"When you get those rare moments of clarity, those flashes when the universe makes sense, you try desperately to hold on to them. They are the life boats for the darker times, when the vastness of it all, the incomprehensible nature of life is completely illusive. So the question becomes, or should have been all a long... What would you do if you knew you only had one day, or one week, or one month to live. What life boat would you grab on to? What secret would you tell? What band would you see? What person would you declare your love to? What wish would you fulfill? What exotic locale would you fly to for coffee? What book would you write?"


Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts

Friday, April 24, 2020

Predictive Analytics: Breaking it Down

Hi There! I am BACK. And I wanted to share what my main focus in life right now is. 

But first, a little background on where I've been for the past 4 years....

I am a Registered Nurse, and have been for 8 years. I have been in healthcare for 13 1/2 years. About 4 years ago I took a position that actually removed me from the bedside but instead I got to be a part of helping to design and change our electronic health record in a way that improved patient safety and made more sense for nurses and physicians to use.

I remember within my first month on the job, I was quickly drawn to the fact that we could use this electronic health record to capture data and summarize data on hundreds of patients. Better yet, in this new electronic health record, we had abilities to build our own reports! Someone very influential to me, someone I think was placed temporarily in my life for the sole purpose of steering me in my life's direction, sat with me or initially two hours and gave me my first high level crash course in reporting. I-was-hooked!

From there, I continued to grow and expand the use of reporting and my passion for it became apparent. I became the person on my team that was known for being able to whip up new reports and to also be a whiz in Microsoft Excel. These skills allowed me to not only create and put together data from within the system, but to also summarize and track that data.

About a year or so into the job, I knew I had to advance my degree. I have a Bachelor's of Science in Nursing, but I needed more. I've always loved school and am a total school nerd. I enrolled into my local college for a Masters in Nursing with a clinical nurse leader track. I was doing well, about 2-3 courses in- but......I hated it. Guys, nothing felt more nauseating and not right to me in my entire life. It was all research papers and evidenced based practice and blah. Not for me. I didn't really know what else to do, so I switched to a Masters in Nursing Administration. In this track I started to see how cool the whole business aspect of the degree was, but again felt nauseated in what I was learning with regards to how broken our healthcare system is. I spent years on the floor doing my best and it was never enough to the same people that I was in a degree trying to become. Again, it didn't feel right. I took a break from school when I was pregnant with my daughter and in the post partum period as well. I thought long and hard about returning and what felt right.

Then I saw it: A new program at the same college- It was a sign! A Masters in Science in Predictive Analytics. Technically this isn't a healthcare degree, its a business degree. I always had felt that I had to stay in nursing because that's what my background was, even if I hated the pursuit of anything further in it. But this degree.... it felt right in my bones. Multiple people have told me that when I start talking about data analytics/predictive analytics, they can visibly see the light in my eyes go on fire, the rise in pitch and rate of speed in my voice increase, and I could talk about it forever. That right there everyone, is passion. And I knew I had to pursue it. I always joked in the last 4 years in my job that if I could wake up and spend all day in an Excel spreadsheet, I would love-my-job. Data to me makes sense. Its tangible but also infinite. It's like a math equation. There's an answer at the end but also infinite answers! It makes me jump up and down inside, can you tell?

So I started this program in January of 2019, when my daughter was ~ 5 months, leaving my husband to watch Abby for the 3 hours a week I spent in class. It sure has been a whirlwind ever since, and I still am spending 12-15 hours a week involved in the program with homework, reading and in class time. But, what's difference in this is that those 12-15 hours don't even feel like "homework" or "work". Sure I need to make sure I get it done within the deadlines, but its FUN! When I make a dashboard or create a model I get a sense of immense joy and celebrate in my newfound abilities. It kind of feels like what I imagine it felt like for Spiderman to suddenly wake up and realize he has superpowers. This is my superpower.

But, as I started meeting other moms and introduced myself and what I do or mentioned my degree, or talked with friends and family about it, I started noticing a frustrating pattern: No matter who it was, within a minute of talking about it, people's eyes started glazing over and they'd switch the topic. I told new people that I was getting my degree in Predictive Analytics and they acted as if I said I was getting the degree in astrophysical quantum mechanical engineering (if that's even a thing?).
It was sad for me because this was my passion and I wanted to tell the world about it. To me, at work or in school, it was all common talk and people understood it, but I wanted to be able to share it with more than that.

So, I'm here to break it down as best I can.

I don't want to give any fancy definitions of what it is, because even I don't understand those. Lots of statistics and blahblahblah.

To me, predictive analytics is as simple as using and understanding data from the past to predict future events. That's it!

Ok so let me break it down into a real elementary example, then I will advance a little from there.

This example brings in my love of epidemiology also, so its fun. Let's say there was a big gala held last weekend celebrating something. 100 people were in attendance. There was a lot of food served, but lets focus on 5 foods: They served chicken, salmon, filet mignon, and ham as the meat choices. They had a big salad on the side for vegetarians.  However, unfortunately, a few days later the party hosts found out that 20 of their guests got really sick! They called and blamed the food they ate. So the hosts had to find out, what was it that made everyone sick? So they interviewed each of the sick to find out what they ate. But what is important here, is where predictive analytics comes into play is not just interviewing what the sick ate, but what the non-sick ate too. For example, if the 20 sick people all had the ham, but so did 70 non-sick people, it's probably not the ham that made everyone sick. But how could we really say for sure? Well, nothing is ever really sure in data analytics. Data analytics treats words like "always" and "never" like the black plague.

So what we do here is treat each one of those food items as variables. (I'll explain that more). Each variable would be "Did this person eat the ham, yes or no?" or "Did this person eat the turkey, yes or no?"  By then viewing the list of the 20 people and what they ate, we could likely identify a pattern of the common thing(s) that the people ate that got sick. OK now stay with me- we can use that knowledge of understanding what we THINK got sick and assign them values. So perhaps those that ate the turkey were 80% more likely to have gotten sick and assign it a value of 0.8. We now PREDICT, will the rest of our guests get sick? So we take that list we have of our 80 non-sick people, and essentially run it through a model to determine a prediction of how likely that person is to be sick. If we found out that ham and turkey were the culprits that made everyone sick, if we took one of the non-sick people and found out he too had ham and turkey, we could give him a pretty accurate high prediction that he may end up also getting sick. However, if one of the non-sick people say they only had the salad, and non of the sick people ate the salad, we can give that person a pretty accurate prediction that they won't join their friends in the quarantine.

This sounds like a silly example, but its how these predictions work. In examples I am involved with at work, the "20 sick people" that are used to learn and understand the variables, is actually 500,000+ people (perhaps more likely in the millions). Taking data from only 20 people can lead to a lot of inaccurate predictions. Maybe they were lying or forgot details. But if we are seeing common patterns on half a million people, we can gain better accuracy in applying what we learn to future predictions. Instead of the "variables" being 5 food groups, we instead look at hundreds of variables to better understand everything we can about these instances. In this way, we actually can learn new things that may be correlated to a disease or effect.

Some examples I am working with in healthcare now are predictive models that can predict how likely a patient is to have a cardiac arrest event, or code blue. We use close to a hundred variables that were studied on thousands of patients that DID have a cardiac arrest (think back to the gala example-the people that DID get sick). By learning what was unique about those patients that did have a cardiac arrest, we can then match that set of variables up to a new patient that walks in the door, to see how closely they align to those variables. Perfect match? Yikes, lets get the code cart ready! Hardly a match at all? Pretty good chance they aren't coding on our watch (Again, nothing is certain).

But think of how useful these models are to us, in healthcare and around the world (I'll get to that). By having a prediction like how likely a patient is to have a code blue, we can better prepare as healthcare workers to make sure that doesn't happen. We can better plan staffing ratios, adjust the treatment plan, get other specialists on board, etc.

I'm working on a few other models in healthcare right now, but there are more than I can even count that are actually out there. We are gathering the ability to predict who will experience a fall, who will contract sepsis, who will come to the emergency department, who will not show up for their appointment, who will come back to the hospital, etc. In each of these cases, these accurate predictions allows us to prepare.

But think of it more globally. These same concepts can and are applied to other "predictable" events. We could essentially predict tidal waves, hurricanes, tornadoes by understanding what variables or conditions were in place before those events happened in the PAST to help us predict the FUTURE. We could predict mass shootings by understanding conditions and variables that were attributed to past mass shootings. We could predict train delays or breakdowns, airport delays, stock markets, retail surges, etc. With the growing amount of data being made available to all of us, even you, we will have more and more ability to predict almost any event that can have attributable data to it.

Anyway, I hope I didn't lose you all! If you can't tell, this stuff is my life's passion and I can't wait to see where it takes me. This is really just the beginning. There is so much more involved to it all than what I wrote about in this blog, hence the need to get an entire degree in it (and even that will barely scratch the surface), but I wanted to at least get the concept out there as easily understood. Maybe I'll even inspire someone to go chase the dream for themselves, too!

Thank you for reading.

Toodles!

_ A Writer in an Informatics Nurse's Body

Wednesday, January 13, 2016

Go-Live Success

Well, as promised- I have returned for a second time in under a week! That's already an accomplishment! Also, as promised- I want to tell you all about how our Go-Live went. Now remember I'm not naming my hospital network or the system we went live with, but refer to my last post for a clue... Now anyway, the system is amazing, just like I knew it would be. It is fascinating having had the privilege of learning the system since September and teaching it to others, but so far only having seen it with fake patients. I was so eager just to get to see it work for real! As we drew closer and closer to the Go-Live Flipswitch, my coworkers fear and anxiety levels rose but my excitement drew higher.

Getting to work with it all weekend after that moment has been fantastic and very eye-opening. I remember having had "play time" on one of my last days of my own training where we were allowed to just play around and practice anything so that we felt completely ready to help once we went-live. I practiced and practiced and I thought surely, I know everything know- What other situation could arise that I don't know how to do?

Well, I should have slapped myself right there because the rest of the weekend I was "go-Live support" which entailed me running around the hospital ( I literally ran up and down some stairs a few occasions) in order to help all three of our units and the ICU, and handle any problems that were arising. Needless to say, my "to-do" list was about 20 items long and it kept me busy all 12 hours of my shift. I would cross one thing off and be on my way to handle another and then on that route another problem would occur. So, point of the story is I thought I knew how to handle everything but then when real patients are in with unique individual situations and the patients aren't fake, certain charting queries come up and there needs to be a firm solution on how to handle that. I was put on the spot many times and had to rack my brain at 3 am in order to get a solution.

It is interesting watching people learn. Like I said before, I had the opportunity all fall to teach fellow nurses, PCAs, and Nurse managers on how to use the system. We faced a lot of kickback, frustration, tears, confusion, etc. And although I saw a lot of frustration with the Go-Live as well, overall these nurses knew that frustration was not going to help their patient and that if they just sit back and let us teach them how to handle the problem, they would go a lot further. Therefore a lot more health care personnel were a lot more open to learning this time around since we were working with real patients, real time, real problems. It was also delightful getting a lot more "Ah-ha!" moments from our users.

It is a known fact that users always learn faster when emerged inside of a real situation. We can only teach these users so much and get them to remember when we are working with "John Playdough" instead of a real patient, and when we are teaching 2-3 months away from the Go-Live day. And yet when these users are using it every second of their shift because they have to for their real patients, they pick it up much faster. Just like learning a language- You learn French much better stuck in the middle of France than you do in a classroom.

Overall this whole experience so far has reinforced within my own self that I love informatics, I love teaching people and I still love healthcare. I can't wait to grow inside this field and to accomplish more tasks. I love being in charge of projects around the hospital and reporting to and talking directly to high-up administration (literally had multiple conversations with the vice president of my hospital over the weekend!) not because of a power trip- but because I like being trusted and knowing that people believe I can accomplish difficult tasks.

Well, another weekend of work ahead-stay tuned! In other news, I get to go to my orientation for my masters program tonight! Super awesome! And next Tuesday I start my class! So exciting! Nerdddddddd. :-)

Friday, May 3, 2013

What's Wrong With our Country

Hey look at me go, two posts in one week! Woot!

Anyway, this topic sprouted into my mind a couple days ago. Let me give you a small back story. Lately, my boyfriend and I have come to the inevitable conclusion that its seriously time to lose weight. Neither of us are significantly overweight, but we're both at the point where it definitely couldn't hurt to lose, either. Those happy blissful first years of dating make for a lot of restaurant frequenting and alcohol, neither of which are good for you! :( So we decided to do this together, the whole diet and exercise thing.

Now I overall thought I ate pretty healthy to begin with. As some of you know, I decided about 6 years ago that I was never going to eat or support any fast food franchise ever again. By support I mean I refuse to even take my kids there and give the franchise money even if its not actually being eaten by me. Will that change when I have ten minutes to feed the kids en route from soccer to dance practice? I hope not! Time will tell, but I hope that I can stick true to my beliefs.

So being that I never eat fast food (except for Subway and Panera if you want to count them), I also never drink Soda, never eat Chocolate and don't typically indulge in a lot of sweets, I eat a LOT of fruit and a fair amount of veggies....My only understandable downfall is my love for restaurants and that I probably don't drink enough water. I also have a bad habit of eating late at night.  Also, working night shift doesn't help at all. So based on all that, it didn't seem fair or right to me that I was still seemingly gaining weight at a rapid pace. So I had to put a stop to it before it got any harder to lose, and my boyfriend was on board. We thought about a couple programs, including Weight Watchers (a personal favorite of mine) or perhaps trying it on our own, or going to see a nutritionist, or a freelance dieting company, or one of those marketed weight loss pills/shakes or whatever.

But instead of spending money right away, we decided to do it on our own with the help of the program "my fitness pal". It's available online and via apps on a lot of phone carriers. Via phone, you can literally scan bar codes of what you are eating and it calculates everything for you. It's futuristic and awesomely awesome. It sets up a profile for you and makes goals and predicts progress for you based on how your day went. At the end of the day it even gives you pie charts of the breakdown of carbs, protein and fat you ate. It's pretty cool, and all for free. It focuses on calories mostly, but also tracks the remainder of nutrition for each product. Like Weight Watchers, It really teaches you what you were doing wrong and opens your eyes to how much you actually eat during the day and where you can cut back. Just from using the app for three days now I've realized a couple of my hinders to weight loss, some being: Starbucks Green tea frapps with soymilk/no whip (still unhealthy), Thai tea with bubbles, RITAS (I'm a ritaholic), my soy ice cream, and wineeeee. All of those said things I knew to not be extremely healthy per say but I didn't consider them to be *the* reason I wasn't losing weight. Now I treat myself to one of those said things when I have a couple calories to spare.

Anyway, the point of this post- what's wrong with this country?

The other night for dinner, my boyfriend and I picked Saladworks for dinner. For those of you unfamiliar with the franchise, its a lot like a Panera Bread- you can pick soups to eat, salads, sandwiches. What I found to be cool is you can create your own salad. My boyfriend got a Chicken Cesar premade salad, dressing on the side- And I made my own. I got romaine lettuce and added chick peas, carrots, egg whites, wheat noodles, croutons and lite raspberry vinaigrette dressing on the side, and it came with a whole wheat roll. For me, that's 509 calories. Not too bad for what I got (a lot) and the roll is to blame for a lot of that. My boyfriends was 441.

Now before I make my point here, lets think about a meal at McDonalds. Now I went to their dollar menu choices and picked out a theoretical/fake meal for my boyfriend and I.

Two McDouble Cheeseburgers, two medium fries and two sweet teas. This led to 1,840 calories, being 920 each.

So Saladworks: 950 calories for BOTH of us, cost me $19.58.
Mcdonalds: 1,840 calories, would cost me about $6.

Yeah.


I had to pause there for a second because it makes me so angry. So lets think about this. The country of America has a raging epidemic of obesity. We have ads everywhere to lose weight. Take this pill, drink this, eat this, join our program, be high school skinny again! Yet we have endless ads for fast food, too. So Okay lets say someone wants to lose weight but they are on a budget, like 89% of the country is. Lets face it the majority of us aren't swimming in cash.  So someone wants to go lose weight so they think, oh hey! Saladworks! I like salad! It's healthy! I'll lose weight! But oh, how much? That's $20!? When I used to spend about $6 dollars on my dinner? I can't afford to lose weight!  So they go back to McDonald's, spend less but also eat less matter, but eat more calories, gain more weight. See where I'm headed here? What incentive does the majority of America have to lose weight when it's obviously dramatically more expensive to lose weight. Joining Weight watchers alone will cost an individual about $52/month alone. People go to the fast food because its cheap, its fast and it tastes good. Places like Panera and Saladworks are dramatically more expensive and it takes longer. This.Is.Why.America.is.Overweight.

In an ideal utopian world, well- my utopia- people would have incentive to buy healthier things because its a lot less expensive. Popular fast food chains would become sky rocket prices-the dollar menu would cease to exist and "Value" meals would now cost $20. People on severe budgets would be drawn to healthier food because its cheaper. Think about it, we are digging ourselves a hole right into health care itself.

Someone on severe budget---> Eats fast food----> Becomes severely overweight----> A lot of health problems arise (diabetes, high cholesterol, high blood pressure, muscle/bone issues, etc)----->they don't go to the doctor because they don't have the money----->they wait and wait and those problems now become---->Strokes, heart attacks, knee replacements, gastric bypass, lifelong rehab, or even death.----they can't pay for that either.

Those second problems are so much more hard to take care of, not only on the demand to healthcare workers but to our economy! Treating someone for a FIRST heart attack that they can't pay for could cost the economy tens of thousands of dollars- and that's if its remotely uncomplicated!


It just gets me so angry. I am blessed enough to be able to afford the higher prices that come with losing weight. But a single mom with 3 kids trying to feed herself and her kids? Perhaps not so much. Yes I over exaggerated, yes I picked out dollar menu items as an example from McDonald's to make my point. Perhaps a more in depth meal at McDonald's would cost up to $15, but can you imagine how many calories that could be? Not only that, but my boyfriend and I were very full after our meal at Saladworks, and we felt great. If I ate $10 worth of food at McDonald's- Not only would I probably feel like complete crap, but it wouldn't be able to keep me full. I'd be craving more fat and sweets within an hour or two and then the cycle repeats.


Okay so I'm done now. I could probably talk for hours and hours about the Nutrition problems with our country, but I can't keep my audience forever. You're probably hungry by now. Just kidding. No I'm actually pretty hungry, I shall make myself some strawberries perhaps....yumm.

I'm sure some people won't agree with me, and that's totally cool- that's ALSO what America is all about- freedom of speech. Amen to that!


With love,


~WNB



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Friday, November 9, 2012

What This Election Means

So now that all the political aftermath has seemed to maybe calm down a bit, let me take a minute to talk about my favorite part about the American Democracy.  Let me remind you I am not passionate about politics in any way. I voted, sure. It's the basic American right. What I felt most passionate about when I was following this election, was which candidate was going to take care of the country's healthcare system better? Thats basically what made my vote for me.

But thats not the point of this blog.


The day of voting, I went after a long day in class/work/orientation. I stood in line like many across the country did that day, and in front of me was an elderly gentleman. I noticed this man was on supplemental oxygen and was alone. He managed to either drive or get dropped off, but regardless made the effort to participate in the election. He then walked all the way into the polling center, and waited in line like the rest of us. What I was pleased to see was that other people in line in front of him, all let him go before them. They also went and got a chair for him to sit in not only while he waited but during the process of actually casting his vote. Other people helped him carry his oxygen machine. The poll director helped him back down the stairs and to his car.

Now I was pleased to see that not only people in my country but people in my community, still have human souls and would go out of their way to make this gentleman comfortable. But what really made me so happy was that this gentleman bothered to come out and vote.

It made me angry to think of how many young and able people don't vote because they're lazy, think their vote won't count, or they don't "believe in politics"....and yet this 90+ gentleman citizen believed enough to make it out to vote.

I don't even care a single ounce if he voted different than me. I don't care whose side he is on. He is on my side because he lives in America, and that is the point. To just participate. To make your voice matter, no matter what you believe in. Thats what election day is all about.


Thats all, simple post today. :)


~WNB


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Friday, August 3, 2012

A Satan kind of Business

Yesterday I went to a hospital-sponsored "Birthday" breakfast, where employees get to sit at a breakfast table with the hospital CEO/CFO and some other important big-wigs. I have been employed at this hospital for what will be 6 years this August, and this is the first birthday that I've actually went.

We just hired a new CEO, and there have been mixed feelings about him. Normal, I suppose,when a new big wig comes to play, as this instantly makes people fear they will lose their job. A CEO has to really work in order to gain the trust from its employees.

So I wasn't sure what to expect from this "birthday breakfast" with the CEO....how many people would go? Would it be 1:1 time with the CEO? What would we talk about? Cupcakes? Breakfast? The weather? Monkeys? History? Rules? Africa? Eggs? Pancakes? Opinions?

We started off the breakfast with one of those "icebreakers" where we all had to share our name, how long we've been employed, what we do.....squishsquash like that.

Then we got into the real mishmosh, the nittygritty of things we've been wanting to hear about. When are we getting our raises back? Whats going to happen to the hospital? Are we going to remodel? Are our jobs secure? Everyone sits tensely in their seats, politely yet rebellious as a lion inside, ready to pounce, yet trying to behave. People get very tense when it comes to money and their jobs.


Lately our hospital census has been in the toilet, meaning we have not very many patients. This raises a lot of concern, being that without enough patients , we won't have enough money to sustain the business or pay our employees. So everyone has been nervous, so of course this issue was brought up with the CEO. His response is what really got me thinking.

He jokingly said, "I guess we gave out too many flu shots this year." People laughed quietly.


But what he said.....it's absolutely true, and yet it isn't true. True, we did give out a lot and they were effective. But we didn't give out "too many". We prevented a lot of people from getting sick this year, and it may have impacted our census, maybe it didn't.

But it got me thinking....running a hospital is like running a Satan business. We thrive, we depend on people getting sick or injured. When less people get sick or injured, our business suffers. We market our business just like any other type of business out there- We billboard and advertise on TV to get people to think of and choose us when they are sick or injured and need to choose an ER.

I guess the point I'm trying to make here is that, an ideal world would be if a hospital could support itself and its employees without depending on others suffering. It can't happen, I suppose, considering money doesn't just magically appear and fund organizations.

In my schooling, we learned about the growing concept that hospital patients were changing. In this present day and in the coming future, a typical hospital patient is a lot sicker than in the past. More and more illnesses and conditions are treated in the outpatient, long term care, clinic or home care setting. This is great for public health care but it could be why we are seeing a lower census as of late. Some of these sicker, long term hospital required care patients don't have insurance or insurance that is going to pay. Also, these patients aren't turning over the beds and are taking up space, draining the staff, etc. So its like the hospital administrations depend on the misfortune of the community to sustain itself, but we need you to get better quickly, so you can be a patient of ours, pay us and then leave so we can give your bed to the next paying patient.  Like I said, its a Satan Kind of Business....


It's similar to the concept of warfare health care. Back in the days of surviving WWI and WWII, we learned and advanced so much in health care because of all the emergent practice we had on suffering soldiers. Suddenly we had patients that were going to die anyway if we didn't try something, so it gave surgeons and doctors of the age to experiment and practice....and sometimes save lives resultingly, sometimes not. But it taught and revolutionized health care. It's the concept of trial and error.  It's yet another example of how health care thrives off the mass suffering off its population.

Yet this concept turns on itself. The more people that suffer and come in to the hospital, the more money the hospital makes. For non-profit organizations, such as mine- this allows us to then put the money back into the hospital, better machines, more nurses, better doctors, new units, more services, which all lead to safer, and better patient outcomes and satisfaction, which then leads to word of mouth in the community to others, which therefore leads to more money back into the hospital from others that are suffering. It's a cycle. A Satan cycle. A necessary cycle in the health care industry. A sad cycle.


I've had this post, this thought, stemming in my head for a long time, since June. I even had half of it written out but decided to halt the writing on it because I felt it was getting too political. I really know nothing about politics or finances. Nothing. I know that. All I know is nursing, nothing administration. All I know is what nurses see and how nurses are affected. So what prompted me to finally go through with this post? My unit, the smallest unit in the hospital, recently shut down last Friday along with the second smallest unit. At first we all thought it would just be the weekend. Tomorrow we will hit one week. All of us are on our toes. This is where a low hospital census hits home. My entire staff team is now orphaned, being sent out around the whole hospital, floated. It's miserable. We all want to be back on the unit we were hired too, the unit we have raised and grown to love throughout the past year.

The only, and I mean only, good thing about this sad misfortune, is that I am at least gaining experience on other units in my hospital. But I miss the familiarity.



Thats all for now folks,

~WNB.




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