Academic literature on the topic 'Comprehensive stroke centre (CSC)'
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Journal articles on the topic "Comprehensive stroke centre (CSC)"
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Kurogi, Ai, Ataru Nishimura, Kunihiro Nishimura, et al. "Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018." BMJ Open 10, no. 8 (2020): e033055. http://dx.doi.org/10.1136/bmjopen-2019-033055.
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ObjectivesComprehensive stroke centre (CSC) capabilities are associated with reduced in-hospital mortality due to acute stroke. However, it remains unclear whether there are improving trends in the CSC capabilities or how hospital-related factors determine quality improvement. This study examined whether CSC capabilities changed in Japan between 2010 and 2018 and and whether any changes were influenced by hospital characteristics.DesignA hospital-based cross-sectional study.SettingWe sent out questionnaires to the training institutions of the Japan Neurosurgical Society and Japan Stroke Society in 2010, 2014 and 2018.Participants749 hospitals in 2010, 532 hospitals in 2014 and 786 hospitals in 2018 participated in the J-ASPECT study, a nationwide survey of acute stroke care capacity for proper designation of a comprehensive stroke centre in Japan.Main outcome measuresCSC capabilities were assessed using the validated scoring system (CSC score: 1–25 points) in 2010, 2014 and 2018 survey. The effect of hospital characteristics was examined using multiple logistic regression analysis.ResultsAmong the 323 hospitals that responded to all surveys, the implementation of 13 recommended items increased. The CSC score (median and IQR) was 16 (13–19), 18 (14–20) and 19 (15–21) for 2010, 2014 and 2018, respectively (p<0.001). There was a ≥20% increase in six items (eg, endovascular physicians, stroke unit and interventional coverage 24/7), and a ≤20% decrease in community education. A lower baseline CSC score (OR: 0.82, 95% CI 0.75 to 0.9), the number of beds≥500 (OR: 3.9, 95% CI 1.2 to 13.0) and the number of stroke physicians (7–9) (OR: 2.6, 95% CI 1.1 to 6.3) were associated with improved CSC capabilities, independent of geographical location.ConclusionsThere was a significant improvement in CSC capabilities between 2010 and 2018, which was mainly related to the availability of endovascular treatment and multidisciplinary care. Our findings may be useful to determine which hospitals should be targeted to improve CSC capabilities in a defined area.
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Li, E., M. Khinda, AY Yu, and MV Vyas. "P.025 Accuracy of code stroke activations: a tale of two comprehensive stroke centres." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 51, s1 (2024): S21. http://dx.doi.org/10.1017/cjn.2024.132.
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Background: We evaluated the accuracy of code strokes activations at two comprehensive stroke centres in Toronto, Canada. Methods: We conducted a multi-centre, retrospective cohort study of all adult patients seen as code stroke in emergency rooms (ER) of two comprehensive stroke centres (CSC) in Toronto, Canada between January 1, 2022 and Dec 31, 2022. We included cases where the code stroke was activated in the field by paramedics and where it was activated in the ER by a physician. We reported off-criteria code stroke activations as the proportion of code stroke activations that did not meet all criteria for activation, and described the criteria that were not met. Results: A total of 677 (61.9% paramedic) code strokes were seen at CSC1 and 439 (80.6% paramedic) at CSC2. At CSC1, 21.2% paramedic-activated and 38.6% ER-activated were off-criteria, and at CSC2, 14.2% paramedic-activated and 48.1% ER-activated code stroke were off-criteria. Most of these were due to incorrect assessment of the last seen normal time. Conclusions: One in five code strokes did not meet criteria for activation. Improving the accuracy of paramedic and ER assessment of last seen normal time may be an avenue to reduce off-criteria code stroke activations.
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Livesay, Sarah. "Comprehensive Stroke Center Certification Series: Setting the Vision." Interventional Neurology 8, no. 2-6 (2019): 215–19. http://dx.doi.org/10.1159/000489045.
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The road to Comprehensive Stroke Center (CSC) certification is challenging and requires full integration of neurological, neurosurgical, neurointerventional, and neurocritical care and rehabilitation services across the entire continuum of care. To successfully achieve this level of certification, centers must coordinate significant resources and services into an organized program. This paper is the first in a three-part series outlining common pitfalls facing many organizations during their journey to initial CSC certification and re-certification and offers a roadmap and pearls for success on this journey. Setting the vision for certification is a key first step in the certification process. This includes fully understanding the certification standards, requirements, and supporting documents. Program leadership must then conduct a thorough gap analysis and build a business plan to support the program as it transitions to a CSC. These key steps should inform the timeline for certification application.
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Requena, Manuel, Marta Olivé-Gadea, Sandra Boned, et al. "Clinical and neuroimaging criteria to improve the workflow in transfers for endovascular treatment evaluation." International Journal of Stroke 15, no. 9 (2019): 988–94. http://dx.doi.org/10.1177/1747493019874725.
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Background Transfer protocols from primary to comprehensive stroke centers are crucial for endovascular treatment success. Aim To evaluate clinical and neuroimaging data of transferred patients and their likelihood of presenting a large infarct core at comprehensive stroke center arrival. Methods Retrospective analysis of population-based mandatory prospective registry of acute stroke patients evaluated for endovascular treatment. Consecutive patients evaluated at primary stroke center with suspected large vessel occlusion and PSC-ASPECTS ≥ 6 transferred to a comprehensive stroke center were included. PSC and CSC-ASPECTS, time-metrics, and clinical data were analyzed. Results During 28 months, 1185 endovascular treatment candidates were transferred from PC to comprehensive stroke center in our public stroke network, 477 had an anterior circulation syndrome and available neuroimaging information and were included. Median baseline NIHSS was 13 (8–19). On arrival to comprehensive stroke center, large vessel occlusion was confirmed in 60.2% patients, and 41.2% received endovascular treatment. Median interfacility ASPECTS decay was 1 (0–2) after a median of 150.7 (SD 101) min between both CT-acquisitions. A logistic regression analysis adjusted by age, time from symptoms to PC-CT, and time from PC-CT to CSC-CT showed that only a baseline NIHSS and PSC-ASPECTS independently predicted a CSC-ASPECTS < 6. ROC curves identified baseline NIHSS ≥ 16 and PSC-ASPECTS ≤ 7 as the best cut-off points. The rate of CSC-ASPECTS < 6 increased from 7% to 57% among patients with NIHSS ≥ 16 and PSC-ASPECS ≤ 7. Conclusion After a median transfer time >2 h, only 11.9% showed ASPECTS < 6 at the comprehensive stroke center. Activation of endovascular treatment teams should not require confirming neuroimaging on arrival and repeating neuroimaging at comprehensive stroke center should only be performed in selected cases.
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Allen, Michael, Kerry Pearn, Martin James, et al. "Maximising access to thrombectomy services for stroke in England: A modelling study." European Stroke Journal 4, no. 1 (2018): 39–49. http://dx.doi.org/10.1177/2396987318785421.
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Purpose Both intravenous thrombolysis (IVT) and intra-arterial endovascular thrombectomy (ET) improve the outcome of patients with acute ischaemic stroke, with endovascular thrombectomy being an option for those patients with large vessel occlusions. We sought to understand how organisation of services affects time to treatment for both intravenous thrombolysis and endovascular thrombectomy. Method A multi-objective optimisation approach was used to explore the relationship between the number of intravenous thrombolysis and endovascular thrombectomy centres and times to treatment. The analysis is based on 238,887 emergency stroke admissions in England over 3 years (2013–2015). Results Providing hyper-acute care only in comprehensive stroke centres (CSC, providing both intravenous thrombolysis and endovascular thrombectomy, and performing >150 endovascular thrombectomy per year, maximum 40 centres) in England would lead to 15% of patients being more than 45 min away from care, and would create centres with up to 4300 stroke admissions/year. Mixing hyper-acute stroke units (providing intravenous thrombolysis only) with comprehensive stroke centres speeds time to intravenous thrombolysis and mitigates admission numbers to comprehensive stroke centres, but at the expense of increasing time to endovascular thrombectomy. With 24 comprehensive stroke centres and all remaining current acute stroke units as hyper-acute stroke units, redirecting patients directly to attend a comprehensive stroke centre by accepting a small delay (15-min maximum) in intravenous thrombolysis reduces time to endovascular thrombectomy: 25% of all patients would be redirected from hyper-acute stroke units to a comprehensive stroke centre, with an average delay in intravenous thrombolysis of 8 min, and an average improvement in time to endovascular thrombectomy of 80 min. The balance of comprehensive stroke centre:hyper-acute stroke unit admissions would change from 24:76 to 49:51. Conclusion Planning of hyper-acute stroke services is best achieved when considering all forms of acute care and ambulance protocol together. Times to treatment need to be considered alongside manageable and sustainable admission numbers.
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Holder, Derek, Kevin Leeseberg, James A. Giles, Jin-Moo Lee, Sheyda Namazie, and Andria L. Ford. "Central Triage of Acute Stroke Patients Across a Distributive Stroke Network Is Safe and Reduces Transfer Denials." Stroke 52, no. 8 (2021): 2671–75. http://dx.doi.org/10.1161/strokeaha.120.033018.
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Background and Purpose: Mechanical thrombectomy has dramatically increased patient volumes transferred to comprehensive stroke centers (CSCs), resulting in transfer denials for patients who need higher level of care only available at a CSC. We hypothesized that a distributive stroke network (DSN), triaging low severity acute stroke patients to a primary stroke center (PSC) upon initial telestroke consultation, would safely reduce transfer denials, thereby providing additional volume to treat severe strokes at a CSC. Methods: In 2017, a DSN was implemented, in which mild stroke patients were centrally triaged, via telestroke consultation, to a PSC based upon a simple clinical severity algorithm, while higher acuity/severity strokes were triaged to the CSC. In an observational cohort study, data on acute ischemic stroke patients presenting to regional community hospitals were collected pre- versus post-DSN implementation. Safety outcomes and rate of CSC transfer denials were compared pre-DSN versus post-DSN. Results: The pre-DSN cohort (n=150), triaged to the CSC, had a similar rate of symptomatic intracerebral hemorrhage and discharge location compared with the post-DSN cohort (n=150), triaged to the PSC. Time to stroke unit admission was faster post-DSN (2 hours 40 minutes) versus pre-DSN (3 hours 29 minutes; P <0.001). Transfer denials were reduced post-DSN (3.8%) versus pre-DSN (1.8%; P =0.02), despite an increase in telestroke consultation volume over the same period (median, 3 calls per day pre-DSN versus 5 calls per day post-DSN; P =0.001). No patients who were triaged to the PSC required subsequent transfer to the CSC. Conclusions: A DSN, triaging mild ischemic stroke patients from community hospitals to a PSC, safely reduced transfer denials to the CSC, allowing greater capacity at the CSC to treat higher acuity stroke patients.
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Leibinger, Franck, Denis Sablot, Laurène Van Damme, et al. "Which Patients Require Physician-Led Inter-Hospital Transport in View of Endovascular Therapy?" Cerebrovascular Diseases 48, no. 3-6 (2019): 171–78. http://dx.doi.org/10.1159/000504314.
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Introduction: The current guidelines advocate the implementation of stroke networks to organize endovascular treatment (ET) for patients with acute ischemic stroke due to large vessel occlusion (LVO) after transfer from a Primary Stroke Centre (PSC) to a Comprehensive Stroke Centre (CSC). In France and in many other countries around the world, these transfers are carried out by a physician-led mobile medical team. However, with the recent broadening of ET indications, their availability is becoming more and more critical. Here, we retrospectively analysed data of patients transferred from a PSC to a CSC for potential ET to identify predictive factors of major complications (MC) at departure and during transport that absolutely require the presence of a physician during interhospital transfer. Methods: This observational, single-centre study included patients with evidence of intracranial LVO transferred for ET from Perpignan to a 156 km-distant CSC between January 1, 2015 and December 31, 2018. We compared 2 groups: MC group (patients who required emergency intervention by the medical team due to life-threatening complications, including need of mechanical ventilation at departure) and non-MC group (all other patients who experienced no or only minor complications that could be managed by the emergency paramedics alone). Results: Among the 253 patients who were transferred to the CSC, 185 (73.1%) had no complication, 57 (22.6%) minor complications, and 11 (4.3%) had MC. In multivariate analysis, MC was associated with basilar artery (BA) occlusion (p < 0.0001), initial National Institute of Health Stroke Scale (NIHSS) score >22 (p < 0.005), and history of atrial fibrillation (p < 0.04). Among the 168 patients treated with intravenous thrombolysis (IVT), only 1 patient (0.6%) had MC due to an IVT-related adverse event during transfer. Conclusions: Physician-led inter-hospital transports are warranted for patients with BA occlusion, initial NIHSS score >22, or history of atrial fibrillation. For the other patients, transfer without a physician may be considered, even if treated with IVT.
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Maas, Willemijn J., Maarten M. H. Lahr, Maarten Uyttenboogaart, Erik Buskens, and Durk-Jouke van der Zee. "Expediting workflow in the acute stroke pathway for endovascular thrombectomy in the northern Netherlands: a simulation model." BMJ Open 12, no. 4 (2022): e056415. http://dx.doi.org/10.1136/bmjopen-2021-056415.
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ObjectiveThe objective of this study is to identify barriers for the timely delivery of endovascular thrombectomy (EVT) and to investigate the effects of potential workflow improvements in the acute stroke pathway.DesignHospital data prospectively collected in the MR CLEAN Registry were linked to emergency medical services data for each EVT patient and used to build two Monte Carlo simulation models. The ‘mothership (MS) model’, reflecting patients who arrived directly at the comprehensive stroke centre (CSC); and the ‘drip and ship’ (DS) model, reflecting patients who were transferred to the CSC from primary stroke centres (PSCs).SettingNorthern region of the Netherlands. One CSC provides EVT, and its catchment area includes eight PSCs.Participants248 patients who were treated with EVT between July 2014 and November 2017.Outcome measuresThe main outcome measures were total delay from stroke onset until groin puncture, functional independence at 90 days (modified Rankin Scale 0–2) and mortality.ResultsBarriers identified included fast-track emergency department routing, prealert for transfer to the CSC, reduced handover time between PSC and ambulance, direct transfer from CSC arrival to angiography suite entry, and reducing time to groin puncture. Taken together, all workflow improvements could potentially reduce the time from onset to groin puncture by 59 min for the MS model and 61 min for the DS model. These improvements could thus result in more patients—3.7% MS and 7.4% DS—regaining functional independence after 90 days, in addition to decreasing mortality by 3.0% and 5.0%, respectively.ConclusionsIn our region, the proposed workflow improvements might reduce time to treatment by about 1 hour and increase the number of patients regaining functional independence by 6%. Simulation modelling is useful for assessing the potential effects of interventions aimed at reducing time from onset to EVT.
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Kaminsky, Anne-Laure, Gioia Mione, Yacoubou Omorou, et al. "Outcome of patients with large vessel occlusion stroke after first admission in telestroke spoke versus comprehensive stroke center." Journal of NeuroInterventional Surgery 12, no. 8 (2019): 753–57. http://dx.doi.org/10.1136/neurintsurg-2019-015342.
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IntroductionWhile telestroke allows early intravenous thrombolysis (IVT) for ischemic strokes in spoke centers, mechanical thrombectomy (MT) for large vessel occlusion (LVO) is mainly performed at comprehensive stroke centers (CSCs). We aimed to compare 3 month outcome in patients with LVO after admission to a spoke center using telestroke compared with first CSC admission in our large regional stroke network, irrespective of final treatment decision.MethodsAll consecutive LVO patients who were admitted to one of six spoke centers or to the regional CSC within 6 hours of symptom onset were prospectively included from September 1, 2015 to August 31, 2017. All patients admitted to spoke centers were assessed on site with cerebral and vessel imaging. Primary outcome was 3 month favorable outcome (modified Rankin Scale score of 0–2).ResultsDistances between spoke centers and CSC ranged from 36 to 77 miles. Among 207 included patients, 132 (63.8%) were first admitted to CSCs and 75 (36.2%) to spoke centers. IVT was administered more in spoke centers (81.3% vs 53.8%, p<0.0001) while MT was performed less (26.7% vs 49.2%, p=0.001) and with a longer time from onset (303 vs 200 min, p<0.0001). No difference was found in 3 month favorable outcome between spoke centers compared with CSCs (32.0% and 35.1%, respectively; OR=0.68; 95% CI 0.42 to 1.10; p=0.12).ConclusionsDespite different distribution of reperfusion therapies for LVO patients managed by telemedicine, we could not demonstrate a difference in functional outcome according to admission location in a large area with long distances between centers.
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Schlemm, Ludwig, Matthias Endres, and Christian H. Nolte. "Bypassing the Closest Stroke Center for Thrombectomy Candidates." Stroke 51, no. 3 (2020): 867–75. http://dx.doi.org/10.1161/strokeaha.119.027512.
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Background and Purpose— Patients with acute ischemic stroke who have large vessel occlusion benefit from direct transport to a comprehensive stroke center (CSC) capable of endovascular therapy. To avoid harm for patients without large vessel occlusion from delayed access to intravenous thrombolysis (IVT), it has been suggested to only redirect patients with high likelihood of large vessel occlusion for whom the additional delay to intravenous thrombolysis (IVT) caused by transport to the CSC is below a certain threshold. However, which threshold achieves the greatest clinical benefit is unknown. Methods— We used mathematical modeling to calculate additional-delay-to-IVT thresholds associated with the greatest reduction in disability-adjusted life years in abstracted 2-stroke center and multiple-stroke center scenarios. Model parameters were extracted from recent meta-analyses or large prospective cohort studies. Uncertainty was quantified in probabilistic and 2-way univariate sensitivity analyses. Results— Assuming ideal treatment time performance metrics, transport to the nearest CSC was the preferred strategy irrespective of additional delay-to-IVT when the transfer time between primary stroke center and CSC was <40 minutes (95% credible interval: 25–66 minutes); otherwise, the optimal additional delay-to-IVT-threshold ranged from 28 to 139 minutes. In multiple-stroke center scenarios, optimal additional-delay-to-IVT thresholds were 30 to 54 minutes in urban and 49 to 141 minutes in rural settings; use of optimal thresholds as compared with a 15 minute-threshold saved 0 to 0.11 and 0 to 0.37 disability-adjusted life years per triage case, respectively. Assuming slower treatment times at primary stroke centers and CSCs yielded longer permissible additional delays. Conclusions— Our results suggest that patients with acute ischemic stroke with suspected large vessel occlusion should be redirected to a CSC if the additional delay to IVT is <30 minutes in urban and 50 minutes in rural settings.
Dissertations / Theses on the topic "Comprehensive stroke centre (CSC)"
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Mota, Clara Pedro Correia Gomes da. "Ten years of Stroke Code: a retrospective review of diagnostic performance at a comprehensive stroke centre." Master's thesis, 2018. https://hdl.handle.net/10216/112054.
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Mota, Clara Pedro Correia Gomes da. "Ten years of Stroke Code: a retrospective review of diagnostic performance at a comprehensive stroke centre." Dissertação, 2018. https://repositorio-aberto.up.pt/handle/10216/112054.
Full textBook chapters on the topic "Comprehensive stroke centre (CSC)"
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Burton, Christopher R., and Caroline Smith. "Understanding Stroke." In Adult Nursing Practice. Oxford University Press, 2012. http://dx.doi.org/10.1093/oso/9780199697410.003.0023.
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The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with stroke in an evidence-based and person-centred way. The chapter will provide a comprehensive overview of the seven stages of stroke, exploring best practice to deliver care, as well as to prevent or minimize further ill-health. Nursing assessments and priorities are highlighted throughout, and the nursing management of the symptoms and common health problems associated with stroke can be found in Chapters 23, 24, and 27, respectively. Stroke is defined as the rapid onset of focal neurological deficit lasting more than 24 hours (in which the patient survives the initial event), with no apparent cause other than disruption of blood supply to the brain (World Health Organization, 1978). As well as being the third commonest cause of death only in middle- and high-income countries (WHO, 1978) (along with cancer and heart disease), stroke is the largest cause of adult physical disability in the world (Bath and Lees, 2000). However, owing to advances in research and evidence synthesis, stroke is now a preventable and treatable disease (National Collaborating Centre for Chronic Conditions (NCCC), 2008). Despite its relative small weight (approximately 2% of body weight), the brain requires 750 ml of bloodflow every minute, and consumes nearly 45% of arterial oxygen (Alexandrov, 2003). Bloodflow to the brain is assured through two circulatory systems (anterior and posterior), which are connected by the circle of Willis, and supplied by the internal carotid and vertebral arteries. Disruption of this bloodflow can be either in the form of a bleed (haemorrhagic stroke) or clot (ischaemic stroke), and the clinical presentation will vary depending on the location of the disruption in the brain. Ischaemic strokes are more common and account for almost 70% of all events (Wolfe et al., 2002). Whilst thorough clinical examination is essential, the only clear tool to identify the type of stroke is to perform a brain scan using either magnetic resonance imaging (MRI) or computed tomography (CT) technology. It is important to note that, often, when a CT brain scan is performed within the first few hours of an event, the scan may not show any significant tissue damage because the changes that occur may take several days to be clearly visible.
Conference papers on the topic "Comprehensive stroke centre (CSC)"
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Yim, Holly, Kyra Steiner, Brian Dewar, Derek Roberts, Dariush Dowlatshahi, and Michel Shamy. "Indications and Outcomes of Carotid Artery Stenting among Consecutive Patients over Age 70 at The Ottawa Hospital, a Comprehensive Stroke Centre in Ontario, Canada (P8-5.020)." In 2023 Annual Meeting Abstracts. Lippincott Williams & Wilkins, 2023. http://dx.doi.org/10.1212/wnl.0000000000203312.
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Newton, B., A. Persad, E. Liu, et al. "E-290 A comparison of thrombolysis with either tpa or tnk in large vessel occlusion patients undergoing transport to a comprehensive stroke centre for mechanical thrombectomy." In SNIS 21st Annual Meeting Abstracts. BMJ Publishing Group Ltd., 2024. http://dx.doi.org/10.1136/jnis-2024-snis.395.
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