• Thursday, December 21, 2023 1:52 PM | Jennifer Casasanta (Administrator)

    The pandemic has brought attention to the safety, health, and well-being of workers in healthcare. Recent efforts to address these issues include, the Office of the Surgeon General’s Addressing Health Worker Burnout,(1) an “Advisory on Building a Thriving Health Workforce,” from the National Academy of Medicine’s National Plan for Healthcare Workforce Wellbeing (2) and the  NIOSH Health Worker Mental Health Initiative (3). For today’s health workers, feeling chronically overwhelmed is commonplace. Increasing evidence of unremitting levels of high work-related stress, often beyond the control of the clinicians, can lead to severe physical and emotional harm. Such stress threatens the sustainability of the healthcare professionals workforce. Research has reported that 1/5 physicians, 1/3 advance practice providers (NP/PAs), and 2/5 nurses are planning to leave practice in the next two years due to difficult working conditions (4). In the most recent study, 44% of health workers reported an intention to look for a new job in 2022, an increase from 33% in 2018 (5).

    To improve working conditions, a Total Worker Health® approach may be particularly relevant to the healthcare sector. In healthcare, studies have found that the majority of occupational stressors causing burnout are due to systemic factors (6, 7); yet most interventions for burnout, quality, and patient safety are directed at the healthcare providers (HCP) and not at the system level (8). One challenge is that the direction of work may arise from external authorities, and communication and design of this work is often top-down.


    The current healthcare work environment has many requirements arising from differences among local hospital systems, regulators and credentialing bodies of healthcare organizations and healthcare providers, insurers, and regulators. A recent survey of 142 physicians in Monroe County, New York; expanded upon the American Medical Association (AMA) 2021 study of physicians on the impact of prior approvals and other related workload (9). The survey found 92% of the physicians reported doing “work outside of work,” defined by the American Medical Association as electronic medical record  work outside of patient scheduled hours (10). For 88% of the respondents, this included weekends. While 57 (40%) of the physicians were glad to have access to electronic medical records at home for flexibility; 46 (81%) of the 57 cited excessive documentation as the reason they had to do this work at home.

    A key to reducing stressors is to ensure an appropriate workload. When job demands chronically outweigh the resources, burnout occurs (11). Currently, in top-down prescribed work situations, senior leadership may not be fully aware of the effort and resources, often including personal time, required to complete work. Additionally, some of the tasks that are being done may not require medical expertise, taking time away from value-added work of delivering care to patients.

    Newer research has shown the physical and emotional harm that comes from these ever-increasing, uncoordinated work expectations (12-17). The time it takes to complete mandatory trainings, administrative work for insurance payment, and respond to messages from patients, made worse with staffing shortages, contribute to the workload of healthcare providers (9). Often healthcare institutions get tasked with mandatory requirements for their operations but are not provided sufficient resources to achieve them. Cognitive (mental) workload debt accumulates when there are not sufficient brain resources to immediately finish a task or when tasks linger. As the mental workload debt accumulates, there is a tipping point past which cognitive function deteriorates (18). The total workload creates higher stress above what would be experienced for purely taking care of the patient.

    The nature of work in healthcare has also changed significantly over the last several decades, largely moving from physical work to more cognitive work. The ongoing need to master new technologies and other cognitive demands may be poorly recognized stressors as they are less quantifiable than physical demands.  This high level of cognitive work expectation without sufficient resources to achieve the work is underestimated and may not be understood to be connected to its harm to clinicians and patients (19, 20).

    The Toll of Workplace Stress

    Addressing the above issues are critical to reducing the job stress faced by healthcare providers. High chronic occupational stress and burnout creates higher risk for major depressive disorder, panic attacks, suicide, heart disease, and stroke (21,22). Chronic psychological distress may affect immunity and trigger inflammatory responses (22-24). Those with burnout may experience specific cognitive impairments, including nonverbal memory, auditory and visual attention limitations. Uncontrolled stress has been found to cause reduced key brain functions and anatomical injury. Due to a sense of calling, many years of education, and student debt, physicians often have uncontrolled stressors, demonstrated in research. It is important to create systems that offer healthcare providers adequate control and autonomy, clear communications, and psychosocially healthy working environments. A case can be made that such healthier working conditions are associated with patient safety and health, reductions in medical errors and malpractice cases, reductions in turnover, and better patient experience (20,25).

    Measuring Workload and Wellbeing

    It is important to assess worker well-being when assessing the quality of service delivered by the organization.  Since healthcare system payments do not include metrics that are related to clinician wellbeing, or assessments of reasonableness of workload, some healthcare systems may have a disconnect between senior leadership and front-line staff. While feedback from patients on their experiences is often communicated to senior leadership, similar feedback from clinicians is often missing. Outcome metrics often include patient safety and healthcare quality measures, but not worker well-being or provider burden. To provide a more complete picture to investors, patients, employees, and the public on healthcare quality and safety sustainability, worker well-being must be measured and reported.

    Healthy Work Design and Total Worker Health

    It is important to apply healthy work design and Total Worker Health principles in healthcare. Specific promising practices include reducing administrative burden, ensuring that the workload is appropriate, and improving the psychosocial work environment. There is opportunity to better design work schedules and tasks, improve operational systems to ensure healthier working conditions, and introduce specific measures to improve worker well-being; many of these actions would also advance patient health and reduce medical errors. Improving organizational structures and reducing hierarchy and gatekeeping could facilitate healthier work (1-3, 25).

    Human Factors/Ergonomics (HFE) and macro/cognitive ergonomics is a field dedicated to jointly optimizing worker well-being and system efficiency (25). Patient safety is a product of system efficiency in a healthcare organization. One key component of this type of framework is to engage “environmental sensors” -those at the interface of the organization and its environment who directly see the organization’s effectiveness in achieving high quality and safe healthcare delivery – who can give feedback to senior leadership to make needed adjustments to be an effective organization achieving its goals (25-27). In the case of healthcare organizations, these sensors would include both patients and healthcare providers. It could be helpful to use  technology to track the time spent by healthcare providers on documentation and administrative support tasks that could be completed by assistants or administrative professionals. Electronic medical record documentation outside of patient scheduled times is an example of work outside of work that should be tracked and monitored by senior leadership, with the goal of being eliminated.

    It would be beneficial to invite healthcare providers to assess internal processes and suggest improvements, streamline data requests and workloads, and creatively look at how the tasks of frontline healthcare providers can more appropriately align with the time and resources they have. Participatory management models get those who do the work integrally involved in improving efficiency of processes and design with benefits to the organization (26-28).

    Get Involved

    There are many ways for healthcare providers and allies to take action.

    In 2017, the National Academy of Medicine launched the Action Collaborative on Clinician Well-Being and Resilience. The collaborative  recommended a systems approach, and last year, released a national plan. (2) The action plan aims to make high-level, systems change. Priority areas of the plan are directed toward leadership, policy-makers, and others who can influence the healthcare work setting. The actions to be taken by leadership are the following:

    1. Create and sustain positive work and learning environments and culture;
    2. Invest in measurement, assessment, strategies, and research;
    3. Support mental health and reduce stigma;
    4. Address compliance, regulatory, and policy barriers for daily work;
    5. Engage effective technology tools;
    6. Institutionalize well-being as a long-term value;
    7. Recruit and retain a diverse and inclusive health workforce.

    Healthcare organizations can commit to putting the national plan into action.

    Organizational leaders and employers can take trainings to better understand burnout and how to create and sustain psychosocial safety at work. New free online trainings by NIOSH include:

    Understanding and Preventing Burnout among Public Health Workers: Guidance for Public Health Leaders (cdc.gov).

    Safety Culture in Healthcare Settings | NIOSH | CDC

    In May 2023, for Mental Health Action Day, NIOSH issued a statement to call for employers to update credentialing applications to remove any overly intrusive questions about mental health. To further support and advance health worker mental health (3), in October, NIOSH launched the Impact WellBeing campaign. The project gives hospital leaders evidence-informed solutions to reduce healthcare worker burnout, sustain wellbeing, and build a system where healthcare workers thrive. It includes steps hospital leaders can take, working closely with their employees, to find long-term solutions to these challenges. Additional elements of the campaign will appear over the next year. Find out more at the resources below.

    Webpage: Healthcare Worker Wellbeing | NIOSH | CDC

    Campaign Webpage: Impact Wellbeing | NIOSH | CDC

    Fact sheet: Making the System Work for Healthcare Workers | NIOSH | CDC

    Joint statement with Dr. Lorna Breen Heroes’ Foundation: Statement on Removing Intrusive Mental Health Questions from Hospital Credentialing Applications from the Dr. Lorna Breen Heroes’ Foundation and the National Institute for Occupational Safety and Health (cdc.gov)


    Michael R Privitera, MD, MS, Professor Emeritus of Psychiatry, University of Rochester Medical Center; Past Medical Director, Medical Faculty and Clinician Wellness Program, 2015-2022

    Chia-Chia Chang, MPH, MBA, is a Public Health Analyst in the Office for Total Worker Health.

    L. Casey Chosewood, MD, MPH, is Director of the NIOSH Office for Total Worker Health.



    1. Addressing Healthcare Worker Burnout. The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce (2022).https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf
    2. National Academy of Medicine’s National Plan for Healthcare Workforce Wellbeing (2022). https://nam.edu/initiatives/clinician-resilience-and-well-being/national-plan-for-health-workforce-well-being/
    3. Healthcare Workers: Work Stress & Mental Health | NIOSH | CDC
    4. Sinsky, C.A., Brown, R.L., Stillman, M.J. and Linzer, M. (2021) COVID-Related Stress and Work Intentions in a Sample of US Health Care Workers. Mayo Clinic Proceedings : Innovations , Quality & Outcomes, 5, 1165-1173. https://doi.org/10.1016/j.mayocpiqo.2021.08.007
    1. Nigam JA, Barker RM, Cunningham TR, Swanson NG, Chosewood LC. Vital Signs: Health Worker–Perceived Working Conditions and Symptoms of Poor Mental Health — Quality of Worklife Survey,  United States, 2018–2022. MMWR Morb Mortal Wkly Rep 2023;72:1197–1205. DOI:   http://dx.doi.org/10.15585/mmwr.mm7244e1
    2. Panagioti, M., Panagopoulou, E., et al . (2017) Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-Analysis. JAMA Internal Medicine, 177, 195-205. https://doi.org/10.1001/jamainternmed.2016.7674
    3. West, C.P., Dyrbye, L.N., Erwin, P.J. and Shanafelt, T.D. (2016) Interventions to Prevent and Reduce Physician Burnout: A Systematic Review and Meta-Analysis. The Lancet , 388, 2272-2281. https://doi.org/10.1016/S0140-6736(16)31279-X
    4. Sinsky, C.A. and Privitera, M.R. (2018) Creating a “Manageable Cockpit” for Clinicians:A Shared Responsibility. JAMA Internal Medicine , 178, 741-742. https://doi.org/10.1001/jamainternmed.2018.0575
    1. Monroe County Medical Society 2023 Survey of physician Workload: https://mcms.org/resources/Documents/Physician%20Wellness%20Survey%20Results%202023.pdf
    1. Reilly M, Wolf M. Reducing pajama time and work outside of work (WOW) August 17, 2022. AMA Podcast. https://www.ama-assn.org/practice-management/physician-health/reducing-pajama-time-and-work-outside-work-wow
    2. Demerouti, E., Bakker, A.B., Nachreiner, F. and Schaufeli, W.B. (2001) The Job-Resources Model of Burnout. Journal of Applied Psychology, 86, 499-512.https://doi.org/10.1037/0021-9010.86.3.499
    1. Savic, I. (2015) Structural Changes of the Brain in Relation to Occupational Stress. Cerebral Cortex , 25, 1554-1564. https://doi.org/10.1093/cercor/bht348
    2.  Michel, A. (2016) Burnout and the Brain. Association for Psychological Science.       http://www.psychologicalscience.org/index.php/publications/observer/2016/february-16/burnout-and-the-brain.html
    3. Alkadhi, K. (2013) Brain Physiology and Pathophysiology under Mental Stress. International Scholarly Research Notices , 2013, Article ID: 806104. https://doi.org/10.1155/2013/806104
    4. Arnsten AFT. The Biology of being Frazzled. Science. 12 June 1998. 280 (5370): 1711-1712.
    1. Golkar, A., et al . (2014) The Influence of Work Related Chronic Stress on the Regulation of Emotion and Functional Connectivity in the Brain. PLOS ONE, 9, e104550. https://doi.org/10.1371/journal.pone.0104550
    2. Ridout, K.K., Ridout, S.J., et al . (2019) Physician-Training Stress and Accelerated Cellular Aging. Biological Psychiatry , 86, 725-730. https://doi.org/10.1016/j.biopsych.2019.04.030
    1. K Tara Smith Ph.D. of HFE Solutions in the United Kingdom (2021) Personal Communication 10-14-21.
    1. Arnsten, A.F.T. and Shanafelt, T. (2021) Physician Distress and Burnout: The Neurobiological Perspective. Mayo Clinic Proceedings , 96, 763-769. https://doi.org/10.1016/j.mayocp.2020.12.027
    1. Privitera, M.R. and MacNamee, K. (2021) Integrating Patient Safety and Clinician Wellbeing. Physician Leadership Journal , 5/6, 39-46.
    2. Wurm W, Vogel K, Holl A, Ebner C, Bayer D, Mörkl S, et al. (2016) Depression-Burnout Overlap in Physicians. PLoS ONE 11(3): e0149913. doi:10.1371/journal.pone.0149913
    3. Sapolsky RM Stress and the brain: individual variability and the inverted-U. Nature Neuroscience. Volume 18 (10) October 2015 ( 1344-46)
    4. Calcia MA, Bonsall DR, et al. Stress and neuroinflammation: a systematic review of the effects of stress on microglia and the implications for mental illness. Psychopharmacology (2016) 233:1637–1650 DOI 10.1007/s00213-016-4218-9
    5. Salim S. Oxidative stress: a potential link between emotional wellbeing and immune response Current Opinion in Pharmacology 2016, 29:70–76
    6. Privitera, M.R. (2022) Promoting Clinician Well-Being and Patient Safety Using Human Factors Science: Reducing Unnecessary Occupational Stress. Health, 14, 1334-1356. https://doi.org/10.4236/health.2022.1412095
    7. Pasmore, W.A. (1988) Designing Effective Organizations: The Sociotechnical Systems Perspective. John Wiley & Sons, New York.
    8. Pasmore, W., Winby, S., Mohrman, S.A. and Vanasse, R. (2019) Reflections: Sociotechnical Systems Design and Organization Change. Journal of Change Management 19, 67-85. https://doi.org/10.1080/14697017.2018.1553761
    9. Ashton M. Getting rid of stupid stuff. N Engl J Med. 2018;379(19):1789-1791. doi:10.1056/NEJMp1809698
    Posted onDecember 19, 2023 by Michael R Privitera, MD, MS; Chia-Chia Chang, MPH, MBA; L. Casey Chosewood, MD, MPH

    CategoriesHealthcareMental HealthStressTotal Worker HealthWell-being

  • Friday, November 17, 2023 8:18 AM | Jennifer Casasanta (Administrator)

    Published 11/17/23 on Channel 10, by Eriketa Cost:

    On Wednesday, Rochester Regional Health said several physicians resigned to start a retainer-based concierge medicine practice.

    The office remains open for business, as RRH works to replace the physicians with other employees in the network. In the statement, RRH says all physicians at the Linden location will continue to see patients through the end of the year.

    “We remain true to our mission to provide high-quality, affordable, and accessible care to our patients and the community. During this transition phase, there will be no interruption to anyone seeking care at the Linden Medical Group practice. Our staff is actively contacting all patients to assist them in transitioning to other providers within our 400-member network,” the statement read.

    News10NBC has been talking to some other doctors throughout the region, who are leaving the practice to go to concierge medicine. Many are unable to speak out, due to non-disparagement agreements in their contracts.

    Head of Monroe County Medical Society Hemant Kalia said the current state of healthcare is contributing to unsustainable rates of burnout. For example, the emergence of two giants, UR Medicine and RRH controlling the market, and the administrative burden that comes with that.

    Another contributing factor, he said, is the disparity of reimbursement between private practices and employed physician groups. Kalia said in a recent survey with members of the medical society, more than 50% percent of respondents said they were burned out.

    As for why some are choosing concierge medicine? Kalia said there’s probably no specific reason. Concierge medicine is when patients pay a premium, perhaps in the form of annual fees, for increased access to providers and care.

    “The main point, the main emphasis is, our physicians are struggling and they’re crying for help,” said Kalia. “We can certainly talk about other innovative models of delivering care, concierge medicine is one of them, but if we don’t address the route cause of the problem, we will continue to see physicians moving out of our region.”

    It has patients like Joe Gonzalez wondering, what’s next?

    Gonzalez said he was shocked to learn in a letter, that his doctor Dr. Jeffrey Vuillequez is no longer practicing there. He said he and his wife would like to continue seeing him, even if means going somewhere else.

    He has an appointment coming up in February, and he’s not sure if he’ll get to connect with him before then. He said the office couldn’t provide a specific end-date. Gonzalez said he called the office to ask some questions, including if he could still be a patient in the future. He says a woman replied, it’s possible he won’t be, if there’s not enough staff. According to the letter Gonzalez got in his MyCare inbox, the office said it will continue to operate with other nurses and staff.

    “You really want to be sure that you have somebody you can see if you are sick. They didn’t even give any advice like, if you’re sick after this date go to the hospital,” said Gonzalez. “Starting over with a new doctor, might happen someday. This was a little bit of a surprise and not much warning.”

    “This seems like a mass exodus from the practice,” he said. “I understand there is probably a bunch of legal things going on behind the scenes, things they can and can’t say,” he said.

    RRH says if you’re a patient at the Linden location, you can still call the office with questions, and make an appointment.


  • Thursday, October 05, 2023 12:12 PM | Jennifer Casasanta (Administrator)

    Good morning 7th District & MCMS Members:

    I hope this email finds you well. I am reaching out to discuss a crucial matter that requires our collective attention and immediate action.

    As you are aware, the Wrongful Death Bill (aka “Grieving Families Act”) is currently under consideration, and its potential implications for our medical community are concerning. We are asking the Governor to veto this legislation (A.6698) because it would harm patient access to care in our communities by significantly increasing damages awardable in wrongful death actions. If signed into law, this could increase already exorbitantly high physician and hospital liability costs by over 40%. In order to effectively oppose this bill, we will need to join forces with MSSNY to greatly strengthen our efforts.

    To that end, a comprehensive strategy, was created, that includes mobilizing our physicians to reach out to the Governor's office through phone calls. MSSNY has provided us with a well-crafted one-page talking points sheet for our physicians to utilize during their conversations (it is attached). This will ensure that you are equipped with the necessary information to express your concerns effectively.

    Furthermore, a schedule was prepared that assigns specific days for each district to make their calls. This approach aims to maximize our impact by creating a coordinated and sustained effort across the state.

    To fully leverage our partnership, we are asking all physicians, and practice leadership, within every county to actively participate in this advocacy campaign. When you make your calls, it would be immensely valuable if they could also inform the MCMS about the experience by emailing Joanne Rau at jrau@mcms.org. This feedback will enable us to gauge the overall response and make any necessary adjustments to our strategy.

    In summary, here are the key action steps:

    • Make Calls: Physicians, and medical practice leadership, should call the Governor's office on their designated day – 7th District (MCMS) will begin on 10/17/2023 then on 11/7/2023. Call Schedule Here!
    • Utilize the one-page talking points sheet during the conversation. Talking Points Sheet Here!
    • Document your experience and share with your 7th District Leadership: Lucia Castillejo at lcastillejo@mcms.org or Joanne Rau at jrau@mcms.org.

    By working together, we can make a substantial impact on this issue and protect the interests of our medical community. MSSNY Leadership is incredibly appreciative for our help in this crucial endeavor.

    Thank you for your attention and your commitment to ensuring the best possible outcomes for our physicians and patients alike.

    Be Well,

    Lucia Castillejo, MS

    Chief Executive Officer (CEO), Monroe County Medical Society

    200 Canal View Blvd. – Suite 202

    Rochester, NY 14623

    Office: 585-473-7573

  • Monday, August 14, 2023 4:05 PM | Jennifer Casasanta (Administrator)

    This morning, August 14, 2023, MCMS and our physician members had breakfast with Senators Samra Brouk and Jeremy Cooney to discuss community health care concerns. Check out our photos of the morning here! 

  • Monday, August 14, 2023 3:29 PM | Jennifer Casasanta (Administrator)

    On Saturday, August 12, 2023, MCMS had its first Member Appreciation BBQ since 2019. Members enjoyed the afternoon at Durand Eastman Park with lunch provided by Sticky Lips BBQ. The event was sponsored by our friends at MLMIC, Sellers Insurance, Merrill Lynch and Alliance Advisory Group. Check out the photos here! https://www.mcms.org/page-1075611

  • Monday, July 17, 2023 12:42 PM | Jennifer Casasanta (Administrator)

    This article was published in the June 25th issue of the Democrat & Chronicle in Rochester, NY. 

    Dear Readers,

    Our regional healthcare system relied upon by our patients faces a potential disaster.

    The New York State Legislature has again passed legislation (A.6698/S.6636) that would exponentially expand damages awardable in wrongful death lawsuits. This bill is very nearly the same as one that was—thankfully—vetoed by Governor Hochul last January. 

    The Governor must veto this new version as well.

    We have great sympathy for the grieving families this legislation seeks to help.  However, any legislation to expand costly lawsuits must be balanced to help to prevent the enormous adverse impact this bill would have on our health care system.  Had this bill been signed into law, it would have made it even more difficult for our struggling community hospitals and medical practices to continue to provide needed patient care. 

    Proponents claim the new bill responds to the Governor’s veto.  It most surely does not.

    Governor Hochul identified several reasons for vetoing the earlier bill, including that it “would increase already high insurance burdens on families and small businesses and further strain already-distressed healthcare workers and institutions” which would be “particularly challenging for struggling hospitals in underserved communities”.  Furthermore, the Governor articulated her concerns that the bill “passed without a serious evaluation of the impact of these massive changes on the economy, small businesses, individuals, and the State's complex health care system.”  The bill does not address these concerns.  It would continue to enable the awards of new categories of damages that multiple actuarial studies show will lead to a nearly 40% growth in liability costs, which would be on top of the already unaffordable costs facing our physicians and hospitals.  Studies from Diederich Healthcare show that from 2019-2021, New York had the highest cumulative medical liability payouts of any state in the country, $1.4 billion, nearly twice as much as the 2nd highest state (Florida) and the 3rd highest state (Pennsylvania). It also had the highest per capita liability payment, 33% more than the 2nd highest state (PA).  These costs far exceed states like California and Texas, with whom New York competes to retain and attract needed specialty care physicians.

    We just completed a State Budget where significant steps were taken to address the stability of our various community health care providers, particularly those providing needed care in our undeserved areas.  Yet by imposing staggering new costs this legislation would undermine the positive steps in the State Budget to protect access to care. 

    Our regional healthcare safety net is already under significant duress even without having to absorb the extraordinary costs this bill would require. I urge the Governor to veto this new legislation, and work with the Legislature to adopt truly balanced legislation that expands the rights of grieving families, while protecting our healthcare safety net. To urge the Governor to veto the bill, please go here


    Dr. Hemant Kalia

    President of the Monroe County Medical Society

  • Wednesday, July 05, 2023 10:24 AM | Jennifer Casasanta (Administrator)

    Check out this article by MCMS President, Dr. Hemant Kalia:


  • Monday, June 12, 2023 12:27 PM | Jennifer Casasanta (Administrator)

    Throughout June, Men’s Health Month aims to encourage boys and men to take charge of their overall health by implementing healthy living decisions.


  • Friday, June 02, 2023 8:25 AM | Jennifer Casasanta (Administrator)

    Update: a short while ago, the NY State Assembly again passed the revised bill by a 132-11 vote.  So, our advocacy focus in the next few days must be on the leadership of the New York State Senate

    Take Action by:

    Contacting the New York State Senate, including to Senate Majority Leader Andrea Stewart-Cousins at 518-455-2585 and Deputy Majority Leader Michael Gianaris at 518-455-3486.

    Send a letter to your Senator, the Senate Majority Leader and the Governor: click here, Oppose Harmful Liability Expansion Bills That Impede Patient Access To Care! Click here to send a letter!

  • Friday, May 05, 2023 10:59 AM | Jennifer Casasanta (Administrator)

    On Monday, May 8, 2023 from 12-1pm Dr. Mathew Devine and Dr. Michael Privitera will be speaking about Physician Burnout and our upcoming Health Symposium on May 17th. You can check them out here!


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