When it comes to HIV prevention and treatment, there is a growing population that is being overlooked — older adults — and implicit ageism is partially responsible for this neglect, according to a presentation at the 125th Annual Convention of the American Psychological Association.
“The lack of perceived HIV risk in late adulthood among older people themselves, as well as providers and society in general, inhibits investment in education, testing and programmatic responses to address HIV in an aging population,” said presenter Mark Brennan-Ing, PhD, director for research and evaluation at ACRIA, a non-profit HIV/AIDS research organization in New York City. “Ageism perpetuates the invisibility of older adults, which renders current medical and social service systems unprepared to respond to the needs of people aging with HIV infection.”
There is an enduring misconception that HIV is a disease of the young, and in particular young gay and bisexual men, according to Brennan-Ing, but it is estimated that in developed countries with well-developed health care systems, almost half of all people living with HIV are 50 or older. In some countries, that number is expected to increase to 70 percent by 2020. People 50 and older account for 17 percent of new HIV infections, and are more likely than younger adults to be diagnosed with AIDS at the same time as they discover their HIV status.
Previous research has suggested as many as two-thirds of all older Americans with HIV have experienced stigma due not only to the disease, but to their age. This phenomenon may be even more pronounced among gay and bisexual men, because of an increased obsession with age and internalized ageism within the gay community.
Despite a median age of 58, older Americans with HIV are more likely to exhibit characteristics of people in their 60s, 70s or even 80s, said Brennan-Ing. The combination of stigma due to age, sexual orientation, race/ethnicity, gender identity and expression, and HIV can lead to a number of negative outcomes specific to this population.
“Stigma results in social isolation, either through rejection by social network members or self-protective withdrawal, leading to loneliness and, ultimately, depression,” he said. “Stigma also makes people reluctant to disclose their HIV status, which could affect their health care treatment or prevent them taking precautions to reduce transmission.”
Older individuals who believe in the negative stereotypes associated with aging can also have poor health outcomes. Negative expectations about aging have been associated with poor cognitive test performance in older individuals and can increase stress, resulting in physical health issues, such as heart disease. More important, if an individual believes that aging leads to inevitable health problems and decline, that person may stop engaging in healthy behaviors, creating a self-fulfilling prophecy.
“These mechanisms may be responsible for empirical findings that internalized ageism is related to both chronic disease and longevity,” he said.
While it may not be possible to reduce ageism at the societal level, there are opportunities at the community level for providers of health and human services to buffer or reduce the impact of ageism for those who are infected or at risk for HIV, he said.
Specifically, Brennan-Ing recommended:
• Training health providers in HIV screening, early diagnosis and initiation of antiretroviral therapy in older populations and integration of key services.
• Prevention, education and outreach targeting older adults.
• Treatment guidelines for older individuals with HIV.
• Funding in line with the aging of the epidemic.
• Engagement of communities, community-based organizations and social service providers in outreach, mental health and social support.
• Addressing the needs of special populations.
“With the demographic shift toward older adults in the HIV population globally, and the elusiveness of a cure, addressing the care needs of this aging population are paramount,” said Brennan-Ing. “The aging of the HIV epidemic will be very challenging, but provides the opportunity to mount a global response that will address the needs of this population across regions and settings.”
Do I Have to Enroll in Medicare if I’m Still Working at 65?
One of the most common questions asked by seniors these days is “Do I need to enroll in Medicare if I’m still working at 65?” The answer isn’t black and white. It depends on multiple factors and personal preferences. If you don’t plan on retiring at 65, you are going to want to ask yourself these questions to figure out when you should enroll in Medicare.
What is the Size of My Employer?
The first thing you need to consider when deciding to enroll in Medicare at 65 is the size of your employer. If you work for a small employer with less than 20 employees, you need to enroll in Medicare when your Initial Enrollment Period arises.
Medicare will become your primary insurance and your group plan will be secondary. Your group plan monitors your age, so there is a chance that they will stop paying your claims if they realize you are eligible for Medicare and don’t have it. You will also have late enrollment penalties later on because you missed your Initial Enrollment Period for Medicare.
If your employer has 20 or more employees, it’s considered a large employer. When working for a large employer you have three options during your Initial Enrollment Period.
- Stick with your group plan and delay enrolling in Medicare until you retire.
- Disenroll from your group plan and enroll in Medicare.
- Have both your group plan and Medicare for extra coverage.
It’s advisable to research and compare premiums costs for both your group plan and Medicare to see which option is best for you. If you choose option one, you will have a Special Enrollment Period once you retire to enroll in Medicare without penalty.
Do I Have Retiree Benefits?
Retiree benefits are health plans that some employers offer to their retirees. Medicare is the primary insurance for these types of health plans. This means you need to enroll in Medicare if you have retiree benefits.
One type of plan that retirees often ask about is COBRA. COBRA allows the retiree to have health coverage up to 18 months after their retirement. However, Medicare requires you to enroll within the first 8 months of having COBRA if you are over 65. Keep in mind that COBRA can also stop paying claims if they realize you are eligible for Medicare, yet you don’t have it.
What if I Don’t Sign Up at All?
Choosing to not enroll in Medicare when you are expected to can cost you a world of trouble. You can end up getting late penalties and delayed coverage if you don’t sign up on time. Yet we see this all time. A healthy person decides not to enroll and doesn’t realize that later he will have considerable penalties because he simply didn’t know the rules.
In this scenario, he must now wait until the next General Enrollment Period (GEP) which begins January 1st and ends March 31st. When you enroll during the GEP, your coverage doesn’t start until that July. This means that you have gone months without health coverage.
How Can I Enroll in Medicare?
Most people qualify for premium-free Part A, so you might as well enroll in at least that when you are first eligible. If you do decide to enroll in full Original Medicare when you are first eligible, you will be safe from the chaos that occurs when you don’t enroll on time.
If your group plan has decent drug coverage, you don’t have to enroll in Part D for drug coverage. Be sure to check if your group plan includes drug coverage because if it doesn’t, you will need to enroll in Medicare Part D.
You can enroll online at the Social Security website, in person at the Social Security office, or over the phone during your Initial Enrollment Period (IEP). Your IEP is a seven-month period. This one-time window begins three months before the month that you turn 65 and lasts for three months after the month that you turn 65.
Can I Disenroll from Medicare if I Return to Work?
Sometimes people retire and then decide to return to work, perhaps in a new field or part-time. If your new employer has more than 20 employees and offers health insurance coverage, you can enroll in that coverage and drop your Medicare Parts B and/or D if you want to. This will save you from paying those premiums. Be sure to confirm that your employer’s plan is equal to or better than Part D benefits so that you don’t incur a penalty later on when you re-enroll in Part D.
There is usually no need to disenroll from Part A since Part A costs nothing for most people. It can coordinate with your employer coverage and potentially reduce costs if you incur a hospital stay. Just keep in mind that you cannot contribute to a health savings account while enrolled in any part of Medicare, so if your employer plan provides an H.S.A., you’ll want to keep that in mind.
Later when you decide to stop working again, you’ll have a special election period to re-enroll in Parts B and D.
Dealing with Medicare while you are still working at 65 can be difficult. It’s important to learn what type of coverage your employer has along with what changes might be made once you get Medicare. Doing your research ahead of time can help you avoid any enrollment mistakes.
Dilemmas and Solutions for Americans Raising Children While Caring for Elderly Family Members
Approximately half of middle-aged people in American provide financial, health, or emotional support for adult parents and minor or adult children. The term “sandwich generation caregiver” emerged in the 1980’s to describe middle-aged people who support minor children while providing physical, emotional, financial, or legal assistance to adults. Of course, doing so much exacts personal costs. Sandwich generation caregivers often experience stress-related illnesses, lost income, and decreased work productivity. They also find it harder to provide prolonged assistance to adult children.
Historically, caregiving could be shared by extended family members who lived in close proximity. Now more people relocate for career opportunities. Younger people may do senior care at a long-distance, or aging parents may move closer to one of their adult children and increase the burden on that family.
Caregivers who are employed full-time and taking care of multiple family members must adjust their work schedule and often take unpaid leave to fulfill obligations. They may lose Social Security and pension benefits or experience stressful financial strains that can cause them to become ill. Very often, sandwich generation caregivers choose to attend to the health of a child or parent and neglect their own health. Poor caregiver health is becoming a public health issue.
Sandwich generation caregivers also face barriers in the workplace and increase the cost of health care for employers. Health care costs for caregivers are approximately $13.4 billion greater than for employees that do not have caregiving responsibilities. Working caregivers may have a hard time juggling the crushing time demands of work and caregiving; and they may pass up promotions, decrease work hours, and take unpaid leave because they have depleted paid vacation and sick days.
Caregiver absences cost the U.S. economy $25.2 billion annually in productivity; and workers often quit jobs, lose lifetime wages, retirement savings, and pension benefits. Less than half of U.S. employers offer flexible schedules or the opportunity to telecommute to accommodate caregiving tasks.
Guilt and Exhaustion
Sandwich generation caregivers at the same time express guilt that they are not doing enough – and say they feel exhausted from doing too much. Guilt and exhaustion about how caregiving affects their children is a perpetual undercurrent of stress that affects their own health. In one of my research interviews, Sophie said “I was a single mom at the time…[my kids] really needed me here and then it would be my night to go shower mom and put her to bed… I’d cry sometimes all the way there and then I’d get there and Mom would be sitting there, facing the wall …and then on the way home you’d cry because…how could I think that I didn’t need to be there.” And in another interview, Ellie explained that she felt “…sometimes it’s almost like a ball and chain and then I think, “What am I teaching my kids… I want them to have the freedom to live their life without feeling obligated to take care of me someday. And sometimes I wonder how strong a message I’m sending in that regard.”
Self-Care Helps Caregivers Cope – and Jobs Can Too
Parenting and caregiving are both consuming roles – yet many caregivers understand that they still need to take care of themselves because otherwise the pressure or anxiety can be overwhelming. Self-care takes many different forms for sandwich generation caregivers: leisure, exercise, and socializing.
Abby, for instance, told me that even during the hardest part of her caregiving experience she still did Friday night dinner and cards with her husband and friends, took her Tuesday golf outing and walked her dog daily. Abby realized that carving out time for herself helped her stay healthy and not resent taking care of her dad. Similarly, at the beginning of our interview, Zach, said he “was not the type of person to feel guilty” about taking time for himself. He incorporated his kids into his coping strategies by going for long walks with them.
Not only do most sandwich generation caregivers need the wages and benefits that work provides, they also need a break from caregiving. Work sometimes offers a “guilt-free” break, allowing them to feel productive and serving as either a social outlet or a place for solitude, as two interviewees explained:
- Chloe stated that caregiving was mentally and physically exhausting. She admitted that it was hard to not feel guilty about taking time for herself but she had a “wake up call” during a physical when her cholesterol and blood sugar were elevated. She allowed herself to relax and socialize during her quarterly conference for work.
- Leah believed the hardest part of being a parent, caregiver, and professor was that she was “always surrounded.” Leah said that she didn’t take any time for herself. She felt she had to work to make up for the “hole” she put her family in to earn her degree but then she revealed that being in her office at work was like a “retreat”. She could play music and work at the computer and just be by herself while she graded papers and worked on her research.
What Employers Can Do
Employee assistance programs, flexible schedules, and telecommuting options can reduce some of the stress sandwich generation caregivers experience. Such employees often miss work due to caregiving tasks and their own poor health as a result of stress. They may not have the time to practice preventative health habits and coping strategies, and some develop cardiac, psychological, and chronic illnesses. Employee assistance programs can reduce such problems, to the benefit of all concerned. Employers can, for starters, create a supportive environment for caregivers and help them to seek and utilize institutional and community resources.
In some cases, flexible schedules and telecommuting may allow caregiver workers to maintain their job productivity and prevent valued employees from having to reduce work hours or quit altogether. Employers and fellow employees should also realize that for some caregiver workers time at the office can also act as a coping strategy because it offers a physical and emotional break. This should not be seen as a problem. When caregivers practice self-care, they are healthier – and can be more productive even as they balance the complex demands of their work and family responsibilities.
Music: The Secret to Mental Health and Balance While Aging
No matter where you travel, you’ll notice one universal truth — music has a very particular and powerful hold on us all. Cultures everywhere make and love music. This has been the case throughout history. We have used music to relax, communicate and celebrate — the human brain is hard-wired to react to music. According to Kimberly Sena Moore, a neurologic music therapist, “Your brain lights up like a Christmas tree when you listen to music.”
The magic of music goes much further than entertainment — there a surprising number of health benefits for the elderly, and there is a lot of evidence to support the fact that music is a secret weapon when it comes to maintaining optimal mental health and balance in our old age.
Boost Memory by Learning to Play an Instrument
If you want to ensure your memory is strong well into your winter years, consider picking up an instrument. Regardless of what you prefer to play, the act of learning how to play will sharpen your memory recall. This is because the process of learning and playing an instrument requires a great number of complex tasks, such as reading musical notes and knowing where to place your fingers. In time, this expands your working memory capacity and your ability to multiprocess without feeling overloaded. You will also be able to remember information for longer periods.
Music Can Act as a Stress Reliever
Coping with stress can become more difficult as we get older. We have less resilience to it, and it can affect us differently, which is stressful in and of itself. On top of changes in response to stress, we can experience changes in triggers as the years go by, so it is important we all find a way to cope.
There have been many studies to show music has a notable (and positive) effect on our stress and blood pressure levels. In fact, this is the case even if we’re not conscious. One study involving surgery patients found the use of music before an operation reduced stress levels to an even greater degree than anti-anxiety medication. The act of singing sends small vibrations throughout the body, which lowers cortisol (the stress hormone) levels and releases endorphins, thereby helping to keep you calm and collected in trying times.
Music Can Reduce Falls in the Elderly
Remarkably, studies show when the elderly exercise while listening to music, it helps them maintain balance and reduce the risk of falling. Falling is a huge concern for those over the age of 65, and music might well be the answer. According to a 2011 Swiss study, where participants were trained to walk and perform certain movements in time to music, they experienced 54% fewer falls when compared to the control group. The study also found that walking speed and stride length increased as a result.
A Good Drum Beat Can Kickstart Brain Function
The brain instinctively syncs to a rhythm. Because of this, therapists use drumming to get through to patients with severe dementia who don’t normally respond to external stimulus. When dementia patients hear music, you can detect a noticeable shift. They show more of an interest in their surroundings, they clap to the beat or even sing. This is because music can stimulate many parts of the brain simultaneously. Music which was popular when the patient was between the ages of 18 and 25 generally gets the most positive response.
Music Can Soothe Physical and Emotional Pain
Swedish researchers have found your favourite music can be a great pain reliever, as it can distract us and boost positive emotions. Interestingly, by evoking nostalgia, music can help us get through the pain, both physical and emotional.
Music Can Combat Depression and Boost Happiness
A serotonin imbalance in the brain causes depression. When you listen to music, you experience a boost in serotonin, so music can be used as a tool to combat depression in the elderly. Doctors claim the simple act of singing can release oxytocin, providing a significant mood booster. So while music alone may never entirely relieve the symptoms brought about by depression, it can certainly do its bit to enhance wellbeing.
Music Provides Opportunities for Social Interaction
Music can provide an essential source for social contact, which promotes interaction and a sense of belonging. This is increasingly important as we age. By incorporating music therapy and joining a choir, the opportunities to socialise and collaborate let us make new friendships and create new bonds.
Music Can Improve Quality and Quantity of Sleep
Many seniors don’t get as much sleep as they need, which can cause serious medical issues in time. Lack of sleep has been shown to have a profound and negative impact on mental health and wellbeing. A 2009 meta-analysis found music can improve the quality and quantity of sleep. Of course, the benefits may not happen overnight. But if you persist, in as little as three weeks, you should notice a pay off from this relaxation technique. Some of these include falling asleep faster and remaining asleep for longer.
Four Calming Techniques to Improve Your Mental Health
If you are like me and the other nearly 325,000,000 trillion people in the U.S., you have experienced stress. From raising kids, dealing with your boss or handling a health issue, you can feel overwhelmed. But there’s good news! Learn how to create peace and take control of your life.
Determining the Type of Stress
Most people do not realize stress, a response to stimuli comes in two varieties which is good stress and bad stress. Bad stress or distress happens when your perception of an event is threatening. According to Stress Management Society, “Through the release of hormones, such as adrenaline, cortisol…the caveman gained a rush of energy…”. This onset of biological and emotional reactions resulted in the need to fight or flight.
Good stress or positive stress is the opposite response. It is marked by feelings of happiness and a sense of confidence. Your thoughts are focused and the energy is motivating.
Four Paths to Calm
Now that you know more about stress, you can start to manage it. Try these tips to make stress ignite your creativity and passion. Make stress work for you.
1. Keep It in Perspective
So, how do you transform your bad stress into good stress? Change your perception. If your job causes you to relocate, consider it a career opportunity. If the throbbing in one of your molars means you need a root canal, don’t panic. Discuss it with an emergency dentist Calgary. Consider it an investment in your health.
2. Calm the Monkey
Your mind races with thousands of thoughts all day. Anxiety builds as you obsess about future concerns. What if this happens, what if that happens? Stop!
Just breathe. As you mindfully count from 1 – 10, inhale and exhale slowly. Feel your heart rate decrease.
The Buddhists used this breathing method for quiet meditation to conquer the Monkey Mind or frenzied mental condition. In Mindfulness: Taming the Monkey Mind by Mitchell Wagner, the author states, “It is not possible for the mind to be open…when it is consumed by anxiety.”
3. Choose the Right Foods
What do yogurt, pistachios, and spinach have to do with relaxation? They contain key ingredients which affect your mood.
According to Organic Facts, pistachios have “6 grams of protein per ounce…”. Protein contains an amino acid which produces serotonin, a regulator of hunger.
Spinach & Avocado
The folate found in this green leafy vegetable produces dopamine, a chemical producing feelings of pleasure. Folic acid improves memory in adults experiencing stress. Avocados are also high in folate and vitamin E.
This comfort-inducing snack is filled with probiotics. It delivers healthful live bacteria in the gut linked to good mental health.
Strawberries, Raspberries, & Blueberries
These fruits are high in vitamin C which helps fight stress.
4. Become a Yogi
Yoga is a tradition dating back 300 years ago. Yoga is low impact and is a synergy of mind, body, and soul.
The International Journal of Yoga published “Exploring the therapeutic effects of Yoga and its ability to increase the quality of life” and found “Yogic practices enhance muscular strength…reduce stress, anxiety…”. Bikram, Hatha, and Kundalini are some of the best forms of yoga for beginners.
Invest in Stress Management
Consult with your doctor. Read books and attend local exercise classes. Stay up-to-date about trends.
Stress is a part of life. Learn stress management. Anticipate the unexpected and choose a strategy challenging you to do your best. Then, sit back and relax.
Loneliness Found to Be High in Public Senior Housing Communities
Older adults living in public senior housing communities experience a large degree of loneliness, finds a new study from the Brown School at Washington University in St. Louis.
Nevertheless, senior housing communities may be ideal locations for reducing that loneliness, the study finds.
“There are many studies on loneliness among community-dwelling older adults; however, there is limited research examining the extent and correlates of loneliness among older adults who reside in senior housing communities,” wrote Harry Chatters Taylor, doctoral student at the Brown School and lead author of “Loneliness in Senior Housing Communities,” published in the Journal of Gerontological Social Work.
The study was co-authored by Yi Wang, doctoral student at the Brown School, and Nancy Morrow-Howell, the Bettie Bofinger Brown Distinguished Professor of Social Policy and the director of the Harvey A. Friedman Center for Aging.
The study examines the extent of loneliness in three public senior housing communities in the St. Louis area. Two of the three complexes were in urban neighborhoods, and the last was located in a suburban neighborhood. All were publicly funded under Section 202 Supportive Housing for the Elderly Program. Data for the project was collected with survey questionnaires with a total sample size of 148 respondents. Loneliness was measured using the Hughes 3-item loneliness scale. Additionally, the questionnaire contained measures on socio-demographics, health/mental health, social engagement and social support.
Results showed approximately 30.8 percent of the sample was not lonely; 42.7 percent was moderately lonely, and 26.6 percent was severely lonely. In analyzing the data, researchers found loneliness was primarily associated with depressive symptoms.
“We speculate that loneliness may be higher in senior housing communities for a few important reasons,” Taylor said. “The first is older adults residing in senior housing communities often have greater risk for loneliness. In order to qualify to live in these senior housing communities, older adults must have a low income, and having a lower income is a risk factor for loneliness.
“Additionally, most of the residents we interviewed identified their marital status as single, which is another risk factor for greater loneliness. Many older adults living in senior housing communities also have greater health and mental health vulnerabilities, which increases the likelihood that an older adult will experience loneliness.”
Despite all that, the study finds, senior housing communities may be better suited to combat loneliness than traditional residential homes.
“We believe that senior housing communities could become ideal locations for reducing loneliness among older adults,” Taylor said. “Senior housing communities are embedded in communities with peers who may have similar age and life experiences. There are occasional activities and support from senior housing management to encourage the building of friendships, bonds and social support among senior housing residents.
“Most senior housing communities also have a common space or multipurpose room available for use, which can also help facilitate building bonds between residents. Senior housing communities are frequently located close to public transportation, which provides access to transportation for residents without automobiles.”
Still, loneliness is frequently a stigmatized condition, he said.
“We often do not like to talk about our feelings of loneliness,” Taylor said. “For practitioners, it is important to be patient when working with older adults, and it could take a while for an older adult, regardless if they reside in a senior housing facility, to admit they are feeling lonely.
“Whether you are a child, relative or family member to an older adult, or provide services to older adults, be patient when discussing issues of loneliness and mental health with older adults.”
Medicare For All – Protection for Your Retirement Plans
An unexpected medical emergency, a life-changing diagnosis, or a car accident are a number of countless situations that can land us in the emergency room, setting off a chain reaction of diagnostic tests, follow-up appointments, prescriptions, treatments, and more. Of course, this all has a significant implication on your pocketbook, and even if you have insurance, the bills can still be staggering.
Health insurance is supposed to be an investment, a sort of safety net to minimize your financial obligations in the event of a significant health illness or injury. But rising premiums, high deductible plans, and coverage exclusions have rendered comprehensive, quality, affordable insurance plans a thing of the past.
This can have significant implications for older adults nearing or at retirement age. A car accident, a cancer diagnosis, or any number of other health issues can quickly drain away savings, including retirement plans.
Health Care Costs Threaten Retirement Plans
Amassing a retirement savings large enough to provide a comfortable living for decades is no small feat. Because seniors tend to see increased health issues and health care costs in their latter years of life, a significant portion of their retirement plan needs to be able to cover those increased costs.
According to a study performed by Fidelity, a 65-year-old couple retiring in 2017 will need to cover approximately $275,000 in health care costs throughout their retirement. That amount reflects a 6% increase over the 2016 figure of $260,000. However, that estimate has increased more than 70% when compared with the initial estimate ever performed by Fidelity back in 2002.
Simply saving up enough money to be able to retire can be a challenge, especially when you encounter unexpected health issues and emergencies earlier on in life. According to a survey by Bankrate, only 41% of adults say that they have enough money in savings to be able to pay off an unexpected cost. However, 45% of survey respondents indicated that they’d had a major unexpected expense in the past 12 months.
And if a family has a high-deductible insurance plan, a single visit to the ER can cost tens of thousands of dollars. Families without adequate savings may feel pressured to reach into retirement savings to fund the emergency, leaving them with even less savings than they’d had initially.
A Compounding Problem
The issue of health care costs depleting retirement savings becomes even more urgent when you consider the seniors who can’t afford to retire at all. The U.S. Jobs Report indicated that the retirement age is increasing, with almost 19% of United States seniors aged 65 or older were working at least part time during the second quarter of 2017. Additionally, 19% of 70- to 74-year-olds were still working.
Working later into life leads to increased retirement savings, but this isn’t a practical option for many seniors. Health issues force many seniors to quit their jobs even if their retirement savings aren’t yet large enough to provide them with long-term security.
Simply finding a job can be a challenge, since employers may be more reluctant to hire seniors (despite age discrimination laws). Seniors may find themselves with fewer job options and may have to settle for lower-paying jobs with poor health insurance policy offerings.
Medicare for All: Protecting Retirement Savings
Medicare for All could be a solution to this growing problem. With single-payer health care, all Americans could enjoy protection against unexpected large medical bills. Americans wouldn’t need to dip into their retirement savings for health-related emergencies. And with reduced health care costs, they could put more earnings into their retirement plans.
If more Americans were able to put aside more retirement savings, they could retire at age 65 without having to worry about extending their employment into their senior years. They could enjoy reduced stress and could focus on healing after a health crisis, rather than worrying about the massive bills that would follow.
With access to the medications and treatments that they need, Americans could enjoy better health, happiness, and an improved quality of life. Isn’t that what we want for our seniors, our retirees, and all American citizens?
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