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1.
J Nurs Adm ; 51(11): 573-578, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1504564

ABSTRACT

The ability to respond effectively and efficiently during times of crisis, including a pandemic, has emerged as a competency for nurse leaders. This article describes one institution's experience using the American Organization of Nurse Leaders Competencies for Nurse Executives in operationalizing the concept of surge capacity.


Subject(s)
Communication , Health Plan Implementation , Nurse Administrators/organization & administration , Professional Competence , Surge Capacity/organization & administration , COVID-19 , Chicago , Humans , United States
2.
Anaesthesist ; 70(7): 582-597, 2021 07.
Article in German | MEDLINE | ID: covidwho-1453677

ABSTRACT

BACKGROUND AND OBJECTIVE: During the initial phase of the COVID-19 pandemic the government of the state of Bavaria, Germany, declared a state of emergency for its entire territory for the first time in history. Some areas in eastern Bavaria were among the most severely affected communities in Germany, prompting authorities and hospitals to build up capacities for a surge of COVID-19 patients. In some areas, intensive care unit (ICU) capacities were heavily engaged, which occasionally made a redistribution of patients necessary. MATERIAL AND METHODS: For managing COVID-19-related hospital capacities and patient allocation, crisis management squads in Bavaria were expanded by disaster task force medical officers ("Ärztlicher Leiter Führungsgruppe Katastrophenschutz" [MO]) with substantial executive authority. The authors report their experiences as MO concerning the superordinate patient allocation management in the district of Upper Palatinate (Oberpfalz) in eastern Bavaria. RESULTS: By abandoning routine patient care and building up additional ICU resources, surge capacity for the treatment of COVID-19 patients was generated in hospitals. In parts of the Oberpfalz, ICU capacities were almost entirely occupied by patients with corona virus infections, making reallocation to other hospitals within the district and beyond necessary. The MO managed patient pathways in an escalating manner by defining local (within the region of responsibility of a single MO), regional (within the district), and cross-regional (over district borders) reallocation lanes, as needed. When regional or cross-regional reallocation lanes had to be established, an additional management level located at the district government was involved. Within the determined reallocation lanes, emitting and receiving hospitals mutually agreed on any patient transfer without explicitly involving the MO, thereby maintaining the established interhospital routine transfer procedures. The number of patients and available treatment resources at each hospital were monitored with the help of a web-based treatment capacity registry. If indicated, reallocation lanes were dynamically revised according to the present situation. To oppose further virus spreading in nursing homes, the state government prohibited patient allocation to these facilities, which led to considerably longer hospital length of stay of convalescent elderly and/or dependent patients. In parallel to the flattening of the COVID-19 incidence curve, routine hospital patient care could be re-established in a stepwise manner. CONCLUSION: Patient allocation during the state of emergency by the MO sought to keep up routine interhospital reallocation procedures as much as possible, thereby reducing management time and effort. Occasionally, difficulties were observed during patient allocations crossing district borders, if other MO followed different management principles. The nursing home blockade and conflicting financial interests of hospitals posed challenges to the work of the disaster task force medical officers.


Subject(s)
COVID-19 , Decision Making, Organizational , Pandemics , Surge Capacity/organization & administration , Critical Care , Disease Management , Emergency Service, Hospital , Germany , Humans , Intensive Care Units , Length of Stay , Nursing Homes , Patient Transfer , Research Report , Resource Allocation
3.
J Nurs Adm ; 51(10): 500-506, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1434561

ABSTRACT

Like any disaster, the COVID-19 pandemic has presented significant challenges to healthcare systems, especially the threat of insufficient bed capacity and resources. Hospitals have been required to plan for and implement innovative approaches to expand hospital inpatient and intensive care capacity. This article presents how one of the largest healthcare systems in the United States leveraged existing technology infrastructure to create a virtual hospital that extended care beyond the walls of the "brick and mortar" hospital.


Subject(s)
COVID-19 , Delivery of Health Care/organization & administration , Home Care Services, Hospital-Based/organization & administration , Hospitals , Surge Capacity/organization & administration , Telemedicine/organization & administration , Humans , Quality of Health Care , SARS-CoV-2 , Telemedicine/methods , United States/epidemiology
6.
Am J Emerg Med ; 49: 100-103, 2021 11.
Article in English | MEDLINE | ID: covidwho-1252390

ABSTRACT

INTRODUCTION: The initial surge of critically ill patients in the COVID-19 pandemic severely disrupted processes at acute care hospitals. This study examines the frequency and causes for patients upgraded to intensive care unit (ICU) level care following admission from the emergency department (ED) to non-critical care units. METHODS: The number of ICU upgrades per month was determined, including the percentage of upgrades noted to have non-concordant diagnoses. Charts with non-concordant diagnoses were examined in detail as to the ED medical decision-making, clinical circumstances surrounding the upgrade, and presence of a diagnosis of COVID-19. For each case, a cognitive bias was assigned. RESULTS: The percentage of upgraded cases with non-concordant diagnoses increased from a baseline range of 14-20% to 41.3%. The majority of upgrades were due to premature closure (72.2%), anchoring (61.1%), and confirmation bias (55.6%). CONCLUSION: Consistent with the behavioral literature, this suggests that stressful ambient conditions affect cognitive reasoning processes.


Subject(s)
COVID-19 , Decision Making, Organizational , Pandemics , Surge Capacity/organization & administration , Cognition , Critical Care , Critical Illness , Emergency Service, Hospital , Humans , Intensive Care Units , Retrospective Studies , Tertiary Care Centers
7.
Crit Care Med ; 49(7): 1038-1048, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1246785

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 pandemic has strained many healthcare systems. In response, U.S. hospitals altered their care delivery systems, but there are few data regarding specific structural changes. Understanding these changes is important to guide interpretation of outcomes and inform pandemic preparedness. We sought to characterize emergency responses across hospitals in the United States over time and in the context of local case rates early in the coronavirus disease 2019 pandemic. DESIGN: We surveyed hospitals from a national acute care trials group regarding operational and structural changes made in response to the coronavirus disease 2019 pandemic from January to August 2020. We collected prepandemic characteristics and changes to hospital system, space, staffing, and equipment during the pandemic. We compared the timing of these changes with county-level coronavirus disease 2019 case rates. SETTING AND PARTICIPANTS: U.S. hospitals participating in the Prevention and Early Treatment of Acute Lung Injury Network Coronavirus Disease 2019 Observational study. Site investigators at each hospital collected local data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Forty-five sites participated (94% response rate). System-level changes (incident command activation and elective procedure cancellation) occurred at nearly all sites, preceding rises in local case rates. The peak inpatient census during the pandemic was greater than the prior hospital bed capacity in 57% of sites with notable regional variation. Nearly half (49%) expanded ward capacity, and 63% expanded ICU capacity, with nearly all bed expansion achieved through repurposing of clinical spaces. Two-thirds of sites adapted staffing to care for patients with coronavirus disease 2019, with 48% implementing tiered staffing models, 49% adding temporary physicians, nurses, or respiratory therapists, and 30% changing the ratios of physicians or nurses to patients. CONCLUSIONS: The coronavirus disease 2019 pandemic prompted widespread system-level changes, but front-line clinical care varied widely according to specific hospital needs and infrastructure. Linking operational changes to care delivery processes is a necessary step to understand the impact of the coronavirus disease 2019 pandemic on patient outcomes.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/organization & administration , Hospitals , Surge Capacity/organization & administration , Critical Care/organization & administration , Hospital Bed Capacity , Humans , Intensive Care Units/organization & administration , SARS-CoV-2 , Surveys and Questionnaires , United States/epidemiology , Workforce/organization & administration
8.
Healthc Q ; 24(1): 28-35, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1190655

ABSTRACT

Provincial health systems have been challenged by the surge in healthcare demands caused by the COVID-19 pandemic; the COVID-19 vaccine rollout across the country has further added to these challenges. A successful vaccination campaign is widely viewed as the only way to overcome the COVID-19 pandemic, placing greater urgency on the need for a rapid vaccination strategy. In this paper, we present emerging findings, from a national research study, that document the key challenges faced by current vaccine rollout strategies, which include procurement and leadership strategies, citizen engagement and limitations in supply chain capacity. These findings are used to inform a scalable vaccine strategy comprising collaborative leadership, mobilization of an integrated workforce and a digitally enabled supply chain strategy. The goal of vaccinating the entire Canadian population in the next few months can be achieved when supported by such a strategy.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Evidence-Based Practice/methods , Immunization Programs/organization & administration , Surge Capacity/organization & administration , COVID-19 Vaccines/supply & distribution , Canada , Humans , Leadership , State Government
9.
Chest ; 160(2): 519-528, 2021 08.
Article in English | MEDLINE | ID: covidwho-1126776

ABSTRACT

BACKGROUND: The COVID-19 pandemic placed considerable strain on critical care resources. How US hospitals responded to this crisis is unknown. RESEARCH QUESTION: What actions did US hospitals take to prepare for a potential surge in demand for critical care services in the context of the COVID-19 pandemic? STUDY DESIGN AND METHODS: From September to November 2020, the chief nursing officers of a representative sample of US hospitals were surveyed regarding organizational actions taken to increase or maintain critical care capacity during the COVID-19 pandemic. Weighted proportions of hospitals for each potential action were calculated to create estimates across the entire population of US hospitals, accounting for both the sampling strategy and nonresponse. Also examined was whether the types of actions taken varied according to the cumulative regional incidence of COVID-19 cases. RESULTS: Responses were received from 169 of 540 surveyed US hospitals (response rate, 31.3%). Almost all hospitals canceled or postponed elective surgeries (96.7%) and nonsurgical procedures (94.8%). Few hospitals created new medical units in areas not typically dedicated to health care (12.9%), and almost none adopted triage protocols (5.6%) or protocols to connect multiple patients to a single ventilator (4.8%). Actions to increase or preserve ICU staff, including use of ICU telemedicine, were highly variable, without any single dominant strategy. Hospitals experiencing a higher incidence of COVID-19 did not consistently take different actions compared with hospitals facing lower incidence. INTERPRETATION: Responses of hospitals to the mass need for critical care services due to the COVID-19 pandemic were highly variable. Most hospitals canceled procedures to preserve ICU capacity and scaled up ICU capacity using existing clinical space and staffing. Future research linking hospital response to patient outcomes can inform planning for additional surges of this pandemic or other events in the future.


Subject(s)
COVID-19 , Critical Care/organization & administration , Hospital Administration , Surge Capacity/organization & administration , COVID-19/epidemiology , Cross-Sectional Studies , Health Care Surveys , Humans , United States/epidemiology
10.
Popul Health Manag ; 24(2): 174-181, 2021 04.
Article in English | MEDLINE | ID: covidwho-998262

ABSTRACT

Italy was one of the countries most affected by the number of people infected and dead during the first COVID-19 wave. The authors describe the rapid rollout of a population health clinical and organizational response in preparedness and capabilities to support the first wave of the COVID-19 pandemic in the Italian province of Modena. The authors review the processes, the challenges faced, and describe how excess demand for hospital services was successfully mitigated and thus overwhelming the healthcare services avoided the collapse of the local health care system. An analysis of bed occupancy in the region predicted during the first weeks of the epidemic. The SEIR model estimated the number of infected people under different containment measures. Community resources were mobilized to reduce provincial hospitals' burden of care. A population health approach, based on a radical reorganization of the workflow and emergency patient management, was implemented. The bed saturation of the Modena Healthcare Agency was measured by an ad hoc, newly implemented intensive care unit (ICU) bed occupancy and COVID-19 centralized governance dashboard. ICU bed occupancy increased by 114%, avoiding saturation of the Modena Healthcare Agency system. The Emilia-Romagna region achieved a higher rate of ICU bed availability at 2.15 ICU beds per 10,000 inhabitants as compared with community 1 ICU bed availability prior to the pandemic. Rapid and radical local reorganization of regional efforts helped inform the successful development and implementation of strategic choices within the hospital and the community to prevent the saturation of key facilities.


Subject(s)
COVID-19/therapy , Communicable Disease Control/organization & administration , Hospital Bed Capacity , Intensive Care Units/organization & administration , Population Health , Surge Capacity/organization & administration , COVID-19/epidemiology , Humans , Italy
12.
Am J Disaster Med ; 15(2): 143-148, 2020.
Article in English | MEDLINE | ID: covidwho-955243

ABSTRACT

The Vancouver Convention Health Centre (VCHC) was rapidly set up as a part of the COVID-19 response in Brit-ish Columbia in order to create surge hospital capacity bed space. Multiple field hospitals were set up across the country in preparation for a possible surge and the VCHC utilized a non-traditional health care space and overlaid it with medical infrastructure. Maximum flexibility was required in planning for multiple patient populations and a novel four-box concept to plan for the requirements of the respective possible populations was developed. Key difficulties that needed to be overcome in planning COVID-19 medical care delivery in a non-traditional space included oxygen delivery, unknown future patient populations, and staffing. A clear recommendation can also now be made that healthcare provision should be considered during the design and build of new recreational or convention facilities in all communities.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Disaster Planning , Health Resources/supply & distribution , Hospital Planning , Pandemics/prevention & control , Pneumonia, Viral/therapy , Surge Capacity/organization & administration , British Columbia/epidemiology , COVID-19 , Coronavirus Infections/epidemiology , Disease Outbreaks , Hospital Bed Capacity , Humans , Pneumonia, Viral/epidemiology , Public Health , SARS-CoV-2 , Surge Capacity/statistics & numerical data
13.
J Pain Symptom Manage ; 61(2): e13-e50, 2021 02.
Article in English | MEDLINE | ID: covidwho-939084

ABSTRACT

CONTEXT: Evidence from prior public health emergencies demonstrates palliative care's importance to manage symptoms, make advance care plans, and improve end-of-life outcomes. OBJECTIVE: To evaluate the preparedness and capacity of palliative care services in the Middle-East and North Africa region to respond to the COVID-19 pandemic. METHODS: A cross-sectional online survey was undertaken, with items addressing the WHO International Health Regulations. Nonprobabilistic sampling was used, and descriptive analyses were conducted. RESULTS: Responses from 43 services in 12 countries were analyzed. Half of respondents were doctors (53%), and services were predominantly hospital based (84%). All but one services had modified at least one procedure to respond to COVID-19. Do Not Resuscitate policies were modified by a third (30%) and unavailable for a fifth (23%). While handwashing facilities at points of entry were available (98%), a third had concerns over accessing disinfectant products (37%), soap (35%), or running water (33%). The majority had capacity to use technology to provide remote care (86%) and contact lists of patients and staff (93%), though only two-fifths had relatives' details (37%). Respondents reported high staff anxiety about becoming infected themselves (median score 8 on 1-10 scale), but only half of services had a stress management procedure (53%). Three-fifths had plans to support triaging COVID-19 patients (60%) and protocols to share (58%). CONCLUSION: Participating services have prepared to respond to COVID-19, but their capacity to respond may be limited by lack of staff support and resources. We propose recommendations to improve service preparedness and relieve unnecessary suffering.


Subject(s)
Attitude of Health Personnel , COVID-19/therapy , Clinical Competence , Infection Control/organization & administration , Palliative Care/organization & administration , Surge Capacity/organization & administration , Africa , COVID-19/complications , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Surveys and Questionnaires
14.
Emerg Infect Dis ; 26(12): 2844-2853, 2020 12.
Article in English | MEDLINE | ID: covidwho-805604

ABSTRACT

The ability of health systems to cope with coronavirus disease (COVID-19) cases is of major concern. In preparation, we used clinical pathway models to estimate healthcare requirements for COVID-19 patients in the context of broader public health measures in Australia. An age- and risk-stratified transmission model of COVID-19 demonstrated that an unmitigated epidemic would dramatically exceed the capacity of the health system of Australia over a prolonged period. Case isolation and contact quarantine alone are insufficient to constrain healthcare needs within feasible levels of expansion of health sector capacity. Overlaid social restrictions must be applied over the course of the epidemic to ensure systems do not become overwhelmed and essential health sector functions, including care of COVID-19 patients, can be maintained. Attention to the full pathway of clinical care is needed, along with ongoing strengthening of capacity.


Subject(s)
COVID-19/transmission , Hospital Bed Capacity/statistics & numerical data , Pandemics/prevention & control , Surge Capacity/organization & administration , Australia/epidemiology , COVID-19/epidemiology , Contact Tracing , Critical Pathways/standards , Humans , Intensive Care Units/statistics & numerical data , Physical Distancing , Public Health , Quarantine/methods
15.
J Perinat Med ; 48(9): 892-899, 2020 Nov 26.
Article in English | MEDLINE | ID: covidwho-745671

ABSTRACT

The global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Hospitals/statistics & numerical data , Obstetrics/methods , Pandemics , Pneumonia, Viral/epidemiology , Pregnancy Complications, Infectious/virology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/therapy , Critical Care/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Hospital Administration , Humans , Infant, Newborn , New York City/epidemiology , Obstetrics/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , Personnel Staffing and Scheduling , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , SARS-CoV-2 , Surge Capacity/organization & administration , Surge Capacity/statistics & numerical data
17.
Crit Care Nurs Q ; 43(4): 468-479, 2020.
Article in English | MEDLINE | ID: covidwho-729225

ABSTRACT

The COVID-19 pandemic presented an unprecedented opportunity to test the emergency management plan of one large urban teaching hospital. In this article, a detailed description of the hospital's surge planning process with lessons learned has been provided.


Subject(s)
Coronavirus Infections/epidemiology , Hospitals, Teaching/organization & administration , Hospitals, Urban/organization & administration , Nurse Administrators/psychology , Pandemics , Pneumonia, Viral/epidemiology , Surge Capacity/organization & administration , COVID-19 , Humans , Pennsylvania/epidemiology
18.
Crit Care Nurs Q ; 43(4): 413-427, 2020.
Article in English | MEDLINE | ID: covidwho-729222

ABSTRACT

As the confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to grow with over 1 million documented infections in the United States alone, researchers and health care workers race to find effective treatment options for this potentially fatal disease. Mortality remains high in patients whose disease course requires mechanical ventilation and admission to intensive care units. While focusing on therapies to decrease mortality is essential, we must also consider the logistical hurdles faced with regard to safely and effectively delivering treatment while limiting the risk of harm to hospital staff and other noninfected patients. In this article, we discuss aspects of surge planning, considerations in limiting health care worker exposure, the logistics of medication delivery in a uniform and consolidated manner, protocols for delivering emergent care in a rapidly deteriorating coronavirus disease-2019 (COVID-19) patient, and safe practices for transporting infected patients.


Subject(s)
Clinical Protocols , Coronavirus Infections/therapy , Hospitals, General/organization & administration , Occupational Exposure/prevention & control , Pneumonia, Viral/therapy , Safety Management/organization & administration , Surge Capacity/organization & administration , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Cross Infection/prevention & control , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intensive Care Units/organization & administration , Pandemics , Pennsylvania/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission
19.
Plast Reconstr Surg ; 146(2): 437-446, 2020 08.
Article in English | MEDLINE | ID: covidwho-692689

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has confronted the U.S. health care system with unprecedented challenges amidst a tenuous economic environment. As inpatient hospitals across the country prepare for an overwhelming influx of highly contagious COVID-19 cases, many nonemergent procedures have been cancelled or indefinitely postponed without guidance regarding eventual safe accommodation of these procedures in the future. Given the potentially prolonged impact of the COVID-19 pandemic on health care use, it is imperative for plastic surgeons to collaborate with other medical and surgical specialties to develop surge capacity protocols that allow continuation of safe, high-quality, nonemergent procedures. The purpose of this article is to provide necessary and timely public health information relevant to plastic surgery and also share a conceptual framework to guide surge capacity protocols for nonemergent surgery.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Regional Health Planning/organization & administration , Surge Capacity/organization & administration , Surgery, Plastic/organization & administration , Ambulatory Surgical Procedures/standards , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Elective Surgical Procedures/standards , Humans , Infection Control/standards , Intersectoral Collaboration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Practice Guidelines as Topic , Reconstructive Surgical Procedures/standards , Regional Health Planning/standards , SARS-CoV-2 , Surgery, Plastic/standards , Surgicenters/organization & administration , Surgicenters/standards , Telemedicine/organization & administration , Telemedicine/standards , United States
20.
Proc Natl Acad Sci U S A ; 117(33): 19873-19878, 2020 08 18.
Article in English | MEDLINE | ID: covidwho-690440

ABSTRACT

Following the April 16, 2020 release of the Opening Up America Again guidelines for relaxing coronavirus disease 2019 (COVID-19) social distancing policies, local leaders are concerned about future pandemic waves and lack robust strategies for tracking and suppressing transmission. Here, we present a strategy for triggering short-term shelter-in-place orders when hospital admissions surpass a threshold. We use stochastic optimization to derive triggers that ensure hospital surges will not exceed local capacity and lockdowns are as short as possible. For example, Austin, Texas-the fastest-growing large city in the United States-has adopted a COVID-19 response strategy based on this method. Assuming that the relaxation of social distancing increases the risk of infection sixfold, the optimal strategy will trigger a total of 135 d (90% prediction interval: 126 d to 141 d) of sheltering, allow schools to open in the fall, and result in an expected 2,929 deaths (90% prediction interval: 2,837 to 3,026) by September 2021, which is 29% of the annual mortality rate. In the months ahead, policy makers are likely to face difficult choices, and the extent of public restraint and cocooning of vulnerable populations may save or cost thousands of lives.


Subject(s)
COVID-19/epidemiology , Coronavirus Infections/epidemiology , Logistic Models , Physical Distancing , Pneumonia, Viral/epidemiology , Quarantine/methods , Surge Capacity/organization & administration , COVID-19/economics , COVID-19/prevention & control , Coronavirus Infections/economics , Coronavirus Infections/prevention & control , Cost of Illness , Hospitalization/economics , Hospitalization/statistics & numerical data , Humans , Pandemics/economics , Pandemics/prevention & control , Pneumonia, Viral/economics , Pneumonia, Viral/prevention & control , Quarantine/economics , Quarantine/organization & administration , Surge Capacity/economics , Time , Vulnerable Populations
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