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Hello Aye, thank you for sharing your proposed project for malaria surveillance for Myanmar. Malaria has been plaguing Myanmar for several years especially in its hilly regions. So, having a sentinel surveillance where normal health clinics and facilities cannot reach is a good thing. Additionally, would not it be a better idea to incorporate ethnic health facilities and consider their rules and regulations as there are many areas governed by ethnic administration?
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Implementing high availability (HA) in one’s hospital has many benefits for both patients and the hospital such as improving the patients’ safety and operational efficiency of the service delivered.
Patients: For the patients, being able to access the critical health services (such as being able to book an urgent appointment for counseling services for their mental well-being and worries related to their conditions) at their time of need can go a long way. Consequently, it can lead to having more trust and satisfaction in the services they received from the facilities by improving their experience. Besides, it can improve patients’ safety by being able to access their medical records and history in critical times like emergency situations for better clinical decision support.
Hospitals: Minimizing downtime and ensuring high availability can enhance the operational continuity of the important hospital services including patient management system, and clinical decision support system (CDSS). Being able to pull up patient record at their time of need, clinicians can provide better clinical decision and care. Additionally, having high availability by applying systems like RAID and other redundant systems can ensure data protection and security. After all, having a disaster recovery plan and backups can prevent from the loss of sensitive and valuable patient information. By doing so, it enhances the experience and safety of the patients resulting in high reputation for the hospital.
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Hello Tanaphum, thank you for sharing your proposed hybrid system on dengue surveillance. I think it is a good idea to use both disease and syndromic surveillance. Additionally, having a weak definition will allow you more flexibility in your system. Regarding your data flow, using models and algorithm can support decision-making process. However, it would be better if I could learn more about the data flow in detail like how you will collect those data from the frontline, for example, schools or clinics.
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As a team leader in data analysis and academic team, I have completed quite a number of projects. The things that come natural to me were “defining the project”, “listing the task”, and “planning the running order”. For example, if the project is “developing a dashboard for dengue fever”. I can effectively break down the project into smaller and more manageable tasks and listing the order to proceed such as choosing the tools, where to obtain the source data, who will collect and clean the data, and who will analyze and create the dashboard.
Additionally, using Gantt chart is more formal and sometimes, and so I use more customizable template designed for each project for tracking and monitoring the progress. Finding the balance between resource available and needed also takes time, so in that case, I usually use communication skills to discuss with stakeholders for the possible outcomes.
However, I sometimes find it hard to assess risk and add contingency plan. This is the area that I need some support. Having a team meeting and brainstorming will learn more about potential risks and ways for contingency plan.
Additionally, re-adjusting the plan is also hard for me due to the time and resource constraint of the nature of the project. Time is the hardest variable to adjust for me especially when your project depends on another project from different department. However, sometimes, it is necessary to delay the project and make it more efficient.
Lastly, reviewing is not formally done, instead, we usually have a team discussion meeting after launching a dashboard or a course, and then we listen to each other’s perspectives on our project and how to improve it. Then, we close the project.
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I have never experienced a breach in organizational data or information system. However, I have known a case where some of the sensitive data from a facility was breached in my region. So, I will use this case instead, but I would not mention the name of the organization and those who are affected in detail.
How it happened: Identifiable information including the person’s full name, parent’s name, national registration number, as well as estimated location was breached by a malicious user. And those data were shared publicly through social media including Facebook. An investigation committee was established and found out that an executive member of the information system shared the data using a social messaging application to one of the staff for matter. However, the end user forwarded it to the one who are seeking that information outside of the organization and used it to blackmail and dis-credit the organization.
The impact: It led to the flooding of messages from the affected persons and temporary shutdown of the whole facility. Even though an investigation committee found out the culprit who forwarded the message to the person outside of the organization and hold the person accountable, the image of the organization was shattered and many people stopped using the facility, and finally led to the closure of the facility.
How to prevent it: Firstly, sending messages across the social media without any encryption method should be avoided. Additionally, sending the raw data that contains sensitive information should not be done without proper security protocols. Both the primary sender and the culprit who forwarded to the malicious person are responsible in this case. Secondly, it highlights that the organization itself is responsible as it does not have proper security protocol and data sharing policy. So, to prevent this type of incident from happening, we need to keep in mind the importance of having the security protocols, data protection policy, limiting the access of information, and sharing only minimum information. Organizations as well as their members should be aware of those protocols and procedures when sharing sensitive information. Providing session on digital security and policy briefing is also an effective way to prevent such incidents from happening again.
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I was an academic manager of medical department at a local education organization. My team consists of eight members including me. Since most of them are students, they are usually energetic and active in teamwork. However, there are times when they feel less engaged, so I had to use the following tricks to motivate them.
Firstly, in those times, I called a team meeting and explained about what the purpose of our team and our current project is and asked them about how we should improve current workflow or current projects. This team meeting usually serves two things. First, it creates an opportunity to talk to each other and how our project is coming. Secondly, by sharing our purpose and listening to feedback from each other, we will have more understanding on what to do and expect next.
Secondly, I applied recognition and appreciation method to motivate my team. Each team member has their own strengths and weaknesses. So, I usually let them know that they are doing a great job and there are people who will support you along the way. Sometimes, I appreciate them as the whole team but sometimes, I appreciate each team member in their respective contribution. Appreciation and recognition can go a long way in a team and can create a strong sense of motivation.
Thirdly, there are times, that I need something to motivate me. At such time, I usually reflect my past completed projects and how it contributed to the community. Reflection of past achievements and contribution mostly motivates me for the coming projects and missions.
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There are two areas that I need to improve my listening skills. The first area is “understanding the big picture“. I am the type of person who are good at recalling details when someone is speaking. But being good at recalling details makes me hard to understand the bigger picture of what the speaker is conveying. So, I need to improve my listening skills so that I can have more understanding on what the big picture is, when someone is talking to me.
To improve my understanding of bigger picture, instead of focusing too much on details and facts, I will try to understand the context of the conversation by paying attention to nonverbal cues, and body languages.
Secondly, I need to improve “empathizing with the speaker“. As I have mentioned in the previous lesson, it is hard for me to understand what other people is feeling. As a result, I am kind of fail to empathize with the speaker when they are feeling emotional or in a difficult situation. So, I need to improve this aspect of listening skills as well.
To improve my empathy, I will try to listen more, paying more attention to emotional clues like facial expression and the tone of the speaker. Then, I will note down some phrases to start with empathizing like “I understand it must have been a difficult time for you”, and so on.
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After listening to both leaders addressing their nations regarding their actions and information related to COVID-19, it is fair to say that Lee Hsien Loong had met all the six principles recommended by CERC.
Firstly, he directly addressed his nation just after two weeks of COVID-19 outbreaks in Singapore and clearly specify where they were and what lied ahead. On the other hand, when Donald Jr Trump addressed his nation, COVID-19 was declared by WHO as a pandemic.Secondly, when Lee informed the public, he clearly stated the facts and compared them with previous SARS outbreaks and mortality rates of influenzas in a simple manner. He supported his claims with facts. On the other hand, Donald Trump did not provide any facts regarding to his claims, which can lead to speculation if he was downplaying the disruption caused by COVID-19. It reduces credibility for his words. He even claimed that “the virus has no chance on his country”, implying that his administration had prepared exceptionally well. Words without evidence and facts create false sense of security in times of crises.
Thirdly, I as a listener felt that the way Lee spoke was more empathetic compared to Donald Trump’s, who seems to be posing in a forceful manner. Additionally, why Donal Trump spent more his speech on blaming certain groups of people and nations, Lee reminded his public to see through this outbreak together rather than blaming.
Fourthly, even though Donald Trump spoke a lot about what his administration had been doing like restriction of travel from certain countries and handing out economic loans for small business, he did not mention what the public should do to reduce the transmission and what to expect. On the other hand, Lee informed his nation about what to do and what not to do like, and clearly stated what lied ahead to prepare it mentally for the public.
To conclude, Donald Trump’s address on his nation seems to me like a praise on his own administration while blaming everyone else. He spoke little of what to do and expect. On other hand, Lee addressed his nation in an empathetic and respectful manner by providing information related to COVID-19 and what to prepare, supported by facts. His address serves as a good set for crisis and emergency risk communication.
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To be honest, I am the type of person who needs more actions on improving my emotional intelligence (EQ) as whole career was based on learning science subjects and drawing insights from numbers. Though I need actions on my emotional intelligence. There is one area that I have strength in terms of EQ.
Self-Regulation: It is my strongest component of emotional intelligence. When I was bombarded with series of complex and stressful situations like project deadlines, I am usually able to calm myself and break the problem down into smaller and manageable pieces.
Action Plan: However, even though it is my strongest component, I can improve it by having more skills on reducing stress in last-minute assignments and urgent change of plan, like finding more ways to manage the stress.
Empathy: It is my weakest component of emotional intelligence. I lack the natural ability to understand and reflect emotions from people around me. As a result, I find it hard to read other’s emotions leading to misunderstanding in building relationships.
Action Plan: To improve empathy, I need to practice more on the soft skills such as active listening, more observation on body language, and keeping a journal with reflections. Active listening and observing body language can open doors to more understanding of how the speaker is feeling and what they are trying to make me understand. Additionally, keeping a journal and reflecting it can make me more aware of my responses and how to improve and regulate it.
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Areas for improvements in Myanmar for future global health security during pandemics, using digital health:
Team: It is one of the challenging themes for the country. Due to decades of conflicts and political instability, the collaboration between different stakeholders were literally non-existent across the different regions. The flow of data was severely damaged and restricted. So, strengthening the inter-cooperation between different stakeholders across the country is the priority thing to be considered for the improvement.
Transparency and Trust: There is a serious need to respect the privacy and consent of the public in using digital devices to record timely data and information. Strengthening the informed consent process is needed, such as advocating and providing awareness session on local and national authorities about the significance of privacy and confidentiality of data collection process.
Technology: Current technical infrastructures are outdated and cannot operate well in some areas. Additionally, lack of stable internet connection and stable electricity support further complicates the implementation process. Serious strengthening of basic health-related technology and infrastructures, expansion of internet connectivity, and stable support of electricity are needed.
Techquity: As I mentioned above, there are still unequal distribution of digital health capabilities across the country for several reasons. Some areas, especially where internet connectivity is severely restricted, the divide is decremental for improvements. So, sharing and providing resources necessary to techquity is in dire need.
Transformation: There is no data sharing standards or effective data governance structure. Additionally, due to current political instability, surveillance systems are not functioning well. However, we could improve it, by empowering community to use digital devices and mobile technologies to manage and tend to their health conditions. Besides, consensus data sharing standards and effective data governance structure across different regions should be established.
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There are eight PEHIC declarations from 2005 to 2024.
1. H1N1 (Swine Flu) pandemic – 2009-2010
2. Polio – since 2014
3. Ebola in Western Africa – 2013-2016
4. Zika Epidemic – 2015-2016
5. Kivu Ebola epidemic – 2018-2020
6. COVID-19 pandemic – 2020-2023
7. Clade II Mpox outbreaks – 2022-2023
8. Clade I Mpox outbreaks – 2024 – presentThere are declared as PHEIC by director-general general as recommended by emergency committee of WHO for the following major reasons:
1. Serious Impact on Public Health,
2. Unusual or Unexpected Occurrence of the Event,
3. Significant Risk of International Spread, and
4. Significant Risk of Internation Travel or Trade Restriction.
These diseases had a serious impact on the public health, their nature of occurrence is unusual or unexpected (deviation from their normal expectancy or geolocation), risk of spread to other locations and regions, as well as of risk of resulting in restrictions in trade and travel.In my opinion, there is a one condition that can lead to another PHEIC in the future. It is the Extensively drug-resistant TB (XDR TB). XDR TB is resistant to many first line and second line injections of anti-tuberculosis treatment. It is a rare type of MDR TB, however, if we could not implement effective quarantine and containment measures, it has the potential to spread the strain to other high-risk populations. According to CDC (2022), the number of cases of pre-XDR TB and XDR TB are rising. If the number of cases continue to rise, it will have the potential to be declared as PEHIC for meeting the following criteria.
1. Serious Impact: It will put a serious impact on the public health increasing the number of hospitalizations. With the lack of effective anti-tuberculosis drugs, the mortality rate will also increase.
2. Unusual or Unexpected: Currently, the number of XDR-TB is within normal expectancy but if it continues to rise, it will be of importance notice to the health authorities around the world.
3. International Spread: If the strain spreads further, it will put the danger of further spreading and causing serious impact.
4. International Risk of Trade or Travel Restriction: Yes, it will have the potential to spread other countries via travel. -
According to Chung et al. (2024), the Korean surveillance system on acute hepatitis B rated high on data quality and timeliness and has high predictive value (94.4%). However, there are some areas needed to be improved, especially in misreporting of chronic cases, and the system’s usefulness.
Misreporting of chronic cases: According to Chung et al. (2024), 36.8% of cases initially reported by medical institutions had to be excluded due to confusion between acute and chronic cases. This highlights that it is the area that needs to be improved in the system. One of the ways to improve this area (gap) is to enhance the characteristics of acute cases that reflect more accurate epidemiological profile of the acute cases. It is also mentioned in the report. Additionally, it would be better, if the clear reporting criteria for asymptomatic patients could be provided. For example, inclusion of liver function test could be a useful criterion in those situations to increase the accuracy of surveillance. This could help the healthcare officials to have a clearer distinction between acute and chronic cases to some extent.
System’s Usefulness: The current surveillance system only monitors the acute cases, which need no urgent response nor could not capture the four indicators needed to elimination of viral hepatitis outlined by WHO: vaccination, prevention of perinatal infection, diagnosis, and treatment. Since Korea is one of the countries that has low HBsAg positivity rates, it is reasonable to focus on monitoring acute cases, but it is also estimated that chronic hepatitis encompasses 2% of total population. Therefore, it would be better if the transition from acute to chronic could be monitored and incorporated into the current surveillance system. This could be done by mandatory reporting of chronic cases, and longitudinal case tracking via follow-ups. The acute cases needed to be followed up after 6-12 months and monitor their disease condition whether the disease is resolved or transitioned to chronic cases. Additionally, chronic cases should be traced back, if there are any report in the acute phase as well. Besides, developing long-term strategies and goals with the insights driven by the updated surveillance system should be incorporated to have a better use of the surveillance system.
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Hello Cing, yes, it is a threat for the organizations. It is a commendable fact that your organization has the proper back up policy. Besides, implementing proper offboarding policies would deter such attacks from happening. Additionally, it would be better if your system has a log to check the activity done to your data.
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Hello Cing, yes, having a harmony at work is a commendable situation for all members in a team. And having a partner that has the skill sets that you mentioned is a great opportunity for the team to grow. Additionally, having a diverse team with diverse characters and skills is also necessary for resolving conflicts at work.
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Hello Wannisa, it is a good plan to have a pen and paper near you to improve your skills “recalling details”. Additionally, I suggest that you should also ask the speaker to clarify if it is the statistics they requested. I understand if the speaker is a senior, you would be afraid to ask her to repeat again. But clarifying is a great tool as it could potentially save you from doing unnecessary work and having to fix the mistaken work.
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Hello Aye, I understand your distraction during some meetings as it happens to me sometimes as well. I believe it depends on the duration of meeting. Some meetings are longer than it should be, in those meetings, I try to refresh myself with drinking water and going out for some time to refresh myself. Additionally, I suggest the team leads that a meeting should not be too long. During my work as an academic manager, I usually kept most meeting under one hour, it kept most people engaging. So, sometimes, it is not your fault, it is due to the length of the meeting.
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Hello Tanaphum, it is a good thing to start with something you enjoy. Additionally, one of my teacher suggested that pausing a lot can deter you from learning, instead, she suggested that I should guess the context if I do not understand a word in a sentence. It improved my comprehension skill a lot. I hope you could try it sometimes.
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Hello Aye, yes, I agree with you that both leaders have utilized some or most of the elements of CERC. However, PM Lee was a better communicator as he not only adhered those principles but also embodied it. On the other hand, though then President Trump used some elements of CERC, his approach led to confusion and reduced the trust in government actions and programs related to COVID-19.
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Hello Wannisa, come to think of it, though the address from Trump has focused less on facts and empathy, he sure uses his direct speaking as his strength in addressing the nation. His focus is more on economy and travel restrictions, both are effective methods during COVID-19. Though I still believe that Trump did a bad job in addressing, I really thank you for highlighting his strengths and approaches in this speech.
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Hello Cing, it is a strength to understand what others are feeling without any judgement. Since you are an introvert, it is understandable that it would take you much effort to express outward empathy. Yes, I agree with your action plan like listening to music, and playing your favorite games can get you through those emotional turnmoil. I also used those things when I felt stressed and got emotional. It helped me a lot.
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Hello Tanaphum, thank you for sharing your points in emotional intelligence along with action plan. I agree with you that finding joy in small things in one’s life is a major strength as well. Additionally, I am also the kind of person who do not think too much about what other people think of me, however, we need to balance logics with empathy so that it is better in building relationship.
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Hello Aye, I agree with your views on the areas of improvement for Myanmar. The trust in authorities has been a sharp decline since the coup. Additionally, consequences spun from the coup has led to collapse of many reform programs and digitalization and innovation of healthcare system. I do hope so that we could rebuild it in a foreseeable time.
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Hello Tanaphum, digitalization of patient’s health record has been a difficult one in most countries, due to lack of supportive healthcare techno-infrastructure. However, with support from government and private sectors, we could envision a scenario where our healthcare sectors use paperless and digitalized health records.
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Hello Wannisa, yes, ensuring personal data protectin act are simple and easy to understand for everyone is a good start for improving trust and transparency. Additionally, I agree with you that no matter how advanced the technology is, there is still a need to improve the digital literacy so that digital equity can be achieved. You have provided a thorough plan for improvement.
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Hello Wannisa, yes, I agree with you in this case that the viruses that are frozen in the permafrost of the arctic and antarctic areas should be a potential to cause PEHIC. Global warming is thawing away the ice-berg in those areas, posing a serious threat to the public. It is also true that the nature and mechanism of those viruses would be unexpected. But since due to its location being far away from human habitants, those viruses would not spread further, expect if human like researchers contacted it. So, quaratining those who came back from those areas should be a good start. Thank you for sharing such a great example.
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Hello Aye, yes, it is fair to say that HIV should be classified as PHEIC for its serious impact on the public health, and its international spread. However, like Wannisa mentioned above, it is not unexpected at this moment. However, like you said, if the highly infectious and more virulent strain of the disease emerges, it would meet the criteria of PHEIC and should be declared accordingly.
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Hello Aye, yes, duplicate reporting and misreporting are major challenges in this surveillance system of Korea. As you suggested, providing health education along with guidelines and protocols could improve its effectiveness. Additionally, integration of this surveillance system with other technologies in health fields like labs would be a great idea to improve.
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Hello Wannisa, thank you for providing two major gaps along with possible solutions. Among them, having an automated data checks with alerts can reduce the mis-reporting but we also need to consider about alert fatigue as well. Additionally, yes, interoperability is still a major issue in this case, and using HL7-FHIR compliant EHR system along with surveillance would improve Health information exchange.
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Hello Wannisa, thank you for highlighting the specific tools and systems for the steps of outbreak investigation. Like you mentioned, electronic surveillance system, databases management system, and statistic software and mass media are important examples of the usage of IT in outbreak investigation.
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Hello Aye, I agree with you that IT can enhance various aspects of outbreak investigation. Like you mentioned above, IT can assist in timely data collection and communication across different rapid response team, and enhance the process of data analysis, resulting in earlier detection and rapid response.
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Hello Aye, yes, we always use data visualization tools for better understanding of the data and comprehension of the information and insights, however, we usually forget their roles and significance. Thank you for highlighting the importance of those tools in outbreak monitoring and disease surveillance. They are the tools that can be tailored to the needs of not only the stakeholders but also for the public.
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Hello Cing, yes, I agree with you that telemedicine has proven its insignificance during the COVID-19 pandemic. During the highly infectious period, it would be hard for the patients with vulnerable conditions to seek health consultations. Using tele-consultation using online video conferencing application can overcome this challenge. Besides, it would be beneficial to integrate the concept and applications of telemedicine in future outbreaks and disease prevention.
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Hello Wannisa, thank you for highlighting the significance of machine learning in modern epidemic surveillance. Yes, I agree with you that it would be rather hard, handy, and long to analyze increasing number of big and online data using traditional method. On the other hand, applying machine learning technique can overcome this challenge and provide timely insights and alerts to the healthcare officials as well as the public.
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Hello Wannisa, yes, dissemination of information related to outbreaks should be targeted not only to health care professionals but also to the public. Like you mentioned, using tools like ProMED, and Healthmap can assist healthcare officials in notifying them of the events related to outbreaks. But online dashboard and social media campaign like raising awareness on regular hand-washing and its benefits in breaking the chain of transmission of monkeypox can enable the public to realize the impact of the outbreaks and ways to prevent them.
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Hello Aye, yes, I agree with your reasoning behind choosing community based surveillance against hospital based surveillance. Your reasoning focuses on the actively seeking of monkeypox cases in the community, because you consider waiting them to show symptoms and admit them to the medical facilities would be too late for the response time. Additionally, yes, early detection of an outbreak can save lives as well as valuable resources with a timely and coordinated response.
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Hello Cing, yes, I agree with you that the type of surveillance system depends on the nature of the disease or conditions being monitored. Additionally, it is a good idea to choose case-based surveillance for monkeypox due to its having few cases currently. Besides, both ProMed and HealthMap are great tools to disseminate faster information related to outbreaks with more accuracy than typical social medica like facebook and twitter.
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