MINNESOTA DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH Autumn 2007 Volume 1, Issue 4 PWDU Quarterly Update Partnership and Workforce Development Unit http://www.health.state.mn.us/freedomtobreathe/ BACKGROUND New Freedom to Breathe (FTB) provisions, under the Minnesota Clean Indoor Air Act (MCIAA) come into effect today, October 1, 2007. Under FTB provisions, smoking is now prohibited in nearly all indoor public places and indoor places of employment. This article will address some of the most common questions being asked about the new law, including, the role of facility managers, the definition of “indoors,” and how the FTB provisions will be enforced. MANAGERS’ ROLES Facility managers are required to: • Post "No Smoking" signs at or near all public entrances. • Ask persons who smoke in restricted areas to stop smoking or require the person to leave the facility if they refuse to stop. • Use lawful methods like those used with disorderly persons for patrons that refuse to comply. • • Refrain from providing ashtrays and matches indoors. Withhold service for patrons who will not comply. A manager or owner who knowingly fails to comply with the provisions of the law is guilty of a petty misdemeanor. Minnesota Department of Health (MDH) has the authority to take enforcement actions that may include monetary penalties up to $10,000. Local public health agencies may choose to respond with fines, license suspension, or other means. WHEN IS INDOORS, INDOORS? Smoking will not be allowed in indoor areas, regardless of special accommodations such as ventilation. Smoking shacks, tents and patios must not be “indoors” according to the following 50 percent rule: Indoor area means all space between a floor and a ceiling that is bounded by walls, doorways, or windows, whether open or closed, covering more than 50 percent of the combined surface area of the vertical planes [walls] that are the perimeter of the area. For example, a shelter with removable windows is an indoor area when the windows are in place, whether they are open or closed. This becomes an outdoor area when the windows have been removed from the structure, if the open or screened area comprises at least 50 percent of all wall space. ENFORCEMENT & COMPLIANCE During the first year, MDH and its partners, including the Local Public Health Association (LPHA), will focus their FTB efforts on education and compliance assistance. LPHA and MDH staff have made presentations at many conferences and held statewide video conference training sessions in August and September. FTB information is available in a variety of formats and on a number of websites (see Page 8). It is expected that most facility managers and patrons will comply with the law once they understand its requirements. “Compliance assistance letters,” available on MDH and partner websites will play an important role. These letters can be sent by local public health or concerned citizens to facilities where smoking is occurring, in violation of the new provisions. Anyone who observes a violation of the smoking laws can send a compliance letter (see link, Page 8) to remind the facility manager of the October 1, 2007 changes in the law. MDH and local agencies will initiate enforcement action when facilities refuse to comply. In this issue: Freedom to Breathe Legislation Page 1 Delegation Agreement—Next Steps Page 2 Environmental Health Knowledge Management Project—Food Program Page 3 Effective Communication Pages 4-5 Bug of the Quarter—Botulism Page 6 The Pickle Law—Home-Canned Goods Page 7 Freedom to Breathe, continued A Note from April Bogard Page 8 Page 2 PWDU Quarterly Update Delegation Agreement Advisory Council - Next Steps BACKGROUND LEADERSHIP ROUNDTABLE DELEGATION AGREEMENT In April 2007, an Advisory Council was formed to review the draft Delegation Agreement for Environmental Health (EH) Services. Advisory Council membership was based on nominations from stakeholders and approved by the Commissioner of Health. MDH Environmental Health Division Director, John Stine, agreed that the time had come to reinstitute statewide environmental health meetings. He proposed a regularly scheduled roundtable among MDH and local EH Directors (or Community Health Directors of counties without an EH Director). It is hoped that the first of these meetings will be held in January 2008. After the last Advisory Council meeting, MDH staff revised the Delegation Agreement and submitted the draft to MDH legal counsel. The next draft will be reviewed by several City and County Attorneys. After a final revision, the Delegation Agreement and accompanying documents will be introduced to stakeholders throughout the state. MDH has not yet determined a sunset date for existing Delegation Agreements. We will continue to update stakeholders, as these and other details are determined. The Advisory Council has held five meetings since April. That process has resulted in a near-final draft of the Delegation Agreement and recommendations for future action. NEXT STEPS The Advisory Council has proposed the following: • Continuation of the Delegation Agreement Advisory Council; • Regular meetings of state and local EH leaders; • Formation of a workgroup to design a process for evaluation of statewide EH programs; and • Formation of a workgroup to write a best practices manual, including materials from state and local EH programs. ADVISORY COUNCIL Advisory Council members who were present at the September 13, 2007 meeting agreed that they would be willing to continue their service until these recommendations had been carried out. They also advised long-term continuation of the Advisory Council to assist MDH with future implementation of delegation agreements and to assist with the creation of statewide EH program goals and standards. EVALUATION PROCESS MDH staff, and counties with delegation agreements received an email on September 17, 2007 requesting nominations for inclusion in an Evaluation Workgroup to be chaired by Michael Nordos, of the MDH Partnership and Workforce Development Unit. The workgroup will consist of five MDH staff and five staff from delegated agencies. One local agency member from each of the two city and three county “teams” (see adjoining text box) will be selected by their respective Advisory Council member from nominations received. The workgroup will design a process for program evaluation during twice-monthly meetings to begin in October. A draft evaluation is expected before May 2008. Advisory Council Membership Representing Delegated Programs: • Minnesota Cities: Lynn Moore, Bloomington Sherry Engelman, Edina • Cities of the First Class: Bill Gunther, Saint Paul Curt Fernandez, Minneapolis • Non-Metro Small Counties: Jason Petersen, Goodhue David Benson, Nobles Bill Patnaude, Beltrami • Metro Counties: Cindy Weckwerth, Washington Duane Hudson, Hennepin • Non-Metro Large Counties: Pete Giesen, Olmsted Hank Schreifels, Stearns MANUAL WORKGROUP Representing All Stakeholders: Advisory Council members Bill Gunther, Curt Fernandez, Lynn Moore, and Pete Giesen offered to draft the outline for an EH manual and toolkit. After review of the outline at the next Advisory Council meeting, topic experts will be recruited for a Manual Workgroup to draft specific Manual chapters. • Local Public Health Association: Sandy Tubbs; Julie Ring • Association Minnesota Counties: John Baerg; Patricia Coldwell. • State Community Health Services Advisory Committee (SCHSAC): Larry Kittelson; Bev Wangerin. • Hospitality Minnesota: Kevin Matzek; Dave Siegel. Page 3 EHKMP (FOOD PROGRAM) UPDATE We are pleased to congratulate the Environmental Health Knowledge Management (EHKMP) Working Group Food Program on the approval of their Action Plan, Part 1, by the EHKMP Steering Committee. BACKGROUND In October 2005, MDH hosted a meeting at which environmental health (EH) partners from across the state discussed the sharing and collection of EH data. With the support of that group, MDH took the lead in bringing together a group of stakeholders to examine the possibility of statewide EH data sharing. The effort that resulted from those early discussions became the Environmental Health Knowledge Management Project (EHKMP). EHKMP is described as an initiative to improve EH services in Minnesota through strategic application and management of EH information on a statewide basis. In November 2005, MDH solicited volunteers to serve on the EHKMP Steering Committee. That group selected food program information as the first focus of EHKMP efforts. (Future working groups will consider the information collected by drinking water, lead, radon, and other programs) The EHMKP Working Group (Food Program) was soon formed. The ten member group includes local partners, a representative of the Minnesota Environmental Health Association, and staff from the Minnesota Departments of Health and Agriculture. Two members of the EHKMP Steering Committee have also participated on the Working Group (Food Program). steps for improving statewide sharing of food program licensure, inspection, and enforcement data; and INITIAL GUIDANCE The EHKMP Steering Committee laid the foundation for the Food Program and subsequent working groups by creating the following: • A diagram or “mind map” that illustrates the benefits of EHKMP and the key relationships and activities that will be important to its success; • A vision statement; and • Programmatic goals for the EHKMP food program effort. WORKING GROUP After more than a year of hard work, the EHKMP Working Group (Food Program) has finalized documents that comprise Part 1: An Action Plan to Improve the Sharing of Food Program Licensure, Inspection, and Enforcement Data. The draft action plan includes: • • • Diagrams illustrating the basic flow of licensure, inspection, and enforcement data within food programs; A dictionary of food program data elements considered important to share on a statewide basis (including separate data dictionaries for licensure, inspection, and enforcement); Recommendations and action • Many supporting documents. NEXT STEPS The EHKMP Steering Committee approved the EHKMP Action Plan: Part 1—Food in September 2007. MDH staffer and EHKMP project manager, Jennifer Miller, will make a few last revisions to action plan documents prior to their posting on the EHKMP website in early October 2007. Plans for implementation of the action plan will be discussed at the next meeting of the EHKMP Steering Committee (October 24, 2007). Several presentations introducing EHKMP process, plans, and products have already been made; more will be forthcoming as local partners are recruited to join the MDH food program in adopting the action plan. FOR MORE INFORMATION To learn more about the EHKMP and its first action plan to be approved and endorsed by the EHKMP Steering Committee, please visit the EHKMP website at: http://www.health.state.mn.us/divs/e h/local/knowproj/index.html. Feel free to contact Jennifer Miller, if you have questions about EHKMP or wish to schedule a presentation for your county, conference or association. Jennifer L. Miller, MRP Planner, Division Services Section Minnesota Department of Health Division of Environmental Health 651-201-4556 [email protected] Page 4 PWDU Quarterly Update Guest Editorial: Toward More Effective Communications — by Ken Schelper, FMP, Vice President, Davanni’s Dedicated to the enlightened Sanitarians of Olmsted County who were among the first to jump on this band wagon with me. NOTE: “More Effective Communications” was the title of a presentation that I made at the MEHA conference earlier this year. The focus of my workshop was how you, as regulators, can more effectively communicate with the establishments and the people you are charged with “overseeing.” This advice is from the perspective of someone who has been in the restaurant industry for 31 years and actively involved in food safety since 1979. SHARED INTEREST Effective communications—as well as persuasion and cooperation— often start with finding a common ground or shared interests. For people working in public health, and those working in the food industry, our shared objective should be to serve safe food to the public. Foodservice inspectors, that is your charge under the law. In the foodservice industry, food safety should be one of our key focuses, but often is not. This is not because we don’t view it as important. If you could remove us from the demands of the moment, most of us would say that food safety is vital—and we would be able to tell you why it is. Unfortunately, food safety is most at risk “during the moment” when so many other things are demanding one’s immediate attention. If a manager fails to take time to observe every food-handling practice during a “rush,” nothing is likely to happen. If a customer’s food is late or their order is wrong, the manager will hear about it—often forcefully and immediately! RISK Whether in the work place or at home, the same principle holds. If you are a parent, you should already know this. The least effective way to get anyone’s willing cooperation is to say “Do it because I say so.” If they don’t understand “why” and “buy-in,” they will do things the way they want to—or the way that is most expedient, as soon as your back is turned. It works the same with employees, young or old. WHAT DOES THIS MEAN? SOME TACTICAL ADVICE You don’t have to convince us or force us (demanding does little good) - just help us. Help us to understand your concerns and to make the connections (Why is this important to both of us?). Help us to identify the biggest risks. DOESN’T THE OLD WAY WORK? No, it probably never did. Here are some reasons why: Food safety is not really under your control or power: Regardless of what regulations say, food safety depends entirely on the day-to-day practices of our businesses and employees. In an era of increased responsibility and increased budgetary constraints, you are in our businesses about .03 percent of our open hours. Food safety depends almost entirely on what happens during that other 99.97 percent of the time. You can’t force people to change: This is basic human nature. For the food industry, it means first being able to identify and prioritize risks, and then to build good practices into our systems and training. For public health sanitarians, it means that you have to take a hard look at how you spend those two or so hours a year that you are in our businesses. It means that you may need to reconsider what your role is in the whole scheme of food safety. It also means that your effectiveness must be even more directly tied to your communications skills. All of the regulations, inspection forms, checklists, and standing orders in the world are worthless if you can’t communicate effectively. HOW DO WE KNOW IF COMMUNICATIONS ARE EFFECTIVE? I define effective communications as those that are Heard, Understood, Accepted and Acted Upon. Too often we are satisfied with Heard (“Well, I told them to …” or “I wrote them up ...”) Ultimately our goal should be Willingly Acted Upon because this implies understanding and commitment. Page 5 — Sharing the Common Ground This takes some effort, but the results are worth it. The food-handling practices will be good when you aren’t there and you won’t have to revisit the same issues in the future. Consider yourself a coach, not a cop; a teacher not a regulator. Acting as a cop or a regulator should be considered a last resort and a sign of a failure of the system. authority barrier. WHAT ARE THE BARRIERS? Begin with clarifying or establishing shared goals. During your first inspection of an establishment or first meeting with a manager, establish relationships and gather information. These should be your primary goals for a first visit, so devote at least 30 minutes to this task. Now you have significantly reduced the fear and defensiveness. Avoid walls, ceilings and nitpicking as much as possible. Concentrate instead on real risks specific to the operation. Provide a focus! If you overwhelm an operator with issues (more than three things), some will be forgotten and none will be considered very important. Here are some of the barriers: authority or status, surprise, defensiveness, fear, distraction, interruption, time (yours and ours), and language. Are any of these potential factors when you visit our place of business? (Of course.) When I refer to language, I’m not just relating it to our immigrant, nonEnglish speakers but to native-born, English speakers. Do you know that today’s high school graduates are only required to read at an 8th grade level? Do you know that about half of the people who take college entrance exams lack sufficient skills to handle introductory courses in history or sociology? Do you know that you don’t always speak clear, understandable English? It’s true. I’ve listened to you for over 30 years and you speak FoCoBiL (standing for Food Code Biological Legalese). FoCoBiL is filled with acronyms, scientific & technical terms, jargon, and numerical references to rules. FoCoBiL is written using legal language, fancy words, and unbelievably run-on sentences. HOW CAN YOU OVERCOME SOME OF THESE BARRIERS? Here are some of my recommendations. Schedule inspections. This will take care of the surprise and a lot of the distractions and interruptions. Stop talking. You can’t learn anything when you are talking—and you already know what you know. Before you can be an effective resource, you have to get to know the operation, the menu and the operator. Remember that the operator is the one who has ultimate control over food safety. Observe, ask questions and provide feedback. It is very hard to “put on a show” for an inspector (Yes, you will continue to be inspectors in our eyes until you change the way you approach us). If the visit is more interactive, employees will be less likely to revert to familiar and incorrect practices after you are gone. Don’t be condescending or threatening. This will help pull down that Offer help and resources. Explain not only the “how” or “what”, but also the “desired results” and the “whys.” Collaborate, negotiate and compromise when possible. Too often sanitarians turn a deaf ear to our operational concerns. Remember that operators and their employees are geared towards expediency. The easier that we can make it for them to do the right thing, the more likely they are to do it after you leave. Set clear goals (no more than three, if possible) that are mutually acceptable, reasonable and achievable. Have operators take responsibility to contact you when items have been completed, if they need help, or if something is preventing them from meeting the goals. Finally KISSS – keep it simple, simple, simple! Don’t talk to me about comminuted fish, potable water, or hygroscopic food. If you can’t figure out a simpler way of saying something (I bet you can) take the time to help us to understand the concept, if you expect to see results. Agree or disagree with this editorial? Put your own editorial on these pages in the next issue. Page 6 PWDU Quarterly Update Quarterly Bug Report - Clostridium botulinum About Foodborne Botulism Botulism is a potentially fatal illness caused by a toxin produced by a bacterium called Clostridium botulinum which is commonly found in soil. These bacteria form spores which survive in the environment until conditions are favorable for growth. They require an anerobic environment to multiply and produce toxins. There are three types of botulism: foodborne, wound, and infant botulism. Foodborne botulism occurs when a person ingests food contaminated with the toxin. Botulism is quite rare. According to the Centers for Disease Control (CDC), an average of 110 cases are reported each year in the U.S. About 25 percent are foodborne. With foodborne botulism, symptoms usually appear within 18 to 36 hours after eating. However, they can start as soon as six hours later, or as long as 10 days later. Symptoms include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and progressive muscle weakness. Intensive supportive care in a hospital is the primary treatment for botulism. If the illness is identified quickly, an anti-toxin can be given to block the effects of the poison. Foodborne botulism can be prevented through safe food handling practices. Although most cases of foodborne botulism are associated with home-canning, outbreaks have also occurred from sources such as improperly handled garlic in oil, chili peppers, and baked potatoes. WHY BOTULISM? The choice of Botulism for this new “Quarterly Bug Report” might seem like an odd one, given the rarity of outbreaks related to C. botulinum. However, a July 2007 outbreak of botulism associated with factorycanned chili products proved to be of considerable interest to the food community. First, contrary to recent history, the outbreak was not related to homecanning. Second, the recall was complicated by the gradual expansion of the list of products that were potentially involved. Third, it became clear that a comprehensive notification and recall of these products would require a multi-jurisdictional effort. THE CHILI SAUCE RECALL First announced in mid-July, the chili sauce recall expanded by the end of the month to include 10 chili sauce products, dozens of canned meals such as hash and stew, and several varieties of dog food— ultimately millions of canned food items. The cause of the outbreak was being investigated as potentially related to a problem on the production line months earlier. clear that existing records and methods did not allow comprehensive notification of all those facilities where canned foods are made available to the public. In late July, the Food and Drug Administration (FDA) reported that more than 3,788 retail stores across the country had been visited by FDA; 1,390 by the U.S. Department of Agriculture. (USDA). Recalled product was found available for purchase in about 300 stores. On July 30, USDA issued a bulletin asking state and local officials to spread word of the recall to food salvage and food bank operations. USDA noted that there is no national salvage operation for FDA to contact, and no list of food banks or food shelves. USDA provided information to be dispersed locally, regarding the safe removal and disposal of these recalled products. TAKE HOME MESSAGES: • Home-canning is not the only source of botulism. • Good record keeping is helpful. • Collaboration is critical to good public health practice. Botulism Information: Centers for Disease Control (CDC): http://www.cdc.gov/ncidod/dbmd/disea seinfo/botulism_g.htm Ultimately, two cases of botulism were identified in Indiana and two cases in Texas. The chili sauce eaten by the Indiana cases tested positive for C. botulinum. United States Department of Agriculture Home-Canning Guide: http://www.uga.edu/nchfp/publications/ publications_usda.html RECALL WRINKLE Minnesota Department of Health: http://www.health.state.mn.us/divs/idep c/diseases/botulism/botulism.html As the recall expanded, and nationwide efforts to remove these foods from shelves progressed, it became Food and Drug Administration Chili Recall: http://www.fda.gov/oc/opacom/hottopic Page 7 The Pickle Bill: Selling Home-Canned Goods WHY A PICKLE BILL? Although prior Minnesota farmers’ market exemptions allowed sale at the markets of homegrown produce, these exemptions did not apply to the sale of any processed foods at farmers’ markets or community events. A Minnesota legislator decided it was time to change that law. The result was the 2006 “Pickle Bill.” This new law is explained in a Minnesota Department of Agriculture fact sheet, Fact Sheet for Certain Home-Processed and HomeCanned Foods. The following is excerpted from that fact sheet. WHO, WHAT, WHERE & HOW? Products covered by the “Pickle Bill” are high-acid (pH value of 4.6 or lower) pickles, vegetables, or fruits. This legislation does NOT cover sales of home-canned, lowacid foods such as peas, green beans, beets, or carrots that have been processed in a boiling water bath or in a home pressure cooker. Under this law, sales of homecanned foods are limited to a maximum of $5,000 per year. The individual who is selling homeprocessed or home-canned acid foods under this exemption must provide, upon request of a regulatory authority, a recipe and the pH results for the product being sold. The food products may only be sold at Minnesota community or social events, or farmers’ markets. This includes county fairs and town celebrations but does NOT include: craft shows; other for-profit events; sales to other businesses; interstate or internet sales; or sales from the home or business. The seller must display a sign or placard at the point of sale which states that the canned goods are homemade and not subject to state inspection. Each food container must be labeled with: the name and address of the person who processed and canned the goods; and the date on which the food was processed and canned. Persons producing and selling these products are urged to: successfully complete a better process school recognized by the Minnesota Commissioner of Agriculture; and have the recipe and manufacturing process reviewed by a person knowledgeable in the food canning industry and recognized by the Minnesota Commissioner of Agriculture as a process authority. This legislation requires that the homeprocessed and homecanned foods consists of either an acid food or an acidified food, The law only applies to pickles, vegetables, or fruits. It does NOT apply to adding acid (i.e. vinegar) to pickled eggs, fish, or meat, even if the product’s final pH is 4.6 or less. FOODS THAT MIGHT BE ALLOWED TO BE SOLD The final pH of the food must be 4.6 or less. Acid foods are defined as foods that have a natural pH of 4.6 or less and acidified foods are defined as low-acid foods to which acid(s) or acid food(s) are added. The types of foods that might be allowed under this exemption include, but are not limited to, homeprocessed or home-canned sweet or dill pickles, tomatoes, salsa, apples, cherries, grapes, plums, peaches, flavored vinegars, and naturally fermented foods such as sauerkraut, pickles, and KimChi (Korean-style fermented vegetables) if the final pH is 4.6 or less. FOODS THAT WOULD NOT BE ALLOWED TO BE SOLD This includes foods that are homeprocessed or home-canned that are not pickles, vegetables or fruits. For example, home-canned fish, pickled eggs, and meat are not allowed. Foods that have a pH of 4.6 or greater are not included under this law. The following foods have a natural pH above 4.6: artichokes, asparagus, beans (lima, string, kidney, Boston style, soy, waxed), beets, broccoli, Brussel sprouts, carrots, cabbage, cauliflower, horseradish, sweet corn, egg plant, mushrooms, peas, most all peppers, potatoes, squash, spinach, and vegetable soups. Therefore, these foods are not allowed unless the pH of these foods is reduced to pH 4.6 or less. Foods that require refrigeration are not allowed. Fresh-processed (not canned) foods that require refrigeration such as fresh salsa and pesto are not allowed. For more information, see the complete fact sheet at: http://www.mda.state.mn.us/food/bu siness/factsheets/picklebill.htm Freedom to Breathe, continued. Minnesota Department of Health Division of Environmental Health Environmental Health Services Section Orville L. Freeman Building 625 North Robert Street Saint Paul, Minnesota 55155 Minnesota Department of Health (MDH), Local Public Health Association (LPHA) and other partners have created a wealth of materials regarding implementation of Freedom to Breathe provisions. • MDH general and situation-specific fact sheets, compliance assistance letters and other information can be found at: http://www.health.state.mn.us/ freedomtobreathe. • See the LPHA “business kit,” training opportunities, and other materials at: http://www.mncounties2.org/lpha/ freedom_to_breathe.htm. • Fresh Air Minnesota provides secondhand smoking facts, and information on smoking cessation, compliance and enforcement at: http://www.freshairmn.org/. • If you have questions or need additional information about Freedom to Breathe, please contact: [email protected]. http://www.health.state.mn.us/foodsafety Note from April Bogard It’s been a busy summer for Environmental Health staff across the state! Many MDH staff members and our local partners were called to participate in the SE MN flood response efforts. Staff worked in the field with those directly affected, directed emergency operations centers, worked in the flood recovery centers, answered calls on the flood hotline, and performed many other valuable tasks during the response. Public health personnel should be applauded for their dedication and tireless efforts to lend a helping hand. We look forward to hearing from our state and local partners about their experiences during the floods. If you would like to contribute an article for our next PWDU Update (published in January 2008), please contact Deborah Durkin. Since our last PWDU update was published, our unit has had some staffing changes. Paul Allwood left MDH and began working at the University of Minnesota. Michael Nordos has joined the PWDU and has enthusiastically taken on the responsibility for chairing the Evaluation Workgroup (part of the Delegation Agreement Advisory Council). Mike is also working on developing training programs for our state and local sanitarians. Please feel free to call any of our staff with questions, comments, concerns, compliments ... April PWDU Staff Contact Information Name Got A Question? Phone and Email April Bogard Supervisor, Partnership and Workforce Development Unit. Deborah Durkin Food Safety Partnership, Food Safety Center, UPDATE, Manual Workgroup, food safety education. [email protected] 651-201-4509 Tony Georgeson Rapid inspection software development, maintenance and training. [email protected] 218-332-5167 Mike Kaluzniak Data systems, Statewide Hospitality Fee, emergency notification system. [email protected] 651-201-4517 Steve Klemm Swimming pool construction, plan review and inspections. [email protected] 651-201-4503 Angela McGovern Administrative support. Michael Nordos Training, Evaluation Workgroup, program evaluation. [email protected] 651-201-5076 [email protected] 651-201-4506 [email protected] 651-201-4511
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