E-ISSN 2757-9204

Journal of Education and Research in Nursing

Volume: 20  Issue: 4 - December 2023
Sevilay Şenol Çelik

2.Effectiveness of Hybrid Simulation in Developing Intramuscular Injection Skills: A Randomized Clinical Trial
Arife Şanlıalp Zeyrek, Nevin Kuzu Kurban
doi: 10.14744/jern.2022.22373  Pages 297 - 304
Background: Intramuscular injection (IMI) is a complex skill that requires knowledge, problem-solving ability, and practical competency. The use of the hybrid simulation (HS) method in nursing education allows students to develop their procedural and operational skills in a safe and realistic environment.

Aim: This parallel-randomized and clinical trial was evaluating the effect of HS on IMI knowledge, skills, self-confidence, and satisfaction levels of nursing students.

Methods: Students were randomly assigned to either the intervention group (n = 63) or the control (n = 63) group. Students in the control group practiced IMI on a partial task trainer, whereas students in the experimental group practiced on HS (a digital half Buttock-mate IMI simulator-standardized patient). Data were collected with IMI Knowledge Test, IMI Skill Checklist, and the Student Satisfaction and Self-Confidence in Learning Scale. The data were analyzed using mean, median, number, and percentage values, Independent Sample t-test, Mann–Whitney U-test, Friedman test, and Chi-square tests.

Results: The mean age of the students was 19.37 ± 0.68 in the intervention group and 19.54 ± 0.86 in the control group. The majority of students were female in both groups (intervention group = 81%, control group = 82.5%). The effect size of the IMI knowledge test (post-test) score (d = 0.31) and IMI administration skill (d = 0.71) of this study was medium, the effect size of satisfaction with learning (d = 1.64) and self-confidence (d = 1.82) was found to be strong. The students stated that the simulation provided a realistic environment, they were nervous during the simulation, and HS training was beneficial.

Conclusions: The HS method increased the performance of students in IMI was effective on self-confidence and satisfaction in learning, but it did not improve knowledge acquisition compared to the traditional method. The findings suggest that the use of HS is an effective educational technique in IMI skill training.

3.The Relationship between Pre-clinical Practice Anxiety and Coronavirus Anxiety of Nursing Students in Türkiye
Afife Yurttaş, Merdiye Şendir, Demet İnangil, Ayşe Kabuk, İlayda Türkoğlu
doi: 10.14744/jern.2022.22380  Pages 305 - 310
Background: The COVID-19 pandemic caused many problems in Türkiye and the world. Education became one of the most important issues negatively affected by this process. Clinical practice, which is stressful for nursing students, can be even more stressful during the pandemic process.

Aim: The aim of this study was to evaluate the relationship between pre-clinical practice anxiety and coronavirus anxiety among nursing students.

Methods: The study is a cross-sectional design. Data were collected with online survey. The study was completed with 166 nursing students. Data were collected with the Personal Information Form, the State Anxiety Inventory and Trait Anxiety Inventory (SAI and TAI), and the Coronavirus Anxiety Scale (CAS). Data were analyzed by Mann–Whitney U, Kruskal–Wallis, Independent Sample t-test, and Wilcoxon and Pearson correlations tests.

Results: The mean age of the students was 19.74 ± 1.38 years, and 81.4% were female. The anxiety levels of the students before the clinical practice; the mean score of SAI was 44.99 ± 7.3, TAI was 46.99 ± 11.7, and CAS was 3.36 ± 4.31. After clinical practice, the mean score of SAI was 43.33 ± 9.4, and CAS was 1.97 ± 2.58. There was a statistically significant decrease in the mean scores of SAI and CAS after clinical practice (P < 0.05). There was a positive relationship between SAI and CAS levels.

Conclusion: The stress and coronavirus anxiety level of nursing students was high before the first clinical practice, and their stress level decreased after the clinical practice. This study proposes the implementation of interventions to reduce the stress levels of students before clinical practice.

4.Biopsychosocial Problems and Coping Methods of Nurses During the COVID-19 Pandemic: A Descriptive and Cross-Sectional Study
Emel Bahadır Yılmaz, Arzu Yüksel
doi: 10.14744/jern.20212.22382  Pages 311 - 317
Background: Studies have shown health care workers experience physical and psychologi-al problems during the COVID-19.

Aim: This study aimed to define nurses’ biopsychosocial problems and coping methods during the pandemic.

Methods: This study was planned as a descriptive and cross-sectional study between 1 September and October 30, 2020, in the 1st year of the pandemic. The sample of the study consisted of 438 nurses. An information form was used to collect the data, including the sociodemographic characteristics of the nurses, the problems they experienced during the pandemic, and their coping methods. Descriptive statistics such as frequency, percentage, mean and standard deviation were used to analyze the data.

Results: The mean age of the nurses was 29.20 ± 6.38. The most intense emotions experienced by nurses during the pandemic period were fear, anxiety (31.7%); concern, doubtfulness (22.9%); and fatigue, distress, and burnout (18.4%). The most important reason for their anxiety was infecting their family, loved ones, relatives, and children (44.3%). The sleep of 30.3% of nurses was irregular. The ways of coping with problems were talking with loved ones (14.8%), taking precautions to avoid getting sick (14.4%), doing activities (13.7%), and positive thinking (10.3%). Of them, 55.7% stated that they had worked in an inadequate and insecure environment.

Conclusion: During the pandemic, nurses experienced biopsychosocial problems and worked in an inadequate and unsafe environment. Nurses should be supported in biopsychosocial and working conditions, including reducing busy working hours, increasing the number of nurses, and increasing the number and accessibility of equipment should be improved.

5.The Impact of Using the Wound Care Escape Room as a Teaching Game on the Opinions and Motivation of Nursing Students
Gülden Küçükakça Çelik, Kübra Türkmen, Fadime Ertural, Gamze Odabaşı
doi: 10.14744/jern.2022.2237  Pages 318 - 322
Background: Using games as a teaching strategy can promote students’ engagement, increasing their learning motivation and interest.

Aim: This study was conducted to examine the nursing students’ opinions and motivations regarding the wound care escape room (WCER) teaching game.

Methods: The sample of the descriptive research comprised 105 students. Before initiating the game, the students were divided into 21 groups, each consisting of five students. The students were required to answer the questions and find the correct options as soon as possible to enter and escape from the WCER. The students were free to try all options. After the WCER game, the students were asked in another classroom to fill out a 5-point Likert-type questionnaire consisting of six items. Descriptive statistical methods (number, percentage, and mean, standard deviation, minimum, median, and maximum) were used when evaluating the data.

Results: The mean age of the students was 20.7128 ± 1.72 years, and most of them were female (69.5%). Concerning the opinions and motivations of the students regarding the game, the answer with the highest score (4.7333 ± 0.57624) was “I had fun playing the game. The following two answers with the highest mean scores were “Playing the game helped me learn the subject” and “There should be more games of this type in nursing education,” with 4.6381 ± 0.60644 and 4.6000 ± 0.68781.

Conclusion: The WCER game can be an enjoyable activity for students in learning a subject, enhancing their motivation before the final exam.

6.The Effect of Touching the Sole of the Infant’s Foot on Starting Times of Sucking and Sucking Efficiency: A Randomized Controlled Study
Safiye Ağapınar Şahin, Sibel Öztürk, Nazlı Akar
doi: 10.14744/jern.2022.22390  Pages 323 - 328
Background: The early initiation of breastfeeding ensures the attachment between the mother and the infant and regular production of breast milk.

Aim: The aim of the study was to evaluate the effect of touching the infant’s sole on grasping/latching on the breast.

Methods: The study’s type was a randomized controlled experimental design. The sample of this study included 78 infants randomized in a maternity hospital in the Southeastern Anatolia Region of Türkiye. Infants who did not suck and latch on the breast at the end of the first 30 min after birth were included in the study. The study data were collected using the personal information form, Bristol Breastfeeding Assessment Scale, and a stopwatch. Data were analyzed using the Shapiro–Wilk test and the independent t-test.

Results: The mean to the breast of the starting ties of sucking the infant in the experimental group was 104.71 ± 61.90, and the mean to starting times of sucking the infant in the control group was 214.95 ± 106.20. Touching the soles of the infants in the experimental group significantly reduced the starting time of grasping/latching on the breast.

Conclusion: Touching the sole was effective in shortening the time of sucking touching the sole of infants is effective in starting sucking earlier. Touching the soles of the infant’s feet also positively affected the newborn’s sucking ability.

7.Comparison of the Prone Position-related Characteristics of Intubated COVID-19 Patients with and without Facial Pressure Injuries
Ayda Kebapçı, Berrin Çepni
doi: 10.14744/jern.2022.22273  Pages 329 - 335
Background: In Coronavirus 2019 (COVID-19) patients, the risk of a facial pressure injury increases due to the prolonged prone position.

Aim: To compare the prone position-related characteristics of intubated COVID-19 patients with and without facial pressure injuries.

Methods: This cross-sectional, retrospective, and case–control study included 49 COVID-19 patients who were intubated and in the prone position in the adult intensive care unit of Koç University Hospital between March 01, 2020, and March 15, 2021. Retrospective data of the patients were obtained using the Patient Information Form. While evaluating the demographic and clinical data, descriptive statistical methods (frequency, percentage, mean, and standard deviation) were used. Furthermore, for the comparison of the prone position-related features (day of onset, frequency, and total duration) between patients with and without facial pressure injuries, the Mann–Whitney U test was used.

Results: It was determined that 52.1% of the intubated patients required a prone position, and 73.4% developed facial pressure injuries after prone positioning. Pressure injury developed on the 7th day of the prone position and on the chin (29%), left cheek (20.5%), nose (17.9%), and right cheek (16.7%), respectively. The prone duration was statistically significantly higher in patients with facial pressure injuries than those without (P <.01).

Conclusions: Pressure injuries occur with a high incidence in intubated COVID-19 patients in the prone position. Importance should be given to maintaining the treatment and care approaches with the multidisciplinary team for patients who still require prolonged prone positioning despite the development of pressure injuries in the facial area. Focusing primarily on preventing pressure injuries in the face area with frequent skin preparations and more frequent head position changes in the early period may contribute to prevention. In addition, there is a need for different and more preventive-oriented measures and specific protocols specific to COVID-19 patients in prolonged prone positions.

8.An Investigation of Physical Activity in Women and Barriers to Physical Activity
Gülpınar Aslan
doi: 10.14744/jern.2022.22316  Pages 336 - 344
Background: Physical activity is one of the fundamental steps that enable us to feel psychologically and physically good in all periods of our life. The importance of physical activity in decreasing anxiety and depression and increasing quality of life as well as rehabilitation has also been highlighted.

Aim: The purpose of this study is to investigate physical activity in women and barriers to physical activity (BPA).

Methods: This study used an analytical cross-sectional design. It was conducted with women who were registered in the Family Health Centers of a city located in the eastern part of Türkiye between May and September 2021. The target population of the study was women who were registered in these units and met the research criteria. The sample size was calculated using the sampling method with an unknown population, which indicated 384 individuals. The study included 830 women who agreed to participate in the study. Random sampling and snowball sampling methods were utilized as the sampling methods. Data were collected through the International Physical Activity Questionnaire and the BPA Scale. Data were analyzed using arithmetic means, standard deviation, skewness and kurtosis coefficients, t-test in independent groups, multiple regression analysis, one-way analysis of variance (ANOVA), Welch ANOVA when group variances were not homogeneous, and Bonferroni and X2 tests for post hoc analyses.

Results: Of all the participating women, 48% reported a low-level activity, 42.7% reported a medium-level activity, and 9.3% reported a high-level activity. The study showed that physical activity levels were low in those who did not do physical activities, smoked, and did not
do regular housework weekly (P < 0.05). BPA scores were significantly higher in those who were obese, had a primary school education level, were married, did not work, did not have social security, had income less than expenses, did not do physical activity, smoked, and had
extended family (P < 0.05).

Conclusion: This study found women’s physical activity levels low and BPA level high. Education and consultancy services to form healthy lifestyle behaviors should be planned, and women’s active life should be enhanced by providing them with accessible and safe environments appropriate to their involvement in physical activity.

9.Comparison of the Toilet Training Features between Children with Normal Development and Children with Down Syndrome at the Ages of 3–6 Years
Vahide Özdemir, Hatice Yıldırım Sarı
doi: 10.14744/jern.2022.21280  Pages 345 - 352
Background: It was indicated that children with Down syndrome complete toilet training later than children with normal development.

Aim: This study was conducted to compare the ages at which toilet training starts and finishes, how long it takes to complete the training, and the materials and methods used in children with normal development and Down syndrome between the ages of 3–6.

Methods: A case-control type study was conducted with the families of 40 children with Down syndrome and 40 children with normal development aged 3–6 who attended special education facilities and kindergartens in the provinces of Kütahya, İzmir, and Eskişehir between May 2019 and December 2019. The data were collected by the researcher using the closed envelope method with the control group, and a face-to-face interview with the parents of the case group using the Sociodemographic Feature Form and Toilet Training Questionnaire. To analyze the data, Descriptive statistics and the Mann–Whitney U test were used.

Results: In children with Down Syndrome, the mean age of starting toilet training was 41.12 ± 14.16 months, the mean age to complete toilet training was 51.75 ± 13.83 months, the mean time to complete toilet training was 41.40 ± 35.51 weeks, the mean age to ditch the diaper at nights was 50.43 ± 14.26 months, and the mean age to ditch the diaper in daytime was 43.23 ± 15.40 months. In children with normal development, the mean age to start toilet training was 30.35 ± 9.57 months, the mean age to complete toilet training was 32.80 ± 11.16 months, the mean time to complete toilet training was 13.10 ± 13.74 weeks, the mean age to ditch the diaper at nights was 32.73 ± 11.14 months, and the mean age to ditch the diaper in daytime was 30.35 ± 9.58 months.

Conclusion: Children with Down syndrome start and complete toilet training later than children with normal development, between the ages of 3 and 6. Toilet training should be done specifically for each child’s developmental characteristics because each child’s developmental process and traits vary.

10.Blood Pressure Measurement Skills with Self-instruction Video in Nursing Students’ Distance Education and Influencing Factors
Şenay Takmak, Müzelfe Bıyık
doi: 10.14744/jern.2023.22375  Pages 353 - 359
Background: Nursing educators are warned to determine the effects on student outcomes of changes in nursing education during the pandemic process and to be prepared for possible pandemics.

Aim: This study aimed to evaluate the factors that affect the blood pressure skill scores, E-learning styles, and blood pressure measurement skill levels of nursing students in distance education.

Methods: This was a descriptive study. This study was conducted between January and April 2021 with 2nd-year nursing students at a public university. The data were collected using a descriptive information form, the e-learning styles scale, a video recording of students’ blood pressure measurement skills, and a blood pressure skill checklist. Mann–Whitney U-test and Kruskal–Wallis test were used to evaluate the difference in blood pressure measurement skill scores.

Results: The mean age of the students was 20.04 ± 1.53 years. Of them, 82.6% were female and 65.2% preferred YouTube for skill training. The mean scores of blood pressure measurement skill of students were 14.61 ± 5.04. Students mostly had independent (66.3%), logical (63%), and audiovisual (44.6%) dominant e-learning styles. The blood pressure measurement skill scores of the students, who are female, have 75–100% synchronous course attendance, and have an independent e-learning style were significantly higher. There was difference between students’ blood pressure skill scores and independent e-learning styles.

Conclusion: In distance education, nursing students’ blood pressure measurement skills are insufficient and should be compensated by face-to-face education. Blood pressure skill self-instruction videos can support laboratory practices in a distance/hybrid nursing education platform.

11.The Relationship between Critical Thinking Skills and Caregiving Roles of Nurses
Anita Karaca, Gizem Kaya, Leyla Kaya
doi: 10.14744/jern.2023.22354  Pages 360 - 366
Background: Critical thinking is a skill highly needed by nurses to solve problems effectively and make the best decisions in clinical environments.

Aim: The purpose of this study was to evaluate the relationship between critical thinking skills and the caregiving roles of nurses.

Methods: This descriptive study included 220 nurses working in a training and research hospital. The data were collected between February and March 2021 using an online questionnaire containing the “Nurse Information Form,” “Nursing Critical Thinking in Clinical Practice Questionnaire,” and “Attitude Scale for Nurses in Caregiving Roles (ASNCR).” The data were analyzed using percentages, means, standard deviation, Shapiro–Wilk, and Spearman’s correlation tests.

Results: The nurses’ mean age was 30.35 ± 7.25 years and they were mostly female (98.2%) and had bachelor’s degree (69.1%), single (51.4%), and worked as nurses for 7.71 ± 7.54 mean years. The lowest mean score received by nurses from the Nursing Critical Thinking in Clinical Practice Questionnaire was (Mean = 19.54, SD = 4.02) in the technical dimension, and their lowest mean score was from the ASNCR was from the attitude towards nurses’ roles in treatment process dimension (Mean = 4.26, SD = 0.76). A moderate, positive, and statistically significant (P < 0.001) correlation was found between the total scores and dimension scores of both scales.

Conclusions: This study found that caregiving roles and critical thinking levels of nurses were above the mean score. It is important to increase the awareness of nurses about critical thinking and decision-making skills in the professional education process. Nurse managers may take an active role in nurturing critical thinking skills for effective outcomes.

12.Determination of Anxiety Level and Psychological Well-being of Undergraduate Nursing Students during COVID-19 Pandemic
Igho Oluku, Ayşegül Savaşan
doi: 10.14744/jern.2023.22395  Pages 367 - 373
Background: The COVID-19 pandemic has brought further attention to the importance of psychological wellness in the human population, as an essential domain in our general well-being.

Aim: This study investigates the anxiety levels and psychological well-being of nursing students during the COVID-19 pandemic.

Methods: This descriptive study was conducted with 206 undergraduate nursing students. The questionnaire including demographic information, Coronavirus Anxiety Scale, and WHO-5 Well-being Index was applied. Data were collected using the Google Surveys application in May 2021. Mann–Whitney-U, Kruskal–Wallis tests, and Pearson correlation analysis were used in the analysis of the data.

Results: The majority of students were female (53.4%) and in the 23–25 years age group (48.1%). The mean coronavirus anxiety score of the students was 3.21 ± 3.09, while the mean WHO-5 well-being score of the students was 11.49 ± 4.51. A moderate and negative correlation was found between the anxiety level and the psychological well-being of nursing students.

Conclusion: Nursing students had no dysfunctional coronavirus anxiety. Due to the suboptimal psychological well-being of the students, nursing students were at risk for depression. The findings of this study provide information to lecturers and administrators related to nursing students’ anxiety and psychological well-being in the pandemic.

13.Psychometric Properties of the Turkish Version of the Self-Regulated Learning Scale in Clinical Nursing Practice
Aydan Baysan, Fatma Orgun
doi: 10.14744/jern.2023.22533  Pages 374 - 379
Background: Self-regulated learning (SRL) is important in nursing education as it helps students take ownership of their learning and become more independent learners. This can be particularly important in a field like nursing, where the ability to continue learning and adapting to new situations is crucial.

Aim: The aim of this study was to assess the psychometric properties of the Turkish version of the SRL Scale in Clinical Nursing Practice (SRLS-CNP).

Methods: The study sample for this cross-sectional validation study consisted of senior nursing students (n = 296). First, the translation and back-translation methods were used to ensure the language validity of the scale. To provide content validity, expert opinions were taken, and a pilot study was conducted. Confirmatory factor analysis and Rasch analysis were performed to demonstrate construct validity. Concurrent validity was analyzed using the Self-Directed Learning Readiness Scale. The test–retest method and Cronbach’s alpha coefficient for the total and subscale scores were used to analyze the reliability of the scale.

Results: Similar to the original scale structure, a structure consisting of two subdimensions, titled motivation and learning strategies, and five factors related to these subdimensions were demonstrated in the first- and second-level confirmatory factor analyses and Rasch analyses. The scale was found to have concurrent validity (r = 0.613) and test–retest reliability (r = 0.878). The Cronbach’s alpha value of the total scale was 0.898.

Conclusion: The SRLS-CNP, which consists of 16 five-point Likert-type items in two subdimensions, is a valid and reliable measurement tool for Turkish society.

14.Pediatric Delirium Knowledge and Attitudes of Nurses in the Intensive Care Unit
İlçim Ercan, Evrim Kızıler
doi: 10.14744/jern.2023.22449  Pages 380 - 386
Background: Pediatric delirium, seen in critically ill children in intensive care units (ICUs), increases the risk of morbidity and mortality. Although delirium is common in critically ill children, only 2% of ICUs screen for delirium.

Aim: The purpose of this study was to determine the ICU nurses’ knowledge and attitudes toward delirium.

Methods: This descriptive study was carried out with 80 nurses working in 6 tertiary ICUs in Türkiye between November 2019 and February 2020. Data were collected using face-to-face interviews method by the Sociodemographic Data Form and Pediatric Delirium Knowledge and Attitudes Questionnaire. Data were analyzed with Mann–Whitney U test, Kruskal–Wallis test, and Spearman correlation analysis.

Results: The majority of the nurses have moderate knowledge about pediatric delirium and are not aware of the screening procedure and instruments for delirium. The majority of the nurses routinely did not screen their patients with delirium and did not know the screening instruments (97.6%) available for delirium. The knowledge mean score and positive attitude of nurses were significantly correlated with nurses’ departments and their education level
of nursing (P < 0.05).

Conclusion: This study showed that nurses working in ICU had moderate knowledge of pediatric delirium, especially its definition, causes, and management. In order to detect pediatric delirium in the early period and manage it properly, it is recommended that training pro-grams be arranged for intensive care nurses. Furthermore, pediatric delirium assessment form with proven validity and reliability in ICUs should be used and evidence-based care guidelines should be created.

15.The Role of Nurses in Preparing Mothers of Premature Infants for Discharge and Home Care
Rukiye Çelik, Naime Altay
doi: 10.14744/jern.2023.22480  Pages 387 - 392
More than 1 in 10 infants worldwide are born each year prematurely. Premature infants are at risk in terms of mortality and morbidity. Premature infants typically need special and intensive care in a Neonatal Intensive Care Unit (NICU). Similarly, mothers need training provided by nurses for discharge and home care. Following the discharge from the NICU, mothers often become primary caregivers who will provide 24-h care. Essential nursing activities are to consider the needs of mothers of premature infants, to make the necessary preparations before discharge, to ensure the transition from the NICU to home in a comprehensive, coordinated, and conscious manner, and to monitor of maternal and infant health. Nurses can use nursing roles such as educator, caregiver, communicator, coordinator, researcher, manager, advocate, and consultant while providing this care to mothers of premature infants. This review article aims to provide nurses with a perspective on preparing the mothers of premature infants for discharge, transition to home, and home care. The study consists of four titles: The preparation of the mother of the premature infant for discharge and the role of the nurse, the preparation for the transition to home and the role of the nurse, the preparation for home care and the role of the nurse, and the methods that can be used in the preparation.

16.Mobile Application for Remote Patient Education and Follow-up for the Prevention of Diabetic Foot: M-DAKBAS
Meryem Kılıç, Ayişe Karadağ
doi: 10.14744/jern.2021.21285  Pages 393 - 398
Diabetic foot, a complication of diabetes mellitus, is a worldwide medical, social, and economic problem. Diabetic foot ulcers that are not included in the early treatment and care program can result in limb amputation and may be life-threatening. Early diagnosis is an important factor to prevent limb loss due to diabetic foot ulcer. The increase in diabetes-related complications has provided an opportunity for the development of different technological approaches to the management of these problems. The support of these technologies by international organizations increases the interest in diabetes technologies all over the world. The increasing use of smartphones has made the use of mobile health applications widespread in the self-management of diseases. Mobile health applications offer the individual the opportunity to be active 24 h a day, without experiencing time and place problems in matters related to their own health. The mobile diabetic foot personal care system (m-DAKBAS) allows the individual with diabetes to get information about the diabetic foot without going to the health center, to acquire the foot care behavior with its reminder and warning system, to take care of himself in an interactive way and it helps to regulate blood glucose, which is one of the important factors in the development of diabetic foot. In this article, the introduction, development purpose and features of the m-DAKBAS application developed for individual with diabetes, their relatives and health professionals are included.

17.Postoperative Delirium and Evidence-Based Nursing Management in Geriatric Patients
Gamze Bozkul, Hande Nur Arslan, Sevilay Şenol Çelik
doi: 10.14744/jern.2021.21262  Pages 399 - 405
Delirium is an important complication that is frequently encountered in geriatric patients in the postoperative period and is characterized by increased unfavorable patient outcomes, causing repeated hospital admissions, increased costs of surgery and care, and decreased quality of life. Nurses play a key role in the provision of care for this complication, which affects patients and their families unfavorably in every aspect from the diagnosis to the management of postoperative delirium. In this review, it is aimed to discuss postoperative delirium and nursing interventions in geriatric patients in line with current and evidence-based information.

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