criança , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Países em Desenvolvimento , Feminino , Saúde Global/economia , Saúde Global/educação , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Educação em Saúde/métodos , Educação em Saúde/organização & administração , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
3.
Ann Glob Health ; 86(1): 112, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32944509

RESUMO

Background: Although "social isolation" protects the life and health of Vietnamese citizens from the adverse effects of the COVID-19 pandemic, it also triggers massive reductions in the economic activities of the country. Objective: our study aimed to identify negative impacts of COVID-19 on occupations of Vietnamese people during the first national lockdown, including the quality and quantity of jobs as well as adverse problems at work due to COVID-19. Methods: A cross-sectional study using web-based platforms was conducted during the first time of social isolation in Vietnam at the beginning of April 2020. We utilized a respondent-driven sampling technique to select 1423 respondents from 63 cities and provinces over Vietnam. Exploratory factor analysis (EFA) was used to define sub-domains of perceived impacts of COVID-19 on occupations. Findings: Approximately two-thirds of respondents reported decreases in their income (61.6%), and 28.2% reported that their income deficit was 40% and above. The percentage of female individuals having decreased revenue due to COVID-19 was higher than that of male respondents (65.2% and 54.7%, respectively). "Worry that colleagues exposed to COVID-19 patients" and "Being alienated because employment-related to COVID-19" accounted for the highest score in each factor. Compared to healthcare workers, being self-employed/unemployed/retired were less likely to suffer from "Increased workload and conflicts due to COVID-19" and "Disclosure and discrimination related to COVID-19 work exposure." Conclusion: Our study revealed a drastic reduction in both the quality and quantity of working, as well as the increased fear and stigmatization of exposure to COVID-19 at workplaces. Health protection and economic support are immediate targets that should be focused on when implementing policies and regulations.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Recessão Econômica/estatística & dados numéricos , Emprego/estatística & dados numéricos , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Controle Social Formal/métodos , Vietnã/epidemiologia , Desempenho Profissional , Carga de Trabalho/estatística & dados numéricos
4.
Middle East Afr J Ophthalmol ; 27(2): 79-85, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874039

RESUMO

PURPOSE: To assess the psychological impact and mental health outcomes including depression, anxiety, and insomnia during COVID-19 crisis among ophthalmologists. METHODS: This was a simple random study in which ophthalmologists practicing in Saudi Arabia were asked to fill in a self-administered online survey during the period from March 28, 2020, to April 04, 2020. Four validated psychiatric assessment tools were used to detect symptoms of depression, anxiety, insomnia, and stress perception. RESULTS: One hundred and seven participants successfully completed the survey with a response rate of 30.6%. Males constituted 56.1% (n = 60). Ophthalmology residents constituted the majority (n = 66, 61.7%). About half of the physicians exhibited symptoms of depression (n = 56, 50.5%), anxiety (n = 50, 46.7%), and insomnia (n = 48, 44.9%). Symptoms of stress ranged between low (28%), moderate (68.2%), and high (3.7%). According to the cutoff values for severe symptoms, 29% were identified as having depression, 38.3% had anxiety, and 15% had insomnia.Depression was found to be more common among female ophthalmologists (P = 0.06), those living with an elderly (P = 0.003), and fellows (P = 0.006). Female ophthalmologists suffering from anxiety were significantly more than male ophthalmologists (P = 0.046). There was a trend toward suffering from anxiety in frontline health-care providers (P = 0.139) and in ophthalmologists who are living with an elderly (P = 0.149). Female participants exhibited significantly more moderate-to-high symptoms of stress (P = 0.018). CONCLUSIONS: Ophthalmologists' psychological needs, females in particular, should be addressed appropriately during the COVID-19 pandemic. Establishing psychological support units, especially for high-risk individuals, should be considered to minimize psychological adverse effects.


Assuntos
Ansiedade/psicologia , Infecções por Coronavirus/epidemiologia , Depressão/psicologia , Oftalmologistas/psicologia , Pneumonia Viral/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Estresse Psicológico/psicologia , Adulto , Ansiedade/epidemiologia , Betacoronavirus , Coronavirus , Depressão/epidemiologia , Feminino , Pessoal de Saúde , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Oftalmologistas/estatística & dados numéricos , Pandemias , Arábia Saudita/epidemiologia , Fatores Sexuais , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Adulto Jovem
6.
BMJ Open ; 10(9): e040487, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912996

RESUMO

OBJECTIVE: To evaluate the quality of information regarding the prevention and treatment of COVID-19 available to the general public from all countries. DESIGN: Systematic analysis using the 'Ensuring Quality Information for Patients' (EQIP) Tool (score 0-36), Journal of American Medical Association (JAMA) benchmark (score 0-4) and the DISCERN Tool (score 16-80) to analyse websites containing information targeted at the general public. DATA SOURCES: Twelve popular search terms, including 'Coronavirus', 'COVID-19 19', 'Wuhan virus', 'How to treat coronavirus' and 'COVID-19 19 Prevention' were identified by 'Google AdWords' and 'Google Trends'. Unique links from the first 10 pages for each search term were identified and evaluated on its quality of information. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: All websites written in the English language, and provides information on prevention or treatment of COVID-19 intended for the general public were considered eligible. Any websites intended for professionals, or specific isolated populations, such as students from one particular school, were excluded, as well as websites with only video content, marketing content, daily caseload update or news dashboard pages with no health information. RESULTS: Of the 1275 identified websites, 321 (25%) were eligible for analysis. The overall EQIP, JAMA and DISCERN scores were 17.8, 2.7 and 38.0, respectively. Websites originated from 34 countries, with the majority from the USA (55%). News Services (50%) and Government/Health Departments (27%) were the most common sources of information and their information quality varied significantly. Majority of websites discuss prevention alone despite popular search trends of COVID-19 treatment. Websites discussing both prevention and treatment (n=73, 23%) score significantly higher across all tools (p<0.001). CONCLUSION: This comprehensive assessment of online COVID-19 information using EQIP, JAMA and DISCERN Tools indicate that most websites were inadequate. This necessitates improvements in online resources to facilitate public health measures during the pandemic.


Assuntos
Infecções por Coronavirus , Internet/normas , Pandemias , Pneumonia Viral , Informática em Saúde Pública , Betacoronavirus , Informação de Saúde ao Consumidor/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Confiabilidade dos Dados , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Informática em Saúde Pública/métodos , Informática em Saúde Pública/normas , Informática em Saúde Pública/tendências
11.
S Afr Med J ; 110(7): 629-634, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32880337

RESUMO

Pandemics challenge clinicians and scientists in many ways, especially when the virus is novel and disease expression becomes variable or unpredictable. Under such circumstances, research becomes critical to inform clinical care and protect future patients. Given that severely ill patients admitted to intensive care units are at high risk of mortality, establishing the cause of death at a histopathological level could prove invaluable in contributing to the understanding of COVID-19. Postmortem examination including autopsies would be optimal. However, in the context of high contagion and limited personal protective equipment, full autopsies are not being conducted in South Africa (SA). A compromise would require tissue biopsies and samples to be taken immediately after death to obtain diagnostic information, which could potentially guide care of future patients, or generate hypotheses for finding needed solutions. In the absence of an advance written directive (including a will or medical record) providing consent for postmortem research, proxy consent is the next best option. However, obtaining consent from distraught family members, under circumstances of legally mandated lockdown when strict infection control measures limit visitors in hospitals, is challenging. Their extreme vulnerability and emotional distress make full understanding of the rationale and consent process difficult either before or upon death of a family member. While it is morally distressing to convey a message of death telephonically, it is inhumane to request consent for urgent research in the same conversation. Careful balancing of the principles of autonomy, non-maleficence and justice becomes an ethical imperative. Under such circumstances, a waiver of consent, preferably followed by deferred proxy consent, granted by a research ethics committee in keeping with national ethics guidance and legislation, would fulfil the basic premise of care and research: first do no harm. This article examines the SA research ethics framework, guidance and legislation to justify support for a waiver of consent followed by deferred proxy consent, when possible, in urgent research after death to inform current and future care to contain the pandemic in the public interest.


Assuntos
Infecções por Coronavirus/epidemiologia , Cuidados Críticos/ética , Estado Terminal/terapia , Mortalidade Hospitalar , Consentimento Livre e Esclarecido/ética , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Causas de Morte , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos/legislação & jurisprudência , Estado Terminal/mortalidade , Países em Desenvolvimento , Feminino , Humanos , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/ética , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Projetos de Pesquisa , Medição de Risco , África do Sul , Populações Vulneráveis/estatística & dados numéricos
16.
Sensors (Basel) ; 20(18)2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32932848

RESUMO

The emerging wearable medical devices open up new opportunities for the provision of health services and promise to accelerate the development of novel telemedical services. The main objective of this study was to investigate the desirable features and applications of telemedical services for the Polish older adults delivered by wearable medical devices. The questionnaire study was conducted among 146 adult volunteers in two cohorts (C.1: <65 years vs. C.2: ≥65 years). The analysis was based on qualitative research and descriptive statistics. Comparisons were performed by Pearson's chi-squared test. The questionnaire, which was divided into three parts (1-socio-demographic data, needs, and behaviors; 2-health status; 3-telemedicine service awareness and device concept study), consisted of 37 open, semi-open, or closed questions. Two cohorts were analyzed (C.1: n = 77; mean age = 32 vs. C.2: n = 69; mean age = 74). The performed survey showed that the majority of respondents were unaware of the telemedical services (56.8%). A total of 62.3% of C.1 and 34.8% of C.2 declared their understanding of telemedical services. The 10.3% of correct explanations regarding telemedical service were found among all study participants. The most desirable feature was the detection of life-threatening and health-threatening situations (65.2% vs. 66.2%). The findings suggest a lack of awareness of telemedical services and the opportunities offered by wearable telemedical devices.


Assuntos
Telemedicina/instrumentação , Dispositivos Eletrônicos Vestíveis , Adulto , Idoso , Betacoronavirus , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Feminino , Geriatria/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Polônia/epidemiologia , Tecnologia de Sensoriamento Remoto/instrumentação , Inquéritos e Questionários , Tecnologia sem Fio/instrumentação
17.
BMC Fam Pract ; 21(1): 203, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32988371

RESUMO

BACKGROUND: Continuing medical education (CME) is essential to developing and maintaining high quality primary care. Traditionally, CME is delivered face-to-face, but due to geographical distances, and pressure of work in Bangladesh, general practitioners (GPs) are unable to relocate for several days to attend training. Using chronic obstructive pulmonary disease (COPD) as an exemplar, we aimed to assess the feasibility of blended learning (combination of face-to-face and online) for GPs, and explore trainees' and trainers' perspectives towards the blended learning approach. METHODS: We used a mixed-methods design. We trained 49 GPs in two groups via blended (n = 25) and traditional face-to-face approach (n = 24) and assessed their post-course knowledge and skills. The COPD Physician Practice Assessment Questionnaire (COPD-PPAQ) was administered before and one-month post-course. Verbatim transcriptions of focus group discussions with 18 course attendees and interviews with three course trainers were translated into English and analysed thematically. RESULTS: Forty GPs completed the course (Blended: 19; Traditional: 21). The knowledge and skills post course, and the improvement in self-reported adherence to COPD guidelines was similar in both groups. Most participants preferred blended learning as it was more convenient than taking time out of their busy work life, and for many the online learning optimised the benefits of the subsequent face-to-face sessions. Suggested improvements included online interactivity with tutors, improved user friendliness of the e-learning platform, and timing face-to-face classes over weekends to avoid time-out of practice. CONCLUSIONS: Quality improvement requires a multifaceted approach, but adequate knowledge and skills are core components. Blended learning is feasible and, with a few caveats, is an acceptable option to GPs in Bangladesh. This is timely, given that online learning with limited face-to-face contact is likely to become the norm in the on-going COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Educação a Distância/métodos , Educação Médica Continuada , Clínicos Gerais/educação , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Ensino , Atitude do Pessoal de Saúde , Bangladesh/epidemiologia , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Instrução por Computador , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Educação Médica Continuada/organização & administração , Educação Médica Continuada/tendências , Estudos de Viabilidade , Humanos , Modelos Educacionais , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Melhoria de Qualidade , Ensino/normas , Ensino/tendências
18.
BMJ Open ; 10(9): e041370, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32988953

RESUMO

OBJECTIVES: To use Population Health Management (PHM) methods to identify and characterise individuals at high-risk of severe COVID-19 for which shielding is required, for the purposes of managing ongoing health needs and mitigating potential shielding-induced harm. DESIGN: Individuals at 'high risk' of COVID-19 were identified using the published national 'Shielded Patient List' criteria. Individual-level information, including current chronic conditions, historical healthcare utilisation and demographic and socioeconomic status, was used for descriptive analyses of this group using PHM methods. Segmentation used k-prototypes cluster analysis. SETTING: A major healthcare system in the South West of England, for which linked primary, secondary, community and mental health data are available in a system-wide dataset. The study was performed at a time considered to be relatively early in the COVID-19 pandemic in the UK. PARTICIPANTS: 1 013 940 individuals from 78 contributing general practices. RESULTS: Compared with the groups considered at 'low' and 'moderate' risk (ie, eligible for the annual influenza vaccination), individuals at high risk were older (median age: 68 years (IQR: 55-77 years), cf 30 years (18-44 years) and 63 years (38-73 years), respectively), with more primary care/community contacts in the previous year (median contacts: 5 (2-10), cf 0 (0-2) and 2 (0-5)) and had a higher burden of comorbidity (median Charlson Score: 4 (3-6), cf 0 (0-0) and 2 (1-4)). Geospatial analyses revealed that 3.3% of rural and semi-rural residents were in the high-risk group compared with 2.91% of urban and inner-city residents (p<0.001). Segmentation uncovered six distinct clusters comprising the high-risk population, with key differentiation based on age and the presence of cancer, respiratory, and mental health conditions. CONCLUSIONS: PHM methods are useful in characterising the needs of individuals requiring shielding. Segmentation of the high-risk population identified groups with distinct characteristics that may benefit from a more tailored response from health and care providers and policy-makers.


Assuntos
Infecções por Coronavirus , Sistemas de Informação em Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral , Gestão da Saúde da População , Medição de Risco/métodos , Gestão de Riscos , Idoso , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Demografia , Inglaterra/epidemiologia , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Fatores de Risco , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração , Índice de Gravidade de Doença
19.
BMJ Open ; 10(9): e039749, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32994257

RESUMO

OBJECTIVES: The growth of COVID-19 infections in England raises questions about system vulnerability. Several factors that vary across geographies, such as age, existing disease prevalence, medical resource availability and deprivation, can trigger adverse effects on the National Health System during a pandemic. In this paper, we present data on these factors and combine them to create an index to show which areas are more exposed. This technique can help policy makers to moderate the impact of similar pandemics. DESIGN: We combine several sources of data, which describe specific risk factors linked with the outbreak of a respiratory pathogen, that could leave local areas vulnerable to the harmful consequences of large-scale outbreaks of contagious diseases. We combine these measures to generate an index of community-level vulnerability. SETTING: 91 Clinical Commissioning Groups (CCGs) in England. MAIN OUTCOME MEASURES: We merge 15 measures spatially to generate an index of community-level vulnerability. These measures cover prevalence rates of high-risk diseases; proxies for the at-risk population density; availability of staff and quality of healthcare facilities. RESULTS: We find that 80% of CCGs that score in the highest quartile of vulnerability are located in the North of England (24 out of 30). Here, vulnerability stems from a faster rate of population ageing and from the widespread presence of underlying at-risk diseases. These same areas, especially the North-East Coast areas of Lancashire, also appear vulnerable to adverse shocks to healthcare supply due to tighter labour markets for healthcare personnel. Importantly, our index correlates with a measure of social deprivation, indicating that these communities suffer from long-standing lack of economic opportunities and are characterised by low public and private resource endowments. CONCLUSIONS: Evidence-based policy is crucial to mitigate the health impact of pandemics such as COVID-19. While current attention focuses on curbing rates of contagion, we introduce a vulnerability index combining data that can help policy makers identify the most vulnerable communities. We find that this index is positively correlated with COVID-19 deaths and it can thus be used to guide targeted capacity building. These results suggest that a stronger focus on deprived and vulnerable communities is needed to tackle future threats from emerging and re-emerging infectious disease.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde/normas , Pandemias , Pneumonia Viral , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Inglaterra/epidemiologia , Disparidades nos Níveis de Saúde , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Prevalência , Saúde Pública/métodos , Saúde Pública/tendências , Melhoria de Qualidade/organização & administração , Fatores de Risco , Análise Espacial
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