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[PMID]:29360310
[Au] Autor:Fleming JA; Brude SB; Thomson Reuters Accelus.
[Ti] Título:Medicaid Provider Tax.
[So] Source:Issue Brief Health Policy Track Serv;2017:1-18, 2017 Dec 26.
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Economia Hospitalar/legislação & jurisprudência
Medicaid/economia
Medicaid/legislação & jurisprudência
Impostos/legislação & jurisprudência
[Mh] Termos MeSH secundário: Educação de Pós-Graduação em Medicina
Governo Federal
Honorários e Preços
Financiamento Governamental
Seres Humanos
Programas de Assistência Gerenciada
Governo Estadual
Impostos/economia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE


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[PMID]:29365282
[Au] Autor:Desai S; McWilliams JM
[Ad] Endereço:From the Department of Population Health, New York University, New York (S.D.); and the Department of Health Care Policy, Harvard Medical School (S.D., J.M.M.), and the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (J.M.M.) - both in Boston.
[Ti] Título:Consequences of the 340B Drug Pricing Program.
[So] Source:N Engl J Med;378(6):539-548, 2018 02 08.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The 340B Drug Pricing Program entitles qualifying hospitals to discounts on outpatient drugs, increasing the profitability of drug administration. By tying the program eligibility of hospitals to their Disproportionate Share Hospital (DSH) adjustment percentage, which reflects the proportion of hospitalized patients who are low-income, the program is intended to expand resources for underserved populations but provides no direct incentives for hospitals to use financial gains to enhance care for low-income patients. METHODS: We used Medicare claims and a regression-discontinuity design, taking advantage of the threshold for program eligibility among general acute care hospitals (DSH percentage, >11.75%), to isolate the effects of the program on hospital-physician consolidation (i.e., acquisition of physician practices or employment of physicians by hospitals) and on the outpatient administration of parenteral drugs by hospital-owned facilities in three specialties in which parenteral drugs are frequently used. For low-income patients, we also assessed the effects of the program on the provision of care by hospitals and on mortality. RESULTS: Hospital eligibility for the 340B Program was associated with 2.3 more hematologist-oncologists practicing in facilities owned by the hospital, or 230% more hematologist-oncologists than expected in the absence of the program (P=0.02), and with 0.9 (or 900%) more ophthalmologists per hospital (P=0.08) and 0.1 (or 33%) more rheumatologists per hospital (P=0.84). Program eligibility was associated with significantly higher numbers of parenteral drug claims billed by hospitals for Medicare patients in hematology-oncology (90% higher, P=0.001) and ophthalmology (177% higher, P=0.03) but not rheumatology (77% higher, P=0.12). Program eligibility was associated with lower proportions of low-income patients in hematology-oncology and ophthalmology and with no significant differences in hospital provision of safety-net or inpatient care for low-income groups or in mortality among low-income residents of the hospitals' local service areas. CONCLUSIONS: The 340B Program has been associated with hospital-physician consolidation in hematology-oncology and with more hospital-based administration of parenteral drugs in hematology-oncology and ophthalmology. Financial gains for hospitals have not been associated with clear evidence of expanded care or lower mortality among low-income patients. (Funded by the Agency for Healthcare Research and Quality and others.).
[Mh] Termos MeSH primário: Custos de Medicamentos
Economia Hospitalar
Convênios Médico-Hospitalares/estatística & dados numéricos
Medicare Part B/economia
Pobreza
Mecanismo de Reembolso
[Mh] Termos MeSH secundário: Custos e Análise de Custo
Hematologia
Hospitais/estatística & dados numéricos
Seres Humanos
Oncologia
Mortalidade
Oftalmologia
Propriedade
Provedores de Redes de Segurança/economia
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMsa1706475


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[PMID]:29365283
[Au] Autor:Gellad WF; James AE
[Ad] Endereço:From the Division of General Medicine and the Center for Pharmaceutical Policy and Prescribing (W.F.G.) and the Health Policy Institute and Department of Health Policy and Management, Graduate School of Public Health (A.E.J.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System (W.F.G.) - both in Pittsburgh.
[Ti] Título:Discounted Drugs for Needy Patients and Hospitals - Understanding the 340B Debate.
[So] Source:N Engl J Med;378(6):501-503, 2018 Feb 08.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Custos de Medicamentos
Economia Hospitalar
Medicare Part B/economia
Pobreza
Mecanismo de Reembolso
[Mh] Termos MeSH secundário: Hospitais
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMp1716139


  4 / 10093 MEDLINE  
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[PMID]:29338028
[Au] Autor:Chen F; Yang M; Li Q; Pan J; Li X; Meng Q
[Ad] Endereço:West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
[Ti] Título:Does providing more services increase the primary hospitals' revenue? An assessment of national essential medicine policy based on 2,675 counties in China.
[So] Source:PLoS One;13(1):e0190855, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To understand whether the increased outpatient service provision (OSP) brings in enough additional income (excluding income from essential medicine) for primary hospitals (INCOME) to compensate for reduced costs of medicine. METHODS: The two outcomes, annual OSP and INCOME for the period of 2008-2012, were collected from 34,506 primary hospitals in 2,675 counties in 31 provinces in China by the national surveillance system. The data had a four-level hierarchical structure; time points were nested within primary hospital, hospitals within county, and counties within province. We fitted bivariate five-level random effects regression models to examine correlations between OSP and INCOME in terms of their mean values and dose-response effects of the essential medicine policy (EMP). We adjusted for the effects of time period and selected hospital resources. FINDINGS: The estimated correlation coefficients between the two outcomes' mean values were strongly positive among provinces (r = 0.910), moderately positive among counties (r = 0.380), and none among hospitals (r = 0.002) and time (r = 0.007). The correlation between their policy effects was weakly positive among provinces (r = 0.234), but none at the county and hospital levels. However, there were markedly negative correlation coefficients between the mean and policy effects at -0.328 for OSP and -0.541 for INCOME at the hospital level. CONCLUSION: There was no evidence to suggest an association between the two outcomes in terms of their mean values and dose-response effects of EMP at the hospital level. This indicated that increased OSP did not bring enough additional INCOME. Sustainable mechanisms to compensate primary hospitals are needed.
[Mh] Termos MeSH primário: Medicamentos Essenciais/economia
Economia Hospitalar
Política de Saúde/economia
[Mh] Termos MeSH secundário: China
Reforma dos Serviços de Saúde/economia
Pesquisas sobre Serviços de Saúde/economia
Recursos em Saúde/economia
Hospitais
Seres Humanos
Modelos Econômicos
Avaliação de Resultados (Cuidados de Saúde)
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Drugs, Essential)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180117
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190855


  5 / 10093 MEDLINE  
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[PMID]:29319943
[Au] Autor:Office of the Secretary, Department of Defense (DoD).
[Ti] Título:TRICARE; Reimbursement of Long Term Care Hospitals and Inpatient Rehabilitation Facilities. Final rule.
[So] Source:Fed Regist;82(249):61678-94, 2017 Dec 29.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This final rule establishes reimbursement rates for Long Term Care Hospitals (LTCHs) and Inpatient Rehabilitation Facilities (IRFs) in accordance with the statutory requirement that TRICARE inpatient care "payments shall be determined to the extent practicable in accordance with the same reimbursement rules as apply to payments to providers of services of the same type under Medicare." This final rule adopts Medicare's reimbursement methodologies for inpatient services provided by LTCHs and IRFs. Each reimbursement methodology will be phased in over a 3-year period. This final rule also removes the definitions for "hospital, long-term (tuberculosis, chronic care, or rehabilitation)" and "long-term hospital care," and creates separate definitions for "Long Term Care Hospital" and "Inpatient Rehabilitation Facility" adopting Centers for Medicare & Medicaid Services (CMS) classification criteria. This final rule also includes authority for a year-end, discretionary General Temporary Military Contingency Payment Adjustment (GTMCPA) for inpatient services in TRICARE network IRFs when deemed essential to meet military contingency requirements.
[Mh] Termos MeSH primário: Planos de Assistência de Saúde para Empregados/economia
Reembolso de Seguro de Saúde/economia
Assistência de Longa Duração/economia
Centros de Reabilitação/economia
Mecanismo de Reembolso/economia
Instituições de Cuidados Especializados de Enfermagem/economia
[Mh] Termos MeSH secundário: Economia Hospitalar
Seres Humanos
Militares
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180122
[Lr] Data última revisão:
180122
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE


  6 / 10093 MEDLINE  
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[PMID]:29232088
[Au] Autor:Dobson A; DaVanzo JE; Haught R; Phap-Hoa L
[Ad] Endereço:Dobson DaVanzo & Associates, LLC.
[Ti] Título:Comparing the Affordable Care Act's Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not.
[So] Source:Issue Brief (Commonw Fund);2017:1-10, 2017 Nov 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: Safety-net hospitals play a vital role in delivering health care to Medicaid enrollees, the uninsured, and other vulnerable patients. By reducing the number of uninsured Americans, the Affordable Care Act (ACA) was also expected to lower these hospitals' significant uncompensated care costs and shore up their financial stability. Goal: To examine how the ACA's Medicaid expansion affected the financial status of safety-net hospitals in states that expanded Medicaid and in states that did not. Methods: Using Medicare hospital cost reports for federal fiscal years 2012 and 2015, the authors compared changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins. Findings and Conclusions: Medicaid expansion had a significant, favorable financial impact on safety-net hospitals. From 2012 to 2015, safety-net hospitals in expansion states, compared to those in nonexpansion states, experienced larger increases in Medicaid inpatient days and Medicaid revenues as well as reduced uncompensated care costs. These changes improved operating margins for safety-net hospitals in expansion states. Margins for safety-net hospitals in nonexpansion states, meanwhile, declined.
[Mh] Termos MeSH primário: Economia Hospitalar/legislação & jurisprudência
Economia Hospitalar/estatística & dados numéricos
Medicaid/economia
Medicaid/legislação & jurisprudência
Patient Protection and Affordable Care Act/economia
Provedores de Redes de Segurança/economia
Provedores de Redes de Segurança/legislação & jurisprudência
Cuidados de Saúde não Remunerados/economia
Cuidados de Saúde não Remunerados/legislação & jurisprudência
[Mh] Termos MeSH secundário: Seres Humanos
Medicaid/estatística & dados numéricos
Provedores de Redes de Segurança/estatística & dados numéricos
Governo Estadual
Cuidados de Saúde não Remunerados/estatística & dados numéricos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE


  7 / 10093 MEDLINE  
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[PMID]:29208839
[Au] Autor:Mohan A; Kaur N; Bhatanagar VC
[Ad] Endereço:Department of Community Ophthalmology, Global Hospital Institute of Ophthalmology, Abu Road, Sirohi, Rajasthan, India.
[Ti] Título:Safety, efficacy and cost-effectiveness of consecutive bilateral cataract surgery on two successive days in tribes at base hospital through community outreach program: A prospective study of Aravali Mountain, North West India.
[So] Source:Indian J Ophthalmol;65(12):1477-1482, 2017 Dec.
[Is] ISSN:1998-3689
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The aim of the study was to evaluate the safety and efficacy of consecutive bilateral cataract surgery (CBCS) on two successive days in a single hospital visit. METHODS: Prospective study was conducted on 565 patients of various tribes of hilly area of West Rajasthan who had come to our hospital through community outreach programmed (CORP) between January 2015 and March 2016. Patients with significant bilateral cataract without any other ocular morbidity were advised bilateral manual small incision cataract surgery on two consecutive days. Intraoperative and postoperative complications were evaluated, and follow-up was done at 1 week, 1 month, and 3 months. RESULTS: Out of 565 patients, 519 underwent both eye surgeries. Second eye surgery was deferred for a later date in 46 cases. Because of intraoperative and postoperative complications in the first eye, 31 had delayed surgeries while 15 patients refused to undergo another eye surgery either because of postoperative day 1 poor vision in the operated eye due to retinal pathologies (n = 8) or unwillingness (n = 7). The second eye surgery was performed for 519 patients, out of whom six had intra or postoperative complications. At 1 month follow-up, four patients had unilateral cystoid macular edema and three had prolonged postoperative inflammation. At 3 months, all patients were satisfied and had no complications. None of the patients had sight-threatening complications such as endophthalmitis, corneal decompensation, or vitreoretinal complications. CONCLUSION: CBCS may be considered safe and cost-effective for patients living in remote locations, dependent on CORP.
[Mh] Termos MeSH primário: Extração de Catarata/métodos
Economia Hospitalar
Hospitais
Complicações Intraoperatórias/epidemiologia
Complicações Pós-Operatórias/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Extração de Catarata/economia
Relações Comunidade-Instituição
Análise Custo-Benefício
Feminino
Seguimentos
Seres Humanos
Incidência
Índia/epidemiologia
Complicações Intraoperatórias/economia
Masculino
Meia-Idade
Procedimentos Cirúrgicos Minimamente Invasivos/economia
Procedimentos Cirúrgicos Minimamente Invasivos/métodos
Complicações Pós-Operatórias/economia
Estudos Prospectivos
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180103
[Lr] Data última revisão:
180103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE
[do] DOI:10.4103/ijo.IJO_641_17


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[PMID]:27770842
[Au] Autor:Doroghazi RM
[Ad] Endereço:The Physician Investor Newsletter, Columbia, Mo. Electronic address: rdoroghazi@yahoo.com.
[Ti] Título:Negative Secular Trends in Medicine: High Hospital Profits.
[So] Source:Am J Med;129(11):1141-1142, 2016 Nov.
[Is] ISSN:1555-7162
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Economia Hospitalar/tendências
Organizações sem Fins Lucrativos/economia
[Mh] Termos MeSH secundário: Seres Humanos
Estados Unidos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171205
[Lr] Data última revisão:
171205
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29045205
[Au] Autor:Zuckerman RB; Joynt Maddox KE; Sheingold SH; Chen LM; Epstein AM
[Ad] Endereço:From the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, DC (R.B.Z., K.E.J.M., S.H.S., L.M.C.); Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital - both in Boston (K.E.J.M., A.M.E.); and the Division of Inte
[Ti] Título:Effect of a Hospital-wide Measure on the Readmissions Reduction Program.
[So] Source:N Engl J Med;377(16):1551-1558, 2017 10 19.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The Hospital Readmissions Reduction Program penalizes hospitals that have high 30-day readmission rates across specific conditions. There is support for changing to a hospital-wide readmission measure to broaden hospital eligibility and provide incentives for improvement across more conditions. METHODS: We used Medicare claims from 2011 through 2013 to evaluate the number of hospitals that were eligible for penalties, in that they met a volume threshold of 25 admissions over a 3-year period for a specific condition or 25 admissions over a 1-year period for the cohorts included in the hospital-wide measure. We estimated the expected effects that changing from the condition-specific readmission measures to a hospital-wide measure would have on average penalties for safety-net hospitals (i.e., hospitals that treat a large proportion of low-income patients) and other hospitals. RESULTS: Our sample included 6,807,899 admissions for the hospital-wide measure and 4,392,658 admissions for the condition-specific measures. Of 3443 hospitals, 688 were considered to be safety-net hospitals. Changing to the hospital-wide measure would result in 76 more hospitals being eligible to receive penalties. The hospital-wide measure would increase penalties (mean [±SE] Medicare payment reductions across all hospitals) from 0.42±0.01% to 0.89±0.01% of Medicare base diagnosis-related-group payments. It would also increase the disparity in penalties between safety-net hospitals and other hospitals from -0.03±0.02 to 0.41±0.06 percentage points. CONCLUSIONS: A transition to a hospital-wide readmission measure would only modestly increase the number of hospitals eligible for penalties and would substantially increase the penalties for safety-net hospitals.
[Mh] Termos MeSH primário: Hospitais/estatística & dados numéricos
Readmissão do Paciente/estatística & dados numéricos
Provedores de Redes de Segurança/estatística & dados numéricos
[Mh] Termos MeSH secundário: Centers for Medicare and Medicaid Services (U.S.)
Economia Hospitalar
Medicare
Reembolso de Incentivo
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, U.S. GOV'T, P.H.S.
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171019
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMsa1701791


  10 / 10093 MEDLINE  
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[PMID]:29028756
[Au] Autor:Chen HF; Karim S; Wan F; Nevola A; Morris ME; Bird TM; Tilford JM
[Ad] Endereço:Departments of *Health Policy and Management †Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR.
[Ti] Título:Financial Performance of Hospitals in the Mississippi Delta Region Under the Hospital Readmissions Reduction Program and Hospital Value-based Purchasing Program.
[So] Source:Med Care;55(11):924-930, 2017 Nov.
[Is] ISSN:1537-1948
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Previous studies showed that the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) disproportionately penalized hospitals caring for the poor. The Mississippi Delta Region (Delta Region) is among the most socioeconomically disadvantaged areas in the United States. The financial performance of hospitals in the Delta Region under both HRRP and HVBP remains unclear. OBJECTIVE: To compare the differences in financial performance under both HRRP and HVBP between hospitals in the Delta Region (Delta hospitals) and others in the nation (non-Delta hospitals). RESEARCH DESIGN: We used a 7-year panel dataset and applied difference-in-difference models to examine operating and total margin between Delta and non-Delta hospitals in 3 time periods: preperiod (2008-2010); postperiod 1 (2011-2012); and postperiod 2 (2013-2014). RESULTS: The Delta hospitals had a 0.89% and 4.24% reduction in operating margin in postperiods 1 and 2, respectively, whereas the non-Delta hospitals had 1.13% and 1% increases in operating margin in postperiods 1 and 2, respectively. The disparity in total margins also widened as Delta hospitals had a 1.98% increase in postperiod 1, but a 0.30% reduction in postperiod 2, whereas non-Delta hospitals had 1.27% and 2.28% increases in postperiods 1 and 2, respectively. CONCLUSIONS: The gap in financial performance between Delta and non-Delta hospitals widened following the implementation of HRRP and HVBP. Policy makers should modify these 2 programs to ensure that resources are not moved from the communities that need them most.
[Mh] Termos MeSH primário: Economia Hospitalar/organização & administração
Programas Governamentais/estatística & dados numéricos
Readmissão do Paciente/economia
Avaliação de Programas e Projetos de Saúde/economia
Aquisição Baseada em Valor/economia
[Mh] Termos MeSH secundário: Programas Governamentais/métodos
Seres Humanos
Mississippi
Estados Unidos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171014
[St] Status:MEDLINE
[do] DOI:10.1097/MLR.0000000000000808



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