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Article ; Online: Effectiveness and cost-effectiveness of a collaborative deprescribing intervention of proton-pump-inhibitors on community-dwelling older adults: Protocol for the C-SENIoR, a pragmatic non-randomized controlled trial.

Romano, Sónia / Monteiro, Luis / Guerreiro, José Pedro / Simões, João Braga / Teixeira Rodrigues, António / Lunet, Nuno / Perelman, Julian

PloS one

2024 Volume 19, Issue 3, Page(s) e0298181

Abstract: Introduction: Worldwide, demographic ageing is a major social, economic and health challenge. Despite the increase in life expectancy, elderly often live with multiple chronic conditions, exposing them to multiple medications. Concerns have been raised ... ...

Abstract	Introduction: Worldwide, demographic ageing is a major social, economic and health challenge. Despite the increase in life expectancy, elderly often live with multiple chronic conditions, exposing them to multiple medications. Concerns have been raised about the growing issue of inappropriate long-term usage of proton-pump inhibitors (PPI), which have been associated with adverse outcomes and increased healthcare costs. Deprescribing is a recommended intervention to reduce or withdraw medicines that might be causing harm or might no longer be of benefit. This protocol details a trial to assess the effectiveness and cost-effectiveness of a collaborative deprescribing intervention of PPI among community-dwelling elderly, involving community pharmacists and general practitioners. Methods and analysis: A pragmatic, multicentre, two-arm, non-randomised controlled trial of a structured PPI collaborative deprescribing intervention in the primary care setting with a 6-month follow-up will be conducted. Patients must be 65 years old or older, live in the community and have been using PPI for more than 8 weeks. We hypothesize that the intervention will reduce the PPI usage in the intervention group compared to the control group. The primary outcome is the successful discontinuation or dose decrease of any PPI, defined as a statistically significant absolute 20% reduction in medication use between the intervention and control groups at 3- and 6-month follow-ups. An economic evaluation will be conducted alongside the trial. This study was approved by the Ethics Research Committee of Nova Medical School, NOVA University of Lisbon and by the Ethics Committee from the Local Health Unit Alto Minho, Portugal. Discussion: This pragmatic trial will provide evidence on the effectiveness and cost-effectiveness of a patient-centred collaborative deprescribing intervention in the community setting in Portugal. It will also inform improvements for the development of future multi-faceted interventions that aim to optimise medication for the community-dwelling elderly. Clinical trial registration: ISRCTN 49637686.
MeSH term(s)	Aged ; Humans ; Cost-Benefit Analysis ; Deprescriptions ; Independent Living ; Proton Pump Inhibitors/therapeutic use ; Protons ; Pragmatic Clinical Trials as Topic ; Non-Randomized Controlled Trials as Topic
Chemical Substances	Proton Pump Inhibitors ; Protons
Language	English
Publishing date	2024-03-26
Publishing country	United States
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0298181
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Effectiveness of a collaborative diabetes screening campaign between community pharmacies and general practitioners.

Murteira, Rodrigo / Cary, Maria / Galante, Heloísa / Romano, Sónia / Guerreiro, José Pedro / Rodrigues, António Teixeira

Primary care diabetes

2023 Volume 17, Issue 4, Page(s) 314–320

Abstract: Aim: To evaluate the impact of a collaborative screening campaign on the prevalence of pre-diabetes and diabetes among the screened population.: Methods: A Longitudinal, multicentre study was developed. The Finnish Diabetes Risk Score (FINDRISC) was ... ...

Abstract	Aim: To evaluate the impact of a collaborative screening campaign on the prevalence of pre-diabetes and diabetes among the screened population. Methods: A Longitudinal, multicentre study was developed. The Finnish Diabetes Risk Score (FINDRISC) was applied to the eligible population in the participating community pharmacies. Individuals with a FINDRISC score ≥ 15, were eligible to measure their glycated haemoglobin (HbA1c) level at the community pharmacy. If HbA1c≥ 5.7%, participants were referred to a general practitioner (GP) appointment for potential diagnosis of Diabetes. Results: Out of 909 screened subjects, 405 (44.6%) presented a FINDRISC score ≥ 15. Among the latter, 94 (23.4%) had HbA1c levels that made them eligible for GP referral, of which 35 (37.2%) completed the scheduled appointments. 24 participants were diagnosed with pre-diabetes, and 11 with diabetes. The prevalence was estimated at 2.5% (CI95% 1.6-3.8%) and 7.8% (CI95% 6.2-9.8%) for diabetes and pre-diabetes, respectively. Conclusion: This collaborative model has proved to be effective in the early detection of diabetes and pre-diabetes. Joint initiatives between health professionals can play a pivotal role in the prevention and diagnosis of diabetes, which may lead to a reduction on the burden to health system and society.
MeSH term(s)	Humans ; Diabetes Mellitus, Type 2/diagnosis ; Diabetes Mellitus, Type 2/epidemiology ; Prediabetic State/diagnosis ; Prediabetic State/epidemiology ; Pharmacies ; Glycated Hemoglobin ; General Practitioners ; Mass Screening ; Risk Factors
Chemical Substances	Glycated Hemoglobin
Language	English
Publishing date	2023-05-06
Publishing country	England
Document type	Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2273997-X
ISSN	1878-0210 ; 1751-9918
ISSN (online)	1878-0210
ISSN	1751-9918
DOI	10.1016/j.pcd.2023.04.007
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Article ; Online: Drug shortages in community pharmacies: Impact on patients and on the health system.

Romano, Sónia / Guerreiro, José Pedro / Teixeira Rodrigues, António

Journal of the American Pharmacists Association : JAPhA

2021 Volume 62, Issue 3, Page(s) 791–799.e2

Abstract: Background: Worldwide, drug shortages are a critical public health concern. Consequences range from inconvenience and distress to more serious concerns related to negative clinical, humanistic and economic outcomes.: Objective: This study aimed to ... ...

Abstract	Background: Worldwide, drug shortages are a critical public health concern. Consequences range from inconvenience and distress to more serious concerns related to negative clinical, humanistic and economic outcomes. Objective: This study aimed to investigate the impact of drug shortages at the community pharmacies on patients and on the health system in Portugal. Methods: A national, cross-sectional, multicenter study was conducted in Portuguese community pharmacies during April 2019. The proportion of patients reporting drug shortages, types of drugs affected and consequent economic burden to patients and the health system were estimated. Regional and urban setting stratification was performed. Results: A total of 71.1% of pharmacies participated in the study and 22,830 patient surveys were retrieved. About 52.2% of patients experienced a drug shortage in the past 12 months; 21.5% had to see a physician to change the prescription and 5.7% declared treatment discontinuation because of this shortage. The estimated economic impact of shortages related to additional physician appointments varied between €2.1-€4.4 million for patients and €35.3-€43.8 million for the National Health Service. Drug shortages were mostly felt in rural and inner regions and least felt in the islands. Conclusion: This national study showed that community pharmacy drug shortages are a national problem with negative consequences on patients and the health system, which need to be tackled and mitigated.
MeSH term(s)	Cross-Sectional Studies ; Humans ; Medical Assistance ; Pharmacies ; State Medicine ; Surveys and Questionnaires
Language	English
Publishing date	2021-12-31
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	2118585-2
ISSN	1544-3450 ; 1544-3191 ; 1086-5802
ISSN (online)	1544-3450
ISSN	1544-3191 ; 1086-5802
DOI	10.1016/j.japh.2021.12.017
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Article: Physical activity promotion in community pharmacies: pharmacists' attitudes and behaviours.

Viegas, Rúben / Godinho, Cristina A / Romano, Sónia

Pharmacy practice

2021 Volume 19, Issue 3, Page(s) 2413

Abstract: Background: Health systems and their professionals play a key role in the promotion and maintenance of behaviours contributing to increased physical activity levels. Pharmacists are well placed within communities, making them an accessible source to ... ...

Abstract	Background: Health systems and their professionals play a key role in the promotion and maintenance of behaviours contributing to increased physical activity levels. Pharmacists are well placed within communities, making them an accessible source to provide brief advice to people on how to be more physically active. Objective: This study aimed to characterize physical activity promotion actions taking place in the Portuguese community pharmacies, as well as the major facilitators and barriers faced by pharmacists in their daily practice. Methods: A cross-sectional study based on an online questionnaire targeting community pharmacists was developed based on COM-B model and the Theoretical Domains Framework (TDF) and distributed by email to 94% of the Portuguese pharmacies. Results: In total, 396 complete responses from community pharmacists were obtained. Three out of four participants reported to promote physical activity in their daily routine, of which 87.7% reported doing it in only a few attendances. The majority (92.3%) mentioned to provide information orally, with walking being the activity most promoted (99.4%). More active and younger pharmacists were more likely to promote physical activity. Nearly all pharmacists (98.7%) believed it was important or very important to practice regular physical activity for the health, but only 41.4% of the respondents were able to correctly identify the WHO general recommendations for physical activity. The lack of coordination with other healthcare professionals (M=3.35; SD=1.11), lack of interest by customers (M=3.25; SD=1.09) and lack of time (M=3.06; SD=1.10) were the main barriers to physical activity promotion, all scoring above the scale mid-point (i.e., 3). Conclusions: Physical activity promotion in the Portuguese community pharmacies is still not present as daily activity. Younger pharmacists seem to be a generation that better understand this need and could easily integrate this practice in their daily routine. Possibilities for including pharmacies and pharmacists as promoters of physical activity in the primary health care sector in the future are discussed in the light of these findings.
Language	English
Publishing date	2021-09-11
Publishing country	Spain
Document type	Journal Article
ZDB-ID	2414565-8
ISSN	1886-3655 ; 1885-642X
ISSN (online)	1886-3655
ISSN	1885-642X
DOI	10.18549/PharmPract.2021.3.2413
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Article ; Online: Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations.

Romano, Sónia / Figueira, Débora / Teixeira, Inês / Perelman, Julian

PharmacoEconomics

2021 Volume 40, Issue 3, Page(s) 269–295

Abstract: Background: Deprescribing can reduce the use of inappropriate or unnecessary medication; however, the economic value of such interventions is uncertain.: Objective: This study seeks to identify and synthetise the economic evidence of deprescribing ... ...

Abstract	Background: Deprescribing can reduce the use of inappropriate or unnecessary medication; however, the economic value of such interventions is uncertain. Objective: This study seeks to identify and synthetise the economic evidence of deprescribing interventions among community-dwelling older adults. Methods: Full economic evaluation studies of deprescribing interventions, conducted in the community or primary care settings, in community-dwelling adults aged ≥ 65 years were systematically reviewed. MEDLINE, EconLit, Scopus, Web of Science, CEA-TUFTS, CRD York and Google Scholar databases were searched from inception to February 2021. Two researchers independently screened all retrieved articles according to inclusion and exclusion criteria. The main outcome was the economic impact of the intervention from any perspective, converted into 2019 US Dollars. The World Health Organization threshold of 1 gross domestic product per capita was used to define cost effectiveness. Studies were appraised for methodological quality using the extended Consensus on Health Economics Criteria checklist. Results: Of 6154 articles identified by the search strategy, 14 papers assessing 13 different interventions were included. Most deprescribing interventions included some type of medication review with or without a supportive educational component (n = 11, 85%), and in general were delivered within a pharmacist-physician care collaboration. Settings included community pharmacies, primary care/outpatient clinics and patients' homes. All economic evaluations were conducted within a time horizon varying from 2 to 12 months with outcomes in most of the studies derived from a single clinical trial. Main health outcomes were reported in terms of quality-adjusted life-years, prevented number of falls and the medication appropriateness index. Cost effectiveness ranged from dominant to an incremental cost-effectiveness ratio of $112,932 per quality-adjusted life-year, a value above the country's World Health Organization threshold. Overall, 85% of the interventions were cost saving, dominated usual care or were cost effective considering 1 gross domestic product per capita. Nine studies scored > 80% (good) and two scored ≤ 50% (low) on critical quality appraisal. Conclusions: There is a growing interest in economic evaluations of deprescribing interventions focused on community-dwelling older adults. Although results varied across setting, time horizon and intervention, most were cost effective according to the World Health Organization threshold. Deprescribing interventions are promising from an economic viewpoint, but more studies are needed.
MeSH term(s)	Aged ; Cost-Benefit Analysis ; Deprescriptions ; Humans ; Independent Living ; Pharmacists ; Quality-Adjusted Life Years
Language	English
Publishing date	2021-12-16
Publishing country	New Zealand
Document type	Systematic Review
ZDB-ID	1100273-6
ISSN	1179-2027 ; 1170-7690
ISSN (online)	1179-2027
ISSN	1170-7690
DOI	10.1007/s40273-021-01120-8
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Article ; Online: G-quadruplexes in cancer-related gene promoters: from identification to therapeutic targeting.

Romano, Francesca / Di Porzio, Anna / Iaccarino, Nunzia / Riccardi, Gelsomina / Di Lorenzo, Ritamaria / Laneri, Sonia / Pagano, Bruno / Amato, Jussara / Randazzo, Antonio

Expert opinion on therapeutic patents

2024 Volume 33, Issue 11, Page(s) 745–773

Abstract: Introduction: Guanine-rich DNA sequences can fold into four-stranded noncanonical secondary structures called G-quadruplexes (G4s) which are widely distributed in functional regions of the human genome, such as telomeres and gene promoter regions. ... ...

Abstract	Introduction: Guanine-rich DNA sequences can fold into four-stranded noncanonical secondary structures called G-quadruplexes (G4s) which are widely distributed in functional regions of the human genome, such as telomeres and gene promoter regions. Compelling evidence suggests their involvement in key genome functions such as gene expression and genome stability. Notably, the abundance of G4-forming sequences near transcription start sites suggests their potential involvement in regulating oncogenes. Areas covered: This review provides an overview of current knowledge on G4s in human oncogene promoters. The most representative G4-binding ligands have also been documented. The objective of this work is to present a comprehensive overview of the most promising targets for the development of novel and highly specific anticancer drugs capable of selectively impacting the expression of individual or a limited number of genes. Expert opinion: Modulation of G4 formation by specific ligands has been proposed as a powerful new tool to treat cancer through the control of oncogene expression. Actually, most of G4-binding small molecules seem to simultaneously target a range of gene promoter G4s, potentially influencing several critical driver genes in cancer, thus producing significant therapeutic benefits.
MeSH term(s)	Humans ; G-Quadruplexes ; DNA/chemistry ; DNA/genetics ; DNA/metabolism ; Patents as Topic ; Promoter Regions, Genetic ; Antineoplastic Agents/pharmacology ; Ligands ; Neoplasms/drug therapy ; Neoplasms/genetics
Chemical Substances	DNA (9007-49-2) ; Antineoplastic Agents ; Ligands
Language	English
Publishing date	2024-01-11
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1186201-4
ISSN	1744-7674 ; 0962-2594 ; 1354-3776
ISSN (online)	1744-7674
ISSN	0962-2594 ; 1354-3776
DOI	10.1080/13543776.2023.2271168
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Article ; Online: Non-alcoholic Wernicke's Encephalopathy mimicking neuromyelitis optica spectrum disorder in a young woman: a case report and literature review.

Zilioli, Alessandro / Misirocchi, Francesco / Mutti, Carlotta / Romano, Sonia / Minetti, Matteo / Chierici, Elisabetta / Florindo, Irene / Spallazzi, Marco / Zinno, Lucia

Acta bio-medica : Atenei Parmensis

2023 Volume 94, Issue S1, Page(s) e2023111

Abstract: Wernicke's encephalopathy is an under-recognized life-threatening disease caused by thiamine (vitamin B1) deficiency. It has historically been related to chronic alcoholic intake but other causes of malnutrition, such as invasive gastric surgery and ... ...

Abstract	Wernicke's encephalopathy is an under-recognized life-threatening disease caused by thiamine (vitamin B1) deficiency. It has historically been related to chronic alcoholic intake but other causes of malnutrition, such as invasive gastric surgery and hyperemesis, have been linked to the onset of this illness over the years, often presenting with atypical clinical manifestations. Herein we report a case of a young obese woman affected by non-alcoholic Wernicke's Encephalopathy following a minimally invasive gastrointestinal surgery. She showed an unusual clinical profile characterized by prominent subacute neuro-ophthalmological involvement which combined to her juvenile age, overweight condition and brain lesions, have made diagnosis challenging due to similarities with Neuromyelitis Optica Spectrum Disorder. Our case underscores the relevance of prompt diagnosis in order to prevent the development of irreversible neuropathological changes and to avoid the use of a long-term immunosuppressive treatment.
MeSH term(s)	Humans ; Female ; Wernicke Encephalopathy/diagnosis ; Wernicke Encephalopathy/etiology ; Wernicke Encephalopathy/drug therapy ; Neuromyelitis Optica/diagnosis ; Neuromyelitis Optica/complications ; Neuromyelitis Optica/drug therapy ; Thiamine Deficiency/complications ; Thiamine Deficiency/diagnosis ; Thiamine/therapeutic use ; Malnutrition
Chemical Substances	Thiamine (X66NSO3N35)
Language	English
Publishing date	2023-06-05
Publishing country	Italy
Document type	Review ; Case Reports ; Journal Article
ZDB-ID	2114240-3
ISSN	2531-6745 ; 0392-4203
ISSN (online)	2531-6745
ISSN	0392-4203
DOI	10.23750/abm.v94iS1.13879
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Article ; Online: Who are the ostomy patients and caregivers attending Portuguese community pharmacies? A cross-sectional study.

Romão, Mariana / Figueira, Débora / Galante, Heloísa / Guerreiro, José / Romano, Sónia

BMC health services research

2020 Volume 20, Issue 1, Page(s) 914

Abstract: Background: In 2017, ostomy patients gained access to ostomy products in community pharmacies that are fully reimbursed by the Portuguese National Health Service. This impacted the daily lives of people with ostomy and opened a new market of products ... ...

Abstract	Background: In 2017, ostomy patients gained access to ostomy products in community pharmacies that are fully reimbursed by the Portuguese National Health Service. This impacted the daily lives of people with ostomy and opened a new market of products and services for pharmacies. However, little is known about the sociodemographic and clinical profile of ostomy patients. This study aims to characterize people with ostomy and their caregivers, evaluate access and satisfaction with the pharmacy and explore participants' expectations regarding services and counselling. Methods: This was an observational, cross-sectional, multicentre study involving pharmacy users who acquired ostomy products in Portuguese community pharmacies. Data were collected through a confidential self-report questionnaire between June and August 2019. Results: Approximately 56% of the participants were ostomy patients, of whom 65.9% were men. The average age of participating ostomy patients was 65.5 years old (SD = 12.9), and near 80% were retired/pensioners. Caregivers were mostly women (81.7%). More than half of the caregivers were employed and acquired products for a direct family member. Three in every four surgical interventions were consequences of cancer. Intestinal ostomy was the most common intervention (78.3%). More than 93% were satisfied with the acquisition of ostomy products at the pharmacy. Approximately 48.2% of ostomy patients received care from a specialized nurse. Conclusion: This study describes the profile of people with ostomy and their caregivers who attend community pharmacies in Portugal. Participants' perceptions of the utility of different proposed services and pharmacist knowledge, as well as the low coverage of ostomy nursing care, highlight the opportunity for an extended role of pharmacists among this group.
MeSH term(s)	Adult ; Aged ; Caregivers/statistics & numerical data ; Community Pharmacy Services/statistics & numerical data ; Cross-Sectional Studies ; Female ; Health Services Accessibility/statistics & numerical data ; Humans ; Male ; Middle Aged ; Ostomy/statistics & numerical data ; Patient Satisfaction/statistics & numerical data ; Pharmacies/statistics & numerical data ; Pharmacists/statistics & numerical data ; Portugal ; Socioeconomic Factors ; State Medicine ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2020-10-02
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-020-05765-7
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Article ; Online: Who are the ostomy patients and caregivers attending Portuguese community pharmacies? A cross-sectional study

Mariana Romão / Débora Figueira / Heloísa Galante / José Guerreiro / Sónia Romano

BMC Health Services Research, Vol 20, Iss 1, Pp 1-

2020 Volume 10

Abstract: Abstract Background In 2017, ostomy patients gained access to ostomy products in community pharmacies that are fully reimbursed by the Portuguese National Health Service. This impacted the daily lives of people with ostomy and opened a new market of ... ...

Abstract	Abstract Background In 2017, ostomy patients gained access to ostomy products in community pharmacies that are fully reimbursed by the Portuguese National Health Service. This impacted the daily lives of people with ostomy and opened a new market of products and services for pharmacies. However, little is known about the sociodemographic and clinical profile of ostomy patients. This study aims to characterize people with ostomy and their caregivers, evaluate access and satisfaction with the pharmacy and explore participants’ expectations regarding services and counselling. Methods This was an observational, cross-sectional, multicentre study involving pharmacy users who acquired ostomy products in Portuguese community pharmacies. Data were collected through a confidential self-report questionnaire between June and August 2019. Results Approximately 56% of the participants were ostomy patients, of whom 65.9% were men. The average age of participating ostomy patients was 65.5 years old (SD = 12.9), and near 80% were retired/pensioners. Caregivers were mostly women (81.7%). More than half of the caregivers were employed and acquired products for a direct family member. Three in every four surgical interventions were consequences of cancer. Intestinal ostomy was the most common intervention (78.3%). More than 93% were satisfied with the acquisition of ostomy products at the pharmacy. Approximately 48.2% of ostomy patients received care from a specialized nurse. Conclusion This study describes the profile of people with ostomy and their caregivers who attend community pharmacies in Portugal. Participants’ perceptions of the utility of different proposed services and pharmacist knowledge, as well as the low coverage of ostomy nursing care, highlight the opportunity for an extended role of pharmacists among this group.
Keywords	Ostomy ; Community pharmacies ; Caregivers ; Health Services accessibility ; Satisfaction ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article: Compost application boosts soil restoration in highly disturbed hillslope vineyard.

Lucchetta, Marco / Romano, Alessandro / Alzate Zuluaga, Monica Yorlady / Fornasier, Flavio / Monterisi, Sonia / Pii, Youry / Marcuzzo, Patrick / Lovat, Lorenzo / Gaiotti, Federica

Frontiers in plant science

2023 Volume 14, Page(s) 1289288

Abstract: A field trial was carried out to investigate the effects of compost application on a young Cabernet sauvignon vineyard located in a hilly area in the North-East of Italy and subjected to land terracing before plantation. The use of a compost based on ... ...

Abstract	A field trial was carried out to investigate the effects of compost application on a young Cabernet sauvignon vineyard located in a hilly area in the North-East of Italy and subjected to land terracing before plantation. The use of a compost based on manure, pruning residues and pomace at a rate of 65 t ha
Language	English
Publishing date	2023-11-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2613694-6
ISSN	1664-462X
ISSN	1664-462X
DOI	10.3389/fpls.2023.1289288
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