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Högberg, K. M., Sandman, L., Nyström, M., Stockelberg, D. & Broström, A. (2018). Caring Through Web-Based Communication: A Qualitative Evaluation of a Nursing Intervention to Create Holistic Well-Being Among Patients With Hematological Disease.. Journal of Holistic Nursing, 36(3), 218-227
Open this publication in new window or tab >>Caring Through Web-Based Communication: A Qualitative Evaluation of a Nursing Intervention to Create Holistic Well-Being Among Patients With Hematological Disease.
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2018 (English)In: Journal of Holistic Nursing, ISSN 0898-0101, E-ISSN 1552-5724, Vol. 36, no 3, p. 218-227Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To examine how written communication between patients with hematological diseases and a nurse within a web-based communication service can be caring.

DESIGN: The study is based on qualitative deductive content analysis of 109 written messages between 10 patients and a responding nurse. The evaluated nursing intervention is a web-based communication service where patients could request support from a responding nurse during 2 months of use. A structured theoretical matrix based on Swanson's theory of caring including compassion, competence, and upholding trust is used for the analysis.

FINDINGS: Nursing compassion emerges when patients share personal matters and the nurse has an opportunity to explicitly display genuine interest and understanding. Nursing competence is required when patients ask for or are in need of information, advice, and emotional support. The nurse can uphold trust when compassion and competence are exhibited and patients share their innermost feelings.

CONCLUSIONS: Web-based communication has the potential to contribute to holistic well-being according to Swanson's theory of caring. The written word lasts, can be read repeatedly, and in connection with writing there is time for reflection. However, the lack of nonverbal cues makes it important that the nurse answers in a fully accurate and explicitly caring way.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
caring, informatics, psychosocial/mental health, telehealth
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-41483 (URN)10.1177/0898010116667343 (DOI)000441596600003 ()27659277 (PubMedID)2-s2.0-85026268201 (Scopus ID)
Available from: 2018-09-18 Created: 2018-09-18 Last updated: 2018-09-18Bibliographically approved
Hedberg, B., Malm, D., Karlsson, J.-E., Årestedt, K. & Broström, A. (2018). Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation. European Journal of Cardiovascular Nursing, 17(5), 446-455
Open this publication in new window or tab >>Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation
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2018 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 5, p. 446-455Article in journal (Refereed) Published
Abstract [en]

Background:

Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.

Aim:

The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.

Methods:

A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale–Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.

Results:

Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.

Conclusion:

Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Atrial fibrillation, decision making, patient-based outcome measure, risk communication
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:hj:diva-37870 (URN)10.1177/1474515117741891 (DOI)000433529700008 ()29135285 (PubMedID)2-s2.0-85041497464 (Scopus ID)
Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-07-06Bibliographically approved
Amofah, H. A., Broström, A., Fridlund, B., Haaverstad, R., Instenes, I., Kuiper, K. K., . . . Norekval, T. M. (2018). Octogenarian patients experiences with hypnotics in relation to sleep disturbances and delirium after aortic valve therapy. European Journal of Cardiovascular Nursing, 17, 104-105
Open this publication in new window or tab >>Octogenarian patients experiences with hypnotics in relation to sleep disturbances and delirium after aortic valve therapy
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2018 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, p. 104-105Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: Sleep disturbance and delirium are complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve replacement (TAVI), especially in octogenarian patients. Sedatives and z-hypnotics are medications distributed to promote sleep. However, a knowledge-gap exists on patient experiences with these medications, and sleep and delirium after the cardiac treatment.

Aim: To explore and describe how octogenarians suffering from delirium after SAVR/TAVI experience their sleep situation related to sedatives and z-hypnotics, in a long-term perspective.

Methods An explorative and descriptive design with a longitudinal qualitative approach was applied. Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium. Information about administration of sedatives and z-hypnotics was collected from the patients journals. The Confusion Assessment Method (CAM) was used to assess delirium, the Sleep Sufficient Index (SSI) and Minimal Insomnia Symptom Scale (MISS) were used to document self-reported sleep and insomnia. All measures were performed at baseline and daily the five first postoperative days. Ten patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were re-interviewed four years later, focusing on their sleep situation.

Findings: For the initial interview, five men and five woman, four after TAVI and six after SAVR, mean age 83 were included. One overarching theme revealed; hours in bed represented an emotional chaos. Three sub-themes described the patients experiences with sleep and delirium, a cascade of distressful experiences, the struggle between sleep and activity and elements influencing sleep. In the category physical sleep distractions, sleep medications emerged as a sleep disturbing element but also to evoke delirium. Patients described to be offered sedatives and z-hypnotics in hospital. However, they did not have a positive experience with this as the medication did not make them sleep better. Moreover, they associated the nightmares by the sedatives Four years after the cardiac treatment, the octogenarian patients described that medication did not have a sleep promoting effect, and they did not want it.

Conclusion: Octogenarian patients are vulnerable to complications like sleep disturbances and delirium. In preventing and treating these conditions, health-care professionals should be aware of the effect and side-effect of sedatives and z-hypnotics in the octogenarian patients. Our findings show that medications should be cautiously used within this group of patients.

Place, publisher, year, edition, pages
Sage Publications, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-41230 (URN)10.1177/1474515118787764 (DOI)000440339600176 ()
Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2018-08-24Bibliographically approved
Broström, A., Pakpour, A. H., Nilsen, P., Gardner, B. & Ulander, M. (2018). Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners' beliefs and practices. Journal of Sleep Research, 1-10
Open this publication in new window or tab >>Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners' beliefs and practices
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2018 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, p. 1-10Article in journal (Refereed) Epub ahead of print
Abstract [en]

The benefits of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea are well established, but adherence tends to be low. Research exploring CPAP practitioners' beliefs around determinants of CPAP adherence, and the actions they use in clinical practice to promote CPAP adherence is lacking. This study aimed to: (i) develop and validate a questionnaire to assess beliefs and current practices among CPAP practitioners; (ii) explore practitioners' beliefs regarding the main determinants of patient adherence, and the actions practitioners most commonly use to promote CPAP adherence; and (iii) explore the associations between perceived determinants and adherence-promotion actions. One-hundred and forty-two CPAP practitioners in Sweden and Norway, representing 93% of all Swedish and 62% of all Norwegian CPAP centres, were surveyed via a questionnaire exploring potential determinants (18 items) and adherence-promotion actions (20 items). Confirmatory factor analysis and second-order structural equational modelling were used to identify patterns of beliefs, and potential associations with adherence-promotion actions. Patients' knowledge, motivation and attitudes were perceived by practitioners to be the main determinants of CPAP adherence, and educating patients about effects, management and treatment adjustments were the most common practices. Knowledge was shown to predict educational and informational actions (e.g. education about obstructive sleep apnea and CPAP). Educational and informational actions were associated with medical actions (e.g. treatment adjustment), but knowledge, attitude and support had no association with medical actions. These findings indicate that a wide variety of determinants and actions are considered important, though the only relationship observed between beliefs and actions was found for knowledge and educational and informational actions. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Adherence, Continuous positive airway pressure, Obstructive sleep apnea, Patient education
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-39057 (URN)10.1111/jsr.12675 (DOI)2-s2.0-85042564274 (Scopus ID)
Available from: 2018-03-27 Created: 2018-03-27 Last updated: 2018-03-27
Lin, C.-Y., Pakpour, A. H., Broström, A., Fridlund, B., Årestedt, K., Strömberg, A., . . . Mårtensson, J. (2018). Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients.. Journal of Cardiovascular Nursing, 33(3), 281-288
Open this publication in new window or tab >>Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients.
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2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 3, p. 281-288Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF).

OBJECTIVE: The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran.

METHODS: Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA).

RESULTS: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47).

CONCLUSIONS: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
confirmatory factor analysis, heart failure, Rasch, self-care behavior scale
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-39222 (URN)10.1097/JCN.0000000000000444 (DOI)000440243400021 ()28858887 (PubMedID)2-s2.0-85045200162 (Scopus ID)HHJADULTIS (Local ID)HHJADULTIS (Archive number)HHJADULTIS (OAI)
Available from: 2018-04-25 Created: 2018-04-25 Last updated: 2018-08-24Bibliographically approved
Broström, A., Wahlin, Å., Alehagen, U., Ulander, M. & Johansson, P. (2018). Sex-specific associations between self-reported sleep duration, depression, anxiety, fatigue and daytime sleepiness in an older community-dwelling population. Scandinavian Journal of Caring Sciences (1), 290-298
Open this publication in new window or tab >>Sex-specific associations between self-reported sleep duration, depression, anxiety, fatigue and daytime sleepiness in an older community-dwelling population
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2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, no 1, p. 290-298Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this study was to explore whether associations between self-reported sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness differed in older community-dwelling men and women. Design: Cross-sectional.

Methods: A community-dwelling sample of 675 older men and women (mean age 77.7 years, SD 3.8 years) was used. All participants underwent a clinical examination by a cardiologist. Validated questionnaires were used to investigate sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness. Subjects were divided into short sleepers (≤6 hours), n = 231; normal sleepers (7-8 hours), n = 338; and long sleepers (≥9 hours), n = 61. ancovas were used to explore sex-specific effects.

Results: Depressive symptoms were associated with short sleep in men, but not in women. Fatigue was associated with both short and long sleep duration in men. No sex-specific associations of sleep duration with daytime sleepiness or anxiety were found.

Conclusion: Nurses investigating sleep duration and its correlates, or effects, in clinical practice need to take sex into account, as some associations may be sex specific. Depressive symptoms and fatigue can be used as indicators to identify older men with sleep complaints.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Aged, Daytime sleepiness, Depression, Insomnia, Rural population, Sex differences, Sleep, Sleep-wake disorders
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-36647 (URN)10.1111/scs.12461 (DOI)000426524200029 ()28574585 (PubMedID)2-s2.0-85020105192 (Scopus ID)
Available from: 2017-07-06 Created: 2017-07-06 Last updated: 2018-07-13Bibliographically approved
Strong, C., Lin, C.-Y., Jalilolghadr, S., Updegraff, J. A., Broström, A. & Pakpour, A. H. (2018). Sleep hygiene behaviours in Iranian adolescents: An application of the Theory of Planned Behavior. Journal of Sleep Research, 27(1), 23-31
Open this publication in new window or tab >>Sleep hygiene behaviours in Iranian adolescents: An application of the Theory of Planned Behavior
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2018 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 1, p. 23-31Article in journal (Refereed) Published
Abstract [en]

Poor sleep quality and inadequate sleep in adolescents are a rising trend globally. The Theory of Planned Behaviour (TPB)-which centres on an individual's attitude toward performing the behaviour, subjective norms and perceived behavioural control-has been applied to examine sleep hygiene behaviours in young adults. We expanded on prior works by using a longitudinal design to examine the effects of TPB factors, together with sleep hygiene knowledge and planning constructs, on sleep hygiene behaviours and on sleep quality and health in a group of Iranian adolescents. A total of 1822 healthy adolescents (mean age = 13.97) from 25 high schools in Qazvin, Iran, completed a self-reported survey at baseline and 6 months later. Structural equation modelling (SEM) was used to delineate the pathway from adolescents' sleep hygiene knowledge, TPB constructs of their behavioural intentions and sleep hygiene behaviours and their sleep quality and self-reported health. The SEM model demonstrated that although behavioural intention, coping planning and action planning predicted the sleep hygiene behaviours positively 6 months later with acceptable model fit [comparative fit index (CFI) = 0.936; Tucker-Lewis index (TLI) = 0.902; root mean square error of approximation (RMSEA) = 0.080; standardized root mean square residual (SRMR) = 0.044], sleep hygiene knowledge did not predict behavioural intentions significantly. Sleep hygiene behaviours were associated with sleep quality and psychiatric wellbeing. Thus, the TPB, combined with coping and action planning, is useful in understanding the sleep hygiene behaviours of adolescents. Health-care providers may want to emphasize TPB constructs and coping and action planning to improve adolescents' sleep hygiene behaviours, rather than rely solely upon increasing adolescents' sleep hygiene knowledge.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
General health questionnaire, Health behaviour, Pittsburgh Sleep Quality Index, Psychological health
National Category
Neurology
Identifiers
urn:nbn:se:hj:diva-36605 (URN)10.1111/jsr.12566 (DOI)000419994500003 ()28593637 (PubMedID)2-s2.0-85020266808 (Scopus ID)HHJADULTIS (Local ID)HHJADULTIS (Archive number)HHJADULTIS (OAI)
Available from: 2017-07-04 Created: 2017-07-04 Last updated: 2018-02-07Bibliographically approved
Iversen, C., Broström, A. & Ulander, M. (2018). Traffic risk work with sleepy patients: from rationality to practice. Health, Risk and Society, 20(1-2), 23-42
Open this publication in new window or tab >>Traffic risk work with sleepy patients: from rationality to practice
2018 (English)In: Health, Risk and Society, ISSN 1369-8575, E-ISSN 1469-8331, Vol. 20, no 1-2, p. 23-42Article in journal (Refereed) Published
Abstract [en]

In this article, we aim to contribute to the emerging field of risk-work studies by examining the relationship between risk rationality and risk practices in nurses’ conversations with Obstructive Sleep Apnoea patients about traffic risks. Legislation in Sweden towards traffic risk involves clinicians making risk assessment of patients prone to falling asleep while driving. In contrast to an overall care rationale, this means that the health of the patient is not the only risk object in treatment consultations. However, guidelines on how to implement legislation are missing. To examine the practical reality of nurses’ traffic-risk work, we draw on an analysis of data from a Swedish study in 2015. This study included qualitative interviews with specialist nurses and video-recorded interactions between nurses and Obstructive Sleep Apnoea patients. We found that a lack of clarity in traffic-risk guidelines on how risk should be addressed was evident in both interview accounts and in observed practice. While nurses primarily accounted for risk work as treatment-relevant education, they practised risk work as interrogation. Patients also treated nurses’ inquiries as assessment – not education – by responding defensively. We conclude that while confusing risk work and treatment enables clinicians to treat patients as competent actors, it obscures the controlling aspects of traffic-risk questions for individual patients and downplays the implications of drowsy driving for general traffic safety. 

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
conversation analysis, Obstructive Sleep Apnoea, risk, risk assessment, risk work, sleepy patients, traffic
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-38188 (URN)10.1080/13698575.2017.1399986 (DOI)000426919500003 ()2-s2.0-85033715587 (Scopus ID)
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2018-07-16Bibliographically approved
Wu, E., Broström, A. & Mårtensson, J. (2018). Undergoing enhanced external counterpulsation treatment - a qualitative study of patients with refractory angina pectoris. European Journal of Cardiovascular Nursing, 17, 12-13
Open this publication in new window or tab >>Undergoing enhanced external counterpulsation treatment - a qualitative study of patients with refractory angina pectoris
2018 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, p. 12-13Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Sage Publications, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-41231 (URN)000440339600020 ()
Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2018-08-24Bibliographically approved
Lin, C.-Y., Broström, A., Nilsen, P. & Pakpour, A. H. (2018). Using extended theory of planned behavior to understand aspirin adherence in pregnant women.. Pregnancy Hypertension, 12, 84-89
Open this publication in new window or tab >>Using extended theory of planned behavior to understand aspirin adherence in pregnant women.
2018 (English)In: Pregnancy Hypertension, ISSN 2210-7789, E-ISSN 2210-7797, Vol. 12, p. 84-89Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To use the Theory of Planned Behavior (TPB) combined with action and coping planning plus global relationship with husband to explain the aspirin adherence in a sample of women with high-risk pregnancy.

METHODS: A total of 535 Iranian women (mean age = 32.29 ± 4.98; year of marriage = 6.89 ± 3.61) completed the study. Each participant filled out several questionnaires on TPB (i.e., a widely applied theory describing how behaviors are influenced by beliefs, attitudes, perceived behavioral control and behavioral intentions), action planning, coping planning and relationship with husband at baseline. Eight weeks later, each participant completed the Five-item Medication Adherence Rating Scale (MARS-5) and underwent the blood test on aspirin serum level to provide the subjective and objective aspirin adherence information, respectively. Structural equation modeling (SEM) was applied to test three proposed models on aspirin adherence.

RESULTS: The TPB with planning plus relationship with husband was supported (comparative fit index = 0.969; Tucker-Lewis index = 0.950). Behavioral intention was the mediator in the associations of aspirin adherence and the following variables: attitude, perceived behavioral control, and relationship with husband. Action and coping planning mediated the associations of aspirin adherence and the two variables of behavioral intention and perceived behavioral control. Relationship with husband mediated the association of subjective norm and aspirin adherence.

CONCLUSIONS: The TPB model with (action and coping) planning plus relationship with husband serves a potential mechanism to explain the aspirin adherence for women with high risk of pregnancy. Possible implications are discussed based on our results.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Aspirin adherence, Health action process approach, Pregnancy, Structural equation modeling, Theory of planned behavior
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychology
Identifiers
urn:nbn:se:hj:diva-39282 (URN)10.1016/j.preghy.2018.04.001 (DOI)000433429700016 ()29674206 (PubMedID)2-s2.0-85045083489 (Scopus ID)HHJADULTIS (Local ID)HHJADULTIS (Archive number)HHJADULTIS (OAI)
Available from: 2018-04-27 Created: 2018-04-27 Last updated: 2018-06-21Bibliographically approved
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