The Improvement Quotient

A Blog by NICHQ

  • How to Cope with Change Fatigue

    Posted April 24, 2015 by Cindy Hutter

    Here at NICHQ, we’re in the improvement business. That means we help a lot of people experience a great deal of change. Whether imposed or chosen, however, frequent change efforts can sometimes lead to change fatigue.

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  • A New Day Aborning for Childbirth

    Posted April 21, 2015 by Jeannette T. Crenshaw, DNP, RN, LCCE, IBCLC, NEA-BC, FAAN

    Because safe and healthy birth sets the stage for successful breastfeeding, we also need focus in a similar way on the actions everyone can take to promote safe and healthy birth.

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  • Join Team NICHQ

    Posted April 17, 2015 by Cindy Hutter

    What makes someone the right candidate to work at NICHQ? We look for excellent people with a passion for improving children’s health who live NICHQ’s values of being agile, bold, innovative, team oriented and fun. If that sounds like you, we encourage you to view our current job openings.

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  • LARC Accessibility, Knowledge Key for Better Interconception Care

    Posted April 15, 2015 by Rachel Kremen

    Contraception is often the last thing on a woman’s mind right after her baby is born. But increasing maternal access to long-acting reversible contraception (LARC) immediately after delivery could have a positive impact on the health of the newborn and future siblings.

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  • The Secret to Increasing Hospital Breastfeeding Rates

    Posted April 09, 2015 by Emily Trask

    As hospitals work to increase exclusive breastfeeding rates, they are often challenged by staff members who are resistant to new processes and workflows. Several hospitals are successfully overcoming this obstacle by fostering staff change agents who are involved in the decisions on changes to existing workflows.

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  • What’s Behind NYC's Drastic Decrease in Infant Mortality Rates?

    Posted April 07, 2015 by Cindy Hutter

    The saying, "if you can make it here you can make it anywhere," of New York City, holds true for even its youngest members. New York City’s infant mortality rate - 4.6 deaths per 1,000 live births in the first year of life - is nearly 30 percent lower than the US rate. What’s the city’s secret?

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  • Making the Case for Using an Internal PTF for Medical Homes

    Posted April 03, 2015 by Cindy Hutter

    In our new white paper, Cultivating Internal Change Agents for Medical Home Transformation, learn about an innovative approach to training internal practice transformation facilitators (PTFs) for medical home implementation efforts.

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  • 8 Strategies for Surviving Team Turnover

    Posted April 01, 2015 by Cindy Hutter

    Team member turnover is unavoidable. People leave organizations, go on maternity leave or have periods when they downgrade their participation to focus on something else. Yes, it is stressful, but it doesn’t mean your improvement work comes to a halt. You can set your team up to survive member transitions with these eight strategies.

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  • Transforming Children's Health Never Ends, and for Good Reason

    Posted March 27, 2015 by Charles Homer, MD, MPH

    From its founding, NICHQ was the leading voice articulating the need for improvement in children’s healthcare. Speaking credibly to the academic, professional and policy communities, we emphasized that quality of care was important to child health, and that it needed focused attention. The improvement journey is hard work and it never ends, but we’re in a better place and have the knowledge, people and tools we need to continue improving the lives of children and families in the months and years ahead.

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  • Eliminating Disparities: from Intent to Action

    Posted March 25, 2015 by Charles Homer, MD, MPH

    In recent months, our nation has experienced an escalation of difficult “conversations” about the persistence of racism, the injustices of income inequality, and the harm that discrimination inflicts on us all. Perhaps more than anywhere else, these issues are inescapable in our healthcare system and manifest themselves in the health outcomes of our children.

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  • Patient Passports Bring Us One Step Closer to a Patient-Centered Healthcare System

    Posted March 19, 2015 by Cindy Hutter

    NICHQ’s Chief Financial Officer and ardent patient engagement advocate, Tom Dahlborg, MSM, has written extensively about the need for patient-centered care. Dahlborg represents NICHQ on the National Quality Forum’s patient and family engagement action team. The team recently released a Patient Passport tool that encourages better patient engagement with providers.

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  • Innovation in the Fight Against Infant Mortality Doesn’t Have to be Scary

    Posted March 16, 2015 by George Dellal, MHA, and Dawn Denno, EdD

    It has been widely documented that the United States lags far behind other developed nations when it comes to infant mortality. Our high infant mortality rate translates to nearly 24,000 babies who won’t live to see their first birthday each year. Despite our country’s best efforts and the millions of dollars spent studying the epidemiology and genetics behind prematurity, educating new parents about safe sleep practices, implementing smoking cessation programs and developing better prenatal care, our infant mortality rate remains tragically, unacceptably high. We owe our mothers better than what we’re providing.

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  • How Delaware Became a Model for States in Preventing Infant Deaths

    Posted March 11, 2015 by Cindy Hutter

    Delaware is capturing the attention of the nation as a source of public health and healthcare innovation. The state’s commitment to examining its infant mortality data, searching for common themes and then creating awareness campaigns to address the unwanted trends is leading to fewer infant deaths.

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  • Improving Statewide Breastfeeding Rates through the Learning Collaborative Model

    Posted March 06, 2015 by Kristen Holmstrand

    NICHQ recently spoke with Veronica Hendrix, LVN, IBCLC, RLC, program coordinator for the Texas Ten Step Program, to get her perspective and advice for other states seeking to expand breastfeeding rates and support.

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  • 8 Tips for Engaging Leaders in Your Project

    Posted March 03, 2015 by Cindy Hutter

    Lack of leadership support is one of the most common reasons that a quality improvement project fails. Whether it is executive, administrative or frontline leadership you are trying to convince, we have eight field-tested tips that will enable your leaders to not only support your project, but also advocate for it.

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  • Snowballs Used to Be Cool

    Posted February 26, 2015 by Jack Maypole, MD

    Boston’s historical snowfall has crippled transit systems, stressed overtaxed social support networks and created insurmountable challenges for all. But, most especially, it has created substantially more difficult—and at times potentially dangerous—conditions for parents of medically complex children who have marginal access to care in the best of times.

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  • How to Start a Community Healthy Weight Clinic

    Posted February 17, 2015 by Cindy Hutter

    The Holyoke Health Center’s Healthy Weight Clinic is changing lives. In a recent 5-month group session, nearly 50 percent of the participants decreased their BMI. We recently sat down with the center’s director, Vincent Biggs, MD, to get tips for starting and running a healthy weight clinic.

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  • Breastfeeding Collaboratives Provide Road Map for Long-Term Success

    Posted February 16, 2015 by Kristie Velarde

    Increasing exclusive breastfeeding rates can seem like a lofty goal for some hospitals, particularly when rates hover below 20 percent. Several hospitals participating in NICHQ-led learning collaboratives found a path that not only brought double-digit growth, but also set the stage for Baby-Friendly designation. Now these hospitals are using best practices to sustain breastfeeding rates and improve outcomes in other clinical areas.

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  • Sickle Cell Pain Protocol Reduces Wait Times for Meds and Eases Patient Frustration

    Posted February 13, 2015 by Rachel Kremen

    To improve the care of its sickle cell patients, Boston Medical Center developed a drug protocol that makes it possible to make quick, accurate decisions about acute care. As a result, the average time to first dose of medication for sickle cell patients experiencing a pain crisis dropped from nearly an hour to 22 minutes. ER staff also stopped second-guessing sickle cell patients asking for pain killers.

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  • Breastfeeding Success Depends On Support During Pregnancy As Much As After

    Posted February 09, 2015 by Pamela Berens, MD

    Most new moms have heard the message that breastfeeding is best for the health of their baby. Unfortunately, successfully meeting a breastfeeding goal isn’t always as easy as deciding to breastfeed. Having ongoing education about breastfeeding during pregnancy can help just as much as post pregnancy, yet it is often not emphasized enough.

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  • Why and How to Include the Patient-Family Voice in a Medical Home

    Posted December 23, 2014 by Bonnie Thompson, Mass Family Voices

    As more primary care practices work towards identifying themselves as a medical home, patients and family caregivers can play a vital role in shaping how healthcare is delivered.

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  • Find Success and Mirror It - Can It Be That Simple?

    Posted December 12, 2014 by Elissa Faro, PhD

    Childhood malnutrition. Infant mortality. Childhood obesity. Health inequalities and disparities. These are just some of the most demanding problems facing those who work to improve child health. However, these big issues are often seemingly intractable. How do you move the needle when previous efforts have yielded such meager results? One answer may lie in the concept of positive deviance.

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  • Managing the Universe of Special Healthcare Needs

    Posted November 17, 2014 by Katrina McCarty, MPA

    A vast universe of symptoms, medications, complications, specialists and tests constantly surround my friend Julie. She is 38 and has Type 1 diabetes (T1D), which she was diagnosed with at age 10. Her quest for a long and prosperous future of good health is both harrowing and inspiring.

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  • Incorporating Quality Improvement in Public Health

    Posted November 11, 2014 by Lloyd Provost, MS

    From my recent experience at the Infant Mortality Summits, a meeting of the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality, it seems that the time is ripe for the widespread growth of quality improvement (QI) strategies in the public health arena.

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  • Contradicting Assumptions About Infant Mortality Rates: How Far Upstream?

    Posted November 04, 2014 by Charles J. Homer, MD, MPH

    Learning often begins when facts contradict our assumptions. While attending the kickoff summits of the Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality in July, I became aware of at least two facts that contradicted my previous assumptions: (1) that infant mortality rates for non-Hispanic blacks are higher in the upper Midwestern states than they are in the deep South and (2) that the declines in infant mortality in several southern states over the past decade have been steeper than anywhere else in the country.

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  • Patient Engagement, Partnerships and Puppies

    Posted October 27, 2014 by Tom Dahlborg, MSM

    I was recently invited to host the World Congress Patient Engagement Summit in Boston. The event promised to “leave behind theory and bring about actionable change with actionable solutions to engage patients and move the needle on clinical outcomes and community health.” And, it lived up to this billing.

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  • Stories Matter

    Posted October 20, 2014 by Marianne McPherson, PhD, MS

    In previous blog posts, I’ve often featured a children’s story as the jumping off point for my message. This time, “story” is the message.

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  • Improvements in Maternity Care Practice Are Not Easy

    Posted September 22, 2014 by Lori Feldman-Winter, MD, MPH

    As NICHQ’s faculty chair for Best Fed Beginnings, a national initiative that supports hospitals seeking Baby-Friendly designation, I am frequently exposed to pushback regarding the improvements required for a hospital to achieve this designation. Recently, an article published in the Washington Post portrayed Baby-Friendly practices as a problematic set of policies that “force” a new mother to breastfeed against her wishes. Nothing could be farther from the truth.

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  • Living the Life of a Sickle Cell Warrior

    Posted September 15, 2014 by Fatima Oyeku

    In support of National Sickle Cell Awareness Month, NICHQ invited Fatima Oyeku, a woman living with sickle cell disease, to share her perspective. “Maybe I'm just being overly optimistic, but I honestly think SCD could be eradicated if more people knew their trait status and have the opportunity to make an informed decision about having children,” she says.

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  • Why I Struggled to Find My Breastfeeding North Star

    Posted August 27, 2014 by Katrina McCarty, MPA

    As a new mom, I found myself searching for a true guiding presence as I tried to make decisions about caring for my daughter and myself. I knew I wanted to breastfeed her and I assumed it would be easy. I assumed the stars would align and she and I would be deliriously connected and she would be nourished. I assumed a hungry baby and a food source were enough. Not quite.

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  • A Busy Summer: Building Blocks, Babies and Breastfeeding

    Posted August 15, 2014 by Meghan Johnson, MSc

    August is typically a month for relaxing, vacationing and taking long weekends to enjoy the warm weather. At NICHQ, we get our share of R & R, but August 2014 is also a particularly busy and exciting time! In August, we celebrate National Breastfeeding Month and World Breastfeeding Week (August 1-7), and as part of that, I am excited to help launch NICHQ’s new breastfeeding project with the New York State Department of Health.

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  • Communicate, Collaborate and Innovate to Reduce Infant Mortality

    Posted July 02, 2014 by Peter Gloor, PhD

    Compared to other Western countries, infant mortality in the US is shockingly high. High infant mortality is a social problem that can only be solved through massive collaboration and out-of-the-box innovation.

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  • Overcoming the Epidemic of Compassion Fatigue

    Posted June 05, 2014 by Lauren Smith, MD, MPH

    Given the many priorities and important issues that are competing for our collective attention, how do we break through the cacophony of dire statistics and grave warnings about so many “epidemics?"

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  • Let the Wild Rumpus Start! Your Ideas Wanted!

    Posted May 16, 2014 by Marianne McPherson, PhD, MS

    There’s no time like the present. We're collecting your wildest, craziest ideas for how we might improve children’s health together.

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  • Collective Impact: Coloring a New Vision of Collaboration

    Posted May 07, 2014 by Marianne McPherson, PhD, MS

    The concept of collective impact is in NICHQ's DNA. All of our work is in some way about bring together participants from difference sectors committed to a common agenda to solve complex social problems. Until recently, we didn't have the benefit of the language or framework.

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  • 10 Steps for Benching Bullying

    Posted April 22, 2014 by Tom Dahlborg, MSM

    There are many broader influences that affect children’s health outside of the clinical setting. This certainly includes the bullying that happens on our ball fields that can lead to physical injury, social problems, emotional problems, mental health problems (e.g., depression, anxiety), and even death. Not to mention bullying can turn children off from physical activities and this can potentially lead to obesity. As an organization that aims for all children to achieve their optimal health, there is much work to be done…together.

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  • What's in a Name

    Posted April 14, 2014 by Charlie Homer

    To more accurately reflect our purpose, we are making a change in our name, from “healthcare” to “health.” NICHQ’s purpose has always been to improve children’s health. That is our passion and now our name is aligned.

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  • Breaking the Food Reward Chain

    Posted March 20, 2014 by Cindy Hutter, MBA

    If we really want to improve children’s health, we need to focus not just on improving the quality of care children receive when they go to the doctor’s office; we need to change all influences that affect a child’s health. This includes modeling and practicing healthy behaviors at home, in school and in the community.

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  • Life Lessons from a First Grade Teacher

    Posted March 18, 2014 by Jonathan Small, MBA

    Many years later, the life lessons I learned from my son's first-grade teacher in 1998 are still profoundly influential, especially when viewed through the lens of quality improvement, a framework I learned later in life.

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  • Viewing Health as a System

    Posted March 07, 2014 by Charlie Homer, MD, MPH

    Improvement science teaches us to view outcomes—such as health—as the inevitable product of a system, with the implication that achieving improved outcomes requires changing the system itself. A deep understanding of the system and how it functions can enable smarter decisions about selecting high leverage changes in order to improve system performance.

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  • Have We Turned the Tide on Childhood Obesity?

    Posted March 04, 2014 by Shikha Anand, MD, MPH

    If you’ve read anything about obesity in the lay press over the past week, you already know that there has been a decline in the prevalence of obesity in American preschoolers.This news is both exhilarating and anxiety provoking. Celebrating too early could distract from the fact that there is so much more work to be done, especially for our most vulnerable children.

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  • Far From a Gold Medal Performance

    Posted February 28, 2014 by Jonathan Small, MBA

    We have a long way to go before we get a gold medal in child health outcomes. I suggest we begin in a humble place – with the recognition that, while we may have much to teach other countries, we also have a lot to learn.

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  • Systems Level Healthcare Improvement Starts with Individual Relationships

    Posted February 24, 2014 by Tom Dahlborg, MSM

    Want to improve the healthcare system from a systems perspective? Develop systems which allow for time, continuity, relationship, trust, authentic sharing, the telling and hearing of the patient’s whole story at each healthcare encounter. Create system change which positions clinicians to use tools such as emotional intelligence and motivational interviewing to ensure optimal sharing and comprehension.

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  • Taking a Bite Out of Mixed Food Messaging

    Posted February 20, 2014 by Cindy Hutter, MBA

    When I first saw McDonald’s Olympic themed advertising that shows Olympians biting their metals contrasted with good looking, fit, young adults biting into chicken nuggets with the tagline, “The greatest victories are celebrated with a bite,” the marketing professional in me thought that was very clever. The parent and healthcare professional in me were horrified.

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  • What Rosie Revere, Engineer Teaches Me About Innovation

    Posted February 19, 2014 by Marianne McPherson, PhD, MS

    I’ve been thinking about innovation a lot lately, in large part due to a renewed commitment at NICHQ to be a hub for creating and spreading innovations. I am so excited about this commitment because I know that new ideas and new approaches—and building them together—will help create a world in which all children achieve their optimal health.

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  • The Secret Ingredient to Fixing Systems Problems

    Posted February 12, 2014 by Cindy Hutter, MBA

    The mantra in quality improvement is “every system is perfectly designed to get the results it gets.” Regardless of your system of choice—your workplace, your home, your community—you’ll need knowledge to improve the system and get the results you want. It’s impossible to be a change agent without being a knowledge seeker first.

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  • Bravo CVS! Now It’s Time for More Health Advocates (You) to Step Up

    Posted February 05, 2014 by Cindy Hutter, MBA

    Just as peer pressure is what gets many young people to start smoking, peer pressure is what it is going to take to get other cigarette retailers to stop. Let’s start loading on the pressure.

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  • What I Learned About Physician Autonomy at the ATM Machine

    Posted January 13, 2014 by Shikha Anand, MD, MPH

    Now that I have the opportunity to work for a quality improvement organization with a vision of ensuring each child achieves his or her optimal health, and to process this information through the lens of my own experiences (personal and professional), my heart still breaks for those children harmed by bullying…AND I see great opportunities for improvement.

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  • Improvement - A Philosophy to Live By

    Posted January 11, 2014 by Meghan Johnson, MSc

    For as long as I can remember, I have been working to make things more organized, effective and efficient. I have spent countless hours organizing and reorganizing things in my life – everything from my son’s toys and games to the storage of our digital photos. It shouldn’t be surprising, then, that I have spent over a decade in project management and just over a year ago, found my way to NICHQ and discovered quality improvement science.

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  • Beyond Bullying

    Posted January 10, 2014 by Tom Dahlborg, MSM

    Now that I have the opportunity to work for a quality improvement organization with a vision of ensuring each child achieves his or her optimal health, and to process this information through the lens of my own experiences (personal and professional), my heart still breaks for those children harmed by bullying…AND I see great opportunities for improvement.

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  • When Did Breastfeeding Become a Choice?

    Posted January 09, 2014 by Jennifer Ustianov, RN, BSN, IBCLC

    I know the tides are beginning to turn. Recent reports show breastfeeding rates are increasing in the US. The journey back to a more supportive breastfeeding culture has begun in this country. But I wonder whether there is more we can do to accelerate this process, so that from this generation forward there is no question and no need to choose.

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  • Like Halloween Every Day

    Posted January 08, 2014 by Rachel Sachs Steele, MEd

    I love Halloween. For one day every year, I get to try something new, look totally silly, celebrate fear and play with possibilities, all without the usual external or internal constraints. Can you imagine what life would be like if we had that freedom all the time?

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  • An Improvement Wake-Up Call

    Posted January 07, 2014 by Jonathan Small, MBA

    It never ceases to amaze me what I learn from my children, especially the youngest ones – my eight-year-old twin daughters. I’ve been working in the quality improvement field for longer than they’ve been alive. But now they’re the ones teaching me about it!

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  • Removing the Burden of Care Coordination

    Posted January 06, 2014 by Cindy Hutter, MBA

    I had never heard of the concept of a medical home before coming to NICHQ, but I’ve now seen what is possible in a patient-focused system where primary care physicians and specialists coordinate to deliver high-quality healthcare. In situations like mine, where there are no established protocols to follow, the need for a medical home is most critical—and paradoxically, most lacking.

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