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2016 China-US DBP Academic Seminar Held in Beijing

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The “Beijing Developmental Behavioral Pediatrics Forum” and “2016 China-U.S. Developmental Behavioral Pediatrics Academic Seminar” were successfully held at Shunyi Women and Children’s Hospital of Beijing Children’s Hospital on 14 October 2016. This seminar was organized by the Developmental Behavioral Pediatrics Group of the Beijing Medical Association Pediatrics Branch, Shunyi Women and Children’s Hospital of Beijing Children’s Hospital, and LIH Olivia’s Place.

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LIH Olivia’s Place invited developmental behavioral and rehabilitation pediatricians from Indiana University to introduce progress in developmental behavioral pediatrics, attracting numerous professionals, pediatricians, and therapists. This seminar was supported by Director Liang Aimin, Vice-Chairman of the Group of Developmental Behavioral Pediatrics of the Pediatrics Branch of Beijing Medical Association. President Du Zhongdong and President Meng Zhansong from Shunyi Women and Children’s Hospital of Beijing Children’s Hospital participated, as well as professionals from pediatric rehabilitation departments, and Hu Dai, Managing Director of LIH Olivia’s Place Beijing. President Du gave remarks on behalf of Qin Jiong, Chairman of the Beijing Medical Association, Developmental Behavioral Pediatrics Group.

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The academic seminar provided a collegial atmosphere. Firstly, Dr. Deanna Willis, Vice Chair of Research, Department of Family Medicine, Indiana University Health, introduced “How to Improve Medical Quality,” and “How to study the Impact of Customer Requirements on Customer Satisfaction by Application of the Kano Model,” She discussed the significance of change and summarized eight steps to successful change.

Dr. Deborah Hamby, expert in developmental behavioral pediatrics and neural rehabilitation at Riley Children’s Hospital in Indiana, shared information on evaluation and treatment of children with Down syndrome. Dr. Charles Dietzen, who specializes in pediatric rehabilitation at IU Health, discussed “Cerebral Palsy and Spasticity Management.” Dr. Fengyi Kuo, Occupational Therapist at LIH Olivia’s Place, presented on the topics of “Family-centered Early Intervention and Therapy for Autistic Children” and “Sensory Integration.”

At the conclusion of the seminar, Director Liang Aimin commented that the success of this seminar has not only promoted academic communication between Chinese and American developmental behavioral pediatricians. The event provided motivation for clinicians specializing in developmental and rehabilitative pediatrics to follow, learn, and apply advanced technology trends.


Shanghai Team Hosts ‘Pop Up’ Conference on Autism

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The Shanghai team, supported by LIH Healthcare Chief Developmental Behavioral Pediatrician Dr. Raymond Tervo, offered a daylong training on assessment and intervention for autism through different pathways. Speakers at the November 18 event included pediatricians, speech-language therapists, occupational therapists, psychologists, and behavioral therapists.  The ‘pop up’ event was attended by approximately 60 invited guests. Dr. Tervo opened the day’s discussions with an introduction to current theory and practice in the area of autism. A number of the clinicians from our team spoke on autism-related topics, interventions and clinical experience. We were delighted to see so many familiar and new faces from the educational and medical communities of Shanghai, Suzhou, and Nanjing. Watch out for details of our next “pop –up” conference in the near future or contact Heidi Gao for more information.

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What is a Shadow Teacher?

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Akshata Kamath, Learning Support Specialist, Shanghai

Akshata Kamath, Learning Support Specialist, Shanghai

Children in schools are taught to develop academic skills, social skills, and independence. Teachers assist children to develop knowledge and gain an understanding of the world around them.  Besides learning academics, teachers help children to understand the rules of play and social interaction, sharing and caring. However, not all children learn at the same pace as their peers and may need additional support in some areas. This is where the role of the shadow teacher, or one on one support, begins.
By definition, a shadow teacher is an educational assistant who works directly with a single child with special needs during his/her early school years. These assistants understand a variety of learning disabilities and how to support them accordingly. Providing a shadow teacher allows the child to attend a mainstream class while receiving the extra attention that he/she needs. Shadow teachers are often referred to as paraprofessionals, student aides, teacher aides and even student tutors.
Shadow teaching is a progressive form of assistance that acts as a resource for the school and the parent. Communication and collaboration between the shadow teacher, the classroom teacher, and the parents is essential when striving for success. Meaningful relationships must be established to best meet the needs of the child. The shadow teacher helps provide the student with continuity in their classes, instills responsibility, fosters independence, and encourages learning.
The role of a shadow teacher is to support the student at school by helping fill in the gaps in the learning process, to help the student build self-confidence, as well as to promote positive interaction in the classroom by helping the student focus on important concepts, and overall help the student to develop academic and social skills. Every child is unique; therefore, the approach and teaching methods and techniques used by each shadow teacher is designed based on the needs of the individual student.

When we hear about the typical day of a shadow teacher, one cannot help but to be impressed! Accompanying a student throughout the school day to provide support and stability is just one of the many things a shadow teacher does. Regardless of the grade or year level in which a shadow teacher is working, all shadow teachers serve a similar role: to help their students adapt to the school environment and to provide strategies that are necessary for growth. A shadow teacher can also be referred to as a skilled educator who works alongside the teacher in the classroom to provide academic, social, behavioral and emotional support to students with learning differences. The increasing number of shadow teachers over the past several years is a clear indication of the vital service that they provide to their students.

Shadowing a student requires that one understand how a child’s age, grade-level, background and social-emotional development interact with the student’s academic abilities and learning style to determine strategies for success. Often times, the teacher’s character and educational philosophy are also key components.
The key ingredients for successful shadow teaching are patience and cooperation. Collaboration and open communication channels between members of the child’s support system are key to achieve his/her target goals. Shadow teachers help students to realize their abilities, uniqueness, and potential, while assisting the classroom teacher to do the same. Ultimately, shadow teachers establish the foundation for students to have an equal opportunity to the excellent education.


Strategic Partnership Supports DBP Learning: First LIH Healthcare International Observership Launched

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Children’s Specialized Hospital, one of the largest providers in inpatient and outpatient care for children with special health challenges received its first developmental behavior pediatrician (DBP) international trainees, Dr. Amy Meng and Dr. Li Liu from China on November 1, 2016. As the two delegates selected by LIH Healthcare and its local partner healthcare organization, Beijing Children’s Hospital, both Dr. Meng and Dr. Liu have a strong background in pediatrics and are committed to bringing internationally proven DBP practices back to China through firsthand clinical experience in an intensive 2-month observership program.

The program is designed with the goal of extensive exposure to the most advanced practices in the field of developmental behavioral pediatrics, with not only direct clinical observation but also ample educational opportunities within a multi-disciplinary team working environment. “Many training activities that we have here are the same as the ones they design for local DBP fellows. We have all heard about popular assessments and evaluations, but important pieces such as the interpretation and implication of the evaluation, and outcomes measures are quite missing in China due to the lack of training in this area. It is exactly how I want to learn DBP, such a wonderful learning opportunity that LIH provides” said by Dr. Liu, Director of the Pediatrics Wellness Program at Beijing Children’s Hospital. Dr. Meng, who practices at LIH Olivia’s Place in Beijing, has routinely encountered patients and families who are facing the challenges associated with diagnoses such as autism spectrum disorder, and attention-deficit/hyperactivity disorder. “We have growing number of patients that require customized treatment. My focus would be learning how to manage cases by using a multi-disciplinary team approach and how to create a seamless workflow to ensure the highest quality service delivered to our patients.”

Since announcement of the official partnership with Children’s Specialized Hospital in New Jersey, US in 2015, management from both organizations has been dedicated to promoting customized training, including direct contact between the employees, bi-weekly training in both clinical and operational and operational areas, and creating a long-term training support system to support LIH Healthcare as we meet the challenge of providing high quality rehabilitative services for people across China.

With an aligned vision to bring high quality, family-centered, evidence-based care and services, the two organizations are working closely to become powerful allies in the journey to create high-value healthcare. Michael Dribbon, Vice President of Business Development of Children’s Specialized Hospital commented “We are very pleased to form a strategic partnership with LIH. The partnership can help us define exciting new opportunities such as the International Observership Program that may lead to change and transformation.”

Left to Right: Michael Dribbon, VP of Business Development, Children’s Specialized Hospital, Anita Lin, LIH Healthcare (US), Dr. Amy Meng, Pediatrician, LIH Olivia’s Place Beijing, Dr. Li Liu, Director of Pediatrics Wellness Program, Beijing Children’s Hospital, Dr. Christopher Haines, Chief Medical Officer, Children’s Specialized Hospital

Left to Right: Michael Dribbon, VP of Business Development, Children’s Specialized Hospital, Anita Lin, LIH Healthcare (US), Dr. Amy Meng, Pediatrician, LIH Olivia’s Place Beijing, Dr. Li Liu, Director of Pediatrics Wellness Program, Beijing Children’s Hospital, Dr. Christopher Haines, Chief Medical Officer, Children’s Specialized Hospital

About LIH Healthcare

LIH Healthcare is licensed by Beijing, P.R.C as a comprehensive rehabilitation services company. LIH Healthcare has a wide health care network both domestically and internationally, focused on managing, innovating, and expanding rehabilitation care throughout China. LIH Olivia’s Place, an LIH Healthcare subsidiary, provides pediatric developmental and rehabilitative services in China. To learn more about LIH Healthcare, visit http://www.lih-invest.com (Chinese-language web site)

 

About Children’s Specialized Hospital

Children’s Specialized Hospital is the nation’s leading provider of inpatient and outpatient care for children from birth to 21 years of age facing special health challenges — from chronic illnesses and complex physical disabilities like brain and spinal cord injuries, to developmental and behavioral issues like autism and mental health. At 12 different New Jersey locations, CSH pediatric specialists partner with families to make innovative therapies and medical treatments more personalized and effective – so children can achieve more of their goals. Visit https://www.childrens-specialized.org/

 

Contact

Anita Lin

LIH Healthcare US Office

Email: anita@lih-invest.com

Phone: 1+734-925-6292


Training Deepens Bond with Shepherd’s Field Children’s Village

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An overwhelming majority of infants and children in China’s welfare centers have a disability. Abandoned by their birth parents because they could not care for them medically or financially, these orphans have a range of disabilities ranging from the easily treatable to high-risk special needs children.

sfcv-groupBut this doesn’t mean orphans don’t have people who love and care for them. Some of the most at-risk orphans are sent to private foster care centers around China. Shepherd’s Field Children’s Village is one of them.

 

Shepherd’s Field was started in the late 1990’s to provide a nurturing home for orphans with the greatest needs. To date, they have cared for more than 4,000 children, have provided more than 3,000 surgeries and medical procedures and have helped over 900 children find their forever families and adoptive homes. Shepherd’s Field Children’s Village is an organization that LIH Olivia’s Place is proud to work with and over the last few years, we have provided direct therapy for some of their most at-risk children. However, although effective, one-on-one therapy impacts only one child. LIH Olivia’s Place has found that by training caregivers, we can empower them with the knowledge that will benefit the children each and every day.shepherds-1

 

img_5855When Shepherd’s Field Children’s Village requested training for their caregivers, we were very enthusiastic. We have worked with Shepherd’s Field for several years, and were pleased to see the effort they put in caring for their children. In August, hosted by Shepherd’s Field, LIH Olivia’s Place conducted an impactful two-day pro-bono seminar for caregivers and therapists from Shepherd’s Field and local welfare centers in Taiyuan.

 

Titled “Feeding and Positioning,” the two-day seminar focused on feeding and positioning techniques for children with severe disabilities and the highest needs. Conducted by Eva Ma, Occupational Therapist, and Chelsey Contillo, Speech-Language Pathologist, the training provided basic knowledge on anatomy/physiology as well as hands-on practical workshops. Eva and Chelsey also conducted a number of assessments and evaluations of Shepherd’s Field children, creating impact for these children immediately!

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img_5856This two-day event also helped create a stronger relationship, trust, and bond between LIH Olivia’s Place therapists and the caregivers and therapists taking care of the children every day. It gave our therapists a chance to understand the living environment of these children so their recommendations could be more effective. Most importantly, it was a heartwarming two days working with the delightful staff and children of Shepherd’s Field.

We are now continuing direct therapy in our clinic on a pro-bono basis for a number of Shepherd’s Field children. Their caregivers also attend and receive recommendations to help the children at the end of each session. It’s wonderful to see the children progress, and the caregivers become more confident in their work. This is why we love what we do!


Dr. Raymond Tervo Named Chief DBP of LIH Healthcare

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Dr. Raymond  Tervo

Dr. Raymond Tervo

Dr Raymond Tervo , Developmental Behavioral Pediatrician, most recently with the Mayo Clinic, Minnesota, has joined LIH Healthcare, commencing in November.

Dr Tervo brings with him extensive experience gained in both clinical and academic settings in the care of children with neurodevelopmental disorders. His most recent appointment was as Senior Consultant at the Mayo Clinic Minnesota and he has served as Professor of Pediatrics at the University of Minnesota. Originally from Canada, Dr Tervo obtained his BS from University of Toronto and MD from McMaster University.

Throughout his career Dr Tervo has been a widely published and highly regarded researcher with strong academic interest and clinical expertise in a wide range of neurodevelopmental disorders, including autism, ADHD and developmental delays.

In his new role as LIH Healthcare Chief Developmental Behavioral Pediatrician, Dr Tervo brings this wealth of experience to China. Dr. Tervo will be providing clinical consultations, joining our multidisciplinary professional teams, as well as conducting training programs in Shanghai, Beijing, Shenzhen, and Kunming.


New Technology Helps with Decision Making for Surgery for Children with Cerebral Palsy

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Lis Ringrose, Physiotherapist, Chief Therapy Officer, LIH Olivia's Place

Lis Ringrose, Physiotherapist, Chief Therapy Officer, LIH Olivia’s Place

Due increased muscle spasticity, children with cerebral palsy (CP) often develop muscle contractures (shortening) and skeletal malalignment (where bones grow at a slightly abnormal angle or hip joints do not form properly). These can affect the functional abilities of a child. For example, because they are unable to straighten their knees fully they have difficulty balancing on one leg and kicking a ball. Or because their hips and knees are unable to straighten fully they can only walk slowly and with difficulty. Usually these challenges can be addressed by physical therapy through specific exercises and activities. However, it is sometimes decided that further intervention is needed if these contractures and malalignments are too significant to be treated just by physical therapy. The first step to consider is conservative treatment such as Botox. However, at times, surgery is necessary to help correct the muscles and/or bony structure.

Orthopedic surgery should not be decided upon lightly and is a decision best informed with the most amount of information possible. Firstly, the desired outcome of the surgery should be considered. Functional information should also be taken into account; what can’t the child do now that he/she wants to do and will surgery help? Are the child and the family willing to undertake the short-term discomfort of surgery and challenge of extra therapy for a long-term gain? Finally, detailed information about the child’s biomechanics (how they move) should be gathered to aid the decision of whether to proceed with surgery, but also, exactly what surgery to do. This information can be gathered by the child’s physical therapist – length of muscles, strength of muscles, and functional skills using compensatory movements. It can also be gathered through a formal gait (walking) analysis which looks in more detail at the action of walking. From this information, conclusions can be drawn that give more detail about how muscles are working and where the strengths and weaknesses are. Gait analysis is best done in a gait lab with specialist equipment; however, there are also now apps for rehabilitation professionals that can be used on iPads and tablets. Physical therapists (PT) are also trained to analyze movement by observation. Gait analysis both in a formal lab setting and through observation by the PT aims to gather information not just about what movements a child can do but how the child does those movements.

Regardless of the amount of information collected prior to surgery, the outcome of orthopedic surgery for children with cerebral palsy is still not always predictable. Some children respond very well and their function is greatly improved. Others can have little if any improvement which is disappointing for both the child and family given the effort that is put in for the surgery and recovery. Recently, a new piece of equipment has been developed to add even more detail to the information that can be collected and used during the decision making process. It is able to analyze the ‘how’ of movement in even more depth.

walk-dmc‘Walk-DMC’ (DMC meaning Dynamic Motor Control) uses electromyography (EMG). Electrodes are placed on the skin over the muscle groups that need to be analyzed and feedback detailed information not just about whether the muscles are working but also when and how much. Comparing the information collected to a ‘typical’ set of information, it can determine the level of muscle control. This can then inform what surgery would be beneficial and which would not. Through collecting data from over 400 children before and after orthopedic surgery, it has been found that those with better muscle control have better outcomes following surgery. With the information collected from Walk-DMC, a child’s team can have this information prior to surgery to help in the decision making process.

This technological development to help clinical decisions has much potential. Researchers plan to collect more information to help with more objective decision making for different types of orthopedic surgery for children differently affected by cerebral palsy. They also plan to monitor children who have less typical movement patterns to discover if corrective orthopedic surgery allows for change in movement patterns to become more ‘normal’ even at older ages. Other than monitoring the outcomes of surgery, the Walk-DMC could also be used to gather information on other treatment approaches that rehabilitation professionals, such as PTs and Occupational Therapists (OT), use in treating children with CP to discover which are most effective at leading to the best movement control.

Walk-DMC is a new development in the move towards providing more targeted, indivualized treatment for children with CP. It is currently not widely available but as it is using already common technology in a new way, the developers hope that is won’t be long until more people can be trained in its use and it can be more widely available.

Original article:
Schwartz MH, Rozumalski A and Steele K, Dynamic motor control is associated with treatment outcomes for children with cerebral palsy. Developmental Medicine & Child Neurology; Volume 58, Issue 11, pp 1139-1145. November 2016
Other sources:
Langston J, University of Washington Today, Walk- DMC Aims to Improve Surgery Outcomes for Children with Cerebral Palsy. 27 April 2016


Dr. Ming Li Visits LIH Healthcare’s US Partner, Children’s Specialized Hospital

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In October 2016, Doctor Ming Li from Peking University First Hospital made a 2-day visit at Children’s Specialized Hospital (CSH) in New Jersey, US. The visit included opportunities to meet with the management and clinical staff from CSH. As a well-established doctor and well-known scholar in the field of pediatrics, Dr. Ming Li was very satisfied with the experience and paid a high compliment to LIH Healthcare, the sponsor of the visit. “There’s nothing any better than coming and having a chance to do clinical rounds, patient observations, and exchange ideas with excellent developmental behavior pediatrics practitioners who face the same challenges. This is quite a fulfilling trip!” Dr. Li said. The visit was a first-time training collaboration between LIH Healthcare and Peking University First Hospital. Dr. Li is a Consultant Pediatric Neurologist and Associate Professor in the Department of Pediatrics at First Hospital of Peking University.


Leader in Taiwan’s Speech-Language Field Joins LIH Healthcare Consultant Advisory Board

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Wang Nan Mai, Speech-Language Pathologist, LIH Healthcare Consultant Advisory Board

Wang Nan Mai, Speech-Language Pathologist, LIH Healthcare Consultant Advisory Board

Wang Nan Mai, SLP (Dept. of Speech Language Pathology and Audiology, Chung Shan Medical University, Taiwan) became a member of the LIH Healthcare Consultant Advisory Board in October. She will routinely consult with speech-language teams throughout LIH Healthcare.

As a speech-language consultant on the Consultant Advisory Board, Wang Nan Mai will support development of clinical training programs and best practice service models for inpatient and outpatient settings. In addition, she will support LIH Healthcare’s efforts to identify and recruit highly-qualified speech-language therapists to provide leadership in this field.

Wang Nan Mai’s expertise makes her an excellent fit to facilitate teaching and research activities throughout LIH Healthcare, as well as to support collaborative research projects with strategic partners.

Nan Mai’s unique background in speech-language therapy combines professional degrees from Soochow University in Taiwan, Minnesota State University in the United States, and 30 years of extensive clinical and teaching experience as one of the few researchers in the early development of speech development assessment models in Taiwan. In the early years, she led the initiative to construct teaching curriculum and labs for the Department of Speech Language Pathology and Audiology.

Nan Mai has served in many leadership roles. Aside from being the director of the Department of Audiology and Speech at Chung Shan Medical University for 6 years, she is the Chairman of the Asia Pacific Society of Speech, Language and Hearing (APSSLH), and a committee member of the International Society for Augmentative and Alternative Communication.


Lazy or “Demand Avoidant”?: Motivating Children with ADHD

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Dr. Sophie Westwood, Clinical Psychologist, LIH Olivia's Place Shanghai

Dr. Sophie Westwood, Clinical Psychologist, LIH Olivia’s Place Shanghai

An article that recently caught my eye, on ADHD and motivation, was written by a guest blogger, Sherry Cramer, an Educational Therapist, and posted on Anne-Marie Morey’s ‘Bay Tree Blog’. Anne-Marie is also a North American educational specialist. She has a great blog and often posts interesting and useful articles and resources. I strongly recommend educators and parents to take a look at her ‘Bay Tree Blog’, http://www.baytreelearning.com/blog/

Difficulties regarding motivation and children and young people are common but there are some specific ways of thinking about this issue and tips and strategies for children with ADHD that can be helpful. Here is the link to the blog to read for yourself http://www.baytreelearning.com/blog/2016/09/06/motivation/
I am going to outline some of the main points and a few other things that I think are important on this topic below. All of the research references can be found in Sherry’s blog post.

Sherry begins by explaining that researchers have found two major circuits of connections in the brain that are implicated in motivational behaviour: the reward and executive circuit. Both, or at least one of these circuits, function differently in the brains of children and young people with ADHD. The reward circuit doesn’t receive enough dopamine to keep children with ADHD focused on their goals and thus they become distracted by their own desires and things around them. A smaller, and less active and mature executive circuit in children with ADHD means that they struggle with ‘executive-function’ based tasks that enable us to plan, organise, pay attention and manage our time. Sherry goes on to describe a variety of tools that help to set up the right environment, details some of the benefits and controversies surrounding medications, and suggests reading for behaviour modification strategies, self-management and building executive functioning skills.

With these difficulties in mind, it makes it easier to see why children with ADHD often find it harder to complete the tasks required of them. In addition to these underlying brain-based skill deficits, other factors such as level of interest (we all like certain things over others), complicated ‘hidden’ social rules, the consequences or rewards of doing something, and the fact that repeated failure of a task can raise anxiety and/or lower self-esteem, commonly influence motivation. Taking these and other factors into account can help to shift the perspective of ‘laziness’ to think about why the child or young person is avoiding the demands of the task. Take for example Jack (a fictional character with realistic difficulties). Jack is an 11-year-old boy living with his parents and sister at home in Shanghai. He has a diagnosis of ADHD and takes medication when he goes to school. Jack’s parents are concerned because he has always loved soccer and plays in a team with his friends at weekends. Lately though, Jack has been playing videogames more and says he ‘can’t be bothered’ to play soccer. When his parents do manage to get him out the door and on the way to soccer practice he moans about going and doesn’t put much effort into the game. Jack’s parents have been sensitive to his needs as a young person with ADHD but are unsure whether this behaviour is laziness or more related to the issues described above. What factors might be contributing to Jacks ‘demand-avoidance’? How do you think Jack’s parents could approach this situation? Is there anything Jack can do to help himself?

The last section of Sherry’s blog posts focuses on how parents and educators can plant the seeds for personal motivation to thrive, and the skills that they might need for nurturing this growth. I echo Sherry’s advice and encourage those that are interested to read the books that she has recommended: they are often books that I recommend in my clinical practice.

References:
http://www.baytreelearning.com/blog/ http://www.baytreelearning.com/blog/2016/09/06/motivation/


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