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COMMUNITY ○ Relationship - friends, family,

● A group of people with common relative, or boss


characteristics or interest living
together within a territory or ● Although all communities are the
geographical boundary same (according to general systems
○ It does not mention how many or theory), each one is unique because
the totality of the involvement of its functions within a specific
people in a community sociocultural, political, economic,
○ It does not state “ALL” and environmental context. They
○ Characteristics - behavior or vary in term of community dynamic -
culture citizen participation, power and
○ We are referring to decision making and community
COMMUNITY OF PEOPLE not collaboration effort (Allender and
community as a place Spradley, 362 - 364)

● A community is a group of people ● A community is regarded as an


sharing common geographic organism with its own stages of
boundaries and/or common values development, and it matures through
and interest within a specific social time. Development is facilitated by
system some catalysts from within and
○ Social system - there is outside the community
communication or interaction in ○ Catalyst - nurses can enter
the system (community health nurses)
because we can help in the
● Behringer and Richards describe a community’s development via
community as “webs of people the community health nursing
shared by relationships, through the activities: community
interdependence, mutual interest development and community
and patterns of interaction” organizing
○ Web of people = social system
○ Webbing - means linking or the ● Anderson and McFarlane
connection of one person to (Anderson, 2000:157) developed the
another community - as - client model which
later on was renamed to community responsibilities required of
- as - partner model personnel in performing various
○ Patient is our CLIENT (individual, functions with a view to achieve
family, population, or community) business goals through
○ Community should be a organization
PARTNER - equal involvement in ○ Role - what the person can do,
terms of decision making, what the person may do, what
identifying problems, creating the person is willing to do
solutions, and so on ○ Organization - simply working
○ The nurse along with the together for a common goal
community should identify the
problem – the community should HEALTH
recognize, they should be aware, ● Health is the basic human right
and treating problem as a
problem ● Health which is viewed as a
○ The problem is recognized first continuum, is considered as the goal
by the community of public health in general, and
community health nursing, in
● The two elements of the model are: particular. It is an important
focus on the community as prerequisite (and consequence) of
partner and the use of the nursing development. By promoting health
process and preventing diseases, CHNs,
therefore, contribute to the country’s
● The people are affected by, and also economic and social development
influence eight subsystems on the ○ The health of the community
community – physical environment, may affect the development of
education, safety and transportation, the nation
politics and government, health and
social services, communication, ● “Health is a state of complete
economics and recreation physical, mental, and social
well-being and not merely the
ORGANIZATION absence of disease or infirmity”
● Organization is a structural (WHO, 1995)
framework of duties and
TYPES OF COMMUNITY (OF PEOPLE) ○ Ex. Santa Rosa
● Geographic
● Common interest CHARACTERISTICS OF A HEALTHY
● Community of solution COMMUNITY (ADPCN)
1. Members are aware of their own
GEOGRAPHIC COMMUNITY health and biologic status
● A community often is defined by its ● Not aware = problem
geographic boundaries ○ Health education or
advocacy campaign
COMMON INTEREST ● Aware = not a problem
● A community also can be identified
by a common interest or goal 2. Members give credit to the
○ Regardless of where you are governing authority
(scattered geographically) ● Two types of leader: Formal
○ Ex. Organization (Pet Lovers and Informal
Club of the Philippines) ○ Formal Leaders - elected or
○ Mobilizing force appointed
■ Example of Elected:
COMMUNITY OF SOLUTION Barangay Chairman,
● A type of community encountered Mayor
frequently in community health ■ Example of Appointed:
practice is a group of people who Tanod, Cabinet Member
come together to solve a problem ○ Informal Leader - according
that affects all of them to seniority, charisma, and
skills
TYPES OF COMMUNITY (AS A PLACE) ■ Example of Seniority:
● Rural - Provinces Elderly in the community
● Urban - City ■ Example of Charisma:
○ Problem: Pollution Priest or pastor
○ How do they address pollution? ■ Example of Skills: Nurses
○ How do they manage to live in a
polluted place? 3. The natural and biological resources
○ Type of work: High salary are open for everybody but the
● Suburban / Rurban
consumption is controlled to help in 8. People are concerned with their
preserving the resources health status
● Law of Conservation ● Health status = general health
● Rural > urban resources condition of the people
● Botika ng Barangay community
● How do you prepare yourself if
4. A healthy community has a strong there are health problems?
and reliables governing bodies ● Do you have any resources in
● Governing bodies = government case of emergency?
(local or national) ● Health condition = community
● Sangguniang Kabataan diagnosis (profile, education,
Sportsfest = beneficial to the work, salary)
people in community
9. Health needs are accessible and
5. People work together to attain affordable to the public and free to
independence the indigent
● To provide the needs of their ● Accessible - distance
family in the community ● Affordable - cheap or free
● Free - means no donation
6. Environmental and physiologic ● 4 A’s
needs are sustained by the families ○ Affordability
○ Accessibility
7. Parents and guardians serve as role ○ Available
models for their children ○ Acceptable - conforming to
● Common issue: Smoking the tradition and values of
○ They cannot teach their the people
children not to smoke if they ● Health services is not free
themselves are smoking because we are paying through
○ 50% of those who smoke our taxes
learned it from peers
○ 50% of those who smoke 10. Everyone is working to attain health
learned it from their parents citizenry
● Independent health care
● Health is in the hands of the 6. Education
people 7. Economics
8. Recreation
CHARACTERISTICS OF A HEALTHY
COMMUNITY PHYSICAL ENVIRONMENT
● Awareness that “we are a 1. Appearance of the community
community” 2. Air quality
● Conservation of natural resources 3. Animals
● Recognition of and respect for the 4. Flora
existence of subgroups 5. Housing
○ Subgroups - organization, 6. Zoning
ethnic group 7. Space
● Participation of subgroups in 8. Green areas
community affairs 9. People
○ Activities - should be applicable 10. Human-made structures
to all 11. Natural beauty
● Preparation to meet crises 12. Water
● Ability to solve problems 13. Climate
● Communication through open
channels HEALTH AND SOCIAL SERVICES
● Resources available to all 1. Acute and chronic conditions
● Setting of disputes through 2. Shelters
legitimate mechanisms 3. Traditional healers
● Participation by citizens in 4. Clinics
decision-making 5. Hospitals
● Wellness of a high degree among its 6. Practitioner’s offices
members 7. Public health services
8. Home health agencies
EIGHT SUBSYSTEMS OF A COMMUNITY 9. Emergency centers
1. Physical environment 10. Nursing homes
2. Education 11. Social service facilities
3. Safety and transportation 12. Mental health services
4. Politics and government
5. Health and social services ECONOMY
1. Industries 5. Extracurricular activities
2. Stores 6. School health service
3. Places for employment 7. School nurse
● Unemployment rate
4. Shops RECREATION
1. Playground
TRANSPORTATION AND SAFETY 2. Forms of recreation
1. Private and public transportation 3. Participation of community in
available recreational activities
2. Sidewalks 4. Transportation and safety
3. Bike trails 5. Facilities for recreation
4. Air quality
5. Crimes COMMUNITY HEALTH NURSING
6. Safety ● Synthesis of nursing knowledge and
practice and the science and
POLITICS AND GOVERNMENT practice of public health,
1. Political activity implemented via a systematic use of
2. Party affiliation nursing process and other
3. Governmental jurisdiction processes to promote health and
4. Decision making prevent illness in population groups
○ Other process - management,
COMMUNICATION supervision process, research
1. Gathering process, advocacy, and political
2. Newspaper stands action
3. Television
4. Radios CHARACTERISTICS OF CHN
5. Formal means of communication 1. Promotion of health and prevention
6. Informal means of communication of disease are the goals of
professional practice
EDUCATION 2. Community health nursing practice
1. Schools is comprehensive, general,
2. Libraries continual, and not episodic
3. Board of education 3. There are different levels of
4. Educational issues clientele: individuals, families, and
population groups and the ○ Worth - consider what they are,
practitioner recognizes the primacy what they do, believe, and value
of the population as a whole ○ Dignity - valued and respected
● Families - living in one for what you are, what you
household believed in, and how you live
● Population group - group your life
according special needs or age
4. The nurse and client has a greater ● This philosophy of care is based on
control in making decisions related the belief that care directed to the
to health care and they collaborate individual, the family, and the group
as equals contributes to the healthcare of the
● Equals - active involvement of population as a whole
the community in all the aspect ○ Achieve wellness - it will
and activities of CHN contribute to general condition of
5. The nurse recognizes the impact of the whole community
different factors on health and has a
greater awareness of his/her clients’ PRINCIPLES OF COMMUNITY HEALTH
lives and situation NURSING
1. The recognized need of individual,
PHILOSOPHY OF COMMUNITY HEALTH families, and communities provides
NURSING the basis for CHN practice
● The philosophy of CHN is based on ○ Aware of their problems and
the worth and dignity of men - concern
Margaret Shetland ○ Recognize needs - focus of
○ Essence of dignity designates intervention
the moral worth or value of all ○ Purpose: further apply public
human beings health measure within the
○ Because of inherent dignity framework of the total CHN effort
human beings are assumed to
possess equal moral status and 2. The knowledge and understanding
therefore they are expected to of the objectives and policies of the
receive equal consideration in agency facilitates goal achievement
matters that affect their core
interest
○ Understanding the community essential to upgrade; and to
health nurse and cascaded to maintain sound nursing practices in
the community people their setting
○ Staff education program -
3. Family as a unit of service training, orientation, seminar, or
○ Family = channel to ensure that workshop
the services of CHN is effective ○ Personal and professional
and has impact development programs

4. Respect for the values, customs, 9. Utilization of indigenous and existing


and beliefs community resources maximizing
the success of the efforts of the
5. Health education and counseling as Community Health Nurses
vitals parts of functions
○ Discussion of issues to promote 10. Active participation of individuals,
or improve people’s health family, and community in planning in
making decision for their health
6. Collaborative work relationships needs, determine, to a large extent,
○ Co-workers and other health the success of the CHN programs
team
11. Supervision of nursing services by
7. Periodic and continuing evaluation qualified CHN personnel provides
provides the means for assessing guidance and direction to the work to
the degree to which CHN goals and be done
objectives are being attained
○ Involved in the appraisal of their 12. Accurate recording and reporting
health program serve as the basis for evaluation of
○ Consultation, observation, and the progress of planned programs
accurate recording and activities and a guide for the
(documentation) future actions
○ To validate information
GOALS OF COMMUNITY HEALTH
8. Continuing staff education program NURSING
and quality services to client that are
● The goal of CHN is to assist COMMUNITY WIDE
individual, family, and community in INTERVENTION
attaining their highest level of
holistic health which is attained ● Utilizes the Nursing Process
through multidisciplinary effort and to ○ ADPIE
promote reciprocally supportive ○ The impact of health services on
relationship between people and population group using a
their physical and social problem-solving method
environment
○ Supportive relationship - people ● Promotive-Preventive by Nature
and community ○ Priority not curative
interventions
SALIENT FEATURES OF COMMUNITY
HEALTH NURSING ● Use a variety of instruments
● Population or Aggregate - Focused ○ Tools - measuring and analyzing
○ Partner - conduct activities community problems
○ Client - nurse-patient relationship ○ Equation - used for vital and
○ The priority for care and health statistics
resources in community are ○ Community map - locate the
primarily allotted for the health areas in the community
needs and problems of the ○ Interview, questionnaire,
individual and families as they schedule, and survey forms
impact the population or the
whole community ● Requires Management Skills
○ During organization of nursing
● Greatest Good for the Greatest service in the local health agency
Number and the activities that require
○ A particular situation is seen as a effective management of a
risk or hazard to the health of the certain health program or service
total community or afflict a ○ Skills - interpersonal,
greater number of individuals is communication and motivation,
considered a COMMUNITY organization, delegation, forward
HEALTH PROBLEM that needs planning and strategic thinking,
problem-solving and decision
making, awareness, and ○ Liaison
mentoring
● Population oriented
THE RECIPIENTS OF CARE BY ○ Case finder
COMMUNITY HEALTH NURSES ○ Leader
1. The individual ○ Change agent
2. The family - basic unit of the society ○ Community mobilizer
3. The population group - vulnerable ○ Coalition builder
group (at risk of developing certain ○ Policy advocate
health or health related problems) ○ Social marketer
4. The community ○ Researcher

DIFFERENT FIELDS OF CHN ROLES OF NURSES IN COMMUNITY


● If the practice is not in the hospital ORGANIZING
then it is considered the field of CHN ● Clinician Role
○ Public Health Nursing ○ The clinician role in the
○ Occupational Health Nursing community health means that the
○ School Nursing nurses ensures health services
■ No employee or student in are provided not just to
school will get sick and will be individuals and families, but also
sent to the hospital to groups or populations
○ Caregiver
ROLES OF CHN ○ Clinician emphases:
● Client oriented 1. Holism
○ Caregiver ● Holistic practice
○ Educator ● Considering the
○ Counselor wholeness of the group
○ Referral source ● Ex. Nurse working with a
○ Role model group of pregnant
○ Case manager teenagers living in a
juvenile detention center
● Delivery oriented (focus on age,
○ Coordinator developmental needs,
○ Collaborator peer influences,
knowledge about ● Advocate Role
pregnancy and delivery, ○ The issue of client’s right is
and issues) important in health care. Every
patient or client has the right to
2. Health promotion receive just, equal, and human
● Focus on wellness treatment
● Promotive and preventive ○ Client advocacy has two
measure underlying goals.
■ One is to help client gain
3. Skill expansion greater independence or
● Skills - observation, self-determination (clients)
listening skills, ■ A second goal is to make the
communication, system more responsive and
counseling skills relevant to the needs of
● Considering clients (providers of
psychological and healthcare services)
socio-cultural factors in ○ The advocate role incorporates
the community four characteristic actions: being
● Other problems that may assertive, taking risks,
affect the client: pollution, communicating and negotiating
violence, crime, poverty, well, and identifying resources
unemployment, and obtaining results
homelessness, limited
funding for health ● Collaborator Role
programs ○ They must work with many
people, including clients, other
● Educator role nurses, physicians, teachers,
○ Community clients usually are health educators, social workers,
not acutely ill and can absorb physical therapist, nutritionist,
and act on health information occupational therapists,
○ The educator role in the psychologist, epidemiologist,
community health nursing is biostatistician, attorney,
significant because a wider secretaries, environmentalists,
audience can be reached city planners, and legislator
○ As members of the health team, ● Community organizing is the
community health nurses process whereby people living in
assume the role of collaborator proximity to each other come
which means working jointly with together into an organization that
others in a common endeavor, acts in their shared self-interest
cooperating as partners ● The process aims to generate
durable power for the community
● Leadership Role organization, such that it can
○ The leadership role focuses on influence key decision-makers on a
effecting change; thus, the nurse range of important issues over time.
becomes an agent of change Community organizers work with
○ As leaders, community health and develop new local leaders,
nurses seek to initiate change facilitating coalitions, and developing
that positively affects people’s campaigns
health. They also seek to
influence people to think and GOALS OF COMMUNITY ORGANIZING
behave differently about their 1. People Empowerment
health and factors contributing to ● Community organizing aims to
it self-efficacy and self-confidence
○ Leader = Role model so that people will be able to
overcome their powerlessness
● Researcher Role and develop their capacity to
○ In the researcher role, maximize their control over the
community health nurses engage situation and place their future in
in the systematic investigation, their hands. Through awareness
collection, and analysis of data building, organizing and
for solving problems and mobilizing community members,
enhancing community health people’s organizations can serve
practice the needs of the community
○ A questioning attitude is a basic
prerequisite for good nursing 2. Improved quality of life
practice ● Community organizing seeks to
secure long and short-term
COMMUNITY ORGANIZING improvements in the quality of
life through sustainable include such topics as employee
community development training and development,
performance improvement,
COMMUNITY DEVELOPMENT emotional intelligence, coaching,
● Community development involves succession planning, key
changing the relationship between employee & organizational
ordinary people and and people competencies, employee career
positions of power, so that everyone development, organizational
can take part in the issues that culture & development, and
affects their lives workforce development
● It starts from the principle that within
any community their is a wealth of ● Community Organizing Participatory
knowledge and experience which, Action Research (COPAR)
if used in creative ways, can be ○ A vital part of public health
channeled into collective actions to nursing. COPAR aims to
achieve the communities desired transform the apathetic,
goals individualistic, and voiceless
poor into dynamic, participatory,
COMMUNITY BUILDING and politically responsive
1. Foster connection community
2. Creates space for sharing
3. Is about collective learning COMMUNITY ORGANIZATION
4. Engages with collective growth PARTICIPATORY ACTION RESEARCH
5. Is about experience ● A continuous and sustained
6. Allows trust-building process of educating, organizing,
7. Is movement formation and mobilizing people through
8. Foster innovation community participation, action, and
research
TOOLS FOR COMMUNITY ● It is otherwise known as a method of
DEVELOPMENT people empowerment and
● Human Resource Development community development through
Program (HRDP) guiding them to build and manage
○ The Human Resource an effective organization utilizing
Development Program (HRDP) community resources for health care
mobilization and ensuring that they ○ Is the community in need of
are efficiently equipped to be on assistance?
their own in dealing or resolving their ○ Do the community members feel
issues in the community the need to work together to
overcome a specific health
PHASES AND ACTIVITIES OF COPAR problem?
PREPARATORY PHASE ○ Are there concerned groups and
1. Pre-entry Phase organizations that the nurse can
2. Entry Phase possibly work with?
ORGANIZATIONAL PHASE ○ What will be the counterpart of
3. Formation Phase the community in terms of
4. Organization-Building Phase community support, commitment,
EDUCATION AND TRAINING PHASE and human resources?
5. Sustenance and Strengthening ● Community Profiling:
Phase ○ Choose a contact person
INTERSECTORAL COLLABORATION ■ Core group = will help the
PHASE nurse to identify other factors
6. Phase out ○ Prepare the community profile
■ A community profile provides
PRE-ENTRY PHASE an overview of demographic
● It involves the selection of the characteristics, community
target community and health related services
● Criteria are utilized to determine and facilities
their need for community organizing
● Happen before we enter the ENTRY PHASE
community ● It involves the integration process
● Some preliminary investigation is and the acquisition of relevant
conducted through the use of information necessary for the
secondary records and ocular conceptualization of the
inspection is done prior to immersion community diagnosis
● The nurse should first coordinate ● It is also during this phase that
with the local government unit during potential leaders are identified
this phase ● We have entered the community
● Area Selection: during this phase
● Integration: ● The core group serves as a
1. Recognize the role and position training ground for developing
of local authorities the potential leaders in:
2. Adapt lifestyle in keeping with ○ Democratic and collective
that of the community leadership
3. Choose a modest dwelling which ○ Planning and assuming task
the people, especially for the formation of a
disadvantaged will not hesitate to community wide organization
enter ○ Handling and resolving group
4. Avoid raising expectations of the conflicts
people. Be clear with your ○ Critical thinking and decision
objectives and limitations making process
5. Participate directly in production
process 4. Setting up the community
6. Make house call and seek out organization
people where they usually gather
7. Participate in some social EDUCATION AND TRAINING PHASE
activities 1. Conducting community diagnosis
● Assisting people in developing a
ORGANIZATIONAL PHASE plan
1. Social Preparation
● The nurse is introduced to the 2. Training of community health
community workers
● Raising awareness of existing ● Committee on health
community needs and problems ● Conduct training needs
● We continuously learn the assessment
community
● Strengthening the relationship 3. Health services and mobilization
with community people ● Allowing people lead to the
community with assistance of the
2. Spotting and developing potential nurse
leaders ● Self-reliant, self-determining,
self-sustaining, and independent
3. Core group formation
4. Leadership formation activities ● A profile
● Gives opportunity to leaders to ● A process
master their organization skills ○ Community diagnosis =
and other skills required of a Assessment and Diagnosis
leader (Nursing Process)

SUSTENANCE AND STRENGTHENING A PROFILE


● It is the end portion of COPAR but ● As a PROFILE, it is a description of
the most important phase. It is the community’s state of health as
during this phase by which the determined by physical, economic,
community and its people are being political, and social factors
developed to be self-reliant ● It defines community and states the
community problem
INTERSECTORAL COLLABORATION ● Purpose: To be able to obtain a
PHASE quick ‘picture’ of a community’s state
● The nurse is in the best position to of health which is as accurate as
facilitate and coordinate with possible
institution, agencies, and other key ● A community profile should:
people to articulate the community’s ○ Summarizes information
needs for support and assistance ○ Present results and figures
clearly
PHASE OUT ○ Be useful for planning and
● People can practice self-reliance monitoring
● Provide opportunity for health
workers to stand on their own A PROCESS
● As a PROCESS, it is a continuous
COMMUNITY learning experience for the nurse /
● Primary client of community in health program coordinator and the staff,
nursing (Spradley, 1990) as well as the community people, for
○ Direct influence the following reason
○ Level where most health service ○ It enables the nurse / program
provision occurs coordinator / staff to adjust or
alter the program for the
WHAT IS COMMUNITY DIAGNOSIS? optimum effectiveness
○ It allows the community to priorities for planning and developing
gradually become aware of the programs of health care for the
solutions community. The data gathered
○ It is an organized attempt to through the process serve as the
involve people in recognizing material for analysis
and resolving problems that
concern them most COMMUNITY DIAGNOSIS
○ It enables the community to ● COMMUNITY ASSESSMENT -
understand at its own pace the keystone of community health
potential advantages to change, nursing process
which may eventually lead to ● UTILIZATION OF DATA - the nurse
attentions in attitudes, values, utilizes the assessment data to
and belief derive the community health nursing
diagnoses and become the bases
COMMUNITY DIAGNOSIS for developing and implementing
● 2 important parts: community health nursing
○ The nurse collects data about interventions and strategies
the community in order to identify
the different factors that may ECOLOGICAL APPROACH TO THE
directly or indirectly influence the COMMUNITY DIAGNOSIS
health of the population ● Community is a product of the
○ The nurse proceed to analyze various interacting elements such
and seek explanation for the as population, the physical and
occurence of health needs and topographical characteristics,
problems of the community socio-economic and cultural factors,
health and basic social services and
WHY UNDERTAKE COMMUNITY the power structure within the
DIAGNOSIS? community
● To have a clear picture of the ● The interrelationship of these
problems of the community and to elements will explain the health and
identify the resources available to illness patterns in the community
the community people ● Payne (1965) attributes much of the
● Community diagnosis enables the failure to address the health
nurse / program coordinator to set
problems of the community to this ○ The objectives or degree of
lack of ecological approach detail or depth of the assessment
● Community health problems are ○ The resources, and
often viewed as technical problems ○ The time available for the nurse
that need technical solutions without to conduct community diagnosis
regard to the interrelatedness of all ● Comprehensive Community
factors and forces that are bearing Diagnosis - aims to obtains general
down on community health information about the community or
● According to Freeman and Heinrich a certain population group
(1981), community health diagnosis ● Problem-Oriented Community
is based on three independent, Diagnosis - type of assessment that
interacting and constantly changing responds to a particular need
conditions ● Before data are collected, the
1. The health status of the community diagnosis objectives
community, including the must be determine as these will
population’s level of vulnerability direct the depth or the scope of the
2. Community health capability or community assessment
the ability of the community to ● The community is NOT a passive
deal with its health problems recipient of care
3. Community action potential, or ● The nurse work WITH and not for
the patterns in which the the community
community is likely to work on its
health problems WHEN IS THE COMMUNITY’S
PARTICIPATION REQUIRED?
THE COMMUNITY ● The nurse is a facilitator working in
● A Place a team composed of community
● A People members and leaders
● A Social System ● The community’s involvement starts
early during the assessment
WHAT ARE THE TYPES OF COMMUNITY phase to create awareness of their
DIAGNOSIS? health needs and problems
● The type of a community diagnosis
may vary according to: COMMUNITY’S PARTICIPATION
● Community’s participation in the 7. Data COLLATION
community diagnosis develops their 8. Data PRESENTATION
commitment and enthusiasm 9. Data ANALYSIS
● The nurse must ensure the 10. Identifying the community health
community’s input in the community nursing PROBLEMS
diagnosis considering their 11. PRIORITY setting
capacities and limitations but with
enough room to develop their
potential

RAPID APPRAISAL
● Allows to gain a general impression
of the community
● Exploratory in nature
● It can provide direction and focus for
the actual community diagnosis
● An opportunity for the nurse to
immerse in the community and get
to know its problems, issues, and
concerns that will contribute in
shaping the plan for subsequent
community organizing process
● It is participatory

STEPS IN CONDUCTING COMMUNITY


DIAGNOSIS
1. Determining the OBJECTIVES
2. Defining the study POPULATION
3. Determining the DATA to be
collected
4. Determining METHODS of collecting
data
5. Developing the INSTRUMENTS
6. Actual data GATHERING

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