Download A study conducted to know the effectiveness of Umbilical cord blood

SYNOPSIS PRESENTATION
Name of the Guide:
Mr. Vijaykumar Malagi
HOD, Pediatric Nursing
P.D Bharatesh college of Nursing, Belgaum.
Prepared By:
Mrs Deepa .Urabinahatti
M.Sc(N)Ist Year
Pediatric Nursing
P.D Bharatesh college of Nursing, Belgaum.
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1
NAME
OF
THE
MRS.DEEPA.URABINAHATTI
CANDIDATE AND
Ist YEAR M.Sc NURSING
ADDRESS
P.D. BHARATESH COLLEGE
OF
NURSING,
HALAGA,
BELGAUM.
2
NAME
OF
THE
INSTITUTION
P.D.BHARATESH
COLLEGE
OF
HALAGA,
NURSING
BELGAUM
3
4
COURSE
OF
THE
M.Sc NURSING Ist YEAR
STUDY AND SUBJECT
PAEDIATRIC NURSING
DATE OF ADMISSION
25/03/ 2010
TO COURSE
5
STATEMENT OF THE
A STUDY TO ASSESS THE
PROBLEM
EFFECTIVENESS
VIDEO
TEACHING
ON
OF
ASSISTED
PROGRAMME
KNOWLEDGE
ATTITUDE
ON
AND
CORD
BLOOD COLLECTION AND
ITS
MEDICAL
SIGNIFICANCE
STAFF
SELECTED
AMONG
NURSES
AT
HOSPITALS
BELGAUM, KARNATAKA.
6. BRIEF RESUME OF INTENDED WORK:
INTRODUCTION
NO GIFT MORE VALUABLE
Child is emotionally, physically bond to mother from the period of
conception. The fetus gets its nutrition for survival from mother through umbilical
cord1.The placenta which is attached to womb supplies the essential nutrients to
fetus for its growth and development.Umbilical cord acts as a bridge between both
mother and fetusUmbilical cord blood is a blood that remains in the placenta and is
attached to umbilical cord after birth2. Cord blood is collected because it contains
stem cells, which are used to treat hemopoietic and genetic disorders.Stem cells
have the ability to generate new tissue in the body. Stem cell banks are large scale
cryogenic facilities that preserves cord blood at around -196ºC. It takes just 5 to 10
minutes to collect cord blood since the cord blood is collected after the baby is
born and the umbilical cord has been clamped and cut. Two report in July 18,
1996.New England Journal of medicine strongly suggest that many of patients
could be helped by transplants of stem cells from placental(cord) blood which is
routinely discarded after babies are born4.Cord blood collection is a very simple
and painless process for both mother and child3.There are two types of cord blood
collection syringe method and bag method.After the health care provider draws the
cord blood from placental end of umbilical cord, the placenta is couriered to stem
cell laboratory, where it is processed for additional stem cell1.
Then the stem cells are separated. Before blood is stored,various tests are
done as hepatitis B etc.Cryopreservant is added to cord blood to allow the cells to
survive the cryogenic process.The blood or stem cells are stored at -19 degree c to
-80 degree c. If storage period exceeds one year, cells should be stored at a
temperature of less than -130 degree c3.
To date, there have been more than 10,000 umbilical cord blood stem cell
transplants reported worldwide.6.
NEED FOR THE STUDY
Umbilical cord blood stem cells are used to treat variety of pediatric
disorders including leukaemia, sickle cell disease, metabolic disorders.It is
estimated that more than 3ooo children have now being treated with cord blood
stem cells. 400-500 new children receive treatment annually.The blood which is
collected from neonate not only useful for child in future but for the whole
family.about 80 pediatric diseases have being treated till today. Stem cell therapy
has shown significant positive results worldwide in conditions like Cerebral palsy,
Mental retardation, Autism and many diseases over the last 3 -6 years3. India
NeoNatal mortality Rate (2005)Almost One in every Three babies in the world,
who die before in India.Of these, over one-fourth happen in Uttar Pradesh alone,
they are four weeks old is reveals ‘State of India’s Newborns’, a report prepared by
UNICEF in association with the World Health Organization, World Bank,
department of health and family welfare, Government of India, and the National
Neonatology Forum.The report, released recently at the National Conference on
Child Survival and Development in New Delhi, claims that of the roughly 26
million children born in India each year, 1.2 million die during the first four weeks.
That’s 30% of the 3.9 million global neonatal deaths.According to the report,the
current neonatal mortality rate (NMR) of 44 per 1,000 live births accounts for
nearly two-thirds of all infant deaths (death before the age of one) and nearly half
of under-five child deaths in India.
India, like other developing countries, is facing an accelerating
demographic switch to non-communicable diseases. In the cities congenital
malformations and genetic disorders are important causes of morbidity and
mortality. Due to the high birth rate in India a very large number of infants with
genetic disorders are bom every year almost half a million with malformations and
21000 with Down syndrome. In a multi-centric study on the causes of referral for
genetic counselling the top four disorders were repeated abortions (12.4 %),
identifiable syndromes (12.1 %), chromosomal disorders (11.3%) and mental
retardation (11%). In a more recent study in a private hospital the top reasons for
referral were reproductive genetics (38.9%) -comprising prenatal diagnosis,
recurrent abortions, infertility and Torch infections mental retardation +- multiple
congenital anomalies (16.1%), Down syndrome (9.1%), thalassemiaJ haemophilia
( 8.8 %), and muscle dystrophyJ spinal muscular atrophy (8.4 %). The disorders for
which prenatal has been done over an 18-month-period are given. A recent study
carried out in three centers (Mumbai, Delhi and Baroda) on 94,610 newborns by
using a uniform proforma showed a malformation frequency of 2.03 %, the
commonest malformations are neural tube defects and musculo-skeletal disorders.
The frequency of Down syndrome among 94610 births was 0.87 per 1000, or 1 per
1150. Screening of 112,269 newborns for aminoacid disorders showed four
disorders to be the commonest-tyrosinemia, maple syrup urine disease and
phenylketonuria. Screening of cases of mental retardation for aminoacid disorders
revealed four to be the commonest-hyperglycinemia, homocystinuria, alkaptonuria,
and maple syrup urine disease. Metabolic studies of cases of mental retardation in
AIIMS, Delhi and KEM Hospital, Mumbai, demonstrated that common disorders
were those of mucopolysaccharides, lysosomes, Wilson disease, glycogen storage
disease and galactosemia. It is estimated that betathalassemia has a frequency at
birth of 1: 2700, which means that about 9,000 cases of thalassemia major are born
every year. Almost 5200 infants with sickle cell disease are born every year.
Disorders, which deserve to be screened in the newborn period, are
hypothyroidism and G-6-PD deficiency, while screening for aminoacid and other
metabofic disorders could presently be restricted to symptomatic infants5.
Stem cell therapy is used to treat incurable diseases like hemopoietic diseases like
leukaemia, thalassemia as well as genetic disorders like Down’s syndrome etc..
more than 80 paediatric diseases have been treated2.The cord blood not only
useful for the child but for the whole family.So the researcher felt there is lack in
awareness of cord blood collection and its significance among staff nurses and
took this study of her interest.
REVIEW OF LITERATURE
 Studies related to assessment of knowledge and attitude of health care
professionals on cord blood collection and storage
* A study conducted on Knowledge and attitudes of pregnant women with
regard to collection, testing and banking of cord blood stem cells(April 2001). A
questionnaire examining sociodemographic factors and women's attitudes to cord
blood banking was developed on the basis of findings from 2 focus groups and a
pilot study. The questionnaire was distributed to 650 women attending antenatal
clinics at a regional women's hospital: A total of 443 women (68%) responded.
More than half of the women (307/438 or 70% [95% confidence interval, CI, 66%
to 74%]) reported poor or very poor knowledge about cord blood banking. Many
of the respondents (299/441 or 68% [95% CI 63% to 72%]) thought that physicians
should talk to pregnant women about the collection of cord blood, and they wanted
to receive information about this topic from health care professionals (290/441 or
66% [95% CI 61% to 70%]) or prenatal classes (308/441 or 70% [95% CI 65% to
74%]). Most of the women (379/442 or 86% [95% CI 82% to 89%]) would elect to
store cord blood in a public bank, many citing altruism as the reason for this
choice. A much smaller proportion (63/442 or 14% [95% CI 11% to 18%]) would
elect private banking, indicating that this would be a good investment or that they
would feel guilty if the blood had not been stored. Additional acceptable uses for
cord blood included research (mentioned by 294/436 women or 67% [95% CI 63%
to 72%]) and gene therapy (mentioned by 169/437 women or 39% [95% CI 34% to
43%]).
* A exploratory descriptive study conducted on Pregnant women's knowledge and
attitudes about stem cells and cord blood banking in two antenatal outpatient
clinics in Istanbul. The sample consisted of 334 pregnant women during routine
prenatal visits. Data were collected in interviews by using an interview form
developed by the researchers according to the literature. The form included
demographic characteristics of participants and 20 questions about stem cells,
storing cord blood and banking and 10 independent attitude statements. The
majority of the participants had a lack of knowledge about stem cells and cord
blood banking and wanted more information. Before pregnancy, they received
some information through the media (newspaper, Internet, television, etc.), but
unintentionally. It was determined that they wanted information before becoming
pregnant, more from their obstetrician but also from nurses and midwives. The
majority also wanted to store their infants' cord blood and stated that they would be
more likely to choose a public cord blood bank.
 Studies related to benefits of cord blood collection.
*
A study conducted to investigate uses of cord blood stem cells. total of 500
neonates having leukemia underwent transplantation for about a month. The results
predicted that about 60% of the neonates had good progress and 20% were coping with
the treatment and 20% of them were having minimal complications.
*
A study conducted on
association of umbilical cord blood lead with
neonatal behavior at varying levels of exposure analyzed the CBL levels
independently and strongly influenced autonomic stability and abnormal reflexes
clusters. However, when the analysis was restricted to neonates with CBL <10
μg/dL, CBL levels strongly influenced the range of state, motor and autonomic
stability clusters. Abnormal walking reflex was consistently associated with an
increased CBL level irrespective of the cut-off for CBL, however, only at the lower
cut-offs were the predominantly behavioral effects of CBL discernible.Our results
further endorse the need to be cognizant of the detrimental effects of blood lead on
neonates even at a low-dose prenatal exposure.
*
A study conducted on Children After a Cord-Blood or Bone Marrow
Transplant
consists of the records of 113 recipients of cord blood from HLA-
identical siblings compared them with the records of 2052 recipients of bone
marrow from HLA-identical siblings during the same period. The study population
consisted of children 15 years of age or younger. compared the rates of GVHD,
hematopoietic recovery, and survival using Cox proportional-hazards regression to
adjust for potentially confounding factors. Recipients of cord blood were younger
than recipients of bone marrow (median age, 5 years vs. 8 years; P<0.001),
weighed less (median weight, 17 kg vs. 26 kg; P<0.001), and were less likely to
have received methotrexate for prophylaxis against GVHD (28 percent vs. 65
percent, P<0.001). Multivariate analysis demonstrated a lower risk of acute GVHD
(relative risk, 0.41; P=0.001) and chronic GVHD (relative risk, 0.35; P=0.02)
among recipients of cord-blood transplants. As compared with recovery after bone
marrow transplantation, the likelihood of recovery of the neutrophil count and the
platelet count was significantly lower in the first month after cord-blood
transplantation (relative risk, 0.40 [P<0.001], and relative risk, 0.20 [P<0.001],
respectively). Mortality was similar in the two groups (relative risk of death in the
recipients of cord blood, 1.15; P=0.43).
*
A study conducted on Stem cell-based strategies for treating pediatric
disorders of myelin The pediatric leukodystrophies comprise a category of disease
manifested by neonatal or childhood deficiencies in myelin production or
maintenance; these may be due to hereditary defects in one or more genes critical
to the initiation of myelination, as in Pelizaeus–Merzbacher Disease, or to
enzymatic deficiencies with aberrant substrate accumulation-related dysfunction,
as in the lysosomal storage disorders. Despite differences in both phenotype and
natural history, these disorders are all essentially manifested by a profound
deterioration in neurological function with age. A congenital deficit in forebrain
myelination is also noted in children with the periventricular leukomalacia of
cerebral palsy, another major source of neurological morbidity. In light of the wide
range of disorders to which congenital hypomyelination and/or postnatal
demyelination may contribute, and the relative homogeneity of central
oligodendrocytes and their progenitors, the pediatric leukodystrophies may be
especially attractive targets for cell based therapeutic strategies.
*
A study conducted on
Predicted Outcome After Cord-Blood
Transplantation in Children With Leukemiaanalyzed factors influencing the
outcome of 102 children with acute leukemia given a cord blood transplantation
(CBT) and reported to the Eurocord Registry. Seventy patients with acute
lymphoblastic and 32 with acute myeloid leukemia were given either a related (n =
42) or an unrelated (n = 60) CBT. Children given CBT during first or second
complete remission were considered as belonging to the good-risk group (n = 66),
whereas those who received a transplant in a more advanced stage of disease were
assigned to the poor-risk group (n = 36). In the related group (RCBT), 12 of 42
patients received transplantation from an HLA-disparate donor, whereas in the
unrelated group (UCBT) 54 of 60 received an HLA mismatched CBT.KaplanMeier estimates for neutrophil recovery at day 60 were 84% +/- 7% in RCBT and
79 +/- 6% in UCBT (P =.16). In multivariate analysis, the most important factor
influencing neutrophil engraftment in UCBT was a nucleated cell dose infused
greater than 3.7 x 10(7)/kg (P =.05, relative risk [RR] of 1.85, 95% confidence
interval [CI]: 0.98-3.4). The incidence of grade II through IV acute graft-versushost disease was 41% +/- 8% in the RCBT group and 37% +/- 6% in the UCBT
group (P =.59). Kaplan-Meier estimates of 2-year event-free survival (EFS) after
RCBT or UCBT were 39% +/- 8% and 30% +/- 7%, respectively (P =.19) In
multivariate analysis, the most important factor influencing EFS was disease status
at time of transplantation: good-risk patients had a 2-year EFS of 49% +/- 7% as
compared to 8% +/- 5% in patients with more advanced disease (P =.0003, RR:
0.40, 95% CI: 0.24 to 0. 65). This was a consequence of both an increased 1-year
transplant related mortality and a higher 2-year relapse rate in the poor-risk group
(65% +/- 9% and 77% +/- 14%, respectively), as compared with good risk patients
(34% +/- 6% and 31% +/- 9%, respectively)These data confirm that allogeneic
CBT from either a related or an unrelated donor is a feasible procedure able to cure
a significant proportion of children with acute leukemia, especially if transplanted
in a favorable phase of disease.
*A study conducted on . [Unrelated umbilical cord blood transplantation as a
treatment for children with malignant leukemia] aims to investigate the efficacy of
unrelated umbilical cord blood transplantation (UCBT) in the treatment of
malignant leukemia in children.Six children with malignant leukemia, including
three cases of acute lymphocyte leukemia [two high-risk patients and one standardrisk patient in complete remission (CR)], two juvenile myelomonocytic leukemia
(one in CR and one in the accelerating stage), and one acute myeloblastic
leukaemia (in CR), received a UCBT. The umbilical cord blood grafts were HLAmismatched at1(n=1)or2(n=1)or3(n=3)loci.Busulfan/cyclophosphamide/ antith
ymocyte globulin (ATG) or total body irradiation (TBI)/cyclophosphamide/ATG
was involved in the myeloablative pretreatment regimen. The median infused
donor nucleated cell was 8.51 x 10(7)/kg of recipient weight, and the CD34+ cell
was 1.81 x 10(5)/kg of recipient weight. Cyclosporin, corticoid, mycophenolate
mofetil and daclizumab were used for prophylaxis of acute graft versus host
disease (GVHD).Results were The time to reach an absolute neutrophil count of
0.5 x 10(9)/L ranged from 11 to 35 days (median: 13 days) and the time to reach a
platelet count of 20 x 10(9)/L ranged from 27 to 68 days (median: 30 days) after
transplantation, and the donors' hematopoietic stem cells were shown in these
patients. Four patients developed grade I to III acute GVHD but responded to
steroids and daclizumab. Chronic GVHD was not found during a 3-16-month
follow-up. Four patients survived and did not relapse during the follow-up.
*
A study conducted to know the effectiveness of Umbilical cord blood
transplantation in Wiskott Aldrich syndrome.objective was the use of umbilical
cord blood (UCB) stem cell transplantation in Wiskott Aldrich syndrome (WAS)
when a matched sibling donor was unavailable.Three children with WAS received
unrelated umbilical cord blood stem cell transplantation after a preparative regimen
for the treatment of combined immunodeficiency diseases. The patients ranged in
age from 1.9 to 7.9 years. The cord blood units were 4/6 HLA antigen matches in 2
children and 5/6 in 1 child, with molecular HLA-DR match in all 3 children.The
result was The time for neutrophil engraftment (ANC >500/mm(3)) was 11 to 16
days, and the average time for platelet engraftment was 36 to 49 days. One patient
had no evidence of GvHD, 1 patient grade I, and 1 patient grade II. No patient had
chronic GvHD. The patient with grade II GvHD also had gut involvement.
Immunologic reconstitution demonstrated that cord blood stem cell transplantation
resulted in consistent and stable T-, B-, and NK-cell development. Functional Bcell antibody responses revealed that 2 of the patients in whom IVIG has been
discontinued had low detectable antibody responses to tetanus and diphtheria
toxoid immunizations at 18 to 24 months after transplantation..
STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO
ASSISTED TEACHING PROGRAMME ON KNOWLEDGE
AND ATTITUDE ON CORD BLOOD COLLECTION AND ITS
MEDICAL SIGNIFICANCE AMONG STAFF NURSES AT
SELECTED HOSPITALS IN BELGAUM KARNATAKA .”
OBJECTIVES
 The objectives of the study are:
 1. To determine the knowledge score of staff nurses on cord blood collection and
its medical significance.
 2. To determine the attitude score on cord blood collection, and its medical
significance among staff nurses..
 3. To find effectiveness of video assisted teaching programme in terms of gain in
knowledge, attitude score of staff nurses.
 4. To find cor-relation between knowledge and attitude on cord blood collection
and its medical significance among staff nurses.
 5. To explore association between knowledge and attitude on cord blood collection
and its medical significance among staff nurses.
HYPOTHESIS
 H1-The mean post test scores of subjects exposed to video assisted teaching
programme on knowledge and attitude of cord blood collection and its medical
significance will be significant to their mean pre test scores as measored by
knowledge and atttitude test at higher level of significance.
 H2-There will be significant correlation of pre test and post test knowledge scores
with pre test and post test scores of subjects.
 H3-There will be significant association between knowledge and attitude scores on
cord blood collection and its medical significance with selected demographic
variables of subjects.
OPERATIONAL DEFINITONS
1.Effectiveness:
Effectiveness is a measure of the ability of a program to produce a
developing key performance indicators.
2.Video assisted teaching programme
It refers to teaching and learning activity by use of visual devices
3.Cord blood collection:
It is collection of blood that remains in placenta and in the attached
umbilical cord after child birth within 15min
4. Medical significance:
Refers to importance of storage and uses of cord blood stem cells in treating
hemopoietic and genetic disorder.
5. Knowledge on cord blood collection:
Refers to the awareness of staff nurses on cord blood collection and its
medical significance.
6. Attitude on cord blood collection:
Refers to opinion of staff nurses on cord blood collection and its medical
significance.
7. Staff nurse:
Refers to
registered nurses who has completed Diploma(GNM) nursing,
Bachelor in nursing (Bsc) and Post bachelor in nursing (PcBsc)and Master in
nursing (Msc) and working in selected hospitals Belgaum.
ASSUMPTIONS
The investigator assumes that,
1. Staff nurses possess less knowledge on cord blood collection and its medical
significance.
2. Staff nurses possess positive attitude towards cord blood collection.
DELIMITATIONS
The study is limited
•
Only 100 staff nurses from selected hospitals Belgaum.
•
Those who are willing to participate in the study.
METHODOLOGY
7.1 Source of data:
Data will be collected from staff nurses who fulfill the inclusion criteria.
7.1.1 Research approach & design:
Quantitaive evaluative approach and pre experimental one group pre test
post test research design will be used in the study.
7.1.2 Setting:
The study will be conducted in selected hospitals at Belgaum, Karnataka
7.1.3 Population:
The target population of the study is staff nurses of selected
hospitals at Belgaum, Karnataka
VARIABLES
INDEPENDENT :
Age , Sex, Education, Working Experience, Source of information, Religion,
Area of residence, Socio economic status, Experience in different wards
DEPENDENT:
Knowledge and attitude on cord blood collection and its medical
significance.
7.2 Methods of data collection:
7.2.1 Sampling procedure:
Purposive sampling method will be used in this study.
7.2.2 Sample size:
The sample size consists of 50 staff nurses at Belgaum, Karnataka
7.2.3 Significance of the study :
This Study signifies about the effectiveness of video assisted teaching
program on cord blood collection and its medical significance.
7.2.4 Inclusion criteria for sampling:
•
Staff nurses available at the time of the data collection.
•
Staff nurses who are willing to participate in the study.
•
Staff nurses working in selected hospitals Belgaum.
•
Registered staff nurses who have completed GNM. Bsc PcBsc and Msc nursing
and working in selected hospitals.
•
7.2.5 Exclusion criteria for sampling:
•
Staff nurses who are not available at the time of data collection
•
Staff nurses who are not willing to participate in the study.
•
ANM and other para medics are excluded from the study.
7.2.6 Instruments intended to be used:
A questionnaire prepared by the investigator will be used to collect
data.
The tool consists of 3 parts:
•
Part A – Socio Demographic Profile.
•
Part B - Structured Knowledge Questionnaire on cord blood collection, its medical
significance.
•
Part c-Structured Attitude scale on cord blood collection an its medical
significance.
7.2.7 Pilot Study:
In order to find out the feasibility of the study, a pilot study will be conducted
among staff nurses who fulfill the inclusion criteria for sample selection. It will be
conducted in the manner in which the final study will be done. These subjects are
excluded for the final study.
7.2.8 Plan for data analysis :
Collected data will be analyzed by using descriptive and inferential
statistics like frequency and percentage, correlation and chi-square or association.
EHTICAL CLEARANCE
1.Has ethical clearance being obtained from your institution?
Yes.
BIBLIOGRAPHY
1.http:/en.wikipedia.org/ wiki/cord blood
2. http:/pediatrics.about.com/od/a grand stages/cord- blood-bank.htm
3. Whaley and Wong’s “Nursing care of Infants and children” 5th edition 1997,
page no: 980
4. chellappa, MJ. Paediatric Nursing: 2nd ed. AP Jain & co-publishers;
5. Polit Denise F., Hunglor, B.P. “Nursing Research”; Principles and methods,
Philadelphia; J.B. Lippincott Company 1991, 64 – 66 P.P and 392 page.
6. Kothari C.R., “Research Methodology Methods and Techniques”, New Delhi Eastern
Limited, 1990
58– 64 P.P.
7. Polit Denise F., Hunglor, B.P. “Nursing Research”; Principles and methods,
Philadelphia; J.B. Lippincott Company 1991, 64 – 66 P.P and 392 page.
8. Trace E.W and Trace, F.W “Elements of Research in nursing Saint louis” ; The
C.V. Mosby company 1973, 30-32 P.P.
9.Whaley and Wong’s “Nursing care of Infants and children” 5th edition 1997,
p.no980.
10 .Davies B.ElwoodNJ. Li S Cullianane.Children’s heart research centre:University of
Melbourne.Australia.
11.Wagner JE.Barker JN.Defor TE. Baker.:Blood and marrow transplant program of
department of pediatrics:University of Minnesota Cancer Centre.Minneapolis.
12.Editorial in “Indian express”, oct 2010.
13. http:/www.dancewithshadow.com/pillscribe/pathcare-labs.
14.ArchanaBP.ManjuRM.Association of umbilical cord blood lead with neonatal
behaviour.
15. India:Indira Gandhi Government Medical College.2006. online [cited on 28 oct
2010]: http://www.behavioralandbrainfunctions.com/content/2/1/22
16.SherwanNl ScolovenoAM.Nursing care of the child bearing family.2nd
edition. Norway. 2005. p.no 389-91.
17.GhaiOP.Essential Pediatrics. New Delhi.CbC Publishers.2005.p.no.480.
18.Pillitre Adele.Child health nursing care of the child and family.Lippincot
publication.1999.p.no.81-3.
19.Gupte Suraj.The short text book for pediatrics, 10th edition.Jaypee brothers
publishers.2004.
20. http:/theonologist.alphamedpics.org/cgi/ful/2151340172
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