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Second Edition of the COVID-19 Pandemic in Europe: Response to Challenges

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 26321

Special Issue Editors


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Guest Editor
Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, 00185 Rome, Italy
Interests: COVID-19 vaccination acceptance; COVID-19 vaccination hesitancy; lockdown; knowledges; behaviours; COVID-19; legionella; legionellosis; migrants; migrant's health; legionnaires' disease; chikungunya; dengue
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
Interests: epidemiology; public health; preventive medicine; health promotion; healthcare associated infections

Special Issue Information

Dear Colleagues,

COVID-19 is an ongoing pandemic that has resulted in global health, economic and social crises. Due to this social and healthcare burden, countries have adopted several strategies to control the spread of the virus, including social distancing, suspension or modification of working activities, restricted movement and obligatory use of facial masks. Healthcare workers who operate on the front line were among the most involved professional categories for both workload and level of infection contracted.

Fortunately, in 2020, the efforts made across the world to rapidly develop vaccines led to several effective vaccines approved in record time. In fact, the vaccination campaign is the primary method to counteract the COVID-19 pandemic; however, sufficient vaccination coverage is conditioned by people’s acceptance of these vaccines. A debate is still ongoing with regard to the compulsory use of the vaccine and the green pass.

At the same time, it is still necessary to develop a more detailed understanding of the spreading dynamics of the virus and its variants, to identify both better diagnostic and therapeutic approaches, as well as vaccine strategies.

In this context, the second edition of this Special Issue aims to publish scientific evidence regarding microbiological and epidemiological aspects of the pandemic, laboratory diagnosis, therapeutic options, vaccine development, COVID-19-related knowledge and behaviors, vaccination strategies, vaccine acceptance, COVID-19-related changes in lifestyles and mental health, new public health approaches, environmental control measures, and communication.

Prof. Dr. Christian Napoli
Dr. Giovanni Orsi
Guest Editors

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Keywords

  • microbiological and epidemiological aspects of the pandemic
  • laboratory diagnosis
  • therapeutic options
  • COVID-19-related knowledge and behaviors
  • COVID-19 vaccine acceptance and hesitancy
  • COVID-19-related changes in lifestyles and mental health
  • new public health approaches
  • environmental control measures
  • correct communication campaigns

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Published Papers (10 papers)

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Research

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9 pages, 2706 KiB  
Article
SARS-CoV-2 Infection in San Patrignano, the Largest European Drug Rehabilitation Community
by Isabella Sala, Carlotta Micaela Jarach, Vincenzo Bagnardi, Maria Sofia Cattaruzza, Michela Morri, Paolo Ottogalli, Vincenzo Zagà, Silvano Gallus and Antonio Boschini
Int. J. Environ. Res. Public Health 2023, 20(3), 2136; https://doi.org/10.3390/ijerph20032136 - 24 Jan 2023
Cited by 1 | Viewed by 1279
Abstract
Background: Studies on SARS-CoV-2 conducted in confined settings for prolonged times allow researchers to assess how the coronavirus spreads. San Patrignano (SP), Italy, is the largest European drug rehabilitation facility. Methods: Between 15 October and 31 December 2020, all SP residents were tested [...] Read more.
Background: Studies on SARS-CoV-2 conducted in confined settings for prolonged times allow researchers to assess how the coronavirus spreads. San Patrignano (SP), Italy, is the largest European drug rehabilitation facility. Methods: Between 15 October and 31 December 2020, all SP residents were tested for SARS-CoV-2. We analyzed the relationships between individual characteristics and being SARS-CoV-2-positive. Three selected predictive models were used to calculate the number of expected hospitalizations. For each model, we summed the estimated individual risks to obtain the expected number of hospitalizations in our sample, and we tested whether the observed and expected numbers differed. Results: Of 807 residents, 529 (65.6%) were SARS-CoV-2-positive. Of these 323 (61.1%) were symptomatic. A strong relationship was found between being positive and living connections (p-value < 0.001). No statistically significant relationship was found with age, sex, smoking history, or comorbidities. Although 9 to 17 hospitalizations were expected, no hospitalizations were observed (p-value < 0.001). No one died of COVID-19. Conclusions: The peculiar characteristics of SP residents or the SP environment might at least partially explain the null hospitalization rates. Despite the extreme uniqueness of our population and despite the protected environment and all precautions that were taken, the fact that the virus was able to circulate and infect a large portion of the population highlights the fundamental role of social interactions in the spread of the disease. Full article
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19 pages, 2060 KiB  
Article
Sustained Cytotoxic Response of Peripheral Blood Mononuclear Cells from Unvaccinated Individuals Admitted to the ICU Due to Critical COVID-19 Is Essential to Avoid a Fatal Outcome
by Guiomar Casado-Fernández, Magdalena Corona, Montserrat Torres, Adolfo J. Saez, Fernando Ramos-Martín, Mario Manzanares, Lorena Vigón, Elena Mateos, Francisco Pozo, Inmaculada Casas, Valentín García-Gutierrez, Sara Rodríguez-Mora and Mayte Coiras
Int. J. Environ. Res. Public Health 2023, 20(3), 1947; https://doi.org/10.3390/ijerph20031947 - 20 Jan 2023
Viewed by 1603
Abstract
The main objective of this study was to determine the influence of the cytotoxic activity of peripheral blood mononuclear cells (PBMCs) on the outcome of unvaccinated individuals with critical COVID-19 admitted to the ICU. Blood samples from 23 individuals were collected upon admission [...] Read more.
The main objective of this study was to determine the influence of the cytotoxic activity of peripheral blood mononuclear cells (PBMCs) on the outcome of unvaccinated individuals with critical COVID-19 admitted to the ICU. Blood samples from 23 individuals were collected upon admission and then every 2 weeks for 13 weeks until death (Exitus group) (n = 13) or discharge (Survival group) (n = 10). We did not find significant differences between groups in sociodemographic, clinical, or biochemical data that may influence the fatal outcome. However, direct cellular cytotoxicity of PBMCs from individuals of the Exitus group against pseudotyped SARS-CoV-2-infected Vero E6 cells was significantly reduced upon admission (−2.69-fold; p = 0.0234) and after 4 weeks at the ICU (−5.58-fold; p = 0.0290), in comparison with individuals who survived, and it did not improve during hospitalization. In vitro treatment with IL-15 of these cells did not restore an effective cytotoxicity at any time point until the fatal outcome, and an increased expression of immune exhaustion markers was observed in NKT, CD4+, and CD8+ T cells. However, IL-15 treatment of PBMCs from individuals of the Survival group significantly increased cytotoxicity at Week 4 (6.18-fold; p = 0.0303). Consequently, immunomodulatory treatments that may overcome immune exhaustion and induce sustained, efficient cytotoxic activity could be essential for survival during hospitalization due to critical COVID-19. Full article
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16 pages, 1631 KiB  
Article
Factors Associated with the Antibiotic Treatment of Children Hospitalized for COVID-19 during the Lockdown in Serbia
by Andreja Prijić, Tatjana Gazibara, Sergej Prijić, Stefan Mandić-Rajčević and Nataša Maksimović
Int. J. Environ. Res. Public Health 2022, 19(23), 15590; https://doi.org/10.3390/ijerph192315590 - 24 Nov 2022
Cited by 2 | Viewed by 1249
Abstract
Unselective use of antibiotics to treat children with COVID-19 is one of the major issues during the pandemic in Serbia. Thus far, there has been no evidence about the predictors of multiple antibiotic use in the treatment of children with COVID-19. The purpose [...] Read more.
Unselective use of antibiotics to treat children with COVID-19 is one of the major issues during the pandemic in Serbia. Thus far, there has been no evidence about the predictors of multiple antibiotic use in the treatment of children with COVID-19. The purpose of this study was to assess the prevalence of antibiotic use, as well as to examine demographic and clinical factors associated with a greater number of antibiotics and with a longer antibiotic treatment administered to hospitalized children with COVID-19 during the lockdown in Serbia. This study included all children who were hospitalized from 6 March to 31 May 2020 at the only pediatric COVID-19 hospital, and who were confirmed to have SARS-CoV-2 infection. Demographic, clinical, and laboratory data were collected from medical records. The antibiotic treatment included the use of azithromycin, cephalosporin (ceftriaxone), ampicillin-amikacin, and hydroxychloroquine. The overall prevalence of antibiotics use in children hospitalized with COVID-19 regardless of age was 47.2% (43.3% in children aged 1–5 years and 44.4% in those aged 5–17 years). In children aged 1–5 years, not having a family member affected by COVID-19 (B = −1.38, 95% confidence interval [CI] −2.43, −0.34, p = 0.011), having pneumonia on chest X-ray (B = 0.81, 95%CI 0.34, 1.29, p = 0.002), being a boy (B = −0.65, 95%CI −1.17, −0.13, p = 0.018), and having higher C-reactive protein (CRP) values on admission (B = 0.12, 95%CI 0.07, 0.17, p = 0.001) were associated with the administration of a higher number of antibiotics. These factors, along with having fever (B = 3.20, 95%CI 1.03, 5.37, p = 0.006), were associated with a longer duration of antibiotic treatment in children aged 1–5 years. In children aged 5–17 years, having pharyngeal erythema (B = 1.37, 95%CI 0.61, 2.13, p = 0.001), fever (B = 0.43, 95%CI 0.07, 0.79, p = 0.018), and pneumonia on chest X-ray (B = 0.91, 95%CI 0.53, 1.29, p = 0.001), not having rhinorrhea (B = −1.27, 95%CI −2.47, −0.08, p = 0.037), being a girl (B = 0.52, 95%CI 0.08, 0.97, p = 0.021), and having higher CRP values on admission (B = 0.04, 95%CI 0.01, 0.06, p = 0.006) were associated with the administration of a higher number of antibiotics. These factors, not including the absence of rhinorrhea, were associated with a longer duration of antibiotics treatment in children aged 5–17 years. Demographic, epidemiological, clinical, and laboratory parameters were associated with the use of multiple antibiotics and a longer duration of antibiotic treatment both among children aged 1–5 years and those aged 5–17 years. Full article
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8 pages, 469 KiB  
Communication
What Is Next for Public Health after COVID-19 in Italy? Adopting a Youth-Centred Care Approach in Mental Health Services
by Silvia Ussai, Giulio Castelpietra, Ilaria Mariani, Andrea Casale, Eduardo Missoni, Marco Pistis, Lorenzo Monasta and Benedetta Armocida
Int. J. Environ. Res. Public Health 2022, 19(22), 14937; https://doi.org/10.3390/ijerph192214937 - 13 Nov 2022
Cited by 2 | Viewed by 1981
Abstract
Although endeavours to protect mental well-being during the COVID-19 pandemic were taken at national and regional levels, e.g., mental support in school, a COVID-19 emergency toll-free number for psychological support, these were sporadic conjunctural financing interventions. In this Communication, the authors conducted a [...] Read more.
Although endeavours to protect mental well-being during the COVID-19 pandemic were taken at national and regional levels, e.g., mental support in school, a COVID-19 emergency toll-free number for psychological support, these were sporadic conjunctural financing interventions. In this Communication, the authors conducted a systematic search for programmatic and policy documents and reports with a solid literature and policy analysis concerning the main objective, which is to analyse the appropriateness in implementing gender- and age-sensitive, integrated, youth-centred mental health services in Italy. The Italian National Action Plan for Mental Health reports a highly fragmented situation in the Child and Adolescent Neuropsychiatry services, in terms of an integrated and comprehensive regional network of services for the diagnosis, treatment, and rehabilitation of neuropsychological disorders in young people. Wide-ranging interventions, systemic actions should be implemented, funded, and included in an overall structural strengthening of the healthcare system, including those dedicated to transition support services. In this context, the National Recovery and Resilience Plan (NRRP), may represent an opportunity to leverage specific funds for mental health in general, and for youth in particular. Finally, mental health service governance should be harmonized at both national and regional EU levels—with the adoption of best practices implemented by other Member States. This includes, among others, health information system and data collection, which is critical for analysing epidemiological trends and for monitoring and evaluating services, to offer a public and integrated system for the care and protection of young people, in line with the Convention on the Rights of the Child. Full article
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12 pages, 1323 KiB  
Article
Factors Associated with the Patient’s Decision to Avoid Healthcare during the COVID-19 Pandemic
by Patrícia Soares, Andreia Leite, Sara Esteves, Ana Gama, Pedro Almeida Laires, Marta Moniz, Ana Rita Pedro, Cristina Mendes Santos, Ana Rita Goes, Carla Nunes and Sónia Dias
Int. J. Environ. Res. Public Health 2021, 18(24), 13239; https://doi.org/10.3390/ijerph182413239 - 15 Dec 2021
Cited by 24 | Viewed by 2678
Abstract
The COVID-19 pandemic has resulted in changes in healthcare use. This study aimed to identify factors associated with a patient’s decision to avoid and/or delay healthcare during the COVID-19 pandemic. We used data from a community-based survey in Portugal from July 2020 to [...] Read more.
The COVID-19 pandemic has resulted in changes in healthcare use. This study aimed to identify factors associated with a patient’s decision to avoid and/or delay healthcare during the COVID-19 pandemic. We used data from a community-based survey in Portugal from July 2020 to August 2021, “COVID-19 Barometer: Social Opinion”, which included data regarding health services use, risk perception and confidence in health services. We framed our analysis under Andersen’s Behavioural Model of Health Services Use and utilised Poisson regression to identify healthcare avoidance associated factors. Healthcare avoidance was high (44%). Higher prevalence of healthcare avoidance was found among women; participants who reported lower confidence in the healthcare system response to COVID-19 and non-COVID-19; lost income during the pandemic; experienced negative emotions due to physical distancing measures; answered the questionnaire before middle June 2021; and perceived having worse health, the measures implemented by the Government as inadequate, the information conveyed as unclear and confusing, a higher risk of getting COVID-19, a higher risk of complications and a higher risk of getting infected in a health institution. It is crucial to reassure the population that health services are safe. Health services should plan their recovery since delays in healthcare delivery can lead to increased or worsening morbidity, yielding economic and societal costs. Full article
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9 pages, 314 KiB  
Article
Fighting COVID-19 Contagion among University Students of Healthcare Professions: An Italian Cross-Sectional Study
by Marco Tofani, Anna Berardi, Maurizio Marceca, Donatella Valente, Alfonso Mazzaccara, Antonella Polimeni and Giovanni Galeoto
Int. J. Environ. Res. Public Health 2021, 18(23), 12676; https://doi.org/10.3390/ijerph182312676 - 1 Dec 2021
Cited by 1 | Viewed by 1662
Abstract
During the pandemic, most governments around the world temporarily closed educational institutions to contain the spread of the Coronavirus Disease 2019 (COVID-19). The objective of the present study is to evaluate the efficacy of an e-learning course on COVID-19 transmission for healthcare university [...] Read more.
During the pandemic, most governments around the world temporarily closed educational institutions to contain the spread of the Coronavirus Disease 2019 (COVID-19). The objective of the present study is to evaluate the efficacy of an e-learning course on COVID-19 transmission for healthcare university students, in order to advance the preparedness of healthcare university students against contracting COVID-19 within the general university population. The e-learning course was run using a free web service for education. Access to the course was limited to participants enrolled in degree courses related to healthcare professions within the Italian university system. A specific and validated questionnaire was administered at two different times (pre-test and post-test). A paired sample t-test was then used to evaluate their knowledge on COVID-19. Furthermore, a questionnaire measuring their satisfaction was distributed. Data were analyzed from a qualitative point of view. The course was made available from March to July 2020. Over 25,000 students from different Italian universities and various backgrounds participated in the course. The analysis of final test scores revealed that approximately 97% of participants acquired new knowledge and skills on COVID-19, with a statistically significant improvement (p < 0.05). Therefore, it is possible to state that most students enrolled in degrees relating to healthcare at Italian universities are adequately trained with respect to COVID-19 knowledge. Furthermore, students declared a high satisfaction rate both with the course content, and with the management of the telematic platform used. Full article

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12 pages, 1007 KiB  
Case Report
COVID-19 Vaccination and Late-Onset Myasthenia Gravis: A New Case Report and Review of the Literature
by Eleonora Virgilio, Giacomo Tondo, Claudia Montabone and Cristoforo Comi
Int. J. Environ. Res. Public Health 2023, 20(1), 467; https://doi.org/10.3390/ijerph20010467 - 27 Dec 2022
Cited by 6 | Viewed by 8031
Abstract
Myasthenia gravis (MG) is a rare autoimmune disease that is potentially threatening for patient life. Auto-antibodies targeting structures of the neuromuscular junction, particularly the acetylcholine receptor (AchR), are often found in the serum of MG patients. New-onset MG after SARS-CoV-2 vaccination has rarely [...] Read more.
Myasthenia gravis (MG) is a rare autoimmune disease that is potentially threatening for patient life. Auto-antibodies targeting structures of the neuromuscular junction, particularly the acetylcholine receptor (AchR), are often found in the serum of MG patients. New-onset MG after SARS-CoV-2 vaccination has rarely been reported since the introduction of vaccination. Infections and COVID-19 infection have also been reported as possible triggers for a myasthenic crisis. We report a case of new-onset MG after receiving the mRNA COVID-19 vaccination. The patient was a 73-year-old male initially presenting with ocular symptoms and a rapid generalization. We also performed a literature revision of 26 described cases of MG after SARS-CoV-2 immunization. The patients were a majority of males with generalized late-onset MG occurring after the first dose of vaccine, similar to our patient. Only our patient showed a thymoma. Thymic mass and the positivity of AchR antibodies suggest that vaccination might have triggered a subclinical pre-existing MG with symptoms flaring. Clinicians should be aware of possible new-onset MG after COVID-19 vaccination, particularly in at-risk patients. Even though COVID-19 vaccination should be recommended in MG patients, particularly in well-compensated patients. However, more studies need to be performed in the future. Full article
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6 pages, 290 KiB  
Commentary
Knowledge and Behaviours towards Immunisation Programmes: Vaccine Hesitancy during the COVID-19 Pandemic Era
by Marco Dettori, Antonella Arghittu and Paolo Castiglia
Int. J. Environ. Res. Public Health 2022, 19(7), 4359; https://doi.org/10.3390/ijerph19074359 - 5 Apr 2022
Cited by 11 | Viewed by 1976
Abstract
Assessing knowledge, attitudes and behaviours towards vaccination is a key strategy when implementing national and international immunisation programmes aimed at improving compliance among the population and thereby increasing vaccination coverage. While vaccination’s role as a powerful life-saving weapon in the fight against infectious [...] Read more.
Assessing knowledge, attitudes and behaviours towards vaccination is a key strategy when implementing national and international immunisation programmes aimed at improving compliance among the population and thereby increasing vaccination coverage. While vaccination’s role as a powerful life-saving weapon in the fight against infectious diseases has been further highlighted following the introduction of the Coronavirus Disease 2019 (COVID-19) vaccine, there is still a discrepancy between the scientific evidence on the effectiveness of vaccines and the perception of the risk attributed to them. Known as “Vaccine Hesitancy” (VH), this phenomenon is the delay in acceptance or refusal of vaccines, despite the availability of services. VH can be found in at least 15% of the worldwide population, and even professional groups tasked with promoting vaccination as a primary prevention measure, e.g., healthcare workers (HCWs), sometimes have doubts regarding vaccination. Since 2014, this Public Health problem has been increasing in 90% of countries worldwide, to the extent that in 2019 it was listed as one of the ten greatest threats to global health by the World Health Organization (WHO). VH has also affected COVID-19 vaccination, hampering the achievement of desired vaccination coverage. Monitoring this trend by studying people’s behaviour and attitudes could be a useful tool to aid Public Health, in orienting vaccination policies and designing new health education and continuous training interventions, aimed at both the general public and accountable cohorts, such as HCWs. Full article
8 pages, 310 KiB  
Brief Report
Vaccine Hesitancy and the Green Digital Pass: A Study on Adherence to the Italian COVID-19 Vaccination Campaign
by Giuseppina Moccia, Luna Carpinelli, Giulia Savarese and Francesco De Caro
Int. J. Environ. Res. Public Health 2022, 19(5), 2970; https://doi.org/10.3390/ijerph19052970 - 3 Mar 2022
Cited by 17 | Viewed by 2211
Abstract
Background: In July 2021, the vaccination campaign in Italy suffered a sudden setback, and the number of vaccine administrations decreased dramatically. On 20 July 2021, the obligation of the Green Digital Pass came into force in order to access work and leisure places, [...] Read more.
Background: In July 2021, the vaccination campaign in Italy suffered a sudden setback, and the number of vaccine administrations decreased dramatically. On 20 July 2021, the obligation of the Green Digital Pass came into force in order to access work and leisure places, penalizing those who had not been vaccinated. The purpose of this work was to investigate the phenomenon of vaccination hesitancy and the underlying reasons, as well as any changes to the membership following the obligation of the Green Pass. Methods: A total of 83 subjects (45.8% F; mean age 22.24 ± 4.308) participated in the survey during the post-vaccine observation phase at the Vaccinal Center of the University Hospital “San Giovanni di Dio e Ruggi d’Aragona” (Salerno, Italy). The questionnaire collected anamnestic information, as well as data on state anxiety (STAI-Y), perception of quality of life (SF-12), perception of COVID-19 risks, and vaccine hesitancy. Results: Among participants, 19.3% reported hesitation. The most common concerns about the COVID-19 vaccine concerned safety and efficacy (4.9%) and the obligation of the Green Pass (4.9%). Conclusions: Findings suggest that delving into the phenomenon of vaccine hesitancy can help to enhance vaccination strategies in order to gain widespread acceptance, a key path to ensuring a quick way out of the current pandemic emergency. Full article
6 pages, 513 KiB  
Brief Report
Emotions and Motivations Underlying Adherence to the Anti-COVID-19 Vaccination Campaign: A Survey on a Sample of Italians under 30 Years
by Luna Carpinelli, Francesco De Caro, Giulia Savarese, Mario Capunzo, Monica Mollo and Giuseppina Moccia
Int. J. Environ. Res. Public Health 2022, 19(1), 77; https://doi.org/10.3390/ijerph19010077 - 22 Dec 2021
Cited by 5 | Viewed by 2408
Abstract
Background: In Italy, the under-30 age category was the one that joined the anti-COVID-19 vaccination campaign in an important way. This study investigates the emotional states and motivations underlying joining the anti-COVID-19 vaccination campaign. Methods: A questionnaire consisting of SF-12, STAI Y, and [...] Read more.
Background: In Italy, the under-30 age category was the one that joined the anti-COVID-19 vaccination campaign in an important way. This study investigates the emotional states and motivations underlying joining the anti-COVID-19 vaccination campaign. Methods: A questionnaire consisting of SF-12, STAI Y, and open questions was administered to investigate the state of health, the state of anxiety, and motivational states of the participants. Results: Of the sample, 80.7% were vaccinated at the first call, deeming the action important to combat the infection. However, 48.2% stated that they were quite worried about the problems related to the pandemic, 37.3% feared being directly infected, and 43.4% were worried about the health of relatives and friends. Conclusions: The positive impact that the vaccination campaign has had on the under-30 category is very significant for the immunization process, which is of fundamental importance for fighting the pandemic, so the “benefits” outweigh the “risks” related to the COVID-19 vaccine. Full article
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