scholarly journals Automatic Digital Analysis of Chromogenic Media for Vancomycin-Resistant-Enterococcus Screens Using Copan WASPLab

2016 ◽  
Vol 54 (10) ◽  
pp. 2464-2469 ◽  
Author(s):  
Matthew L. Faron ◽  
Blake W. Buchan ◽  
Christopher Coon ◽  
Theo Liebregts ◽  
Anita van Bree ◽  
...  
Keyword(s):  
Health Care ◽  
Digital Images ◽  
Package Insert ◽  
Improve Patient Care ◽  
Standard Of Care ◽  
Labor Cost ◽  
High Definition ◽  
Content Type ◽  
Chromogenic Agar ◽  
Vancomycin Resistant

Vancomycin-resistant enterococci (VRE) are an important cause of health care-acquired infections (HAIs). Studies have shown that active surveillance of high-risk patients for VRE colonization can aid in reducing HAIs; however, these screens generate a significant cost to the laboratory and health care system. Digital imaging capable of differentiating negative and “nonnegative” chromogenic agar can reduce the labor cost of these screens and potentially improve patient care. In this study, we evaluated the performance of the WASPLab Chromogenic Detection Module (CDM) (Copan, Brescia, Italy) software to analyze VRE chromogenic agar and compared the results to technologist plate reading. Specimens collected at 3 laboratories were cultured using the WASPLab CDM and plated to each site's standard-of-care chromogenic media, which included Colorex VRE (BioMed Diagnostics, White City, OR) or Oxoid VRE (Oxoid, Basingstoke, United Kingdom). Digital images were scored using the CDM software after 24 or 40 h of growth, and all manual reading was performed using digital images on a high-definition (HD) monitor. In total, 104,730 specimens were enrolled and automation agreed with manual analysis for 90.1% of all specimens tested, with sensitivity and specificity of 100% and 89.5%, respectively. Automation results were discordant for 10,348 specimens, and all discordant images were reviewed by a laboratory supervisor or director. After a second review, 499 specimens were identified as representing missed positive cultures falsely called negative by the technologist, 1,616 were identified as containing borderline color results (negative result but with no package insert color visible), and 8,234 specimens were identified as containing colorimetric pigmentation due to residual matrix from the specimen or yeast (Candida). Overall, the CDM was accurate at identifying negative VRE plates, which comprised 84% (87,973) of the specimens in this study.

scholarly journals A Single Negative Result for van Quantitative PCR on Enrichment Broth Can Replace Five Rectal Swab Cultures in Screening for Vancomycin-Resistant Enterococci

2017 ◽  
Vol 55 (7) ◽  
pp. 2261-2267 ◽  
Author(s):  
J. M. Fonville ◽  
C. M. C. van Herk ◽  
P. H. A. C. Das ◽  
J. H. B. van de Bovenkamp ◽  
L. van Dommelen
Keyword(s):  
Quantitative Pcr ◽  
Rectal Swab ◽  
Agar Plate ◽  
Improve Patient Care ◽  
Blood Agar Plate ◽  
Enrichment Broth ◽  
Content Type ◽  
Chromogenic Agar ◽  
Vancomycin Resistant ◽  
Improve Patient

ABSTRACT The increased incidence of infections by vancomycin-resistant Enterococcus (VRE) causes an accumulation of patients who are either colonized with VRE or flagged as potentially colonized with VRE. Since such patients require precautionary isolation upon admission to a hospital, rapid methods to establish VRE colonization status would improve patient care and optimize hospital operation. We evaluated van quantitative PCR (qPCR) on one enrichment broth as a VRE-screening approach. We obtained 255 sets of five rectal specimens from 243 patients. The specimens were cultured using an amoxicillin-containing enrichment broth. Subsequently, a chromogenic agar was incubated and suspect colonies were inoculated on a blood agar plate and characterized by matrix-assisted laser desorption ionization–time of flight (MALDI-TOF), followed by a vancomycin Etest in cases in which Enterococcus spp. were detected. The culturing results were compared with the outcome of van qPCR on all enrichment broths of the first rectal swab. The van qPCR was positive for 43% of the sample sets ( vanA , n = 5; vanB , n = 101; vanA and vanB , n = 3). Based on culture data, 20 (7.8%) of the sets were VRE positive in at least one of five samples. The negative predictive value of van qPCR on the first enrichment broth was 99.3%. With a cutoff quantification cycle ( C q ) value of >35 to discriminate negative and positive samples, 87% of the negative patients can be identified within a day after obtaining the sample, compared to 7 days in the culturing approach. VRE screening using qPCR on one enrichment broth can quickly identify non-VRE-colonized patients and therefore decrease costs and limit unnecessary isolation restrictions.

scholarly journals Resistance Mechanisms, Epidemiology, and Approaches to Screening for Vancomycin-Resistant Enterococcus in the Health Care Setting

2016 ◽  
Vol 54 (10) ◽  
pp. 2436-2447 ◽  
Author(s):  
Matthew L. Faron ◽  
Nathan A. Ledeboer ◽  
Blake W. Buchan
Keyword(s):  
Health Care ◽  
Infection Control ◽  
Control Strategies ◽  
Resistance Mechanisms ◽  
Clinical Microbiology Laboratory ◽  
Laboratory Methods ◽  
Content Type ◽  
Important Health ◽  
Vancomycin Resistant ◽  
Hospital Acquired

Infections attributable to vancomycin-resistantEnterococcus(VRE) strains have become increasingly prevalent over the past decade. Prompt identification of colonized patients combined with effective multifaceted infection control practices can reduce the transmission of VRE and aid in the prevention of hospital-acquired infections (HAIs). Increasingly, the clinical microbiology laboratory is being asked to support infection control efforts through the early identification of potential patient or environmental reservoirs. This review discusses the factors that contribute to the rise of VRE as an important health care-associated pathogen, the utility of laboratory screening and various infection control strategies, and the available laboratory methods to identify VRE in clinical specimens.

The Future of Telepathology for the Developing World

2011 ◽  
Vol 135 (2) ◽  
pp. 211-214 ◽  
Author(s):  
Charles L Hitchcock
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Digital Images ◽  
Virtual Slide ◽  
Digital Camera ◽  
Improve Patient Care ◽  
Limited Resources ◽  
Software Application ◽  
Open Platform ◽  
Delays In Diagnosis

Abstract Physician shortages are acute in developing countries, where disease burden is the greatest and resources for health care are very limited. A lack of pathologists in these countries has lead to delays in diagnosis and misdiagnoses that adversely affect patient care and survival. The introduction of telepathology into countries with limited resources for health care is but one of multiple approaches that can be used to alleviate the problem. Telepathology is the electronic transmission of digital images that can be used for education and diagnostic consultation. A basic system consists of a microscope with a mounted digital camera linked to a computer. The ability to produce histologic slides, to repair and maintain equipment, and to provide training are also needed for the successful use of this technology. iPath is a Web-based, open platform, software application which was developed at the University of Basel, Switzerland, for telepathology and which brings together pathologists from around the world to provide telepathology support for diagnostic consultation and provides education to centers with limited resources. The use of virtual-slide technology to provide a digital image of an entire glass slide is another technology for diagnostic consultation and pathology education. This technology requires more costly resources to support it, which may limit its utility in many areas. Telepathology can generate collections of digital images and virtual slides needed for training indigenous pathologists in their countries to become self-sufficient. Thus, the long-term goal of this technology is to improve patient care and survival.

scholarly journals Automated Scoring of Chromogenic Media for Detection of Methicillin-Resistant Staphylococcus aureus by Use of WASPLab Image Analysis Software

2015 ◽  
Vol 54 (3) ◽  
pp. 620-624 ◽  
Author(s):  
Matthew L. Faron ◽  
Blake W. Buchan ◽  
Chiara Vismara ◽  
Carla Lacchini ◽  
Alessandra Bielli ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Digital Camera ◽  
Standard Of Care ◽  
Digital Analysis ◽  
Automated Scoring ◽  
Methicillin Resistant ◽  
Content Type ◽  
Specimen Processing ◽  
Chromogenic Agar ◽  
Total Laboratory Automation

Recently, systems have been developed to create total laboratory automation for clinical microbiology. These systems allow for the automation of specimen processing, specimen incubation, and imaging of bacterial growth. In this study, we used the WASPLab to validate software that discriminates and segregates positive and negative chromogenic methicillin-resistantStaphylococcus aureus(MRSA) plates by recognition of pigmented colonies. A total of 57,690 swabs submitted for MRSA screening were enrolled in the study. Four sites enrolled specimens following their standard of care. Chromogenic agar used at these sites included MRSASelect (Bio-Rad Laboratories, Redmond, WA), chromID MRSA (bioMérieux, Marcy l'Etoile, France), and CHROMagar MRSA (BD Diagnostics, Sparks, MD). Specimens were plated and incubated using the WASPLab. The digital camera took images at 0 and 16 to 24 h and the WASPLab software determined the presence of positive colonies based on a hue, saturation, and value (HSV) score. If the HSV score fell within a defined threshold, the plate was called positive. The performance of the digital analysis was compared to manual reading. Overall, the digital software had a sensitivity of 100% and a specificity of 90.7% with the specificity ranging between 90.0 and 96.0 across all sites. The results were similar using the three different agars with a sensitivity of 100% and specificity ranging between 90.7 and 92.4%. These data demonstrate that automated digital analysis can be used to accurately sort positive from negative chromogenic agar cultures regardless of the pigmentation produced.

scholarly journals Evaluation of WASPLab Software To Automatically Read chromID CPS Elite Agar for Reporting of Urine Cultures

2019 ◽  
Vol 58 (1) ◽  
Author(s):  
Matthew L. Faron ◽  
Blake W. Buchan ◽  
Hasan Samra ◽  
Nathan A. Ledeboer
Keyword(s):  
Bacterial Culture ◽  
Urine Culture ◽  
High Sensitivity ◽  
Standard Of Care ◽  
Turnaround Time ◽  
High Definition ◽  
Clinical Laboratories ◽  
Time Stamps ◽  
Chromogenic Agar ◽  
Urine Specimens

ABSTRACT Urine cultures are among the most common specimens received by clinical laboratories and generate a major share of the laboratory workload. Chromogenic agar can expedite culture results, but technologist review is still needed. In this study, we evaluated the ability of the WASPLab software to interpret urine specimens plated onto chromID CPS Elite (CPSE) agar. Urine specimens submitted for bacterial culture were plated onto CPSE agar with a 1-μl loop using the WASP. Each plate was imaged after 0 and 18 h of incubation, and colonies were enumerated by color using the WASPLab software and a technologist’s reading from a high-definition (HD) monitor. The results were reported as negative if <10 colonies/plate were detected. Laboratory information system (LIS) time stamps were used to measure the time to result. A total of 1,581 urine cultures were tested. The sensitivity and specificity of the software were 99.8% and 68.5%, respectively, which included 2 manual-positive/automation-negative (MP/AN) results and 170 manual-negative/automation-positive (MN/AP) results. Of the 170 MN/AP specimens, 116 were caused by microcolonies missed by the technologist. The remaining MN/AP results were caused by either count differences near the 10-colony threshold (n = 43) or count differences of >50 CFU (n = 11). The use of both CPSE agar and the WASPLab software improved the time to result for urine culture, reducing the average time to result by 4 h 42 min for negative specimens and 3 h 28 min for positive specimens compared to that with standard-of-care testing. These data demonstrate that the use of CPSE agar and automated plate reading has the potential to improve turnaround time while maintaining high sensitivity and reducing urine culture workload.

scholarly journals A Phenotypically Silent vanB2 Operon Carried on a Tn1549-Like Element in Clostridium difficile

mSphere ◽  
2016 ◽  
Vol 1 (4) ◽  
Author(s):  
Daniel R. Knight ◽  
Grace O. Androga ◽  
Susan A. Ballard ◽  
Benjamin P. Howden ◽  
Thomas V. Riley
Keyword(s):  
Health Care ◽  
Clostridium Difficile ◽  
Resistance Genes ◽  
Vancomycin Resistance ◽  
Content Type ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Emergence Of Resistance ◽  
First Time

ABSTRACT In an era when the development of new antimicrobial drugs is slow, vancomycin remains the preferred antimicrobial therapy for Clostridium difficile infection (CDI), the most important health care-related infection in the world today. The emergence of resistance to vancomycin would have significant consequences in relation to treating patients with CDI. In this paper, we describe for the first time a complete set of vancomycin resistance genes in C. difficile. The genes were very similar to genes found in vancomycin-resistant enterococci (VRE) that were associated with the emergence and global dissemination of this organism. Fortunately, the C. difficile strain did not show any reduced susceptibility to vancomycin in vitro (MIC, 1 mg/liter), possibly because of a small difference in one gene. However, this observation signals that we may be very close to seeing a fully vancomycin-resistant strain of C. difficile. In the last decade, Clostridium difficile infection (CDI) has reached an epidemic state with increasing incidence and severity in both health care and community settings. Vancomycin is an important first-line therapy for CDI, and the emergence of resistance would have significant clinical consequences. In this study, we describe for the first time a vanB2 vancomycin resistance operon in C. difficile, isolated from an Australian veal calf at slaughter. The operon was carried on an ~42-kb element showing significant homology and synteny to Tn1549, a conjugative transposon linked with the emergence and global dissemination of vancomycin-resistant enterococci (VRE). Notably, the C. difficile strain did not show any reduced susceptibility to vancomycin in vitro (MIC, 1 mg/liter), possibly as a result of an aberrant vanRB gene. As observed for other anaerobic species of the animal gut microbiota, C. difficile may be a reservoir of clinically important vancomycin resistance genes. IMPORTANCE In an era when the development of new antimicrobial drugs is slow, vancomycin remains the preferred antimicrobial therapy for Clostridium difficile infection (CDI), the most important health care-related infection in the world today. The emergence of resistance to vancomycin would have significant consequences in relation to treating patients with CDI. In this paper, we describe for the first time a complete set of vancomycin resistance genes in C. difficile. The genes were very similar to genes found in vancomycin-resistant enterococci (VRE) that were associated with the emergence and global dissemination of this organism. Fortunately, the C. difficile strain did not show any reduced susceptibility to vancomycin in vitro (MIC, 1 mg/liter), possibly because of a small difference in one gene. However, this observation signals that we may be very close to seeing a fully vancomycin-resistant strain of C. difficile.

scholarly journals Genomic Insights to Control the Emergence of Vancomycin-Resistant Enterococci

mBio ◽  
2013 ◽  
Vol 4 (4) ◽  
Author(s):  
Benjamin P. Howden ◽  
Kathryn E. Holt ◽  
Margaret M. C. Lam ◽  
Torsten Seemann ◽  
Susan Ballard ◽  
...  
Keyword(s):  
Health Care ◽  
Infection Control ◽  
Enterococcus Faecium ◽  
De Novo ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Content Type ◽  
New Findings ◽  
Cross Transmission ◽  
Vancomycin Resistant

ABSTRACTNosocomial outbreaks of vancomycin-resistantEnterococcus faecium(VREfm) are thought to occur by transmission of VREfm between patients, predicting that infection control interventions will limit cross-transmission. Despite implementation of such strategies, the incidence of VREfm infections continues to rise. We aimed to use genomics to better understand the epidemiology ofE. faeciumwithin a large hospital and investigate the reasons for failure of infection control strategies. Whole-genome sequencing was performed on 61E. faecium(36 VREfm) isolates, predominately from blood cultures collected at a single hospital between 1998 and 2009, and on fivevanB-positive anaerobic commensal bacteria isolated from human feces. Phylogenomic analysis and precise mapping of thevanBgene, which contains the Tn1549transposon, showed that at least 18 of the 36 VREfm isolates had acquired the transposon via independent insertion events, indicatingde novogeneration of VREfm rather than cross-transmission. Furthermore, Tn1549sequences found in 15 of the 36 VREfm isolates were the same as the Tn1549sequence from one of the gut anaerobes. National and international comparatorE. faeciumisolates were phylogenetically interspersed with isolates from our hospital, suggesting that our findings might be globally representative. These data demonstrate that VREfm generation within a patient is common, presumably occurring in the human bowel during antibiotic therapy, and help explain our inability to reduce VREfm infections. A recommendation from our findings is that infection control practices should include screening patients for specific hospital clones of vancomycin-susceptibleE. faeciumrather than just VREfm.IMPORTANCEEnterococcus faeciumis an increasingly important human pathogen causing predominantly antibiotic-resistant infections in hospitalized patients. Large amounts of health care funding are spent trying to control antibiotic-resistant bacteria in hospitals globally, yet in many institutions around the world, vancomycin-resistantE. faecium(VREfm) infections continue to rise. The new findings from this study help explain the failures of our current approaches to controllingvanBVREfm in health care institutions. Given the importance of this bacterium as a cause of hospital-acquired infections and the difficulties faced by infection control units in trying to prevent colonization in their institutions, the novel findings from this study provide evidence that a new approach to controlling VREfm in hospitals is required. In particular, more attention should be given to understanding the epidemiology of hospital-adapted vancomycin-susceptibleE. faecium, and patients at higher risk forde novogeneration of VREfm need to be identified and optimally managed.

scholarly journals 1758. Impact of Accelerate Pheno™ Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S61-S61 ◽  
Author(s):  
Ryan Dare ◽  
Kelsey McCain ◽  
Katherine Lusardi ◽  
Kay Daniels ◽  
Jacob Painter ◽  
...  
Keyword(s):  
Blood Culture ◽  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Detection System ◽  
Positive Culture ◽  
Retrospective Chart Review ◽  
Improve Patient Care ◽  
Standard Of Care ◽  
Historical Cohort ◽  
Stewardship Program

Abstract Background Molecular-based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate Pheno™ blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture. Methods This is a single-center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected February–March 2018 (intervention) and compared with a January–April 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4. Results Of the 143 positive cultures performed on ACCEL during intervention, 118 (83%) were identified as on-panel organisms. Seventy-five (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (P = NS), MEWS severity score (P = 0.10), source of bacteremia (P = NS), and pathogen detected (P = 0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7 hours vs. 53.8 ± 20.9 hours; P &lt; 0.001) and AST (31.9 ± 11 hours vs. 71.8 ± 20 hours; P &lt; 0.001) were shorter in the intervention arm. Conclusion Compared with standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. The use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings. Disclosures All authors: No reported disclosures.

Commentary on “Diabetes and people with learning disabilities: issues for policy, practice and education”

2020 ◽  
Vol 25 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Brianne Redquest ◽  
Yona Lunsky
Keyword(s):  
Health Care ◽  
Learning Disabilities ◽  
Health Care Providers ◽  
Diabetes Care ◽  
Future Research ◽  
Care Providers ◽  
Family Carers ◽  
Content Type ◽  
Policy Practice

Purpose There has been an increase in research exploring the area of intellectual and developmental disabilities (IDD) and diabetes. Despite being described as instrumental to diabetes care for people with IDD, the role and experiences of family carers, such as parents and siblings, are often neglected in this research. However, it is clear that family carers do not feel that they have sufficient knowledge about diabetes. The purpose of this commentary is to extend the content from “Diabetes and people with learning disabilities: Issues for policy, practice, and education (Maine et al., 2020)” and discuss how family carers can feel better supported when caring for someone with IDD and diabetes. Design/methodology/approach This commentary discusses specific efforts such as STOP diabetes, DESMOND-ID and OK-diabetes for people with IDD including family carers. Encouragement is given for health care providers to recommend such programmes to people with IDD and their family carers. It is also suggested that health care providers involve family carers in diabetes care planning and implementation for people with IDD. Findings It is hoped that if changes are made to current diabetes practices and more research with family carers is conducted, diabetes prevention and management for people with IDD will be more successful and family carers can feel more confident in providing support to their loved ones. Originality/value Research exploring the role of family carers in diabetes care for people with IDD and diabetes is very limited. This commentary makes recommendations to help family carers feel better supported in their role. It also provides areas for future research.

scholarly journals Improved Estimation of Winter Wheat Aboveground Biomass Using Multiscale Textures Extracted from UAV-Based Digital Images and Hyperspectral Feature Analysis

2021 ◽  
Vol 13 (4) ◽  
pp. 581 ◽  
Author(s):  
Yuanyuan Fu ◽  
Guijun Yang ◽  
Xiaoyu Song ◽  
Zhenhong Li ◽  
Xingang Xu ◽  
...  
Keyword(s):  
Winter Wheat ◽  
Least Squares ◽  
Aboveground Biomass ◽  
Regression Models ◽  
Digital Images ◽  
Predictive Performance ◽  
Estimation Accuracy ◽  
Support Vector ◽  
Biomass Estimation ◽  
High Definition

Rapid and accurate crop aboveground biomass estimation is beneficial for high-throughput phenotyping and site-specific field management. This study explored the utility of high-definition digital images acquired by a low-flying unmanned aerial vehicle (UAV) and ground-based hyperspectral data for improved estimates of winter wheat biomass. To extract fine textures for characterizing the variations in winter wheat canopy structure during growing seasons, we proposed a multiscale texture extraction method (Multiscale_Gabor_GLCM) that took advantages of multiscale Gabor transformation and gray-level co-occurrency matrix (GLCM) analysis. Narrowband normalized difference vegetation indices (NDVIs) involving all possible two-band combinations and continuum removal of red-edge spectra (SpeCR) were also extracted for biomass estimation. Subsequently, non-parametric linear (i.e., partial least squares regression, PLSR) and nonlinear regression (i.e., least squares support vector machine, LSSVM) analyses were conducted using the extracted spectral features, multiscale textural features and combinations thereof. The visualization technique of LSSVM was utilized to select the multiscale textures that contributed most to the biomass estimation for the first time. Compared with the best-performing NDVI (1193, 1222 nm), the SpeCR yielded higher coefficient of determination (R2), lower root mean square error (RMSE), and lower mean absolute error (MAE) for winter wheat biomass estimation and significantly alleviated the saturation problem after biomass exceeded 800 g/m2. The predictive performance of the PLSR and LSSVM regression models based on SpeCR decreased with increasing bandwidths, especially at bandwidths larger than 11 nm. Both the PLSR and LSSVM regression models based on the multiscale textures produced higher accuracies than those based on the single-scale GLCM-based textures. According to the evaluation of variable importance, the texture metrics “Mean” from different scales were determined as the most influential to winter wheat biomass. Using just 10 multiscale textures largely improved predictive performance over using all textures and achieved an accuracy comparable with using SpeCR. The LSSVM regression model based on the combination of the selected multiscale textures, and SpeCR with a bandwidth of 9 nm produced the highest estimation accuracy with R2val = 0.87, RMSEval = 119.76 g/m2, and MAEval = 91.61 g/m2. However, the combination did not significantly improve the estimation accuracy, compared to the use of SpeCR or multiscale textures only. The accuracy of the biomass predicted by the LSSVM regression models was higher than the results of the PLSR models, which demonstrated LSSVM was a potential candidate to characterize winter wheat biomass during multiple growth stages. The study suggests that multiscale textures derived from high-definition UAV-based digital images are competitive with hyperspectral features in predicting winter wheat biomass.

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