Guest guest Posted January 11, 2011 Report Share Posted January 11, 2011 Nice puzzle, If she thinks that the two bottles are SEPARATE then it is possible to think that they taste different. Or her bitter receptors DNA synthesis has been somehow downregulated due to her exposure to wormwood. On the other hand, if there really was no wormwood in the mix, maybe you MADE wormwood out of the other herbs - maybe the step from herbalism to alchemy is not such a big one........what was in her mix? best wishes, Guy > Hi everyone > > I wonder if any of you can shed light on something that has > happened to some medicine I dispensed. > > On 14th December I sent some medicine to a patient who was going > away for Christmas and didn't want to run out. > Last week she phoned me and said she had just started taking it but > it tasted really bitter so she wondered if it had gone off. > So I checked through her Rx and my tracking system and checked the > individual herbs I had used (all same batches sitting on shelf > still - thank goodness for Christmas!). > > Nothing tasted strange at all. > I sent her small amount as replacement and asked her to compare > tastes. I got her to send the bitter one back to me and it came > with a note. See below. > > I need to explain my dispensing process so you can see how I am > baffled. > Usually, I use 200 ml bottles so patients get 2 x 200 mls each > appt. (5mls tds) > For postal medicines I do the same thing but with plastic. > I dispense into a jug and decant from there into the two bottles - > so the mixture in the two bottles is the same. > For postal meds, I always make up a Rx, label it, write out > invoice, address envelope etc - basically see the whole process > through from beginning to end for each patient - so there can be no > possibility of mixing up different patients medicines. > > On 14th dec this was in fact the only medicine I had to put in the > post that day. > I made it up according to my usual process. > Patient received 2 bottles that had come from same jug. She phoned > me when opened first bottle and said it was bitter. > > I tasted it and undoubtedly it tastes of wormwood - not something > that is in her Rx. > What is bizarre is that she didn't return the 2nd bottle but > included a note saying she had since tried 2nd bottle (hadn't > thought of that before) but found it tasted fine. > > So, how can 2 bottles of medicine dispensed at same time, from same > stock, into same jug and then decanted, taste different? > > Any ideas? > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 11, 2011 Report Share Posted January 11, 2011 Perhaps the bottle was contaminated? Sometimes it happens that something gets into an individual bottle or jar. Sent using BlackBerry® from Orange Re: Bizarre occurrence Nice puzzle, If she thinks that the two bottles are SEPARATE then it is possible to think that they taste different. Or her bitter receptors DNA synthesis has been somehow downregulated due to her exposure to wormwood. On the other hand, if there really was no wormwood in the mix, maybe you MADE wormwood out of the other herbs - maybe the step from herbalism to alchemy is not such a big one........what was in her mix? best wishes, Guy > Hi everyone > > I wonder if any of you can shed light on something that has > happened to some medicine I dispensed. > > On 14th December I sent some medicine to a patient who was going > away for Christmas and didn't want to run out. > Last week she phoned me and said she had just started taking it but > it tasted really bitter so she wondered if it had gone off. > So I checked through her Rx and my tracking system and checked the > individual herbs I had used (all same batches sitting on shelf > still - thank goodness for Christmas!). > > Nothing tasted strange at all. > I sent her small amount as replacement and asked her to compare > tastes. I got her to send the bitter one back to me and it came > with a note. See below. > > I need to explain my dispensing process so you can see how I am > baffled. > Usually, I use 200 ml bottles so patients get 2 x 200 mls each > appt. (5mls tds) > For postal medicines I do the same thing but with plastic. > I dispense into a jug and decant from there into the two bottles - > so the mixture in the two bottles is the same. > For postal meds, I always make up a Rx, label it, write out > invoice, address envelope etc - basically see the whole process > through from beginning to end for each patient - so there can be no > possibility of mixing up different patients medicines. > > On 14th dec this was in fact the only medicine I had to put in the > post that day. > I made it up according to my usual process. > Patient received 2 bottles that had come from same jug. She phoned > me when opened first bottle and said it was bitter. > > I tasted it and undoubtedly it tastes of wormwood - not something > that is in her Rx. > What is bizarre is that she didn't return the 2nd bottle but > included a note saying she had since tried 2nd bottle (hadn't > thought of that before) but found it tasted fine. > > So, how can 2 bottles of medicine dispensed at same time, from same > stock, into same jug and then decanted, taste different? > > Any ideas? > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 11, 2011 Report Share Posted January 11, 2011 nice idea, Guy. There definitely was no wormwood in mix. She tasted it 'bitter' sent it back and I identified wormwood by taste. I've been seeing her for a while - she's actually the hyperthyroid patient I mentioned a few months ago - and her mix has hardly changed since day 1, so she is very familiar with the taste. She has never had wormwood. The only thing that has changed is that at first I gave her Passiflora but for a while she has had Scutellaria. mix contains Lycopus, Leonurus, , Crataegus and Scutellaria. I can't even say I took Art abs off the shelf beside the right herb by mistake as there is no alphabetical mix up possible - and in any case, as I said it all went into jug first. She has watched me make up her medicine often enough to know the two bottles are identical - or at least they used to be identical before I passed them over to royal mail. 's idea of contaminated bottle is plausible - but a virgin bottle? I'm just waiting for my last patient so I took all my plastic bottles, had a good sniff and then put a little water in each and tasted - nothing. Clearly I need a life. I can't even say I've upset the wormwood fairy so she or he is seeking vengeance, because I really like wormwood and although I don't give it to patients all that often I am one of those weird people who likes the taste of wormwood. If you or anyone else can do some chemical or alchemical equation from the ingredients above and create wormwood taste - selectively mind as it was only in 50% - please let me know. All other suggestions - bar insanity - very welcome! > > Nice puzzle, > If she thinks that the two bottles are SEPARATE then it is possible > to think that they taste different. Or her bitter receptors DNA > synthesis has been somehow downregulated due to her exposure to > wormwood. On the other hand, if there really was no wormwood in the > mix, maybe you MADE wormwood out of the other herbs - maybe the step > from herbalism to alchemy is not such a big one........what was in > her mix? > best wishes, > Guy > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 11, 2011 Report Share Posted January 11, 2011 Using Batch Master PRO you would have been able to: Check who had been responsible for this order (automatically documented) Check which batches of product should have gone into the bottle whether they still happen to be on the shelf or not (automatically documented) Check if any products that you suspect may have been incorrectly dispensed have been (Batch Master PRO monitors the life of the whole batch received you would have been able to check the history of each product used and any suspected errors against what is still on your shelves. This would have brought any discrepancies immediately to light.) You would have been able to produce paperwork demonstrating to your client your investigation and working on this issue to satisfy her about what she has received. You would have been able to eliminate the possibility that a Schedule 3 herb had entered the prescription accidentally by checking for any discrepancies in these items. As a member of council I'm sure you remember that I have written on a few occasions offering to demonstrate what having a total traceability system means. The NIMH council has always rejected this offer. It seems you are now demonstrating clearly the need for every member to be able to resolve these issues and be able to produce paperwork to demonstrate it. My offer is still open despite the negative response of the council. It certainly would have been able to allow you to say and demonstrate from your side what has happened here. As it is you are left speculating and leaving yourself open to accusations from your client about the nature of what their prescription actually contains. Lorraine Lorraine Hodgkinson MNIMH MRCHM HERBS AND HELPERS 6, Butts Fold, Cockermouth, Cumbria, CA13 9HY. UK. Tel: +44 (0) 1900 826392 Mobile: 07761 489838 (O2) www.herbalmedicineuk.com > Hi everyone > > I wonder if any of you can shed light on something that has happened to some medicine I dispensed. > > On 14th December I sent some medicine to a patient who was going away for Christmas and didn't want to run out. > Last week she phoned me and said she had just started taking it but it tasted really bitter so she wondered if it had gone off. > So I checked through her Rx and my tracking system and checked the individual herbs I had used (all same batches sitting on shelf still - thank goodness for Christmas!). > > Nothing tasted strange at all. > I sent her small amount as replacement and asked her to compare tastes. I got her to send the bitter one back to me and it came with a note. See below. > > I need to explain my dispensing process so you can see how I am baffled. > Usually, I use 200 ml bottles so patients get 2 x 200 mls each appt. (5mls tds) > For postal medicines I do the same thing but with plastic. > I dispense into a jug and decant from there into the two bottles - so the mixture in the two bottles is the same. > For postal meds, I always make up a Rx, label it, write out invoice, address envelope etc - basically see the whole process through from beginning to end for each patient - so there can be no possibility of mixing up different patients medicines. > > On 14th dec this was in fact the only medicine I had to put in the post that day. > I made it up according to my usual process. > Patient received 2 bottles that had come from same jug. She phoned me when opened first bottle and said it was bitter. > > I tasted it and undoubtedly it tastes of wormwood - not something that is in her Rx. > What is bizarre is that she didn't return the 2nd bottle but included a note saying she had since tried 2nd bottle (hadn't thought of that before) but found it tasted fine. > > So, how can 2 bottles of medicine dispensed at same time, from same stock, into same jug and then decanted, taste different? > > Any ideas? > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2011 Report Share Posted January 12, 2011 Hi , if a trace of wormwood was at the bottom of your jug, it could have gone into the last bottle, as it may have stayed at the bottom of the mix. Does that make sense to you? Marilena. To: ukherbal-list From: herbsandhelpers@... Date: Wed, 12 Jan 2011 06:39:06 +0000 Subject: Re: Bizarre occurrence Using Batch Master PRO you would have been able to: Check who had been responsible for this order (automatically documented) Check which batches of product should have gone into the bottle whether they still happen to be on the shelf or not (automatically documented) Check if any products that you suspect may have been incorrectly dispensed have been (Batch Master PRO monitors the life of the whole batch received you would have been able to check the history of each product used and any suspected errors against what is still on your shelves. This would have brought any discrepancies immediately to light.) You would have been able to produce paperwork demonstrating to your client your investigation and working on this issue to satisfy her about what she has received. You would have been able to eliminate the possibility that a Schedule 3 herb had entered the prescription accidentally by checking for any discrepancies in these items. As a member of council I'm sure you remember that I have written on a few occasions offering to demonstrate what having a total traceability system means. The NIMH council has always rejected this offer. It seems you are now demonstrating clearly the need for every member to be able to resolve these issues and be able to produce paperwork to demonstrate it. My offer is still open despite the negative response of the council. It certainly would have been able to allow you to say and demonstrate from your side what has happened here. As it is you are left speculating and leaving yourself open to accusations from your client about the nature of what their prescription actually contains. Lorraine Lorraine Hodgkinson MNIMH MRCHM HERBS AND HELPERS 6, Butts Fold, Cockermouth, Cumbria, CA13 9HY. UK. Tel: +44 (0) 1900 826392 Mobile: 07761 489838 (O2) www.herbalmedicineuk.com > Hi everyone > > I wonder if any of you can shed light on something that has happened to some medicine I dispensed. > > On 14th December I sent some medicine to a patient who was going away for Christmas and didn't want to run out. > Last week she phoned me and said she had just started taking it but it tasted really bitter so she wondered if it had gone off. > So I checked through her Rx and my tracking system and checked the individual herbs I had used (all same batches sitting on shelf still - thank goodness for Christmas!). > > Nothing tasted strange at all. > I sent her small amount as replacement and asked her to compare tastes. I got her to send the bitter one back to me and it came with a note. See below. > > I need to explain my dispensing process so you can see how I am baffled. > Usually, I use 200 ml bottles so patients get 2 x 200 mls each appt. (5mls tds) > For postal medicines I do the same thing but with plastic. > I dispense into a jug and decant from there into the two bottles - so the mixture in the two bottles is the same. > For postal meds, I always make up a Rx, label it, write out invoice, address envelope etc - basically see the whole process through from beginning to end for each patient - so there can be no possibility of mixing up different patients medicines. > > On 14th dec this was in fact the only medicine I had to put in the post that day. > I made it up according to my usual process. > Patient received 2 bottles that had come from same jug. She phoned me when opened first bottle and said it was bitter. > > I tasted it and undoubtedly it tastes of wormwood - not something that is in her Rx. > What is bizarre is that she didn't return the 2nd bottle but included a note saying she had since tried 2nd bottle (hadn't thought of that before) but found it tasted fine. > > So, how can 2 bottles of medicine dispensed at same time, from same stock, into same jug and then decanted, taste different? > > Any ideas? > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2011 Report Share Posted January 12, 2011 > > > Hi , if a trace of wormwood was at the bottom of your jug, it could have gone into the last bottle, as it may have stayed at the bottom of the mix. > Does that make sense to you? You can taste 1 drop of wormwood in 10,000 and it is incredibly difficult to wash off the bitterness from your fingers. Do you use a plastic jug ? I find aromatics linger on plastic too. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2011 Report Share Posted January 12, 2011 I use a similar dispensing method to you , maybe one or more of the herbs sedimented before dispensing into the two bottles meaning the second bottle got alot more of a particular herb...? Ciara Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2011 Report Share Posted January 12, 2011 Dear Lorraine I'm so glad you think human error could be a possibility. Shall I point out to you that the only human error here is that you did not read the post thoroughly? Do you honestly think that I would not have considered human error? I did not give my entire process for tracking my use of medicines as there is no need to elaborate on this list. it is standard procedure for all herbalists to have a tracking system. just because I don't use yours is no reason to suggest that I have not been thorough in looking at the situation. If you had read the post thoroughly you would find that I dispensed 400 mls of medicine and then put it in separate containers. One of them has a bitter taste and the other has not. So find the human error in that, please. As to the situation with my patient, I am delighted to know that you seem to understand the relationships I have with my patients better than I do. While I would not be arrogant (or stupid) enough to think I could never be the issue of a complaint, I would expect my patients o come to me in the first instance and for me to take their concern seriously and deal with it. I would also expect to report an adverse reaction on the yellow card scheme. Or perhaps you think I am not professional enough to do that? It certainly seem to me that you are suggesting that. best wishes Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2011 Report Share Posted January 12, 2011 Dear Lorraine And just what makes you think I am not able to do any, or all, of this? There are several things in your message. Firstly, my post was not intended for you to launch into a sales pitch. I have not demonstrated the need to use your system. If you had read my message properly you would see that. Secondly, whether I am on NIMH council or not is irrelevant. Basically you have just taken this opportunity to attempt to influence people, and generate yet another sales pitch. You are aggrieved because the NIMH has declined to endorse your product. You have been given reasons for that one numerous occasions. This list, and I will remind you that this is an open list and not an exclusively NIMH one, is not the place to raise NIMH related matters. Please do the others on the list the courtesy of respecting that. Finally, and this is what concerns me most here: Are you saying that you keep your schedule 3 herbs in the same place as non S3 herbs? I simply could not make the mistake of 'accidentally dispensing a schedule 3 herb' but from what you say here it suggests to me that you could. So how do you keep your S3 herbs? Are they on open shelves? Or do you keep them separate? It is against the NIMH Code of ethics, all good practice, not to mention the law of the land (1968 medicines Act) not to keep your S3 herbs separate and locked away. I sincerely hope you are doing that. best wishes Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2011 Report Share Posted January 12, 2011 Dear Lorraine Schedule 3 herbs cannot accidentally get into a prescription - they have to be taken from their locked place and dispensed appropriately. I don't use a dispenser as you do, so I know exactly when I use them. I am gravely concerned that you are not ensuring safe and legal dispensing of the S3 herbs in your dispensary. best wishes Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2011 Report Share Posted January 12, 2011 Hi Zoe and Marilena I wondered that too - but why one bottle and not the other? I use a pyrex jug, but I do use a polyprolene measuring cylinder (having broken numerous glass ones). Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2011 Report Share Posted January 12, 2011 hi Alix interesting thought but absolutely no reason for it that I can see. attention seeking - no she's a level headed person others tampering - no they've seen her health improve dramatically, and she was pretty ill. There have been developments with this though. I have the bottle sitting on my shelf. I also made up some of her mixture and have it in a separate bottle. When she sent her 'bitter mix' back to me, I opened it as I said and I tasted wormwood. Fairly unmistakable taste. I made up some of her mix and tasted it for myself - no wormwood of course. I've been tasting both of them for several days and at lunchtime today I discovered that the wormwood taste has almost disappeared, still there a bit but nothing like the distinct taste that was there before. However, it does not taste pleasant. It tastes bitter but not in the way we expect herbs to taste bitter. The other one tastes as it did a few days ago. Could it be that something has in fact 'gone off' as she originally thought? I suppose the only way to discover that is ask a supplier if they can check it for me. The individual herbs taste fine. The difference between these two bottles now on my shelf is that one is in glass and the other in plastic. Maybe something in the plastic is leaching out? , is that plausible? But why would it taste of wormwood and then change a few days later? Curious indeed. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2011 Report Share Posted January 12, 2011 Sending this again as it seemed to have got lost in cyberspace the 1st time I sent it an hour ago... Apologies if you get it twice ----- Forwarded Message ---- To: ukherbal-list Sent: Wednesday, 12 January, 2011 16:41:07 Subject: Re: Re: Bizarre occurrence Hi From what you say, common sense says that both your bottles were the same. My feeling is that your patient's taste perceptions and needs changed - similar to the zinc test that's marketed, you can't taste it when you need zinc but you can when you don't. By the time she got to the second bottle, she didn't need that bitter taste any more - the first bottle had done it's job from that particular point of view. I think it's similar to patients who forget to take their medicine when previously they never forgot - they just don't need the taste any more. Taste is very therapeutic, particularly bitters as we all know. Does that fit with your patient? Helen ________________________________ To: " ukherbal-list " <ukherbal-list > Sent: Wednesday, 12 January, 2011 15:50:22 Subject: Re: Re: Bizarre occurrence  I once dispensed into 2 bottles from a jug and the patient said one bottle seemed weaker than the other. This would back up the sedimentation thought train. Which at the time I did put it down to. I am sure that we are all very precise and careful with our dispensing process. After all, next to actual prescription writing it's the dispensing of the medicine that determines what the patient will be taking!! Of course we are human and errors can be made, this is why we have a method of dispensing as you have described . I am sure batch master is a useful tool, especially in busy dispensaries where there might be multiple dispensers but I am sure the individual herbalist has a strict enough procedure and if thought the taste of the herb was due to dispensing error she probably would not have felt the need to post the question on the forum. Medical Herbalist On 12 Jan 2011, at 02:36 PM, " irishherbalist " wrote: > > > I use a similar dispensing method to you , maybe one or more of the herbs >sedimented before dispensing into the two bottles meaning the second bottle got >alot more of a particular herb...? > Ciara > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2011 Report Share Posted January 12, 2011 Forgot to say that as well as that I dispensed Art abs in August last year and didn't use it again until 20th December so there couldn't be trace of it in the jug or cylinder. I did say I don't use it often! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2011 Report Share Posted January 13, 2011 Hi Zoe That's a reasonable idea but I don't think explains it. Like helen suggested about taste receptors, I don't think it fits. the two medicines just simply taste different but have come from same source. The mystery medicine today has no trace of wormwood taste at all. I read your message and have just tried (again) the herbs in the Rx separately. Lycopus is also bitter, but it is not the same taste. None of them has the same taste. I have two bottles here made from exactly the same ingredients and they taste different. Patient has two other bottles made from same ingredients that taste identical but different to one of the ones I have here. After Alix's post, I called patient again to double check what had happened. She ordered the Rx before Christmas as she was going away and did not want to run out. I sent her meds as previously stated (and you can rest assured I can demonstrate due diligence till the cows come home). She took one bottle to France with her and left the other one here. While in France she was still taking her previous batch. However, she returned home a few days early and the day after coming back, opened the bottle for her final dose of the day. Noticed bitter taste. Took another dose next morning and again noticed bitterness, so phoned me. I checked etc, sent her replacement etc etc. So contents of both bottles identical, sent at same time. The bottles have sealed caps and it was only when she came back that she opened it. Seals unbroken so no tampering and no contamination possible. Replacement bottle tastes exactly the same as the 2nd bottle. I don't re-use plastic bottles. The only difference is that one bottle has been to France and back. Not exposed to undue heat - but possibly a bit cold as she was in French Alps. Perhaps, more along the lines of what suggested, rather than the bottle being contaminated, the bottle itself is defective? how would I know that? It's a PET bottle. I don't like posting glass, but I'm also not keen on plastic and getting less keen by the day! PS I thought you were having torrential rain, not a drizzle? Thanks for links Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2011 Report Share Posted January 13, 2011 Good question Alix, but I don't think it would - people travel by plane and that's even higher altitude. I've had patients take medicines to all sorts of places and not have problems. Baffling isn't it? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2011 Report Share Posted January 13, 2011 Eurostar, Kerry. it's a reasonable thought though, but again -she had another bottle of medicine with her (previous one with same herbs, but dispensed at different time) and that was not effected. That one was different batch of and Lycopus. however bottle was glass not plastic. I am thinking more and more that there must be something about this particular bottle. I'm not sure I really want to start thinking about what x-rays do to our medicines ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2011 Report Share Posted January 14, 2011 Perhaps not so much psychopathic and more of a Columbo tendency? By pure coincidence I had to go to Shrewsbury today - home of course to Ellis 's Cadfael (medieval detective monk/herbalist). I wasn't doing any sleuthing though. And what do I discover when I come back? You have created Miss Marple's Herbal Detective Agency. I always knew there was genius on this list. Thanks for brilliant email, Fiona - loved it. What happens in chapter 2? > > > > > > > > > > > > > > > > > > > > > > > > > > > Hi Zoe > > > > > > > > That's a reasonable idea but I don't think explains it. > > > > Like helen suggested about taste receptors, I don't think it fits. > > > > the two medicines just simply taste different but have come from same source. > > > > > > > > The mystery medicine today has no trace of wormwood taste at all. > > > > I read your message and have just tried (again) the herbs in the Rx > > > > separately. > > > > Lycopus is also bitter, but it is not the same taste. None of them has the > > > > same taste. > > > > I have two bottles here made from exactly the same ingredients and they taste > > > > different. Patient has two other bottles made from same ingredients that taste > > > > identical but different to one of the ones I have here. > > > > > > > > After Alix's post, I called patient again to double check what had happened. > > > > She ordered the Rx before Christmas as she was going away and did not want to > > > > run out. > > > > I sent her meds as previously stated (and you can rest assured I can > > > > demonstrate due diligence till the cows come home). > > > > She took one bottle to France with her and left the other one here. While in > > > > France she was still taking her previous batch. However, she returned home a > > > > few days early and the day after coming back, opened the bottle for her final > > > > dose of the day. Noticed bitter taste. Took another dose next morning and > > > > again noticed bitterness, so phoned me. > > > > I checked etc, sent her replacement etc etc. > > > > > > > > So contents of both bottles identical, sent at same time. The bottles have > > > > sealed caps and it was only when she came back that she opened it. Seals > > > > unbroken so no tampering and no contamination possible. > > > > Replacement bottle tastes exactly the same as the 2nd bottle. I don't re-use > > > > plastic bottles. > > > > The only difference is that one bottle has been to France and back. Not > > > > exposed to undue heat - but possibly a bit cold as she was in French Alps. > > > > > > > > Perhaps, more along the lines of what suggested, rather than the bottle > > > > being contaminated, the bottle itself is defective? how would I know that? > > > > It's a PET bottle. > > > > I don't like posting glass, but I'm also not keen on plastic and getting less > > > > keen by the day! > > > > > > > > > > > > > > > > PS I thought you were having torrential rain, not a drizzle? Thanks for links > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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