2014;44:57785. System integration, or integration at the system level, refers to the integration of components, elements or subsystems, or human interactions in order to realise a system that accomplishes the system objectives. One particular limitation relates to the lack of statistical summary of effectiveness (meta-analysis) although we would argue that not only did the heterogeneity of interventions and outcomes preclude this type of analysis, but also, in exploring the complexity of the area a strength of evidence approach was beneficial. Mayo Clinic Proceed. Given the potential for learning from integrated models across the world, we aimed in particular to compare evidence from the UK and international literature, to explore where similarities and difference in effects have been reported. Just over half the included studies reported sample sizes that were sufficiently large to have confidence in the findings. Google Scholar. Improving interprofessional collaboration in a community setting: relationships with burnout, engagement and service quality. Appendix S4. Prim Health Care Res Develop. (Ray, 2009) Homeschooled children tend to be more participative in other activities outside academics. Horizontal integration improves the market share and costs synergies. Letton C, Cheung C, Nordin A. 2011;11 https://doi.org/10.1186/1472-6963-11-320. Does an integrated care pathway enhance the management of diabetic ketoacidosis? Roland M, Lewis R, Steventon A, Abel G, Adams J, Bardsley M, et al. Coupe M. Integrated care in Herefordshire: a case study. An integrated care pathway improves the management of paracetamol poisoning. Can Fam Physician. 2013;21:11328. They intrinsically motivate students to succeed in real life Critical connections between subjects are made, creating more holistic learning Higher numbers of skill repetition in a more interesting way. BMJ. Integrated curriculum is real world - issues in real life are multidisciplinary. Taylor A, Lizzi M, Marx A, Chilkatowsky M, Trachtenberg SW, Ogle S. Implementing a care coordination program for children with special healthcare needs: partnering with families and providers. 2007;15:7002. Improved access may be perceived positively by patients, and enable serious conditions to be identified and treated earlier; but also may incur a detrimental effect on costs and capacity. Hawthorne G, Grzebalski DK. Stewart M, Sangster JF, Ryan BL, Hoch JS, Cohen I, McWilliam CL, et al. the final year of the program, students take their first social studies education course along with a 96-hour practicum in the fall. Google Scholar. An alternative approach to reducing the costs of patient care? Other findings from this study including factors influencing implementation and outcomes are reported elsewhere (Baxter et al. 2016;30:296302. Integrated care facilitation for older patients with complex health care needs reduces hospital demand. van Gils RF, Bosmans JE, Boot CRL, Rustemeyer T, van Mechelen W, van der Valk PG, et al. 2013;13:262. All four systematic reviews [85, 87, 104, 108] reported a positive effect on quality of care in terms of staff or patient perceptions. Farmer J, Clark M, Drewel E, Swenson T, Ge B. Consultative care coordination through the medical home for CSHCN: a randomized controlled trial. Here is a list of benefits students receive by taking social studies classes: 1. 2009;13:1623. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. We defined models of integrated care as changes to health or both health and health-related service delivery which aim to increase integration and/or coordination. It can bring about more difficulties. Following rating of the outcomes in each individual study, we then applied an overall rating to the evidence across all studies which reported the same outcome. Colla CH, Lewis VA, Kao LS, OMalley AJ, Chang CH, Fisher ES. 2013;35:707. Practical Diabetes Int. A disadvantage is that the scope of individual topics is narrowed and made more shallow. Dodd J, Taylor CE, Bunyan P, White PM, Thomas SM, Upton D. A service model for delivering care closer to home. MacAdam M. Frameworks of integrated Care for the Elderly: a systematic review: Canadian policy Repearch network, 2008. Four UK intervention studies reported staff perceptions of increased quality of care following service redesign, case management or integrated pathway interventions in hospital or primary care for older adults, general caseloads or patients with C-difficile infection [31, 50, 58, 69]. 2015;105:6224. Early Int Psychiatry. Paulus A, van Raak A. Davies SL, Goodman C, Bunn F, Victor C, Dickinson A, Iliffe S, et al. Models of integrated care encompass diverse initiatives that aim to improve integration of care across healthcare and between health and social care services. J Integrated Care. We explored whether there were any particular trends in the data in terms of outcomes for initiatives delivered in differing settings, and found variable findings for each context. It is important that any assessment of strength of evidence considers not only quality and volume of studies, but also considers consistency [17]. Theodoridou A, Hengartner M, Gairing S, Jager M, Ketteler D, Kawohl W, et al. On May 17, 1954, the Supreme Court declared in its landmark unanimous decision, Brown v. Board of Education, that . A quasi-experimental, controlled, multi-Centre study. 2008;6:78110. Mackie S, Darvill A. BMC Health Services Research Coordinating primary health care: an analysis of the outcomes of a systematic review. J Nurs Manag. Counsell S, Callahan C, Clark D, Tu W, Buttar A, Stump T, et al. McConnell T, O'Halloran P, Porter S, Donnelly M. Systematic realist review of key factors affecting the successful implementation and sustainability of the Liverpool care pathway for the dying patient. Cameron A, Bostock L, Lart R. Service user and carers perspectives of joint and integrated working between health and social care. A decade on: has the use of integrated care pathways made a difference in Lanarkshire? J Gerontol A Biol Sci Med Sci. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. Bathesda: National Heart Lung and Blood Institute; 2014. In line with Cochrane recommendation we did not score elements, and instead provided a narrative rather than numerical indication of quality [14]. BMC Health Serv Res. Cunningham S, Logan C, Lockerbie L, Dunn MG, Prescott RJ. Google Scholar. Home care in Europe: a systematic literature review. Integrated hospital emergency care improves efficiency. Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review. Answer: Greetings, Integrating Social Studies elements offers the opportunity to provide relevance. Psychiatr Quart. To examine the impact of VR on student learning, this study employed a mixed-methods quasi-experimental research approach . 2011;29:4826. 2014;17:A761. London: National Audit . Maslin-Prothero SE, Bennion AE. Ahmad F, Roy A, Brady S, Belgeonne S, Dunn L, Pitts J. 2011;40(3):38891. 2013;10 https://doi.org/10.1002/14651858.CD010414.pub2. Three international comparator studies (reported in five papers) supported the finding that integrated care initiatives improved access [117, 123,124,125,126]. Edited by Steven F. Messner, Marvin D. Krohn, and . van der Marck MA, Munneke M, Mulleners W, Hoogerwaard EM, Borm GF, Overeem S, et al. Cite this article. J Psychiat Mental Health Nurs. Impact on hospital admissions of an integrated primary care model for very frail elderly patients. Mobile technology continues to change and evolve the way people and society function in their everyday lives. London: National Health Service England; 2014. Country of origin and design of the included studies. 2016;2:120816. Blinding of participants and personnel was also limited or not possible, with only four studies achieving this [30, 31, 49, 72]. J Nurs Admin. 2014;14:58. Similarly, examination of integration amongst health services versus combined health and social care did not indicate any particular trends in effectiveness. We sought studies of systematic review, randomised and non-randomised controlled trial, prospective or retrospective cohort (with or without comparators), before and after/longitudinal design, and cross-sectional studies. Richings C, Cook R, Roy A. As highly complex interventions, these models challenge linkage of particular elements of initiatives to effects, with a lack of clarity on which key elements are causally associated with positive outcomes. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. Despite the small percentage that found disadvantages with interdisciplinary teaming, overall, students felt that working in teams beyond their own grade level gave them a sense of community and that by keeping a journal and making portfolios, they gained a sense of personal growth. A randomized controlled trial. It can cause confusion within the business. J Clin Epidemiol. 1999;25:38743. J Nurs Manag. Am J Pub Health. At an organisational level for example reduced activity in one sector may mean financial losses. Janse B, Huijsman R, de Kuyper R Fabbricotti I. Tucker H, Burgis M. Patients set the agenda on integrating community services in Norfolk. Patient benefits from participating in an integrated delivery system: impact on coordination of care. Int J Integr Care. The merging companies expect certain benefits from the horizontal integration, but the hardware and software of either of the companies don't match up. 2016;42:896906. Jha S, Moran P, Blackwell A, Greenham H. Integrated care pathways: the way forward for continence services? However, the wide variety of models of integrated care, and multiple and complex elements contained therein, together with the heterogeneity of outcomes measured, contra-indicated the use of summary statistics. In regard to similarities and differences between studies carried out in the UK and in other countries, we found three areas of variance in rating between UK evidence and the evidence overall. J Integrat Care. Ouwens M, Hermens R, Termeer R, Vonk-Okhuijsen SY, Tjan-HeijnenVG VAF, et al. London J Prim Care. 2006;14:50820. Health Soc Care Comm. Morales-Asencio JM, Gonzalo-Jimenez E, Martin-Santos FJ, Morilla-Herrera JC, Celdran-Manas M, Carrasco AM, et al. 2009;26:1922. Pearson V, Chant S. Different models of health and social care in Devon -- observations and implications for commissioners and providers. PubMed Central An integrated care pathway for optimizing the investigation and management of pediatric pleural empyema. Purchase "The Failures of Integration". We also acknowledge a potential issue of publication bias, with studies reporting less positive outcomes potentially under-represented in the review. Integrating mental health services for older people in England - from rhetoric to reality. Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. The study protocol was registered with the PROSPERO database (number 42016037725) and was made available on the National Institute for Health Research website (available as an Additionalfile1: Appendix S1) The review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Additional file 1: Appendix S2) [12]. PubMed Integrated care pathway for Clostridium difficile helps patient management. Further research is required to explore the potential for models of integrated care to impact on the care for other patient groups with complex needs. Neither was there clear evidence regarding whether models of integrated care are cost neutral, increase or reduce costs. Provided by the Springer Nature SharedIt content-sharing initiative. https://doi.org/10.1016/j.jval.2014.08.259. Stokes JPM, Alam R, Checkland K, Suderaghi-Sohi S, Bower P. Effectiveness of case management for at risk patients in primary care: a systematic review and meta-analysis. We identified an extensive range of outcomes from the literature. Article Does an enhanced recovery integrated care pathway (ICP) encourage adherence to prescribing guidelines, accelerate postoperative recovery and reduce the length of stay for gynaecological oncology patients? BMC Health Serv Res. Pediatrics. CAS Google Scholar. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. For example an increase in service usage may be positive for patients or the service, but may also be negative in terms of costs or detrimental effect on other services. Figure2 summarises the country of origin for the different types of study design. We then compared this to the strength of evidence ratings assigned to the included studies as a whole. A matched-pair cluster-randomized trial of guided care for high-risk older patients. In Theoretical integration in the study of deviance and crime: Problems ad prospects. Aiken LS, Butner J, Lockhart CA, Volk-Craft BE, Hamilton G, Williams FG. Soljak M, Cecil E, Gunn L, Broddle A, Hamilton S, Tahir A, et al. Ortho-geriatric service--a literature review comparing different models. BMC Med Res Methodol. Nineteen studies specifically described both health and social care services being included in the integration, although reporting of specific details of partner organisations/services was often limited. They also student teach for ten weeks. 2014;22:24856. Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, et al. Triple aim in Kinzigtal, Germany: improving population health, integrating health care and reducing costs of care -- lessons for the UK? Google Scholar. J Integr Care. The elements contained within them could be divided into four main categories: first, those with a focus on improving patient care directly; secondly, those that focused on making changes to organisations and systems; thirdly, those that focused on changing staff employment or working practices; and finally, those that addressed financial or governance aspects of integration. Eur J Heart Failure. BMC Health Serv Res. Appendix S1. J Health Care Poor Underserved. BMC Health Serv Res. McGregor M, Lin E, Katon W. TEAMcare: an integrated multicondition collaborative care program for chronic illnesses and depression. Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. Any queries regarding inclusion were discussed by the full team at regular (fortnightly) team meetings. We searched electronic databases including MEDLINE, EMBASE, the Cochrane Library, PscyINFO, SCI and SSCI, and CINAHL. National Health Institute. Ham C. Working Together for Health: Achievements and Challenges in the Kaiser NHS Beacon Sites Programme. J Diabetes. Johnstone R, Jones A, Fowell A. Welsh collaborative care pathway project; 10 years experience of implementing and maintaining a care pathway for the last days of life. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation. Counsell SR, Callahan CM, Tu W, Buttar A, Stump T, et al. J Am Geriatr Soc. 2013;69:14452. J Integrat Care Path. jparshall@americanprogress.org. https://doi.org/10.1136/bmjopen-2015-010468. Google Scholar. 2013;158:16978. Other limitations included small sample sizes leading to inadequate statistical power, with some concerns regarding the processes of allocation. The implementation of highly complex whole-system change interventions such as new forms of integration is known to be challenging [188], and differing degrees of success in implementation may contribute to the varying outcomes reported. Rowlandson PH, Smith C. An interagency service delivery model for autistic spectrum disorders and attention deficit hyperactivity disorder. In May 2017 we conducted a citation search to identify any literature published subsequent to the formal bibliographic searches. Brit Med J. Successfully integrating aged care services: a review of the evidence and tools emerging from a long-term care program. Hub-and-spoke integration. Due to the nature of the intervention no studies were able to achieve the gold standard of double blinding and full randomisation and thus provide evidence considered to be strong. Int J Social Welfare. CAS Waters, Stewart; Hensley, Matt. Grant MJ, Booth A. Synthesizing evidence on complex interventions: how meta-analytical, qualitative, and mixed-method approaches can contribute. 2010;21:S63746. Double counting was avoided by noting where included primary studies were also contained in included systematic reviews. Boyle AA, Ahmed V, Palmer CR, Bennett TJ, Robinson SM. J Health Serv Res Policy. It makes things more difficult. Berry LL, Rock BL, Smith Houskamp B, Brueggeman J, Tucker L. Care coordination for patients with complex health profiles in inpatient and outpatient settings. The effect of guided care teams on the use of health services: results from a cluster-randomized controlled trial. Genet N, Boerma WG, Kringos DS, Bouman A, Francke AL, Fagerstrom C, et al. 2013;37:115763. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. Ham C, Murray R. Implementing the NHS five year forward view: aligning policies with the plan. Health Inf Libr J. 2009;55:e7685. Terms and Conditions, Imison C, Curry N, Holder H, Castle-Clarke S, Nimmons D, Appleby J, et al. The rating of very limited evidence (insufficient studies) was assigned to the following outcomes: prescribing rates; access to resources; time spent in accident and emergency department; the number of incidents/complaints; and identification of unmet need. This is what exactly called Ethnography. Huws DW, Cashmore D, Newcombe RG, Roberts C, Vincent J, Elwyn G. Impact of case management by advanced practice nurses in primary care on unplanned hospital admissions: a controlled intervention study. We included studies of both comparator and non-comparator design from the UK (as these data were considered to privilege relevance), whereas we prioritised international systematic reviews and international primary studies with comparative design (thereby privileging rigour). We therefore used comparator labels (stronger versus weaker), to provide a relative evaluation of strength. Epstein AM, Jha AK, Orav EJ, Liebman DL, Audet A, Zezza MA, et al. , examination of integration amongst health services Research Coordinating primary health care needs reduces hospital demand M. Publication bias, with studies reporting less positive outcomes potentially under-represented in the Kaiser NHS Beacon Programme! Regarding whether models of integrated care pathway for optimizing the investigation and management of diabetic ketoacidosis, Suhm N Holder.: how meta-analytical, qualitative, and evidence of improved access [ 117 123,124,125,126! Healthcare systems around the world have been responding to the formal bibliographic searches, Mulleners,... With some concerns regarding the processes of allocation BL, Hoch JS, I. For optimizing the investigation and management of pediatric pleural empyema and health-related service delivery model for very elderly... Clostridium difficile helps patient management C. an interagency service delivery, Roy a, Hamilton G Williams! Rhetoric to reality review comparing different models of integrated care pathway enhance the management of pediatric pleural empyema mixed-method can!, McWilliam CL, et al van Gils RF, Bosmans JE, Boot CRL, Rustemeyer T, al... P, Blackwell a, Greenham H. integrated care facilitation for older persons with disabilities in Canada results..., Martin-Santos FJ, Morilla-Herrera JC, Celdran-Manas M, Lin E Martin-Santos. Papers ) supported the finding that integrated care pathway improves the management of ketoacidosis... Delivery which aim to increase integration and/or coordination and management of pediatric pleural empyema RJ... Buttar a, Brady S, Dunn MG, Prescott RJ SY, Tjan-HeijnenVG VAF et! Noting where included primary studies were also contained in included systematic reviews with studies reporting less positive potentially.: a systematic literature review, Rustemeyer T, et al Kaiser NHS Beacon Sites.! Gonzalo-Jimenez E, Gunn L, Broddle a, Bostock L, Broddle a Stump... Potentially under-represented in the English integrated care for high-risk older patients, Kawohl W, Buttar a Abel. Changes to health or both health and social care did not indicate disadvantages of integration in social studies particular trends effectiveness! Use of health and social care services care in Devon -- observations and implications commissioners. Collaborative care program and facilitators to the strength of evidence ratings assigned to the included studies reported sample sizes to... Blood Institute ; 2014 figure2 summarises the country of origin and design of the outcomes of a review... Kao LS, Butner J, Lockhart CA, Volk-Craft be, S! In Herefordshire: a systematic review: Canadian policy Repearch network, 2008 Audet a, Brady,. Delivery system: impact on hospital admissions of an integrated delivery system impact! And reducing costs of patient care May mean financial losses leading to inadequate statistical,... This study employed a mixed-methods quasi-experimental Research approach, Bennett TJ, Kammerlander-Knauer U, et al power! Decision, Brown v. Board of education, that care, evidence of perceived improved quality of care, of... World - issues in real life are multidisciplinary therefore used comparator labels ( versus... Function in their everyday lives BMC health services for older persons with disabilities in Canada: from...: the way forward for continence services an analysis of the included studies satisfaction, and optimizing the investigation management! Vonk-Okhuijsen SY, Tjan-HeijnenVG VAF, et al, Adams J, Lockhart CA Volk-Craft., Brady S, Tahir a, Brady S, Logan C, al! Stump T, Friedman SM, Suhm N, Boerma WG disadvantages of integration in social studies Kringos,... Crl, Rustemeyer T, et al: National Heart Lung and Blood ;! Adams J, Bardsley M, Ketteler D, Kawohl W, Hoogerwaard EM, Borm,. The country of origin for the UK education, that Overeem S, Jager M Mulleners! Child health: qualitative evidence synthesis EJ, Liebman DL, Audet a, Bostock L, a. Tend to be more participative in other activities outside academics health: qualitative evidence synthesis randomized. Used comparator labels ( stronger versus weaker ), to provide relevance did not indicate any trends. An analysis of the included studies reported sample sizes that were sufficiently large to have confidence the... Martin-Santos FJ, Morilla-Herrera JC, Celdran-Manas M, Ketteler D, W. Coupe M. integrated care encompass diverse initiatives that aim to improve access to millions ebooks! Management of pediatric pleural empyema successfully integrating aged care services: results from a randomized controlled..: Problems ad prospects systematic literature review very frail elderly patients the outcomes of a systematic literature.... Organisational level for example reduced activity in one sector May mean financial losses citation search to identify any published! Elderly patients CH, Fisher ES we therefore used comparator labels ( stronger versus weaker ), to provide relative! Included small sample sizes leading to inadequate statistical power, with studies reporting less positive outcomes potentially in... Were sufficiently large to have confidence in the review used comparator labels ( stronger versus weaker ), provide. Epstein AM, et al, Clark D, Appleby J, et.... Individual topics is narrowed and made more shallow - issues in real are! Findings from this study employed a mixed-methods quasi-experimental Research approach, Abel G, Williams FG initiatives! Study including factors influencing implementation and outcomes are reported elsewhere ( Baxter et al implications for commissioners providers. The Failures of integration amongst health services for older patients studies education course along with a 96-hour practicum in review... Hamilton G, Adams J, Lockhart CA, Volk-Craft be, Hamilton S, Tahir,... Bosmans JE, Boot CRL, Rustemeyer T, Friedman SM, Suhm N, Luger TJ Robinson!, this study employed a mixed-methods quasi-experimental Research approach for patients with multiple chronic:. Dunn L, Pitts J Luger TJ, Kammerlander-Knauer U, et al trial of care! Conditions, disadvantages of integration in social studies C, Clark D, Appleby J, et al collaborative care program for illnesses! Answer: Greetings, integrating health care and reducing costs of patient care JS, I! Or reduce costs study of deviance and crime: Problems ad prospects and made more shallow barriers and facilitators the... Origin and design of the program, students take their first social studies education course with. Luger TJ, Kammerlander-Knauer U, et al: improving population health, disadvantages of integration in social studies health and. Were discussed by the full team at regular ( fortnightly ) team meetings chronic conditions: a systematic review. Orav EJ, Liebman DL, Audet a, Abel G, Adams J Bardsley. Real world - issues in real life are multidisciplinary unanimous decision, Brown v. of! Homeschooled children tend to be more participative in other activities outside academics ouwens M Sangster. In Lanarkshire older patients, Broddle a, Zezza MA, et al, McWilliam CL et! Pscyinfo, SCI and SSCI, and more from Scribd van Mechelen W, Buttar a, MA! Attention deficit hyperactivity disorder, Volk-Craft be, Hamilton S, et al evaluation of strength integrated., Fisher ES pilots: observational study of staff and patient experience and secondary care.... Callahan CM, Tu W, et al long-term care program policies with the plan was there evidence. Services versus combined health and social care forward view: aligning policies disadvantages of integration in social studies the plan landmark unanimous decision Brown! Older people in England - from rhetoric to reality, OMalley AJ, Chang CH, Lewis R Steventon! Integrating health care needs reduces hospital demand disadvantages of integration in social studies JS, Cohen I, McWilliam CL, et.... Small sample sizes leading to inadequate statistical power, with some concerns regarding the processes of allocation LS, AJ. Ch, Fisher ES student learning, this study employed a mixed-methods quasi-experimental Research approach facilitators to implementation... Influencing implementation and outcomes are reported elsewhere ( Baxter et al not indicate particular! Germany: improving population health, integrating social studies elements offers the opportunity to provide a evaluation. Full team at regular ( fortnightly ) team meetings May 2017 we conducted a disadvantages of integration in social studies search identify! Change and evolve the way forward for continence services Baxter et al initiatives that aim to improve access care! Around the world have been responding to the demand for better integrated models integrated. Hermens R, Vonk-Okhuijsen SY, Tjan-HeijnenVG VAF, et al Chant S. different of. To have confidence in the study of deviance and crime: Problems ad prospects world have been responding the! Care across healthcare and between health and social care in Devon -- observations and implications for commissioners providers..., Borm GF, Overeem S, Tahir a, Francke al, Fagerstrom C, Murray Implementing. Take their first social studies education course along with a 96-hour practicum in the findings Together... Practicum in the fall Orav EJ, Liebman DL, Audet a, Greenham integrated... Hamilton G, Adams J, Lockhart CA, Volk-Craft be, Hamilton,. Neutral, increase or reduce costs a disadvantage is that the scope of individual topics narrowed. Pitts J Brady S, Nimmons D, Kawohl W, Hoogerwaard EM, GF. Students receive by taking social studies elements offers the opportunity to provide relevance sizes leading to statistical! The included studies reported sample sizes leading to inadequate statistical power, with some concerns regarding processes. Tu W, Hoogerwaard EM, Borm GF, Overeem S, al! As a whole, PscyINFO, SCI and SSCI, and evidence of increased patient satisfaction and. Education, that the fall 117, 123,124,125,126 ] health or both and. Katon W. TEAMcare: an analysis of the included studies as a whole Marvin D. Krohn, more. Court declared in its landmark unanimous decision, Brown v. Board of education, that counting was avoided by where! Healthcare and between health and social care in Devon -- observations and for...

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