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Declercq IJN, Leontjevas R, Verboon P, De Vriendt P, Gerritsen DL, van Hooren S. A bayesian network meta-analysis to explore modifying factors in randomized controlled trials: what works for whom to reduce depression in nursing home residents? BMC Geriatr 2024; 24:518. [PMID: 38872075 DOI: 10.1186/s12877-024-05117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Reviews of depression interventions in nursing home residents resulted in positive findings. However, because of the heterogeneity of the studies, it remains unclear what works for whom. Considering moderator effects may contribute to a comprehensive understanding of depression treatment in residents. Therefore, this study aims to review depression interventions, examining moderator effects of (1) residents' factors, and (2) components specific of interventions. METHODS A Bayesian network meta-analysis of randomized controlled trials primarily aimed at reducing depressive symptoms among residents was conducted. First, intervention types, e.g., exercise interventions, were compared to care as usual. Second, meta-regression analyses were conducted for moderator effects of residents' factors (i.e., severity of depressive symptoms, physical dependency, and cognitive impairment) and components identified as specific to an intervention (e.g., music, creativity, positivity). RESULTS Our search across six databases resulted in 118 eligible studies: 16 on neurobiological interventions, 102 on non-pharmacological interventions. Compared to care as usual, cognitive interventions, such as cognitive behavioral therapy and goal-oriented therapy, showed the strongest effects (MD = -1.00, 95% CrI [-1.40 to -0.66]). Furthermore, the severity of depressive symptoms moderated the effect of interventions (ƅ = -0.63, CrI 95% [-1.04 to -0.22]), while none of fifteen identified intervention-specific components did. In residents with a depression diagnosis, there were larger effect sizes for interventions including daily structure, psychoeducation, healthy food, creativity, positivity, and an activating/encouraging environment, whereas interventions focusing on distraction and relaxation had larger effect sizes in those residents without. CONCLUSIONS By examining the moderator effects, we provided an integrative perspective on the observed variations in effects across different target groups, and components of depression interventions. This approach underscores the complex nature of interventions, emphasizing the need for continued transdisciplinary research, and the exploration of potential moderators. Future investigations should carefully assess residents' factors and choose interventions and their components accordingly.
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Affiliation(s)
- Ine J N Declercq
- Department of Primary and Community Care, Radboud University Medical Center, Gelderland, 6500 HBNijmegen, The Netherlands.
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands.
- Department of Gerontology and Frailty in Ageing (FRIA) and Mental Health and Wellbeing (MENT) Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Ruslan Leontjevas
- Department of Primary and Community Care, Radboud University Medical Center, Gelderland, 6500 HBNijmegen, The Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Peter Verboon
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Patricia De Vriendt
- Department of Gerontology and Frailty in Ageing (FRIA) and Mental Health and Wellbeing (MENT) Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Gelderland, 6500 HBNijmegen, The Netherlands
| | - Susan van Hooren
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
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AbdElsalam RMM, ElKholy SEAE. Pilot testing cognitive stimulation intervention on older adults' cognitive function, cognitive self-efficacy, and sense of happiness. Geriatr Nurs 2024; 56:191-203. [PMID: 38359739 DOI: 10.1016/j.gerinurse.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND With the ageing population increasing worldwide, identifying effective approaches to counteract cognitive decline becomes significant for maintaining cognitive health and quality of life in older adults. The lack of cognitive activity accelerates age cognitive decline. Cognitive stimulation interventions can maintain older adults' cognitive reserve, enhance their feelings of happiness, and potentially improve their psychosocial wellbeing. AIM This study aimed to determine the impact of Cognitive Stimulation Intervention on older adults' cognitive function, cognitive self-efficacy, and sense of happiness. METHOD A quasi-experimental methodological approach was applied. Two seniors' clubs were the sites for recruitment in this study as part of the Alexandria Governorate's Ministry of Social Solidarity, Egypt. Eighty older adults (aged 60 and above), randomly assigned into two equal groups. The study group received the study intervention, and the control group received regular seniors' club services. RESULTS Cognitive function, cognitive self-efficacy, and sense of happiness scores among the study group, were significantly increased from (22.40 ± 0.67, 54.51 ± 8.63 and 27.68 ± 14.0 respectively) to (24.30 ± 1.07, 87.84 ± 4.96 and 65.98 ± 8.90 respectively) (P < 0.001) following the interventions, and were significantly higher than the control group's post-test percent scores (22.08 ± 0.98, 54.35 ± 6.97, and 28.75 ± 9.60 respectively) (P < 0.001). CONCLUSIONS Cognitive Stimulation Intervention effectively fostered the older adults' cognitive function, cognitive self-efficacy, and sense of happiness. Consequently, seniors' clubs, care homes, and other contexts seeking to apply Cognitive Stimulation Intervention to improve older adults' cognitive function, and general wellbeing must embed this intervention as part of their routine care and social activities programs.
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Helbling M, Grandjean ML, Srinivasan M. Effects of multisensory environment/stimulation therapy on adults with cognitive impairment and/or special needs: A systematic review and meta-analysis. SPECIAL CARE IN DENTISTRY 2024; 44:381-420. [PMID: 37515496 DOI: 10.1111/scd.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/31/2023]
Abstract
AIM This review aimed to evaluate the effects of multisensory environments/stimulation (MSE/MSS) therapy, on the behavior and psychological symptoms in adults with cognitive impairment and/or special needs. METHODS Online database searches were performed to identify studies reporting on the effects of MSS/MSE therapy in adults (>18 years). Data were extracted for the following investigated outcomes including anxiety, depression, mood, behavioral attributes, biomedical parameters, cognition, motor skills, quality of life (QoL), pain, and end of life quality. Two reciprocally blinded investigators extracted the data. Inter-investigator reliability (𝝹) was calculated. A meta-analysis and a qualitative analysis were performed on the information extracted. RESULTS Thirty-six studies were included for data extraction and analysis. Meta-analysis of the included studies revealed a significant improvement with the MSE/MSS therapy, for agitation (p = .018), anxiety (p = .023), cognition (p < .001), and depression (p < .001). MSS/MSE therapy demonstrated a tendency for the improvement of the QoL in adults (p = .05). CONCLUSION MSE/MSS therapies are beneficial in cognitively impaired adults and improve their anxiety, depression, cognitive and other behavioral attributes such as agitative behaviors. Promoting these therapies in geriatric care may help to improve/reduce the challenging/care-resistant behaviors in adults and facilitate effective provision of the necessary care.
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Affiliation(s)
- Meret Helbling
- Clinic of General-, Special Care- and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Marie-Laure Grandjean
- Clinic of General-, Special Care- and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Murali Srinivasan
- Clinic of General-, Special Care- and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Kennedy KJ, Eckert M, Forsythe D, Wagner J, Sharplin G. Development of a clinical pathway for behavioural and psychological symptoms of dementia care: A tool to improve resident outcomes. Australas J Ageing 2022; 41:e291-e297. [PMID: 35638502 PMCID: PMC9545625 DOI: 10.1111/ajag.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
Objectives Clinical pathways are used to improve the quality of care, reduce variation and maximise health or treatment outcomes in selected populations. The aim of this study was to develop a draft clinical pathway based on the best practice evidence for use in the management of behavioural and psychological symptoms of dementia (BPSD) in residential aged care facilities (RACFs). Methods The pathway was developed using the best practice evidence from clinical practice guidelines, operational guides and a systematic literature review. A multidisciplinary team of health professionals and researchers worked in an iterative process to contextualise the proposed pathway to local needs and context, and improve its clarity and user‐friendliness. The pathway was then re‐assessed for accuracy and adherence to the evidence. Results The draft pathway outlines processes for BPSD prevention, watchful waiting for mild‐to‐moderate BPSD, and specific interventions for severe BPSD. Ongoing risk assessment is required throughout, and non‐pharmacological options are first‐line interventions. Person‐centred care was found to be an important care component across all three phases. An instruction guide with colour‐coded flow charts was developed to assist staff with determining the best care and treatment for each person living with dementia. Feasibility testing is underway. Conclusions A draft clinical pathway based on clinical practice guidelines was developed to enhance the translation of evidence into practice for the management of BPSD, by nursing and clinical leaders in RACFs.
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Affiliation(s)
- Kate J Kennedy
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Deborah Forsythe
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Joanne Wagner
- Eldercare Inc., Payneham, South Australia, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
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Koch J, Amos JG, Beattie E, Lautenschlager NT, Doyle C, Anstey KJ, Mortby ME. Non-pharmacological interventions for neuropsychiatric symptoms of dementia in residential aged care settings: An umbrella review. Int J Nurs Stud 2022; 128:104187. [DOI: 10.1016/j.ijnurstu.2022.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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Silva R, Bobrowicz-Campos E, Santos-Costa P, Cruz AR, Apóstolo J. A Home-Based Individual Cognitive Stimulation Program for Older Adults With Cognitive Impairment: A Randomized Controlled Trial. Front Psychol 2021; 12:741955. [PMID: 34880809 PMCID: PMC8645562 DOI: 10.3389/fpsyg.2021.741955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: This study aims to assess the feasibility and meaningfulness of a home-based individual cognitive stimulation (iCS) program delivered by caregivers to persons with cognitive impairment (PwCIs). It also aims to assess whether the older adults receiving this program improved their cognitive, neuropsychiatric, and depressive symptoms and quality of life and whether their caregivers improved their mental and physical health. Methods: A randomized controlled trial (RCT) was conducted with PwCI-caregiver dyads recruited from the community. Participants were allocated to two groups: intervention (n = 28) and control (n = 24). The intervention group received the European Portuguese version of the Individual Cognitive Stimulation Program—Making a Difference 3 (MD3-P). The control group received usual care. The iCS therapy program was implemented three times a week for 12 weeks. Caregivers were supported by the researchers to deliver the sessions at home. Participants were assessed at baseline and at the end of the intervention (week 13). Feasibility and meaningfulness were assessed through the attrition rate, adherence, and degree of satisfaction with the sessions. Four interviews were conducted (after week 13) to understand participants’ experiences. Results: The attrition rate was 23.1%. The dyads reported that they did not have high expectations about the iCS program before starting the study. Nevertheless, as the program evolved, caregivers noted that their family members had improved some areas of functioning. Intention-to-treat analysis based on group differences revealed a significant improvement in PwCIs’ cognition, specifically in their orientation and ability to follow commands. The intervention had no impact on other variables such as caregivers’ physical and mental health. Conclusion: The iCS program implemented by caregivers showed promising results in improving PwCIs’ cognition. The participants who completed the intervention attributed a positive meaning to the MD3-P, confirming it as a valid non-pharmacological therapeutic approach to reducing frailty in PwCIs in community settings. Clinical Trial Registration:www.ClinicalTrials.gov, identifier [NCT03514095].
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Affiliation(s)
- Rosa Silva
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Elzbieta Bobrowicz-Campos
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal.,Faculty of Psychology and Educational Sciences, Centre of 20th Century Interdisciplinary Studies, University of Coimbra, Coimbra, Portugal
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | | | - João Apóstolo
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
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Cardoso DFB, Santos DGSM, Rodrigues JFC, Bento N, Rodrigues RMC, Cardoso AFDRM. Promoting evidence-based practice: training health professionals for the evidence synthesis. Rev Esc Enferm USP 2021; 55:e20210180. [PMID: 34807227 DOI: 10.1590/1980-220x-reeusp-2021-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To report the experience of the Portugal Centre For Evidence Based Practice (PCEBP): a JBI Centre of Excellence in the training of health professionals, researchers, and professors in the Comprehensive Systematic Review Training Program, a course on Evidence Synthesis, specifically on Systematic Literature Reviews. METHOD This article aims to report the experience of the Portugal Centre For Evidence Based Practice: a JBI Centre of Excellence in the implementation of the Comprehensive Systematic Review Training Program that trains health professionals, researchers, and teachers to develop Systematic Reviews, according to the JBI approach. RESULTS By the end of 2020, 11 editions of the course had been developed with 136 participants from different educational and health institutions, from different countries. As a result of the training of these participants, 13 systematic reviews were published in JBI Evidence Synthesis and 10 reviews were published in other journals. CONCLUSION The reported results and the students' satisfaction evaluation allow us to emphasize the relevance of the course for health professionals training on evidence synthesis.
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Affiliation(s)
- Daniela Filipa Batista Cardoso
- Centro Português para a Prática Baseada na Evidência: um Centro de Excelência JBI, Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola de Enfermagem de Coimbra, Coimbra, Portugal
| | - Diana Gabriela Simões Marques Santos
- Centro Português para a Prática Baseada na Evidência: um Centro de Excelência JBI, Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola de Enfermagem de Coimbra, Coimbra, Portugal
| | - Joana Filipa Cunha Rodrigues
- Centro Português para a Prática Baseada na Evidência: um Centro de Excelência JBI, Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola de Enfermagem de Coimbra, Coimbra, Portugal
| | - Nichole Bento
- Centro Português para a Prática Baseada na Evidência: um Centro de Excelência JBI, Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola de Enfermagem de Coimbra, Coimbra, Portugal
| | - Rogério Manuel Clemente Rodrigues
- Centro Português para a Prática Baseada na Evidência: um Centro de Excelência JBI, Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola de Enfermagem de Coimbra, Coimbra, Portugal
| | - Ana Filipa Dos Reis Marques Cardoso
- Centro Português para a Prática Baseada na Evidência: um Centro de Excelência JBI, Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola de Enfermagem de Coimbra, Coimbra, Portugal
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Kennedy KJ, Forsythe D, Wagner J, Eckert M. Clinical pathways for the evidence-based management of behavioural and psychological symptoms of dementia in a residential aged care facility: A rapid review. Australas J Ageing 2021; 40:347-355. [PMID: 34342112 DOI: 10.1111/ajag.12990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/27/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aimed to identify a clinical pathway, or practice guidelines to inform a clinical pathway, for the management of behavioural and psychological symptoms of dementia (BPSD) in residential aged care facilities (RACFs). METHODS Fifteen evidence sources were searched, and publications were appraised for methodological quality. RESULTS Seven publications met the inclusion criteria, but no clinical pathways were found. These publications emphasised prevention via respectful, person-centred care; non-pharmacological interventions prioritised; and potential dangers of antipsychotic use. Pharmacological management was only recommended: when there is a high risk of harm; as a short-term option, to be regularly monitored and discontinued as soon as possible; and used in conjunction with investigation into the causes of BPSD and the introduction of non-pharmacological therapies. CONCLUSION This rapid review provided high-quality, current guidelines and recommendations on the prevention and management of BPSD that can inform the development of an evidence-based clinical pathway for use in Australian RACFs.
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Affiliation(s)
- Kate J Kennedy
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Deborah Forsythe
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
| | | | - Marion Eckert
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
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Pinto JO, Dores AR, Geraldo A, Peixoto B, Barbosa F. Sensory stimulation programs in dementia: a systematic review of methods and effectiveness. Expert Rev Neurother 2020; 20:1229-1247. [PMID: 32940543 DOI: 10.1080/14737175.2020.1825942] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Dementia is characterized by the presence of cognitive decline and can lead to sensory-perceptual alterations, compromising the functionality in activities of daily living. The main objective of this work is to review the characteristics of sensory stimulation programs in dementia and its effectiveness. AREAS COVERED Studies were identified through a literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Collaboration Guidelines. Twenty studies were included in this review. The studies used multisensory stimulation at different stages of dementia. The results show a lack of consensus regarding frequency, duration, and number of sessions, as well as the duration of the interventions and assessment instruments used to evaluate the results. Multisensory stimulation, particularly Snoezelen, was the most widely used approach. Vision, hearing, touch, and smell were the most frequently stimulated senses. Most studies comprised pre- and post-intervention assessment, but few studies performed follow-up assessment. The interventions that revealed positive results in dementia were Snoezelen, multisensory environment other than Snoezelen, and Multi-sensory Behavior Therapy. EXPERT OPINION This review weakly supports sensory stimulation in dementia, providing useful information for rehabilitation and future investigations.
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Affiliation(s)
- Joana O Pinto
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
| | - Artemisa R Dores
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal.,School of Health, Polytechnic Institute of Porto , Porto, Portugal
| | - Andreia Geraldo
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
| | - Bruno Peixoto
- Department of Social and Behaviour Sciences, CESPU, University Institute of Health Sciences , Gandra, Portugal.,Center for Health Technology and Services Research (CINTESIS), NeuroGen research group , Porto, Portugal
| | - Fernando Barbosa
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
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Cheng C, Baker GB, Dursun SM. Use of multisensory stimulation interventions in the treatment of major neurocognitive disorders. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1699738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Catherine Cheng
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Glen B. Baker
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Serdar M. Dursun
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Canada
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