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Which Of The Following Insulins Should Never Be Withheld

Parents On Trial For Refusing To Give Insulin To A Child With Type 1 Diabetes

Parents On Trial For Refusing To Give Insulin To A Child With Type 1 Diabetes

Parents on Trial for Refusing to Give Insulin to a Child with Type 1 Diabetes Alex Raditas death is why we have to fight myths about Type 1 diabetes. This week, Emil and Rodica Radita are on trial in Calgary for the first-degree murder of their 15-year-old child, Alexandru (Alex), who had Type 1 diabetes. Prosecutors allege that the Raditas withheld insulin and starved the child until he was 37 pounds, according to a CBC report . By the end of his life, Alex was wearing a diaper and his body was covered with sores. The Raditas were trying to cure his Type 1 diabetes through prayer, and had attempted to wean him off insulin. This wasnt the first time they had attempted this, as Alex was taken away from them in 2003 for the very same act of neglect and placed in a foster home, where he thrived. He was returned to his family a year later, and they then moved from the province of British Columbia to province of Alberta. Once in Alberta, they never saw a doctor; social workers, apparently, didnt pick up their trail. The Raditas arent the only ones to have killed their child through diabetes ignorance. In 2015, an Australian 7-year-old died after his parents opted for slapping therapy instead of insulin. And in 2013, a U.S. court upheld the conviction of a Wisconsin couple who tried to pray away their 11-year-old daughters undiagnosed Type 1 diabetes rather than seek medical help. Im sure that there are many more children who have died from untreated Type 1 diabetes in similar ways, only the cause of death was less obvious or the diabetes was undiagnosed. Like many, I want to condemn the Raditas and turn the page, but I cant, not fully. Thats because in some ways I was once like them. I didnt withhold insulin, but I did withhold vaccines until my child was five. My reasoning Continue reading >>

Basal Insulins Incorrectly Withheld

Basal Insulins Incorrectly Withheld

You may be surprised to learn that nurses sometimes inappropriately hold basal insulin doses (daily or every 12 hours) when a patient’s blood glucose is normal at the time a dose is due. This may be appropriate for mealtime or short-acting insulin products, but not basal insulins that can last for up to 24 hours, such as insulin glargine (LANTUS) or insulin detemir (LEVEMIR). These events occurred with medical patients, not patients undergoing surgical procedures for whom it may have been appropriate to withhold doses or partial doses if they were not eating post-operatively…. When a basal dose is withheld, the patient’s fasting blood glucose the following morning is likely to rise. In the hospital, staff found patients with blood glucose readings in the 200–300 mg/dL range. This error is more likely to be noticed if a pharmacy prepares basal insulin doses and investigates when the doses have not been administered. One hospital told us that they were seeing a few cases per week until they looked into the situation and made changes. The hospital’s education department chose this as a topic for a program. The hospital also has changed their Lantus labels, adding a reminder, "Don’t hold without MD order." Diabetes in Control would like to acknowledge the Institute for Safe Medication Practices’ outstanding work in medication safety, including the above excerpt. For more information on this issue as well as other important safety issues, please visit ISMP.org. Report Medication Errors to ISMP: Diabetes in Control is partnered with the Institute for Safe Medication Practices (ISMP) to help ensure errors and near-miss events get reported and shared with millions of health care practitioners. The ISMP is a Patient Safety Organization obligated by law to maintain Continue reading >>

Proper Use

Proper Use

Drug information provided by: Micromedex Make sure you have the type (beef and pork, pork, or human) and the strength of insulin that your doctor ordered for you. You may find that keeping an insulin label with you is helpful when buying insulin supplies. The concentration (strength) of insulin is measured in USP Insulin Units and USP Insulin Human Units and is usually expressed in terms such as U-100 insulin. Insulin doses are measured and injected with specially marked insulin syringes. The appropriate syringe is chosen based on your insulin dose to make measuring the dose easy to read. This helps you measure your dose accurately. These syringes come in three sizes: 3/10 cubic centimeters (cc) measuring up to 30 USP Units of insulin, ½ cc measuring up to 50 USP Units of insulin, and 1 cc measuring up to 100 USP Units of insulin. It is important to follow any instructions from your doctor about the careful selection and rotation of injection sites on your body. There are several important steps that will help you successfully prepare your insulin injection. To draw the insulin up into the syringe correctly, you need to follow these steps: Wash your hands with soap and water. If your insulin contains zinc or isophane (normally cloudy), be sure that it is completely mixed. Mix the insulin by slowly rolling the bottle between your hands or gently tipping the bottle over a few times. Never shake the bottle vigorously (hard). Do not use the insulin if it looks lumpy or grainy, seems unusually thick, sticks to the bottle, or seems to be even a little discolored. Do not use the insulin if it contains crystals or if the bottle looks frosted. Regular insulin (short-acting) should be used only if it is clear and colorless. Remove the colored protective cap on the bottle. Do not Continue reading >>

Type 1 Diabetes Mellitus Treatment & Management

Type 1 Diabetes Mellitus Treatment & Management

Approach Considerations Patients with type 1 diabetes mellitus (DM) require lifelong insulin therapy. Most require 2 or more injections of insulin daily, with doses adjusted on the basis of self-monitoring of blood glucose levels. Long-term management requires a multidisciplinary approach that includes physicians, nurses, dietitians, and selected specialists. In some patients, the onset of type 1 DM is marked by an episode of diabetic ketoacidosis (DKA) but is followed by a symptom-free “honeymoon period” in which the symptoms remit and the patient requires little or no insulin. This remission is caused by a partial return of endogenous insulin secretion, and it may last for several weeks or months (sometimes for as long as 1-2 years). Ultimately, however, the disease recurs, and patients require insulin therapy. Often, the patient with new-onset type 1 DM who presents with mild manifestations and who is judged to be compliant can begin insulin therapy as an outpatient. However, this approach requires close follow-up and the ability to provide immediate and thorough education about the use of insulin; the signs, symptoms, and treatment of hypoglycemia; and the need to self-monitor blood glucose levels. The American Diabetes Association (ADA) recommends using patient age as one consideration in the establishment of glycemic goals, with targets for preprandial, bedtime/overnight, and hemoglobin A1c (HbA1c) levels. [5] In 2014, the ADA released a position statement on the diagnosis and management of type 1 diabetes in all age groups. The statement includes a new pediatric glycemic control target of HbA1c of less than 7.5% across all pediatric age groups, replacing earlier guidelines that specified different glycemic control targets by age. The adult HbA1c target of les Continue reading >>

To Hold Or Not To Hold: Understanding Insulin

To Hold Or Not To Hold: Understanding Insulin

You’re about to walk into your patient’s room with a syringe full of insulin. The unit secretary shouts, “Hey. The physician just made your patient NPO.” Ugh...now what? Do you give the insulin? Do you hold it? Are you confident that you would know what to do every time? If you don’t, you’re not alone. However, by understanding the different CATEGORIES of insulin, I guarantee you will! There are 3 categories of insulin: Basal, Prandial (bolus), and Correction (sliding scale). Basal (Lantus, NPH, Levemir) This is the insulin your body needs just to meet its basal metabolic functions. Let’s say you decide not to eat for a day. If you’re NOT a diabetic, your cells still need glucose for energy, so your liver continuously kicks out a small amount of glucose (gluconeogenesis) – prompting your pancreas to secrete a small amount of insulin – to feed your body’s cells (energy). Remember? Insulin acts as the key to unlock the door of the cell to let the glucose in. If you ARE a diabetic and decide not to eat, your liver will still kick out glucose but since your pancreas doesn’t secrete insulin (Type I), all of your insulin needs, need to come exogenously (shot) – we need to give you a shot of basal insulin…even when you’re not eating – remember, the liver will still kick out glucose! 24 hours a day – 365 days a year – you have glucose in your bloodstream whether you’re eating it or your liver is kicking it out! Therefore, basal insulin should NEVER be held. Patients with Type I diabetes need basal insulin 24 hours a day. If they are NPO, the general rule of thumb is that they need ½ of their usual dose. For example, if they are on 50 units of Lantus a day, when they are NPO, they need approximately 25 units. Prandial (Novolog, Humalog) Its Continue reading >>

Management Of Diabetes Mellitus In Surgical Patients

Management Of Diabetes Mellitus In Surgical Patients

Abstract In Brief Diabetes is associated with increased requirement for surgical procedures and increased postoperative morbidity and mortality. The stress response to surgery and the resultant hyperglycemia, osmotic diuresis, and hypoinsulinemia can lead to perioperative ketoacidosis or hyperosmolar syndrome. Hyperglycemia impairs leukocyte function and wound healing. The management goal is to optimize metabolic control through close monitoring, adequate fluid and caloric repletion, and judicious use of insulin. Patients with diabetes undergo surgical procedures at a higher rate than do nondiabetic people.1,2 Major surgical operations require a period of fasting during which oral antidiabetic medications cannot be used. The stress of surgery itself results in metabolic perturbations that alter glucose homeostasis, and persistent hyperglycemia is a risk factor for endothelial dysfunction,3 postoperative sepsis,4 impaired wound healing,5,6 and cerebral ischemia.7 The stress response itself may precipitate diabetic crises (diabetic ketoacidosis [DKA], hyperglycemic hyperosmolar syndrome [HHS]) during surgery or postoperatively, with negative prognostic consequences.8,9 HHS is a well known postoperative complication following certain procedures, including cardiac bypass surgery, where it is associated with 42% mortality.9,10 Furthermore, gastrointestinal instability provoked by anesthesia, medications, and stress-related vagal overlay can lead to nausea, vomiting, and dehydration. This compounds the volume contraction that may already be present from the osmotic diuresis induced by hyperglycemia, thereby increasing the risk for ischemic events and acute renal failure. Subtle to gross deficits in key electrolytes (principally potassium, but also magnesium) may pose an arrhy Continue reading >>

An 18-year-old Patient With Type 1 Diabetes Undergoing Surgery

An 18-year-old Patient With Type 1 Diabetes Undergoing Surgery

Description of Case An 18-year-old Caucasian male with type 1 diabetes presented to the emergency department complaining of severe left knee pain and swelling after sustaining a knee injury that occurred during a high school football match. Joint effusions were visible and palpable above the left knee, and there was significant loss of smooth motion of the knee, passively performed. Plain X rays showed no signs of fractures. The patient had had type 1 diabetes for six years, and his insulin regimen consisted of insulin glargine, 35 units at 8:00 p.m., and insulin lispro, 23 units at 8:00 a.m. and 16 units at 8:00 p.m. The patient had no apparent complications related to type 1 diabetes. On examination he was alert, his pulse was 76 bpm regular, and his blood pressure was 118/66 mm Hg. Recently, the patient had had frequent episodes of both hyperglycemia and hypoglycemia. However, he had never developed diabetic ketoacidosis (DKA). His recent HbA1c was 9.5%, demonstrating inadequate glycemic control. The patient was referred to an orthopedic surgeon, and arthroscopy was scheduled a few days later. A complex tear of the medial meniscus extending to the articular surfaces was diagnosed. Partial meniscectomy was recommended. (This procedure usually takes about one hour—nonetheless, the preoperative preparation for general anesthesia and the postoperative recovery may add several hours to this time.) When Would You Have This Patient Report to the Hospital? The Day before Surgery or the Morning of Surgery? This patient should be hospitalized no later than the evening before surgery, given his history of frequent episodes of hypo- and hyperglycemia and his poor glycemic control. This should allow for final optimization of glucose control before surgery. Ideally, frequent con Continue reading >>

Basal Insulins Incorrectly Withheld; Issues With Insulin Pump; Future Devices For U-500 Insulin; Patients Needed Testing After Pen Misuse; Diastat Acudial Requires Setting And Locking Of The Dose

Basal Insulins Incorrectly Withheld; Issues With Insulin Pump; Future Devices For U-500 Insulin; Patients Needed Testing After Pen Misuse; Diastat Acudial Requires Setting And Locking Of The Dose

Basal Insulins Incorrectly Withheld; Issues With Insulin Pump; Future Devices for U-500 Insulin; Patients Needed Testing After Pen Misuse; Diastat Acudial Requires Setting and Locking of the Dose Michael R. Cohen , RPh, MS, ScD* and Judy L. Smetzer , RN, BSN *President, Institute for Safe Medication Practices, 200 Lakeside Drive, Suite 200, Horsham, PA 19044; phone: 215-947-7797; fax: 215-914-1492; e-mail: [email protected] ; Web site: www.ismp.org . *President, Institute for Safe Medication Practices, 200 Lakeside Drive, Suite 200, Horsham, PA 19044; phone: 215-947-7797; fax: 215-914-1492; e-mail: [email protected] ; Web site: www.ismp.org . Vice President, Institute for Safe Medication Practices, Horsham, Pennsylvania. Copyright 2014 Thomas Land Publishers, Inc. These medication errors have occurred in health care facilities at least once. They will happen againperhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at [email protected] . ISMP guarantees the confidentiality and security of the information received and respects reporters wishes as to the level of deta Continue reading >>

Chapter 51 Flashcards | Quizlet

Chapter 51 Flashcards | Quizlet

Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low fat intake and low levels of stimulation do not reduce a patient's need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise. A medical nurse is caring for a patient with type 1 diabetes. The patient's medication administration record includes the administration of regular insulin three times daily. Knowing that the patient's lunch tray will arrive at 11:45, when should the nurse administer the patient's insulin? Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level. A diabetes nurse educator is teaching a group of patients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic patient? A) Do not eliminate insulin when nauseated and vomiting. B) Report elevated glucose levels greater than 150 mg/dL. C) Eat three substantial meals a day, if possible. D) Reduce food intake and insulin doses in times of illness. The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, Continue reading >>

Diabetes In Children: Food Issues At School

Diabetes In Children: Food Issues At School

Diabetes in Children: Food Issues at School New challenges emerge when your child with diabetes begins school. Starting a good communication system with key people at the school can help make this transition a smooth one. It's helpful to schedule a conference with school personnel-principal, teachers, coaches, bus driver, school nurse, and lunchroom workers-after your child is first diagnosed. Do this again at the beginning of each school year. Your child needs to always have available the supplies for doing a blood sugar test . If possible, the school nurse will have these supplies available also. Snacks, school lunches, and party food are issues that need to be addressed before your child starts school. If your child takes insulin, his or her teacher needs to understand why snacks are so important. Explain how snacks prevent low blood sugar. Teachers should know that snacks should never be withheld or delayed. Provide details on when your child needs snacks-for example, during the day and either before, during, or after exercise. Your child can have regular school lunches. If there are many items to choose from, your child needs to understand the meal plan thoroughly to make the best choices. Ask to be informed in advance if meals will be delayed because of special school activities, such as parties or trips, so that your child's insulin or snack schedule can be adjusted accordingly to prevent a low blood sugar episode. When blood sugar should be checked and insulin given. Your child's usual symptoms of low and high blood sugar (hypoglycemia and hyperglycemia). Preferred treatment for hypoglycemia and hyperglycemia and when to notify parents. Emergency contact numbers, including parents and health professionals. The plan should specify how your child's needs are take Continue reading >>

Glycemic Control In Hospitalized Patients Not In Intensive Care: Beyond Sliding-scale Insulin

Glycemic Control In Hospitalized Patients Not In Intensive Care: Beyond Sliding-scale Insulin

Glycemic control in hospitalized patients who are not in intensive care remains unsatisfactory. Despite persistent expert recommendations urging its abandonment, the use of sliding-scale insulin remains pervasive in U.S. hospitals. Evidence for the effectiveness of sliding-scale insulin is lacking after more than 40 years of use. New physiologic subcutaneous insulin protocols use basal, nutritional, and correctional insulin. The initial total daily dose of subcutaneous insulin is calculated using a factor of 0.3 to 0.6 units per kg body weight, with one half given as long-acting insulin (the basal insulin dose), and the other one half divided daily over three meals as short-acting insulin doses (nutritional insulin doses). A correctional insulin dose provides a final insulin adjustment based on the preprandial glucose value. This correctional dose resembles a sliding scale, but is only a small fine-tuning of therapy, as opposed to traditional sliding-scale insulin alone. Insulin sensitivity, nutritional intake, and total daily dosing review can alter the physiologic insulin-dosing schedule. Prospective trials have demonstrated reductions in hyperglycemic measurements, hypoglycemia, and adjusted hospital length of stay when physiologic subcutaneous insulin protocols are used. Transitions in care require special considerations and attention to glycemic control medications. Changing the sliding-scale insulin culture requires a multidisciplinary effort to improve patient safety and outcomes. In the United States, the prevalence of diabetes mellitus is now 10.8 percent of adults 20 years and older, and 23.1 percent of adults 60 years and older.1 An estimated one in five U.S. health care dollars is spent caring for someone with diabetes.2 Over the past 10 years, the Agency fo Continue reading >>

Content Title Fetched

Content Title Fetched

Maintain an adequate fluid intake (sugar free) of 100-200mL (approximately 1 glass) every hour Maintain a regular intake of carbohydrate, regardless of blood glucose to facilitate insulin administration; insulin is required to correct ketosis. At mealtimes, if unable to eat, but tolerating fluids, take carbohydrate in the form of 200mL of the following: pure fruit juice, ribena, milk, milk with drinking chocolate or ovaltine, (flat) Coca Cola or Lemonade (sugary). If vomiting, consider an anti-emetic injection. Provide with 'Dioralyte' or 'Rehidrat'. Instruct to reconstitute as directed and to take an egg-cupful every 10 minutes. Hospital admission is indicated if unable to swallow or keep fluids down (view below). Ensure that glucose monitoring technique and equipment is accurate and available. Increase the frequency of blood glucose monitoring to at least 4 hourly. Arrange to review results with patient. See contact numbers for Diabetes Specialist Nurses Check ketones in patients who are acutely unwell, vomiting and / or during pregnancy, irrespective of BG level. An elevated ketone result identifies the risk of Diabetic Ketoacidosis (DKA.) Ketonuria/Ketonaemia is an early sign of decompensation and if acted upon promptly, can often prove possible to avert hospital admission (view below). Algorithm for Hyperglycaemia in adults. Ketones should be checked 2 - 4 hourly during acute illness. Ketostix (Bayer Diagnostics) reagent strips for urine testing Optium B-ketone test strips for blood ketone testing with OptiumNeo meter (Abbot). Glucomen Lx plus ketone sensors for blood ketone testing with Glucomen Lx meters (Menerini) All people with type 1 diabetes should be informed and educated in ketone monitoring Blood ketone meter and urine dipsticks measure different ketone Continue reading >>

Overview

Overview

Increasing data show a strong association between hyperglycemia and adverse inpatient outcomes. The American Diabetes Association and the American College of Clinical Endocrinology recommend all glucose levels be below 180-200 mg/dL in non-critically ill patients. Since hospitalizations are unstable situations, even patients who are well controlled on non-insulin agents as outpatients are usually best managed with insulin while they are inpatients. Insulin may be safely administered even to patients without previously diagnosed diabetes. As long as the prescribed doses are below what is normally produced by the pancreas, the patient will not become hypoglycemic. If the glucose level drops, endogenous insulin secretion will reduce to compensate. The total daily insulin requirement in insulin-sensitive patients (e.g., type 1 diabetes mellitus [T1DM]) is approximately 0.5-0.7/units/kg/day. Insulin requirements in patients with insulin-resistant type 2 diabetes may vary greatly and can exceed 1-2 units/kg/day. A conservative estimate for initial insulin therapy in any inpatient with hyperglycemia is to start with the T1DM dose (i.e., approximately 0.5-0.7 units/kg/day). · Effective inpatient insulin regimens typically include 3 components · Basal insulin (e.g., scheduled NPH, insulin glargine [Lantus], or insulin detemir [Levemir]), which is used to manage fasting and pre-meal hyperglycemia. Generally half of the total daily insulin dose. · Nutritional or prandial insulin (e.g., scheduled regular insulin, insulin lispro [Humalog], insulin aspart [Novolog], or insulin glulisine [Apidra]), which controls hyperglycemia from nutritional sources (e.g., discrete meals, tube feedings, total parenteral nutrition [TPN], IV dextrose). Generally half of the total daily insuli Continue reading >>

Managing Glucose Levels In Hospital Patients

Managing Glucose Levels In Hospital Patients

Managing glucose levels in hospital patients Author: Stacey A. Seggelke, MS, RN, ACNS-BC, BC-ADM, CDE, Over the last 25 years, more than twice as many patients have been discharged from U.S. hospitals with a diagnosis of diabetes mellitus (DM). In 2006, the number reached an estimated 5.2 million. The increase stems from many factors, including the overall rise in obesity, which parallels the increase in type 2 diabetes. Typically, about 25% of hospital patients have a diagnosis of DM or hyperglycemia during their hospital stay. Historically, managing hyperglycemia in the hospital has been seen as secondary to managing the admitting diagnosis. But a growing body of literature supports targeted glucose control, because hyperglycemia in hospital patients can prolong lengths of stay, increase the infection risk, and raise mortality. This article, which addresses glucose management in hospital patients who arent critically ill, is based largely on guidelines from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). Generally, hyperglycemia in hospital patients is classified as known DM, newly diagnosed DM, or stress hyperglycemia. Known DM applies to patients with preexisting type 1, type 2, or gestational diabetes. Newly diagnosed DM refers to patients newly diagnosed during their hospital stay who meet ADA diagnostic criteria. A hemoglobin A1c (HbA1c) level of 6.5% or higher indicates DM and reflects an average blood glucose (BG) level of 140 mg/dL. The HbA1c test indicates the average BG level over the preceding 2 to 3 months; an elevated HbA1c level indicates the patients BG level was high before admission. Hospital patients with HbA1c levels of 6.5% or higher usually are classified as newly diagnosed, even though th Continue reading >>

Not So Fast With The Insulin?

Not So Fast With The Insulin?

I was drawn to this article, because I am pretty sure getting Insulin exogenously is a bad idea for Type 2 types. it sounds logical at first, but I think the author is onto something. I have been injecting insulin for about 13 years. And the result has been, my control of blood sugars is getting further and further out of control, not getting into control. Before I started injecting, before I was diagnosed, really, I had all the symptoms, but I didn't know that they were diabetic symptoms. And somewhat crazy, I through everything away in my house that was not natural, or had ingredients in it that were not natural. Then, I concocted this diet consisting basically of fruits, nuts, berries and vegetables. I got rid of all dairy, and most meats; I did eat chicken breasts and salmon. I eliminated all sugar. Even juice. And I went to the health club daily, and spent 20 minutes in the sauna, 20 minutes on a treadmill walking slowly, and swam 20 minutes gently. Nothing vigorous. Within 4 months, I had lost 60 pounds, looked and felt great, had the energy of a 10 year old, and the sex life of a 16 year old. I am a guy, and at that time I was 41. Then, for various reasons, I gained back the weight, and by age 44 I was officially diagnosed with Type 2 and given insulin immediately because my sugars were so high when I checked into the ER because, I felt like I was dying (no energy). Went through all the learning curve about the disease, tried meds, which did nothing, and pretty much felt depressed with the new diagnosis. I had remembered, after learning what the symptoms were, that I had all these symptoms before, and seemed to cure them all with diet and exercise. It was tough though, because no knowing exactly what helped or didn't help, I tended to vacillate for the next sever Continue reading >>

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