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Fischer Grönlund, C., Isaksson, U. & Brännström, M. (2023). Moral distress thermometer: Swedish translation, cultural adaptation and validation. Nursing Ethics
Open this publication in new window or tab >>Moral distress thermometer: Swedish translation, cultural adaptation and validation
2023 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Moral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time.

Aim: The aim of this study was to translate the MDT and adapt it to the Swedish cultural context. R

esearch design: The first part of this study concerns the translation of MDT to the Swedish context, and the second part the psychometric testing of the Swedish version.

Participants and research context: 89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch’s ANOVA, Games–Howell post-hoc test and Pearson’s correlation analysis were done.

Ethical considerations: The study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration.

Results: The translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress.

Conclusion: The MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
health care professionals, instrument, moral distress, questionnaire, translation, validation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-215080 (URN)10.1177/09697330231197707 (DOI)2-s2.0-85172656359 (Scopus ID)
Funder
Umeå UniversityKarolinska Institute
Available from: 2023-10-13 Created: 2023-10-13 Last updated: 2023-10-13
Valan, L., Isaksson, U. & Hörnsten, Å. (2023). Needs and expectations of nurse-led digital support among parents of children in child health care. Child Care Health and Development
Open this publication in new window or tab >>Needs and expectations of nurse-led digital support among parents of children in child health care
2023 (English)In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214Article in journal (Refereed) Submitted
Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-215112 (URN)
Available from: 2023-10-09 Created: 2023-10-09 Last updated: 2024-03-22
Fischer Grönlund, C., Brännström, M. & Isaksson, U. (2023). Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP). BMC Medical Ethics, 24(1), Article ID 35.
Open this publication in new window or tab >>Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP)
2023 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 24, no 1, article id 35Article in journal (Refereed) Published
Abstract [en]

Background: Moral distress has been described as moral constraints and uncertainty connected with guilty feelings of being unable to give care in accordance with one's values for good care. Various instruments to measure moral distress have been developed. The instrument measure of moral distress for healthcare professionals (MMD-HP) was developed to capture the experience and frequency of moral distress among various healthcare professionals. The MMD-HP has been translated and culturally adapted into the Swedish language and context; however, the translation has not been validated. Therefore, this study aimed to evaluate the validity and reliability of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP).

Methods: Eighty-nine staff from various professions at a hospital in northern Sweden participated in the study. A confirmatory factor analysis was performed to check for consistency with the original version of the MMD-HP. To evaluate internal consistency, Cronbach's alpha was calculated for each domain and for the scale as a whole.

Results: The scale as a whole showed a Cronbach's alpha of 0.96, with a range between 0.84 and 0.90 between the different subscales. A confirmatory factor analysis based on the original four-factor structure showed good fit indices with a χ2/df of 0.67, CFI at 1.00, TLI at 1.02 and NFI at 0.97. RMSEA was at 0.00, and SRMR was at 0.08. A comparison of the total score between three equally large groups of years of experience at the present workplace showed no significant differences (F = 0.09, df = 2, p = 0.912).

Conclusions: We found that the Swedish version of the MMD-HP has shown validity and reliability for use in a Swedish context for measuring moral distress among health personnel.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Moral distress, Instrument, Measure, Healthcare professionals, Psychometrics, Validation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-208781 (URN)10.1186/s12910-023-00916-x (DOI)000997702200001 ()37254086 (PubMedID)2-s2.0-85160608925 (Scopus ID)
Funder
Karolinska InstituteUmeå University
Available from: 2023-05-31 Created: 2023-05-31 Last updated: 2023-09-05Bibliographically approved
Sjöström, A. E., Hajdarevic, S., Hörnsten, Å., Kristjánsdóttir, Ó., Castor, C. & Isaksson, U. (2023). The Swedish version of the eHealth literacy questionnaire: Translation, cultural adaptation, and validation study. Journal of Medical Internet Research, 25, Article ID e43267.
Open this publication in new window or tab >>The Swedish version of the eHealth literacy questionnaire: Translation, cultural adaptation, and validation study
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2023 (English)In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 25, article id e43267Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: With the increasing digitalization in health care, an effective instrument is necessary to assess health care consumers' digital competencies-their "eHealth literacy." The 7-scale eHealth Literacy Questionnaire (eHLQ), based on the theoretically robust eHealth Literacy Framework, has shown strong psychometric properties in Denmark and Australia.

OBJECTIVE: The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Swedish version of the eHLQ.

METHODS: We followed the Translation Integrity Procedure guidelines to translate and culturally adapt the questionnaire to Swedish using forward and backward translations, review by an expert panel, and cognitive interviewing. The psychometric properties of the Swedish eHLQ were investigated by evaluating its internal consistency (Cronbach α) and a priori-defined factor structure (confirmatory factor analysis).

RESULTS: A total of 236 primary health care patients and parents of hospitalized children were included in the validation analysis. The mean age was 48.5 years, and 129 (55%) were women. All 7 eHLQ scales showed good internal consistency, with the Cronbach α ranging from .82 to .92. Single-factor and 7-factor confirmatory factor analysis showed satisfactory model-fit values. With one exception, all items demonstrated satisfactory loadings on their respective factors.

CONCLUSIONS: The Swedish eHLQ demonstrated strong psychometric properties. It has the potential as a useful tool for a variety of purposes, including population surveys, intervention evaluations, and eHealth service implementations.

Place, publisher, year, edition, pages
JMIR publications, 2023
Keywords
cultural adaptation, digital health, eHLQ, eHealth, eHealth literacy, health literacy, validation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-206994 (URN)10.2196/43267 (DOI)37043268 (PubMedID)2-s2.0-85152474327 (Scopus ID)
Funder
Swedish Diabetes AssociationForte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2023-04-24 Created: 2023-04-24 Last updated: 2024-01-17Bibliographically approved
Pusa, S., Isaksson, U. & Sundin, K. (2021). Evaluation of the Implementation Process of a Family Systems Nursing Approach in Home Health Care: A Mixed-Methods Study. Journal of Family Nursing, 27(3), 235-249
Open this publication in new window or tab >>Evaluation of the Implementation Process of a Family Systems Nursing Approach in Home Health Care: A Mixed-Methods Study
2021 (English)In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 27, no 3, p. 235-249Article in journal (Refereed) Published
Abstract [en]

To support the incorporation of Family Systems Nursing (FSN) in clinical practice, more understanding is needed about the implementation of FSN in home health practice settings. Thus, the aim of this study was to evaluate nurses' perspectives about the implementation process of Family Systems Nursing Conversations (FSNCs) in home health care. A mixed-methods research design was used, integrating qualitative and quantitative data, and using triangulation as a methodological metaphor. The Quality Implementation Framework (QIF) was applied to guide the implementation process, and Proctor et al.'s taxonomy of implementation outcomes was used to evaluate the process. The findings demonstrated that FSN implementation was in progress. Overall, acceptability and appropriateness of FSNCs were evaluated as positive by home health nurses; however, some obstacles were found relating to feasibility, adoption, and fidelity. These results contribute to an increased understanding of the process and challenges of implementing FSNCs in home health care.

Place, publisher, year, edition, pages
Sage Publications, 2021
Keywords
Family Systems Nursing, Family Systems Nursing conversations, family nursing, home health care, implementation, mixed methods
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-182069 (URN)10.1177/10748407211000050 (DOI)000638966100001 ()33825569 (PubMedID)2-s2.0-85104229063 (Scopus ID)
Available from: 2021-04-08 Created: 2021-04-08 Last updated: 2023-08-11Bibliographically approved
Sjöström, A. E., Hajdarevic, S., Hörnsten, Å., Öberg, U. & Isaksson, U. (2021). Experiences of Online COVID-19 Information Acquisition among Persons with Type 2 Diabetes and Varying eHealth Literacy. International Journal of Environmental Research and Public Health, 18(24), Article ID 13240.
Open this publication in new window or tab >>Experiences of Online COVID-19 Information Acquisition among Persons with Type 2 Diabetes and Varying eHealth Literacy
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2021 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 24, article id 13240Article in journal (Refereed) Published
Abstract [en]

During the COVID-19 pandemic, the Internet has been a major source of information for people to keep updated with news and guidelines. However, concerns have been raised about the ‘infodemic’, which includes the overabundance of online information and the spread of misleading information. Adequate eHealth literacy skills among world citizens have therefore been emphasized as vital during the pandemic. Persons with type 2 diabetes have been at increased risk of severe outcomes of COVID-19 disease. 

This study aimed to explore online COVID-19 information acquisition experiences among persons with type 2 diabetes and varying eHealth literacy. Fifty-eight participants filled out the eHealth Literacy Scale (eHEALS), along with a qualitative questionnaire with free-text questions. Additionally, 10 participants were interviewed. Thematic analysis was applied to identify patterns in participants’ experiences. Two domains were identified: perceived challenges with online information about COVID-19, and coping strategies to manage challenges. The perceived challenges were: being exposed to information overload, dealing with conflicting information, and being strongly emotionally affected. The related coping strategies were: protecting oneself, trusting authorities, taking command, and using common sense. 

These strategies often involved triangulation of the information obtained, including participants consulting their common sense, various sources, or family and friends. This paper highlights the crucial role of authorities in delivering online information, that according to health literacy principles, is easy to access, understand, and use. Furthermore, our results reinforce the importance of diabetes nurses, as well as healthcare professionals in general, in encouraging patients to share their Internet findings, promote information from reliable sources, and deliver tailored information that suits individual needs. Because our results underline the importance of social support in eHealth literacy and the assessment of online health information, the inclusion of family and friends needs to be increasingly considered in diabetes care. Due to the small homogenous sample, the results of this study cannot be generalized. However, the reader can assess the transferability to other situations and settings based on our contextual descriptions.

Place, publisher, year, edition, pages
MDPI, 2021
Keywords
COVID-19, eHealth literacy, type 2 diabetes, online health information, health literacy, distributed health literacy, nursing
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-190739 (URN)10.3390/ijerph182413240 (DOI)000737910700001 ()2-s2.0-85121114972 (Scopus ID)
Funder
Swedish Diabetes Association
Available from: 2021-12-23 Created: 2021-12-23 Last updated: 2023-12-09Bibliographically approved
Svahn, S., Lövheim, H., Isaksson, U., Sandman, P.-O. & Gustafsson, M. (2020). Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden. European Journal of Clinical Pharmacology, 76(4), 525-537
Open this publication in new window or tab >>Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden
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2020 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 76, no 4, p. 525-537Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to describe changes in the pattern of cardiovascular agents used in elderly people living in nursing homes between 2007 and 2013. Further, the aim was to analyse the use of cardiovascular drugs in relation to cognitive impairment and associated factors within the same population, where prescription of loop diuretics was used as a proxy for heart failure.

Methods: Two questionnaire surveys were performed including 2494 people in 2007 and 1654 people in 2013 living in nursing homes in northern Sweden. Data were collected concerning drug use, functioning in activities of daily living (ADL) and cognition, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The use of different drugs and drug classes among people at four different levels of cognitive function in 2007 and 2013 were compared.

Results: The proportion of people prescribed ASA and diuretics was significantly lower at all four levels of cognitive function in 2013 compared to 2007. Among people prescribed loop diuretics, the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs) increased from 37.8 to 45.6%, β-blockers from 36.0 to 41.8% and warfarin from 4.4 to 11.4%. The use of warfarin, ACEI/ARBs, β-blockers and mineralocorticoid receptor antagonists (MRAs) were less common among individuals with more severe cognitive impairment.

Conclusion: The results indicate that cardiovascular drug treatment has improved between 2007 and 2013, but there is room for further improvement, especially regarding adherence to guidelines for heart failure. Increasing cognitive impairment had an effect on treatment patterns for heart failure and atrial fibrillation.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
Cardiovascular drugs, Drug use, Heart failure, Major neurocognitive disorders, Nursing home
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-169526 (URN)10.1007/s00228-019-02778-y (DOI)000521297200007 ()31915846 (PubMedID)2-s2.0-85077552235 (Scopus ID)
Available from: 2020-04-03 Created: 2020-04-03 Last updated: 2020-10-13Bibliographically approved
Ludvigsson, C., Isaksson, U. & Hajdarevic, S. (2020). Experiencing improved assessment and control of pain in end-of-life care when using the Abbey Pain Scale systematically. Nursing Open, 7(6), 1798-1806
Open this publication in new window or tab >>Experiencing improved assessment and control of pain in end-of-life care when using the Abbey Pain Scale systematically
2020 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 7, no 6, p. 1798-1806Article in journal (Refereed) Published
Abstract [en]

Aim: To describe staff's reflections on aspects influencing pain assessment at end‐of‐life (EoL) care in nursing homes before and after the implementation of the Abbey Pain Scale (APS).

Background: People with cognitive impairment in the EoL care often suffer from underdiagnosed and undertreated pain due to the lack of knowledge and guidelines for systematic pain assessment.

Methods: Semi‐structured focus group interviews were conducted and analysed using qualitative content analysis.

Results: The staff described their experiences before the implementation of APS as striving to achieve control of pain by trusting in themselves and the team, while the experiences after the implementation of APS were described as improving symptom control with remaining weak confidence in the team .

Conclusions: Implementation of APS was experienced as improving systematic pain assessment. Efforts to establish clear routines and improve confidence in the care team would be prioritized to optimize pain assessment and pain relief in EoL care.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
end-of-life care, nurses, nursing, pain, terminal care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-173870 (URN)10.1002/nop2.566 (DOI)000551112600001 ()33072364 (PubMedID)2-s2.0-85088315171 (Scopus ID)
Available from: 2020-08-06 Created: 2020-08-06 Last updated: 2023-03-24Bibliographically approved
Orre, C. J., Pusa, S., Tibblin, A. & Isaksson, U. (2020). Implementation and involvement of a dynamic instrument as a practice support in rehabilitation processes of chronic diseases. In: Kirsty Christer; Claire Craig; Paul Chamberlain (Ed.), Kirsty Christer; Claire Craig; Paul Chamberlain (Ed.), Proceedings of the 6th International Conference on Design4Health: Volume 3. Paper presented at e 6th International Conference on Design4Health, Amsterdam, the Netherlands, July 1-3, 2020 (pp. 28-35). Sheffield: Lab4Living, Sheffield Hallam University
Open this publication in new window or tab >>Implementation and involvement of a dynamic instrument as a practice support in rehabilitation processes of chronic diseases
2020 (English)In: Proceedings of the 6th International Conference on Design4Health: Volume 3 / [ed] Kirsty Christer; Claire Craig; Paul Chamberlain, Sheffield: Lab4Living, Sheffield Hallam University , 2020, p. 28-35Conference paper, Published paper (Refereed)
Abstract [en]

In the rehabilitation of chronic and severe illnesses, it is common to use paper-based questionnaires to capture experiences of symptoms associated with illness or treatment. Managing such instruments consumes time, and offers care professionals a narrow space of possible actions toward the patients. The purpose of this paper was to report the initial concerns we encountered in the early phases involving a dynamic instrument in nursing practice. 

This project is based on the Self Management Assessment Scale (SMASc) with the purpose to provide digital support that enables personalized work methods with the patient. With SMASc, patients answer questions on a mobile phone, tablet or computer. The compiled result is provided instantly before the patient-nurse consultation. SMASc is here understood as an interactive artefact with dynamic affordances. A dynamic instrument manifests a theoretical foundation aligning to the use situation, is programmable and digitally distributed, and offers individually compiled datafied views that connect the person's situation and the theoretical apparatus - in this case, a person's need for self-management support. 

The data this report builds on was produced during two project meetings and throughout the design and development of the instrument prototype. Data analysis approach applied was an analysis focusing on emerging concerns surfacing from discussions that followed the introduction of the prototype. 

We found that the nurses cared for the development of their practice and strived to advance and steer it in a more nursing-oriented direction. They did not fully comply with the instrument's item formulations and how these should or could be used. Further work has to be done to involve more stakeholders in the future work so that everyone feels engaged and can put their views on the design of the instrument, and on the implementation work itself.

Place, publisher, year, edition, pages
Sheffield: Lab4Living, Sheffield Hallam University, 2020
Keywords
caring, co-design, dynamic instruments, implementation, nursing, ownership, rehabilitation, trust.
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-222455 (URN)978-1-8381117-0-0 (ISBN)
Conference
e 6th International Conference on Design4Health, Amsterdam, the Netherlands, July 1-3, 2020
Available from: 2024-03-18 Created: 2024-03-18 Last updated: 2024-03-19Bibliographically approved
Öberg, U., Orre, C. J., Hörnsten, Å., Jutterström, L. & Isaksson, U. (2020). Using the Self-Management Assessment Scale for Screening Support Needs in Type 2 Diabetes: Qualitative Study. JMIR Nursing, 3(1), Article ID e16318.
Open this publication in new window or tab >>Using the Self-Management Assessment Scale for Screening Support Needs in Type 2 Diabetes: Qualitative Study
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2020 (English)In: JMIR Nursing, ISSN 2562-7600, Vol. 3, no 1, article id e16318Article in journal (Refereed) Published
Abstract [en]

Background: Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses’experiences using a digitalized scale for measuring patients’ needs for self-management support in primary health care settings has been found. Objective: This paper describes diabetes specialist nurses’ (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support. Methods: This qualitative study is based on observations and interviews analyzed using qualitative content analysis. Results: From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient’s term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration. Conclusions: Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalize

Background: Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses’ experiences using a digitalized scale for measuring patients’ needs for self-management support in primary health care settings has been found.

Objective: This paper describes diabetes specialist nurses’ (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support.

Methods: This qualitative study is based on observations and interviews analyzed using qualitative content analysis.

Results: From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient’s term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration.

Conclusions: Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalized care. Using a screening instrument in a patient meeting may also contribute to a role change in the work and practice of DSNs.

Place, publisher, year, edition, pages
JMIR Publications, 2020
Keywords
eHealth, internet, type 2 diabetes, self-management, primary health care, qualitative research, nursing
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-175682 (URN)10.2196/16318 (DOI)
Available from: 2020-10-06 Created: 2020-10-06 Last updated: 2022-02-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5191-4599

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