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  • 1. Bertilsson, Emelie
    et al.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Usage of Do-not-attempt-to resuscitate-orders in a Swedish community hospital – Patient involvement, documentation and compliance2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e93-e94Article in journal (Refereed)
  • 2.
    Branje, Johanna
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Josefsson, Marielle
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    När hjärtat stannar: En kvalitativ intervjustudie om sjuksköterskors upplevelser av att vårda vid ett hjärtstopp på vårdavdelningar.2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: When a patient has a cardiac arrest, it is included in the RN's duties to start CPR in order to try to save the patient's life. In the general nursing ward, more advanced treatment, so-called hospital CPR, is used. A cardiac arrest can be daunting for the nurse because they probably need to shift from a calm situation to an emergency situation. It may feel stressful, but knowledge and experience helps the RN to act. The treatment of cardiac arrest is performed in teams with several professions which means that it is important to have a good teamwork.

    Aim: The aim of the study was to investigate the RN’s experiences of caring for a cardiac arrest occurring at nursing wards.

    Method: As a method, a qualitative interview study was chosen, based on seven semi- structured interviews. The interviews were transcribed and then analyzed with a qualitative content analysis that suited the aim of the study.

    Result: The result showed that there were four categories that contributed to the experience of cardiac arrest; "Knowledge of cardiac arrest", emphasizing the importance of education, routines and experience. "When cardiac arrest is in progress" that includes the first response, CPR situation, and termination of CPR. "Working in team" consisting of cooperation, safety and instruments for teamwork. Finally, "Processing after cardiac arrest" that involved debriefing, follow-up and perception of cardiac arrest. All of these areas together formed an idea of ​​cardiac arrest.

    Conclusion: Cardiac arrest is an urgent situation that the nurse remembers for a long time, and it is therefore important that the wards work with all categories identified in the results to support and facilitate the nurses engaged in a cardiac arrest in a nursing ward.

  • 3.
    Bremer, Anders
    University of Borås.
    Etiska aspekter vid HLR2012In: Hjärtstoppsymposium 2012, Stockholm, Sverige 24 April, 2012Conference paper (Other academic)
  • 4.
    Bremer, Anders
    University of Borås.
    Etiska värderingar inom spansk och svensk ambulanssjukvård2015In: Forskningssymposium om prehospital akutsjukvård: Torsdag 5 mars 2015, Högskolan i Borås, 2015Conference paper (Other academic)
  • 5.
    Bremer, Anders
    et al.
    University of Borås.
    Sandboge, Samuel
    Rosengren, Ewa
    Etiska ”knäckfrågor” inom HLR2016In: HLR2016 : Ett hjärtsäkert Sverige: Göteborg 11-12 oktober, 2016Conference paper (Other academic)
  • 6.
    Bremer, Anders
    et al.
    University of Borås.
    Sandman, Lars
    University of Borås.
    Etiska aspekter på HLR2011In: HLR 2011, HLR rådet , 2011Conference paper (Refereed)
    Abstract [en]

    Hälso- och sjukvårdens övergripande mål kan uttryckas som främjande av optimal livslängd med god livskvalitet och ett gott liv. Målet kan betraktas som etiskt. Vid en patients hjärtstopp är målet med den medicinska behandlingen (hjärtlungräddning, HLR) att personen överlever med åtminstone acceptabel livskvalitet. I det akuta, prehospitala skedet är det dock svårt att bedöma utfallet avseende framtida livskvalitet förutom i vissa få och relativt välbestämda fall. Det är dessutom svårt att få vetskap om patientens eventuella önskemål om sin vård. Som regel påbörjas därför HLR. Etiska riktlinjer kan ge viss vägledning i beslut om att avbryta HLR när det finns skäl att tro att målet inte kan uppnås. Ramarna för sådana riktlinjer bygger på respekt för patientens autonomi och integritet, rättvisa samt rimlighet i vårdarens yrkesroll. Detta innebära exempelvis respekt för patientens eventuella önskemål avseende HLR, undvikande av att patienten exponeras samt ansvar för att resurserna används så rättvist som möjligt. Det sistnämnda kan ibland innebära att ambulanspersonal avviker från en HLR-plats efter att HLR avbrutits för något som är viktigare än vården av närstående. Vård av närstående bör dock betraktas som en rimlig uppgift i ambulanspersonalens yrkesroll där ansvaret handlar om att tillvarata närståendes kunskap och erfarenhet, visa dem omtanke och respekt samt ge stöd, vägledning och information. Närståendes delaktighet ska främjas och kommunikationen med dem ske respektfullt, lyhört och empatiskt. Närståendes initiala roll vid en patients hjärtstopp är viktig genom att de kan bidra med värdefull informa-tion om patienten och även återge patientens vilja i förekommande fall. I händelse av att patienten avlider är målet att lindra närståendes lidande. Forskning visar dock att ambulanspersonalens uppfattningar om närståendevården och närståendes närvaro under HLR varierar från att anses som viktig för närståendes sorgeprocess och återhämtning, till att inte ingå i vårdarrollen, negativt påverka HLR-beslut och innebära emotionell belastning för vårdarna. Närståendes närvaro vid HLR tycks för en del ambulanspersonal innebära svårigheter att ge närstående emotionellt stöd och ibland leda till att HLR fortsätter längre än vad som är medici-niskt motiverat, antingen som ett sätt att lindra närståendes lidande eller för att vårdarna inte förmår att skifta från patientvård till vårdande av närstående. Att utföra HLR för någon annan skull än för patienten och längre än medicinskt motiverat är emellertid etiskt tveksamt och flyttar dessutom fokus från närståendes behov. Närståendes känslor av överväldigande ansvar och ofrivillig ensamhet belyser istället vikten av att uppmärksamhet på närståendes verkliga behov, främjande av kontrollkänsla och försök till skuldavlastning. Ambulanspersonalens uppriktighet, medmänsklighet och närvaro framstår som centrala aspekter i en etiskt god vård av närstående i samband med en patients hjärtstopp och plötsliga död.

  • 7.
    Brüggemann, A. Jelmer
    et al.
    Linköpings universitet.
    Swahnberg, Katarina
    Linköpings universitet.
    Patients’ silence towards the healthcare system after ethical transgressions by staff: associations with patient characteristics in a cross-sectional study among Swedish female patients2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 6Article in journal (Refereed)
    Abstract [en]

    Objectives: To identify which patient characteristics are associated with silence towards the healthcare system after experiences of abusive or ethically wrongful transgressive behaviour by healthcare staff.

    Design: Cross-sectional questionnaire study using the Transgressions of Ethical Principles in Health Care Questionnaire.

    Setting: A women's clinic in the south of Sweden.

    Participants: Selection criteria were: consecutive female patients coming for an outpatient appointment, ≥18-year-old, with the ability to speak and understand the Swedish language, and a known address.

    Questionnaires were answered by 534 women (60%) who had visited the clinic, of which 293 were included in the present study sample.

    Primary outcome measure: How many times the respondent remained silent towards the healthcare system relative to the number of times the respondent spoke up.

    Results: Associations were found between patients’ silence towards the healthcare system and young age as well as lower self-rated knowledge of patient rights. Both variables showed independent effects on patients’ silence in a multivariate model. No associations were found with social status, country of birth, health or other abuse.

    Conclusions: The results offer opportunities for designing interventions to stimulate patients to speak up and open up the clinical climate, for which the responsibility lies in the hands of staff; but more research is needed.

  • 8.
    Brüggemann, Jelmer
    et al.
    Linköpings universitet.
    Wijma, Barbro
    Linköpings universitet.
    Swahnberg, Katarina
    Linköpings universitet.
    Patients’ silence following healthcare staff’s ethical transgressions2012In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 19, no 6, p. 750-763Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine to what extent patients remained silent to the health care system after they experienced abusive or wrongful incidents in health care. Female patients visiting a women’s clinic in Sweden (n = 530) answered the Transgressions of Ethical Principles in Health Care Questionnaire (TEP), which was constructed to measure patients’ abusive experiences in the form of staff’s transgressions of ethical principles in health care. Of all the patients, 63.6% had, at some point, experienced staff’s transgressions of ethical principles, and many perceived these events as abusive and wrongful. Of these patients, 70.3% had remained silent to the health care system about at least one transgression. This silence is a loss of essential feedback for the health care system and should not automatically be interpreted as though patients are satisfied.

  • 9.
    Eklöf, Motzi
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Då tystnadsplikt ersätts av informationsdelning2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 43, p. 1912-1914Article in journal (Refereed)
    Abstract [en]

    The right to personal integrity and privacy is enshrined in overarching laws and regulations. Ethical codes for physicians emphasize the importance of discretion and professional confidentiality. The use of shared electronic medical records is developing into a system of direct access to extensive amounts of personal information without informed consent from patients. Confidentiality-breaching provisions in the Swedish law allow, and require, an increasing number of obligations regarding registration and disclosure. IT systems are never completely secure. The consequences of electronic medical records, in combination with legislation on a collision course with venerable ethical requirements, needs to be discussed in a broader societal context.

  • 10.
    Eklöf, Motzi
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Journalföring à 23 öre metern och etik i vården2014Other (Other (popular science, discussion, etc.))
  • 11.
    Furingsten, Lovisa
    et al.
    Dalarna University.
    Sjögren, Reet
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Mälardalen University.
    Forsner, Maria
    Dalarna University.
    Ethical challenges when caring for dying children2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 2, p. 176-187Article in journal (Refereed)
    Abstract [en]

    Background: Caring for dying children presents special challenges, according to the children themselves, their relatives and healthcare professionals. Objective: The aim of this study was to describe caring as represented in healthcare workers' experiences of caring for dying children. Method: A phenomenological approach was chosen, in-depth interviews were carried out and data were analysed in four steps focusing on (a) open reading, (b) meaning units, (c) constituents and (d) essence. Ethical considerations: Four nurses in a general acute paediatric care setting in Sweden participated after providing written informed consent. Voluntary participation and confidentiality were ensured, and the study was ethically approved. Findings: The essence of caring for dying children was likened to a musically attuned composition, comprising five constituents: presence, self-knowledge, injustice in dying, own suffering and in need of others. Presence was found to be a prerequisite for caring when a child is dying. Self-knowledge and support from others can be of help when struggling with emotional pain and injustice. Discussion: Caring for dying children has been found to be a delicate task for healthcare workers all over the world, and the ethical dimension is emphasized in international research. In this study, emotional pain and suffering accompanied caring, but an atmosphere in which it is possible to give and get support from colleagues and to have time to grieve and time to focus on the patient's needs may ease the burden, as can having time to process thoughts about life and death, and a possibility to grow in self-knowledge. Conclusion: Caring in ethically demanding situations may be facilitated through presence, atmosphere, self-knowledge and time. The challenge does not demand highly technological solutions; these assets are readily available, no matter where on earth. However, there is a need to further investigate these prerequisites for caring, particularly when a child is dying.

  • 12.
    Hansson, Matilda
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bruce, William
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Staying Alive: Sjuksköterskans chans till reflektion efter att aktivt deltagit vid ett hjärtstopp2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Att vara närvarande vid ett hjärtstopp kan vara psykiskt påfrestande för vilken

    sjuksköterska som helst. Genom att kontinuerligt få träning och uppdatera sin kunskap

    gällande HLR ger det sjuksköterskan möjlighet att vid senare tillfälle reflektera över

    händelsen och därmed kunna släppa situationen.

    Syfte: Var att belysa allmänsjuksköterskans chans till reflektion efter att aktivt deltagit vid ett

    hjärtstopp.

    Metod: Var en kvalitativ intervjustudie med semistrukturerade intervjufrågor. Fem stycken

    sjuksköterskor intervjuades under november 2017. Intervjuerna transkriberades och efter en

    manifest analysmetod delades innehållet upp i fyra kategorier med två underliggande

    kategorier tillhörande varje kategori.

    Resultat: Det visade att chansen till reflektion var bristande. Vissa informanter upplevde att

    de fick chans till reflektion, medan andra ansåg att det var en brist. Resultatet visade även

    skillnaden på hur snabbt reflektionen skedde efter ett hjärtstopp mellan avdelningar.

    Informanterna uttryckte även detta som en brist, då de ibland inte fick utlopp för sina egna

    känslor och tankar.

    Slutsats: Efter avslutad studie syns bristen vara för stor då alla borde få samma chans till

    reflektion efter avslutad HLR.

  • 13.
    Heidenreich, Kaja
    et al.
    Örebro University.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Borås.
    Materstvedt, Lars Johan
    Norwegian University of Science and Technology, Norway;University of Glasgow, UK.
    Tidefelt, Ulf
    Örebro University.
    Svantesson, Mia
    Örebro University.
    Relational autonomy in the care of the vulnerable: health care professionals' reasoning in Moral Case Deliberation (MCD)2017In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, p. 1-11Article in journal (Refereed)
    Abstract [en]

    In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans.

  • 14. Jónssson, Jón Jóhannes
    Genterapi vid MPS och cystisk fibros1996In: Genterapi på människa: Vad kan vi? Vad bör vi?, Köpenhamn: Nordisk ministerråd , 1996Chapter in book (Refereed)
  • 15.
    Nord, Anette
    et al.
    Linköping University.
    Lundgren, Johan
    Bremer, Anders
    University of Borås.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Israelsson, Johan
    Linköping University.
    Apropå! – HLR och rätten till en värdig död2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 20, article id 113:DZEHArticle in journal (Other (popular science, discussion, etc.))
  • 16.
    Sandlund, Mikael
    et al.
    Umeå University.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Ågård, Anders
    Sahlgrenska University Hospital.
    Engström, Ingemar
    Universitetssjukvårdens forskningscentrum, Örebro.
    Sallin, Karl
    Uppsala University.
    Kontinuitet främjar personligt och professionellt ansvarstagade2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 42, p. 1-2, article id ETHIArticle in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Att utröna medicinska behov, fatta beslut och se dem genomförda är läkarens ansvar.

    För att få veta den enskilde patientens värderingar och önskemål krävs en förtroendefull relation med vårdgivaren. Kontinuitet förenklar skapandet av en sådan relation.  

    Trots att kontinuitet är centralt är det inte ett mål i sig, utan bör betraktas som ett medel för att uppnå andra mål som följer av läkarens yrkesetik och lagstiftning.

  • 17.
    Swahnberg, Katarina
    et al.
    Hälsouniversitetet, Linköping.
    Berterö, Carina
    Minimizing human dignity: staff perception of abuse in health care2012In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 7, no 1, p. 33-38Article in journal (Refereed)
    Abstract [en]

    In earlier studies we have shown that abuse in health care (AHC) is commonly reported among both male and female patients. In this study, we present an evaluation of an intervention against AHC based on Forum Play. The evaluation was conducted by means of pre- and postintervention interviews with the staff at a woman's clinic. The interviews were analysed using the constant comparative method. The results of this postintervention study stand out in loud contrast to the results of the preintervention studies. Staff had moved from a distant and fluctuating awareness of AHC to a standpoint characterized by both moral imagination and a sense of responsibility.

  • 18.
    Zbikowski, Ancke
    et al.
    Linköpings universitet.
    Brüggemann, Adrianus Jelmer
    Linköpings universitet.
    Wijma, Barbro
    Linköpings universitet.
    Zeiler, Kristin
    Linköpings universitet.
    Swahnberg, Katarina
    Linköpings universitet.
    Ethical guidelines and the prevention of abuse in healthcare2012In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 165, no 1, p. 18-28Article in journal (Refereed)
    Abstract [en]

    Objective

    In obstetrical and gynaecological healthcare, patients often find themselves in a vulnerable position. Sensitive issues such as sexual and reproductive health are addressed and certain procedures can be experienced as abusive. According to research a lifetime prevalence of abuse in healthcare (AHC) can be assumed for 13–28% of female patients in the Nordic countries. In the present study we analyse the content of ethical documents for healthcare professionals within obstetrics and gynaecology in Sweden, in order to find out to what extent ethical guidelines consider issues that have shown to be related to the occurrence of AHC.

    Study design

    We searched the literature to find empirical data on AHC. Guidelines for nurses, midwives and physicians were selected. After developing an analytical framework based on the empirical data the content of the ethical guidelines was analysed.

    Results

    The various ethical guidelines for staff working within obstetrics and gynaecology differ distinctively from each other regarding their content of issues that are related to AHC. Issues that were mostly disregarded were: considering the patient's perspective and the patients’ possible experience of violence, considering power imbalances within healthcare, sexual misconduct, how to deal with other professional's ethical misconduct and how professionals relate to each other. We found the ethical guidelines of the International Federation of Gynecology and Obstetrics (FIGO) and of the International Confederation of Midwives to be those which contained most of the issues that have empirically shown to be important in regard to AHC.

    Conclusion

    While staff members from different professions may share responsibility for the same patient, their ethical guidelines vary considerably. To become a possible resource for prevention of AHC, we suggest that ethical guidelines in healthcare should be revised following empirical research on ethical conduct. As ethical guidelines cannot be effective by their existence only, we would like to initiate a discussion on the function and use of ethical guidelines in general and regarding AHC in particular. Being aware that ethical guidelines are only a part of ethics in healthcare, however, we envision a broader approach to the aim of preventing AHC, where research is encouraged on how a virtue ethics approach could be applied.

  • 19.
    Zbikowski, Anke
    et al.
    Linköping University.
    Zeiler, Kristin
    Linköping University.
    Swahnberg, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Forum Play as a method for learning ethical practice: a qualitative study among Swedish health care staff2016In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 11, no 1, p. 9-18Article in journal (Refereed)
    Abstract [en]

    Background In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care.

    Method Ten health-care workers participating in a Forum Play course took part in this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison.

    Results The analysis resulted in the core category "developing response–ability." It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency.

    Conclusion The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation.

  • 20.
    Ågård, Anders
    et al.
    Sahlgrenska University Hospital.
    Bremer, Anders
    University of Borås.
    Sallin, Karl
    Uppsala University.
    Engström, Ingemar
    Örebro University.
    Ethical controversies in the process of formulating new national guidelines on cardiopulmonary resuscitation in Sweden2017In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 12, no 4, p. 174-179Article in journal (Refereed)
    Abstract [en]

    The Delegation for Medical Ethics within the Swedish Society of Medicine has taken the initiative to create national ethical guidelines on cardiopulmonary resuscitation. The reasons behind this initiative were indications of differences in the way decisions about cardiopulmonary resuscitation were made and documented and requests expressed by health- care professionals for new national ethical guidelines. During the process of creating the guidelines, a number of work- shops were held with representatives from the delegation and clinical experts from various branches of medicine. Several versions of the working document were sent to consultation bodies with requests for comments. We therefore believe that the final guidelines are well supported by the medical profession in Sweden. The purpose of this article is to present ethical issues on which it was difficult to reach consensus due to divergent opinions expressed by the people and organisations involved. The arguments for and against a particular point of view or wording in the text are presented. The main controversies were related to the following six issues; Determining whether or not cardiopulmonary resus- citation is beneficial for the patient – The presence of close loved ones during cardiopulmonary resuscitation – Performing cardiopulmonary resuscitation for the benefit of people other than the patient – Ambulance personnel’s mandate to decide not to initiate and to terminate cardiopulmonary resuscitation outside hospital – Limiting the length and content of cardiopulmonary resuscitation – Whether or not to specify a week of gestation before which cardio- pulmonary resuscitation should not be started. 

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