By Rhona Sloss, Specialist Pharmacist Critical Care and Reena Mehta, Pharmacy Team Leader Critical Care, King’s College Hospital NHS Foundation Trust
As part of the King’s Critical Care Team, we have had to respond quickly to a rapidly changing Covid-19 situation, after receiving our first patient on Friday 6th of March.
Over the last three weeks, we have been faced with new
challenges on an hourly basis, as we prepare to increase our critical care bed
capacity by 380% across two sites. While this brings several operational and
logistical challenges, it is also important to prioritise appropriate clinical
strategies and medication safety considerations to ensure patient safety is not
With a variety of consultants from different specialities caring for patients, as well as junior doctors with no prior critical care experience, some consistency in our clinical approach is required. Based on the recognisable pattern of how Covid-positive patients present, we have created an “admission prescribing order set” to ensure key drugs are prescribed quickly and accurately. We have focused on streamlining sedation strategies by devising a flow sheet to guide the choice of appropriate agents, giving options of alternatives if supply of first line drugs becomes difficult. To help with prescribing and administration, all areas have implemented a pre-printed infusion prescription chart. These interventions are necessary in order to ensure patients can be managed safely.
The increasing demand and workload placed on our critical
care nurses over the past three weeks has also been evident. As nurse-to-patient
ratios increase, it is important as pharmacists to consider reviewing the
various medicines management policies and seek opportunities to make safe
changes which can help during this period. This may include single nurse checking
of injectables (with some exceptions) and reviewing storage of medicines at the
bedside where POD lockers may not be available.
Considering strategies to reduce the burden on nurses of
continually drawing up multiple infusions is also vital. Ideas we have
considered include giving medications as intermittent boluses instead of
infusions, using more concentrated solutions and looking at options to source
pre-filled syringes, including exploring an in-house CIVAS service.
As pressure on us all undoubtedly increases in the coming
weeks, the crucial role of clinical pharmacists will be more vital than ever. As
we continue to learn on a daily basis and deal with new challenges, the value
of communicating with each other, both locally and nationally, has never been
During LGBTQ+ history month, two deputy chief pharmacists tell us what visible leadership means to them
For me, leadership is about being able to be authentic and to allow my personality to be intrinsic to my leadership style. As a professional, feeling able to show the whole of my identity hasn’t always been easy and I have often struggled in terms of whether to be open about being a gay man in the workplace. I’ve worked in a whole plethora of teams within the NHS and I found that how comfortable I felt about being open about my sexuality differed significantly depending on the organisation I worked in.
One of my most significant negative interactions was when working as a pharmacist visiting a GP surgery to support with their medicines optimisation work streams.
I remember the homophobic conversations in the room which made me feel uncomfortable and I remember almost feeling that I had recoiled into a shell of who I truly was. I remember feeling physically uncomfortable, which impacted on my interactions with the staff and my focus to carry out the task at hand.
On the other hand, the culture within my current organisation is very different. A culture of openness and equality and diversity is high up on the trust’s agenda.
I feel I am able to be my authentic self, which I believe brings richness to my leadership and helps me to establish meaningful professional relationships based on trust and mutual understanding. Ultimately, I feel I work more effectively in my role which benefits my team and leads to better patient care. I feel empowered within my organisation and I have also taken on the role as chair of the trust’s LGBTQ+ committee, which comes at an exciting time as we begin to prepare our plans for Birmingham Pride.
I am likely to be one of many LGBTQ+ people who have had these experiences and this is why I believe visible diversity and inclusion within leadership is so important. We need more visible LGBTQ+ role models to ensure our workforce feels empowered and enabled to shine as their authentic selves as it will lead to increased confidence, motivation and ultimately positively impact the quality of care we provide to our patients.
I work in a teaching hospital. I am also gay. I also have type 1 diabetes. I’ve also struggled with my mental health. Sounds a lot? Perhaps, but there’s not much I can do to change any of it. Instead I accept the challenges and do not allow them to hold me back.
I’ve had a
varied and interesting career to date and leadership has been at the heart of
it. I’ve watched leaders and their styles over the years and this has helped to
develop my own leadership. Interacting
with leaders of other professions, with whom I work closely has also taught me
honestly say that being gay has never affected my career. My sexuality has
always been accepted, from being a student, up to the present day. I was
worried at university about the demographic of my peers being different to
mine, but I was lucky to have a large and diverse friendship group. I’ve
watched gay leaders in pharmacy with respect and really feel that sexuality has
been a non-issue in my career.
In 2016 I was diagnosed with type 1 diabetes out of the blue. This led to a very difficult episode of anxiety and depression, having lived with anxiety all of my life. I felt like my career was over and could not imagine ever leaving the comfort of my role at the time. I knew that I wanted to be a leader and develop further – but could not see how I could ever do that.
Thanks to support from various leaders, I was able to get back to normal over a few months. I began to develop my leadership again and thanks to visible and honest leaders who showed interest in me, I took the next step in my career.
In all this I learned a valuable lesson that leaders are not perfect. They are human and have the same individual challenges as everyone else. I was surprised to learn how many leaders struggle with anxiety. It’s taught me that with the right mind set anything is possible. As a leader I can be confident and anxious at the same time. I can do my job and not worry about hypos, so long as I have sweets in my pocket. I can openly talk about my male fiancé and not be judged. I feel privileged to be in this position and to have had the same chances as everyone else.
Pre-Reg year is a tough one, no question: finally putting all of your
hard-earned knowledge to work in the real world. And you still have your
Pre-Reg exams to pass at the end of it!
the RPS offers events across the country to ensure you get into practice with a
minimum of sleepless nights!
interactive sessions look at real-life examples to help you pass your exams and
be ready for practice. They’re an invaluable opportunity to identify your
strengths and weaknesses, highlighting key areas to focus your revision on.
At every event you’ll hear from experienced tutors with top tips, both for exams and challenging practice situations. You’ll also get to know fellow Pre-Reg pharmacists, as well as recruiters looking for their next generation of top pharmacists. We spoke to RPS member Pardis Amin-Eshghi, who told us all about her experience of the two-day event in London.
“I heard about the upcoming RPS event from my tutor, swiftly booked my place and then attended a weekend of intense, focused learning on how to pass my pre-registration exam in order to become a qualified pharmacist.
When it comes down to how to prepare, neither the tutors nor the GPhC recommend making your revision an exercise on how much one can memorise from the resource materials (and there is a lot to memorise). It’s more about how well one can apply that knowledge to the everyday scenarios found in practice, whether it be in hospital or community pharmacy.
The Pre-Reg event is split into two days. Day 1 revolves around clinical lectures, case studies, calculations, and (my personal favourite) OTC. During the sessions, it was great to have the opportunity to bounce off ideas and then network with the other pre-reg’s. In addition to this, the calculation section (hosted by Simon Harris) involved going through all 12 types of pharmaceutical calculation questions listed in the framework – all in a succinct, step-by-step manner.
Being a big clinical buff, one of the highlights of the event was a clinical lecture hosted by Nadia Bukhari (who’s also the series managing editor of ‘Pharmacy Registration Assessment Questions’, a series that has been a staple in my exam practice). I was enthralled by the way the subject matter was taught, with the key take-home message being that this exam is checking our depth in knowledge. When tackling a scenario, ask yourself, e.g. “Why should a patient be on this medication?”, “Why does this medication cause this side effect?”, “What is the result of this interaction?”, “What other medications should this patient be on?” etc.
Day 2 commenced with an interactive session on Law & Ethics, with the main event being the mock paper (done under strict exam conditions, reflective of the actual day), with the questions representative of the style of questions provided by the GPhC. Once both papers were complete, they went through the answers and the rationale behind them. In the end, we got to take the paper/ resource packs home to go over again, along with our booklet of the slides used throughout the event. Overall, I found these events to be pivotal for the learning and development of any pre-reg that’s on the final hurdle to qualify as a day 1 pharmacist.”
by Elen Jones, Director for RPS Wales, and Robbie Turner, RPS Director of Pharmacy and Member Experience
Elen: Swapping the baby wipes, nappies and the bottles for policies, business plans and strategic meetings.
Maternity leave is over. In a blink of an eye, my baby boy is babbling away and walking round the furniture. He’s nine months, I just about feel like I’m getting to grips with being a mum of two and all of a sudden, it’s time to go back to work.
It’s been amazing to spend so much time with the boys; watching the little one develop and being able to take my eldest to school every day as he starts nursery has been brilliant. On the flip side, it’s often felt chaotic. The demands of two children are something else!
Three weeks into maternity leave I attended an interview and
was fortunate enough to get a new role as Director of RPS Wales.
It’s such a privilege to be returning to work and starting this role. I definitely had huge anxiety during the days leading up to my return. How will we cope with getting the boys to nursery and all be out the door by 8am? How will I catch up on the last 9 months? RPS think I’m the right person for the job, but what will members and my team really think? Impostor syndrome was creeping in! I did check out the RPS Return to Practice guide which helped allay some of my worries. I’ve been back in work for two weeks, and I miss my boys very much. Fortunately, my youngest has settled into nursery quite well (better than his big brother did!)
If I’m really honest, I’m actually feeling more like me again. I’m back to feeling more in control, enthused by the work and by my colleagues. I’m full of ideas, getting out there and speaking to like-minded pharmacists. I’ve caught up with lots of our members already, everyone’s been so kind and supportive.
The sleepless nights unfortunately don’t stop when you return to work, but I don’t mind them as much now, time with the boys has become more precious. I so look forward to getting back from work to their big smiles and hugs.
So, a big thank you to all my colleagues and our amazing members for all the support and your patience while I’ve been away! I look forward to working with you all to make sure RPS and pharmacy continue to go from strength to strength.
Robbie: This year I’m going to get an extra three months off work. And, I’ve been surprisingly anxious about it.
Not that pre-holiday anxious when you’re trying to
work out exactly how much ludicrously expensive sun cream to pack so you don’t
need to bring any back with you. No, it’s a feeling that’s hard to describe but
I bet there are millions or people (mainly women) who have experienced it even
more deeply than me.
My partner Ben and I are soon (everything crossed)
going to adopt two children. We’ve been aiming to make this a reality for over
a year now. A big thank you to work friends and colleagues who have given me
support and advice over the last year. Your words of encouragement have been
hugely helpful. But, nobody warned me about this bit – preparing for paternity
I know we’re lucky at RPS to have a good paternity leave entitlement. As part of our work on inclusion and diversity we identified that our gender pay gap was too high and introducing paternity pay was one of the tools we put in place to start to be a better employer for both men and women. Check out this article “Men’s parental leave is key to women’s progression”
I’d like to think that I’ve always been supportive of women (and I think it has always been women who’ve taken any form of parental leave in my teams) when they announce the news that they are pregnant. I’ve cried a few times, but that’s always been with excitement rather than thinking about covering their maternity leave! I know this isn’t the experience of lots of women and that’s one of the reasons why I’m committed to taking my full paternity allowance. What I’ve never considered is what could be going through an expectant mother’s mind when they’re thinking about taking parental leave. And I now have a small insight into both their perceptions AND the realities..
I work with a great team
who are brilliant at their jobs. Even
then, I’m worried about the added pressure me going off for three months will
put on them. BUT, when I really reflect,
my main worry is the complete opposite. It’s that I will get found out as a bit
of a fraud. That everyone will cope just fine without me or (arghhhhh) that it
will be even better when I’m not here interfering and distracting people. Will
I still have a job at the end of it all? How much will the world of pharmacy
have moved on – will I be able to catch back up?
So, if I’m feeling like this – a (fairly confident), white man, in a senior role, only going on paternity leave for three months – then what must it be like for others who don’t have the same privilege of gender, colour, or seniority facing up to a year away from the work place?
Now, when women (and
increasingly, men) tell me their great news about their pregnancy or adoption
I’ll be just as excited but I’ll also understand how stressful planning for
parental leave can be. Wish me luck!
Are you returning to practice? Check out our Return to Practice guide which is packed full of practical advice and tips to help you return to the workplace with confidence.
those unfamiliar with Pharmacist Support – we’re the profession’s
independent charity supporting pharmacists and their families, former
pharmacists and pharmacy students in
times of need.
In the past 10 years we’ve seen the number of acts of support the charity has been called upon to provide increase from over 700 in 2008 to over 7,000 in 2018. As we’ve grown and developed as a charity – so have the pressures. Although this is something we’ve been monitoring over the years through enquiries and service use, in May of this year we felt that the time was right to reach out to the profession once again, and to ask more generally about the issues and the challenges causing you the most stress today.
Through an online survey and
series of in-depth interviews you told us that you needed support with stress at work, with work-life balance and with
managing your wellbeing. In October we joined forces with the RPS as part of their workforce
wellbeing campaign to dig a little deeper into these issues. You highlighted
that this stress was linked to unrealistic expectations, leading to concerns
around making mistakes and burnout.
Back in 2013 the charity recognised a need for more proactive support
and following receipt of a large legacy from Pharmacist Robert Wardley, set
about researching, piloting and launching a new wellbeing service. This service
– delivered in a workshop format – consisted of information to help individuals
understand the importance of wellbeing, recognise the signs and symptoms of stress
in themselves and others and to provide tools and techniques to help manage
those pressures. To date this service – now made up of workshops covering
resilience, time management and assertiveness, webinars and fact sheets – has supported
thousands of individuals (students and pharmacists) across the profession – almost
5,000 acts of wellbeing support in total.
Another part of this wellbeing support is our Listening Friends stress
helpline. Staffed by trained volunteers who are pharmacists, this service
provides a listening ear to individuals struggling with a range of personal and
professional issues. In the last 10 years these dedicated volunteers have made
over 2,700 calls to colleagues in stress & been able to help them navigate their
way through many challenging situations.
Monitoring and understanding these pressures helps us ensure the charity’s services remain relevant and useful and the information we’ve gathered and you’ve provided through these surveys has informed the development our new 5 year strategy. Moving forward Pharmacist Support will be looking to further develop and shape our proactive wellbeing support and will aim to champion the wellbeing of those in the pharmacy profession alongside partners like the RPS.
So, thank you for your input over this past year. We look
forward to sharing our new strategy with you and hope that you’ll join us on
this new phase of our journey!
By Ravi Sharma, Director of England, Royal Pharmaceutical Society
Like with any profession, the mental health and wellbeing of a workforce is paramount to being successful. As pharmacists, we have a duty to provide the best possible care for patients and I realise this means our job becomes very intense and stressful at times. We know that pharmacists continue to work tirelessly on the frontline every single day to help improve patient care, safety and reducing pressures on the NHS.
Our recent research with Pharmacist Support to investigate workplace pressures has been very revealing and shocking. With over 1300 responses to our survey in just two weeks, we know that this is a topic people really care about, with nearly 75% of pharmacist saying their workplace environment has negatively impacted their mental health and wellbeing. As a staggering 80% of respondents also highlighted that they are at high or very high risk of burnout because of exhaustion and a further 44% concerned about potentially making mistakes or providing poor quality to patients, the magnitude of the problem is much more significant. We have released our initial survey findings which indicates the problem and our full report will be published in the spring next year.
This is a real problem which needs to be addressed by the
government immediately. The RPS is calling for access to NHS commissioned
mental health and wellbeing services to cover all pharmacists working in any
area of practice, just like what all doctors and dentists are entitled to. What
we need to understand is the root causes to these problems and why the health
and wellbeing of pharmacists is compromised. This will enable preventive
measures to be put into place. We will be engaging with key stakeholders and
our members in the new year to help understand the causes and the best
Having recently written to the Secretary of State for
Health calling for pharmacist’s wellbeing to be supported more proactively, we
hope this is a key issue for the government to address. We will continue to
lobby and fight for pharmacists and ensure that the newly formed government
tackles this as a priority.
Our aim is to ensure we can look after our pharmacists.
We need to work with and listen to our members and form key relationships with
stakeholders to produce a brighter future for the workforce. Together, we can
make a real difference for our profession.
The extent of workforce pressures on the mental health and
wellbeing of pharmacists, pre-regs and students is shocking.
When we asked you to tell us about your experiences in our workplace wellbeing survey in September, over a 1300 of you responded in a fortnight. Thank you to everyone who shared their stories with us and our survey partner, the charity Pharmacist Support.
Pharmacists all over the country told us they are suffering from severe stress and burnout because of the pressures they are facing at work.
This is totally unacceptable.
The data you have provided us with is powerful. Our next step is to lobby governments, NHS and employers across Great Britain to make sure all pharmacists get equal access to wellbeing support. At present, only those pharmacists employed directly by the NHS get access to help, alongside doctors and dentists, who get it regardless of where they work. We are fighting for all of you to get the same support.
Workplace pressure contributes significantly to poor mental health and wellbeing. Some of the themes we’ve picked up include how poor mental health is not specific to one sector of practice, it can affect all pharmacists wherever they work. A large proportion of respondents told us they are at a high risk of burnout. Many of you have also said that you’re very concerned about the effects your stress has on patient safety. In addition, survey respondents feel that workplace pressures can cause people to disengage from their role, creating personal unhappiness and a less productive workforce.
Campaigning for you
Our lobbying work around this is now focusing on getting preventative measures in place and structured mental health and wellbeing services for all pharmacists. I’d go as far as saying that the NHS is at risk of creating workforce inequalities by providing support services for some staff and not others. We need to learn the lessons from the workforce pressures our GP and nurse colleagues have experienced, rather than make the same mistakes.
In December we’ll be publishing a summary of the topline survey results and will provide a more detailed report in Spring 2020. We’ll then hold a roundtable with key stakeholders to identify solutions to the problems raised in the survey. We’ll continue to engage with you, the NHS and government to get equal access to the right support for the profession.
Remember, if you’re struggling to manage your wellbeing, you’re not alone. Pharmacist Support – the profession’s charity – has free and confidential services that may help. For information, a stress helpline, specialist advice, wellbeing workshops and online resources visit Pharmacist Support firstname.lastname@example.org or call 0808 168 2233.
As your professional body, we are now working towards an inclusion and diversity strategy for pharmacy that values difference. We want to recognise, celebrate and encourage all voices and experiences across pharmacy so we can better represent you and our patients.
I’ve had the pleasure of attending three recent events hosted by the RPS to engage with members on this really important issue. The first was a celebration during Black History Month of the BAME community’s contribution to pharmacy and we had fantastic contributions and insights shared on the day.
second was an Inclusion & Diversity workshop which was a key milestone on
the programme of work we’ve embarked on. Being authentic at work, and in turn
being able to feel a sense of true belonging, is something that means so much
to each of us individually and I’m keen to champion this here at the RPS. I’m a
strong believer that you can only be your best self if you are allowed to be
the person you truly are in your workplace, so this programme, under the
guidance of our excellent Chair, Asif Sadiq MBE, will produce a strategy that
we hope will resonate across the profession as well as within the RPS itself.
third event I attended was the Retired Pharmacist Group of the RPS. It’s clear
to me that older age does not mean a decline in drive, energy and enthusiasm
for the profession (or for life!) and I came away feeling both inspired and
thankful to have among our membership such passionate and professional people
who we can all learn so much from. I do hope RPG members take up my invitation
to become RPS Mentors!
Our recent I&D survey of members has highlighted that they wish us to do more in the areas of disability, race and age, and we’ll be looking at how we can do this most effectively. We’ve also got a timeline of our activity so you can track our progress.
My view is that we can only be effective at tackling I&D issues if we’re not afraid to hear about the problems and challenges faced and address them. This requires each of us to have the courage to speak up and commit to not walking past inappropriate activity where we see it. Those of us in a position to create the environment for concerns to be raised without fear should do everything we can to enable that to happen.
said at our I&D workshop that at times I had been self-conscious as a
white, middle aged, heterosexual male trying to engage in conversation about
BAME and LGBT+ issues as it might be perceived that I had no credibility to do
so. Having talked about this with many people, I now realise that I’m not alone
in having that concern BUT that it’s better to share my perspective, understand
it for what it is, listen to all the other perspectives and actively contribute
to this vital agenda. No one individual can profess to speak on behalf of
groups of others, as we each have a unique perspective – we are all individuals
after all, even though we will identify with certain groups.
can only have credibility in this space if we ‘walk the talk’. Part of our
commitment is therefore to do what is right by publishing data that shows our
performance as an employer striving to create equal opportunity. We already
publish data on our gender
pay gap here at RPS and in future I am committing that we will also publish
data on ethnicity and pay. We are not required by law to do either but it’s
simply the right thing to do, as we believe we should lead by example.
encourage you to engage with this discussion about inclusion and diversity
whenever and wherever you can and to champion everyone’s right to be their
authentic self in the workplace. Being authentic, feeling comfortable with who
we are and bringing a diversity of perspectives and views to work will enrich
the RPS and help us deliver the best possible support for our members, whatever
their age, race, gender or sexuality.
Part of our work here at the RPS Museum includes
researching various aspects of pharmacy history so we can enrich our displays,
tours and articles, especially those areas that are currently under-represented
in the museum.
A recent focus of this research has been to uncover more stories relating to BAME communities. This isn’t an easy task as historical registers of pharmacists did not record information relating to ethnicity. In addition to this lack of documentary evidence, there is little visual material available, particularly in the early years of the Society before the widespread introduction of photography.
But we didn’t let that stop us. When we look through the records, we can see tantalising glimpses of stories that we can use as a starting point for our research. The earliest specific reference we have found in the Society’s archive is the arrival of the first black African student at the School of Pharmacy in 1847, as noted in the report of the Annual General Meeting of May 1848, which reflects the attitudes of the time:
“It is also
gratifying to find that some have come from distant countries, and one of
these, an intelligent African, is probably the first native of that soil who
will apply a knowledge of Chemistry acquired in an English School, with the
view of promoting the arts of civilization among his colored brethren.”
But who was this student? Frustratingly he isn’t named, but
he may have been Joseph Mailloux. The Society published its first list of
‘Foreign Life Members’ in the Pharmaceutical Journal in 1856 and Joseph is
listed as having been admitted to membership in 1847. He was based in Mauritius,
which at that time was a British colony. His certificate number of 28 shows
that he took and passed one of the Society’s exams, so would have been studying
at the School around the time referred to in the above report.
Despite poring over the various resources available to us, we couldn’t find out much more about Joseph Mailloux. He remains on the Society’s register until 1877, so seems to have had a 30-year career. An annotation in the Registrar’s copy of the register confirms that his removal was because he had died, but no obituary was published in either the Pharmaceutical Journal or the Chemist and Druggist, a familiar story with international members of the Society at this time.
There is still a lot of work to do in terms of including more marginalised voices in the museum. Hopefully this blog has shown that there are stories to be told and histories to be revealed – we just need to keep on digging to find them and highlight diversity in the profession.
I met my mentor Aamer Safdar whilst working at Kings College London. I was the 3rd year Professional Lead, and was introduced to him and he told me about his background, both personal and professional. Just by listening to him, I knew that his values were similar to my own.
I now work at BUPA as the Chief Pharmaceutical Officer’s Clinical Fellow, but before that I worked within the Education Directorate at RPS. It was there I worked alongside Aamer in projects involving undergraduates. You will hear that pharmacy is a small world and this is one such example! My manager explained how it is important to work alongside colleagues who will challenge your thinking and I found this in Aamer. Our mentor/mentee relationship first established when we went out for dinner as a post-work group; it was here when I decided to formalise my mentor/mentee relationship with him.
I’ve benefited greatly from the mentor/mentee relationship.
It’s given me thinking space but its been advantageous to both my personal and
professional life to have someone to challenge my own thinking in whatever
situation or scenario I am experiencing. In our last meeting Aamer and I spoke about
authenticity, congruence and integrity.
I found it particularly useful hearing from someone in Aamer’s position,
a current GPhC Council member and previous RPS English Pharmacy Board member,
about how important it is to stay true to your own values and what these values
We use the RPS mentor platform to record our meetings and
have found that, as well as the normal methods of keeping in touch, the
platform has been beneficial in keeping us focused. I couldn’t stress the
importance of having a mentor enough. It
has really helped me focus whenever I have found myself in a sticky situation
and I’m grateful for the time Aamer has shared with me.
Being a Mentor: Aamer Safdar
I have been a mentor
to many people inside and outside of pharmacy and have used a variety of
methods with my mentees which have included traditional face to face sessions
as well as mentoring exclusively by email and by phone; in the latter two
cases, I never met my mentees in real life until much later in our
I currently mentor two pharmacists, at different stages in their careers, using the RPS mentoring platform. The platform is useful because I have outlined the areas in which I would like to mentor in to manage my mentees’ expectations.
In both of my meetings, we spoke about our careers and challenges at different levels and I was able to share my experiences and wisdom from both my day job and from being in national boards. Much of my wisdom has come from my own mentors, who have been different people at different stages of my career,and with different perspectives and advice. Without a mentor to bounce things off, I doubt I would have done many of the things I have done in my career.
The Royal Pharmaceutical Society is the dedicated professional body for pharmacists and pharmacy in England, Scotland and Wales.
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