Resources for Nurses and Clinic Personnel
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2009 Fact Sheet from the U.S. Centers for Disease Control & Prevention (the CDC): "HIV/AIDS and Young Men Who Have Sex With Men": http://www.cdc.gov/healthyyouth/sexualbehaviors/pdf/hiv_factsheet_ymsm.pdf (pdf format)
Why are gay, lesbian, bisexual and transgender teens at such high risk for pregnancy and STDs (including HIV)?
First, their potential partners belong to a smaller population than other teens' partners (i.e., there are fewer gay, lesbian, bi and transgender people), and disease just spreads more quickly in smaller pools of people.
Also, some lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth have sex or choose parenthood as a way to cope with emotional and physical harassment. When you've experienced a lot of stigma and rejection, it's not uncommon to feel depressed. Drugs and sex are ways of comforting yourself. Sex under-the-influence is often risky sex.
Sometimes heterosexual dating and sex are seen as potential "fixes" for something that society has taught us is broken. And the risk for lesbian and bi teenage women may be elevated - despite the fact that heterosexual young women get HIV in greater actual numbers - because when lesbian and bi young women have heterosexual sex, it's often (as it is with most people) with their closest friends, some of whom are gay and bi teenage men.
There's less social and legal support for long-term same-sex relationships. When teens can't bring their boyfriend or girlfriend to a school dance or party, when they can't invite them home for dinner or even hang out together at the mall for fear of assault, the stress of that social isolation on the relationship may lead to faster break-ups. And therefore more total lifetime partners. And therefore greater risk of HIV and other STD's.
There are certainly exceptions among people of both genders, but in general, men tend to have more partners in their lives than women have. But heterosexual guys may not have as many total partners as they're hard-wired or socially programmed to have, due to what some sociologists call "the moderating influence" of women, to whom monogamy may matter more. (Although the generalizations speak ONLY to the disease's epidemiology and it is very important that educators not stereotype girls or guys, regardless of their sexual orientations.)
Some LGBTQ teens get sexually assaulted (a sad reality for a much higher proportion of LGBTQ youth than for their heterosexual peers). Youth who've been sexually assaulted may feel less worthy of protection and may find it particularly tough to practice safer sex.
Finally, given the fact that some studies have found as many as 40% of homeless youth are gay, lesbian or bisexual, some of their sex -- heterosexual and homosexual -- may be "survival sex" (a barter for a meal or a place to sleep). Survival sex is often risky sex.
Does that mean every gay, lesbian, bisexual and transgender teen is at risk?
Not at all. For instance, LGBTQ youth who've abstained altogether or used protection really carefully may actually have lower risk than their straight friends. It's not who you are; it's what you do and who you do it with that puts you at risk. A nurse or doctor should treat every person as an individual and never assume anything about that person's behavior.
But it does mean that LGBTQ teens have a right to know their potential risk and how to keep themselves and their friends safe. And it does mean we need to be honest with our health care providers, so they can give us the best possible care.
Accord Alliance: In 2006, a consensus for a new paradigm of care for people diagnosed with "intersex" conditions was developed by 50 international experts and patient advocates. Accompanied by a change in nomenclature referring collectively to these conditions as disorders of sex development, or DSD. Accord Alliance's mission is to promote comprehensive and integrated approaches to care that enhance the health and well-being of people and families affected by DSD. http://www.accordalliance.org/
Note: Intersex Society of North America (ISNA) was devoted to systemic change to end shame, secrecy and unwanted genital surgeries for people born with anomaly of the reproductive system. They worked to end the idea that intersexuality is shameful or freakish. Because Accord Alliance (above) opened its doors in March, 2008 and will continue to lead national efforts to improve DSD-related health care and outcomes, ISNA closed its doors with the comfort and knowledge that its work will continue to have an impact. Archives of ISNA's historical documents and accomplishments will be preserved at the Kinsey Institute at Indiana University and the ISNA website will remain up as a historical artifact. http://isna.org/
Adolescent Sexual Health and the Dynamics of Oppression: A Call for Cultural Competency: 4-page handout from Advocates for Youth. http://www.advocatesforyouth.org/publications/iag/oppression.htm and http://www.advocatesforyouth.org/publications/iag/oppression.pdf (pdf format)
American Journal of Public Health June 2001 issue focuses on lesbian, gay, bisexual and transgender health. View abstracts and full texts at http://www.ajph.org/content/vol91/issue6/index.shtml#JOURNAL_ARTICLE including among many useful articles:
Same-sex romantic attraction and experiences of violence in adolescence by Russell et al,
Trans health crisis: for us it's life or death by Leslie Feinberg
Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools by Blake et al,
Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women by Marrazzo et al,
Removing the barriers: improving practitioners' skills in providing health care to lesbians and women who partner with women by Scout et al
American Psychological Association's Healthy Lesbian, Gay, and Bisexual Students Project provides resources and training events to school counselors, nurses, psychologists and social workers to help these professionals be more effective in meeting the health and mental health needs of LGBQ youth. Email: HealthyLGBStudentsProject@apa.org; Web site: http://www.apa.org/ed/hlgb
Basic Tips for Health Care and Social Service Providers Working with Transgendered People: 2-page handout available free online: http://www.gender.org/resources/dge/gea01006.pdf (pdf format)
Britain's UK Intersex Association: writings by intersex individuals and excellent links: http://www.ukia.co.uk
"Cancer Facts for Lesbians and Bisexual Women" from the American Cancer Society. Are your lesbian and bi students less likely to get a pap test because they don't think they're at risk? Great flyer, downloadable free, for your clinic or counseling waiting room or the literature rack in your classroom or library. It explains the ways in which lesbian and bisexual women are at higher risk than other women for various cancers and it encourages prevention and early detection: http://www.cancer.org/downloads/COM/CancerFactsfor%20Lesbians03.pdf (pdf format)
Celebrating the Pride and Diversity Among and Within the Lesbian, Gay, Bisexual, and Transgender Populations: health issues, especially alcohol and other substance abuse, treatment resources, from the U.S. Substance Abuse and Mental Health Services Administration: http://www.health.org/features/lgbt
Clinical Guidelines For The Management Of Disorders Of Sex Development In Childhood and Handbook for Parents. Invaluable tools regarding intersex. Copyright (c) 2006 Intersex Society of North America, March 25, 2006. Go to: http://www.dsdguidelines.org
Comprehensive School Health Manual: (NEWLY UPDATED 2007) from the Massachusetts Department of Public Health - Sheetz, A. H. & Goodman, I. F. (Eds.)., Available SOON - free - online at: http://www.maclearinghouse.com/schoolhealthmanual.htm and CDs of the manual are NOW available through the online Massachusetts Health Promotion Clearinghouse: http://www.maclearinghouse.com/. The CDs are also available at the Massachusetts State Bookstore. To order the CD, please visit the bookstore website: http://www.sec.state.ma.us/spr/sprcat/catidx.htm.
Depression: This article by a youth intern for other GLBTQ youth talks about when feeling sad or hopeless "is more than just a temporary mood change" and what to do about it. It offers other youths' stories and poems and a ton of great toll-free hotlines and web sites: http://www.youthresource.com/our_lives/depression/index.cfm
Eighty-three Thousand Youth: Selected Findings of Eight Population-Based Studies: This report by The Safe Schools Coalition (posted in pdf format at http://www.safeschoolscoalition.org/83000youth.pdf ) describes the studies themselves and details their findings pertaining to anti-GLBT harassment and the safety and well-being of sexual minority students. The studies conclude that targets of anti-GLBT harassment (even heterosexual targets) and students who identify as GLB and/or who have had same-sex relationships are:
- less likely than their peers to report having the support of families and teachers,
- 1.5 to 4 times more likely to report having been threatened or injured with a weapon at school,
- 2-7 times more likely than their peers to report missing school out of fear, and
- significantly more likely to report drug use, pregnancy, dangerous dieting, and suicide attempts.
Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults. - Caitlin Ryan, et al. PEDIATRICS Vol. 123 No. 1 January 2009, pp. 346-352 (doi:10.1542/peds.2007-3524) This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth. See NPR's coverage of the study here: http://www.npr.org/templates/story/story.php?storyId=98782569Gender and Sexuality 101 (pdf file) - by Caryn B. Oppenheim with support from Safe Schools Coalition. This is a sixteen page report with chapters on "Fluidity, Categorization, and Vocabulary" - “Coming Out” - "Language and Homophobia" - "Intersections of Identity" - "Testimonies" and "International Perspectives.""Schools should be a community where students, peers, friends, teachers, and families work together to support the well being and growth of children in a holistic manner. The writing and compilation of this booklet serves several purposes. First, through exposing high school students to ideas that they may not encounter until college, I wish to mitigate homophobia. ... It is my hope that the ideas conveyed in this packet will expand the way people think about gender and sexuality, diminishing the gap between “us” and “them”. Secondly, I encourage a dialogue between students, teachers, and parents about the issues covered in this booklet."
The Handbook of Lesbian, Gay, Bisexual, and Transgender Public Health: A Practitioner's Guide to Service. Edited by Michael D. Shankle, MPH, Research Specialist, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania; Soft Cover: ISBN-13: 978-1-56023-496-8. Click here.
Health Concerns of the LGBT Community: from Lesbian, Gay, Bisexual and Transgender People in Medicine, an advocacy committee of the American Medical Students Association: http://www.amsa.org/adv/lgbtpm/concerns.cfm
The Gay, Lesbian, Bisexual, and Transgender Health Access Project: http://www.glbthealth.org
Gender Variance Support Group: This is a monthly support and information group sponsored by at Children's National Medical Center in Washington, D.C. for parents of young children (ages 3-12) with strong and persistent cross-gender interests. The group is co-facilitated by Edgardo Menvielle, MD, Department of Psychiatry, CNMC and Catherine Tuerk, MA, RN, CS, private practice: Contact: Edgardo Menveille MD, MSHS; Phone: 202-884-5158; E-Mail: email@example.com; More info: http://www.dcchildrens.com/ProgramAndServices/Program_GenderVarianceSupportGroup.asp
GLBT Health Webpages:
topics of concern to GLBT people from hate crimes to breast cancer, from
finding a sensitive health care provider to medical and emotional issues for
transgendered people. Also guidance to health care providers, from Public
Health - Seattle & King County: http://www.metrokc.gov/health/glbt
HIV/AIDS and Young Men Who Have Sex With Men - a May 2009 factsheet from Department of Health and Human Services Division of Adolescent and School Health. http://www.cdc.gov/healthyyouth/sexualbehaviors/pdf/hiv_factsheet_ymsm.pdf(pdf file)
Well-Being: A Professional's Guide to Gay, Lesbian, Bisexual and Transgendered
Youth Health: This 2002
guide from the Minnesota Department of Health was designed to increase
knowledge of health issues unique to gay, lesbian, bisexual and transgendered
(GLBT) youth, and to increase skills in communicating and educating diverse
audiences of community members and schools about promoting the health of GLBT
youth. Free online at: http://www.mnschoolhealth.com/article/2002/09/020918134315-566149/9662.pdf
People 2010 Companion Document for LGBT Health:
first-ever comprehensive document on the state of LGBT health, its focus areas
include mental health, HIV, tobacco, injury and violence prevention, substance
abuse and more: http://www.glma.org:16080/policy/hp2010/
If You Are Concerned About Your Child's Gender Behaviors: A Parent guide: from Children's National Medical Center in Washington D.C.. Sections include: Defining Gender-Variance; Commonly Seen Behaviors; Why Gender-Variance Occurs; What to Expect in the Future; Child's View of Himself; Can it be Changed?; How to Help; Pitfalls to Avoid; Dealing With My Feelings; and Seeking Professional Help. Printed copies of the booklet they publish in English & Spanish are available for a .50 donation to cover printing and postage. http://www.dcchildrens.com/dcchildrens/about/subclinical/subneuroscience/subgender/guide.aspx
Outreach Program for Children with Gender-Variant Behaviors and their Families at Children's National Medical Center: http://www.dcchildrens.com/dcchildrens/about/subclinical/subneuroscience/gender.aspx
"Invisible Californians: Lesbian, Gay, Bisexual, Transgender Substance Abuse Clients and Their access to prevention, treatment and recovery support services in the State": http://www.adp.ca.gov/TA/pdf/GLBT_Position_paper_2004.pdf (pdf format)
Lesbian Health: The journal "Health & Sexuality Magazine" of ARHP, the Association of Reproductive Health Professionals, devoted an entire to lesbian and bisexual women's health. It includes an article on lesbian adolescents by Caitlin C. Ryan, MSW, ACSW, and Donna Futterman, MD. The entire issue is available online at: http://www.arhp.org/healthcareproviders/onlinepublications/healthandsexuality/lesbianhealth/index.cfm?ID=202
Lesbian Health in Primary Care, Part One: Opening Your Practice to the Sexual Minority Patient, H. Joan Waitkevicz (Women's Health in Primary Care, Vol 7, No. 3, April 2004.) Lesbian and bisexual women have distinct health care concerns. This article discusses the medical and mental health needs of women who partner with women, as well as techniques to foster clinician/patient communication. It also offers providers tips for providing culturally competent care. Download the entire article: http://www.womenshealthpc.com/4_04/pdfs/134LesbianHealth1PC.pdf (pdf format) Lesbian Health in Primary Care, Part Two: Sexual health care and counseling for women who have sex with women (Women Health Primary Care 2004;7(5):226-232) Dr. Waitkevicz presents suggestions for helping all female patients communicate their sexual health concerns and reviews the sexual practices of women who have sex with women. She also offers recommendations on screening for, preventing, and managing sexually transmitted infections in this population. http://www.womenshealthpc.com/6_04/pdfs/226LesbianHealth2PC.pdf (pdf format)
Lesbian STD page: from a doctor and a nurse practitioner at the University of Washington: http://www.lesbianstd.com/
The National Sexuality Education Standards: Core Content and Skills, K–12: provides clear, consistent and straightforward guidance on the essential minimum, core content for sexuality education that is age-appropriate for students in grades K–12. The Standards are presented both by topic area and by grade level. Four leading health organizations released the first-ever national standards for sexuality education in schools. Published in the Journal of School Health, the ground-breaking Standard are the result of a cooperative effort by the American Association for Health Education, the American School Health Association, the National Education Association Health Information Network, and the Society of State Leaders of Health and Physical Education, in coordination with the Future of Sex Education (FoSE) Initiative. Nearly 40 stakeholders including content experts, medical and public health professionals, teachers, sexuality educators, and young people developed the standards in a two-year process. “These National Sexuality Education Standards provide teachers, schools, school districts, and state education agencies with a new national standard—the minimum they need to teach to set students on a path to sexual health and responsible adulthood,” said Jerry Newberry, Executive Director of the National Education Association Health Information Network (NEA HIN). “They set forth essential sexuality education core content and skills responsive to the needs of students and in service to their overall academic achievement.” Website: http://www.futureofsexed.org/fosestandards.html; Standards document: http://www.futureofsexed.org/documents/josh-fose-standards-web.pdf (pdf file)
PFLAG's Straight for
Equality in Healthcare:
Whether you want to find out more about what it means to be an ally in
healthcare, you want to learn more about the specific healthcare concerns/needs
of the gay, lesbian, bisexual and transgender (GLBT) community, or you're
looking for everyday actions you can take to support GLBT people at your
practice, there's something here for you. Straight for Equality in Healthcare is
a part of PFLAG Nationalâ€™s Straight for Equality program, which seeks to invite,
educate, and engage allies in the gay, lesbian, bisexual and transgender
Straight for Equality in Healthcare aims to:
Invite straight healthcare providers to become allies to GLBT people.
Educate healthcare providers about the unique healthcare concerns of the GLBT community and how healthcare professionals can increase their cultural competence to provide better service to all patients.
Engage allied and potentially allied healthcare providers in creating a safe, inclusive, and culturally competent atmosphere in all aspects of healthcare for GLBT people.
Provider's Handbook on Culturally Competent Care -- Lesbian, Gay, Bisexual and
a FREE handbook printed by Kaiser Permanente's National Diversity Council.
Phone: 510-271-6485. You'll
likely get a voice mail & you need to be very specific! There are 4 different handbooks (one re: the LGBT Population, and
others re: the African-American Population, the Asian/Pacific Islander
American Population and the Latino/a Population), so you need to let them know
exactly which one(s) you want and how many.
A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals: excellent handbook by the U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatments. 2001 - 209 pages. http://media.shs.net/prevline/pdfs/BKD392/index.pdf (pdf format)
Respecting the Rights of GLBTQ Youth, A Responsibility of Youth-Serving Professionals: This entire issue of Advocates for Youth's journal Transitions (Vol. 14 June 2002) is worth reading. The contents include: 3Rs & GLBTQ Youth, Latino YMSM, Stressors for GLBTQ Youth, Transgender Youth, Harassment in School, Serving HIV-Positive Youth, Youth Activism, Coming Out?, Creating Inclusive Programs, Emergency Contraception, Abstinence-Only Education, Bill of Rights, and GLBTQ Youth of Color. For the pdf version, go to: http://www.advocatesforyouth.org/publications/transitions/transitions1404.pdf (pdf format) or, for html, go to: http://www.advocatesforyouth.org/publications/transitions/transitions1404.htm
Safer Sex for Bisexuals and Their
Partners: brochure offers explicit safer sex
advice (too explicit for a pamphlet rack in many public school nurses'
Sexual intercourse, abuse and
pregnancy among adolescent women; Does sexual orientation make a difference?:
Saewyc, E.M., Bearinger, L.H., Blum, R.W. & Resnick, M.D. (1999) Family
Planning Perspectives, 31(3), 127-131. http://www.guttmacher.org/pubs/journals/3112799.pdf
Sexual Orientation and Adolescents: From Pediatrics, the journal of the American Academy of Pediatrics: http://pediatrics.aappublications.org/cgi/reprint/113/6/1827
Specific Intersex-related Sites:
Androgen Insensitivity Syndrome (CAIS):
Klinefelter Syndrome: http://www.nlm.nih.gov/medlineplus/klinefelterssyndrome.html
mosaics and children with Gender Identity Disorder:
and more at ...
Intersex Society of North America: http://www.isna.org/drupal/weblink?PHPSESSID=0298f467879941dcdb01266dff70157d
Talk About Sex provides young people with basic information about a range of sexuality topics as well as referrals to reputable websites for more information. More than a brochure, but less than a book, SIECUS' new "minibook" includes "chapters" entitled: What is Sexuality; Sexual Rights; Basic Biology; Staying Healthy; Gender Identity; Sexual Orientation; Relationships; Communication Skills; Choosing What to Do; Sexual Behavior; Sexual Response; Sexual Abuse; Birth Control; STDs/HIV; and Find Out More. Hard copies available $3/each by calling 212-819-9770 or order online. Download the publication free here: http://www.siecus.org/pubs/TalkAboutSex.pdf (pdf format)
Talk About Tina is a web site devoted to the issue of methamphetamine use among gay and bisexual men: http://www.talkabouttina.org
and the GLBT Community" from the American
Cancer Society. Are all your tobacco messages
directed at heterosexual students? Great flyer, downloadable free,
for your clinic or counseling waiting room or the literature rack in your
classroom or library. It asserts that at least 30,000 gay and lesbian people
die in the U.S. every year from tobacco. It declares that tobacco kills more
people than alcohol, car accidents, suicide, AIDS, murder, illegal drugs and
fire - combined!!! It describes the ways in which the tobacco industry targets
GLBT folks and it encourages critical viewing of tobacco advertising: http://www.cancer.org/downloads/COM/GLBT%20Tobacco.pdf
For Caring: 17
minute video â€“ 2000, Mary-Helen Mautner Project for Lesbians with Cancer.
School nurses â€“ and every other health care provider â€“ should see this
video. Contains discussions with physicians and interviews with a diverse
group of lesbians describing their experiences with barriers to accessing
health care services. Easy to understand its implications beyond cancer and
beyond lesbians. $25.00 plus $6.00 shipping and handling. Email: firstname.lastname@example.org
Phone: 202-332-5536; Order form on web site: http://www.mautnerproject.org/images/form.pdf
â€¦ Nurses and Clinic Staff
Thorough and professionally responsible web site on the medical and
psychological aspects of transgender health care: http://www.transgendercare.com/index.htm
The Transgender Umbrella: Clinical Skills for Empowering Transgender and Gender Queer Clients: Transgender Health Program Website Vancouverâ€™s Transgender Health Program has created practice guidelines for clinicians in British Columbia who are already â€śtrans-positiveâ€ť but lack the clinical knowledge necessary to effectively work with the transgender community, as well as consumer information (for trans people and loved ones) and frameworks for clinician training. Local and international experts in transgender care worked with local members of the transgender community to create seven sets of guidelines for health and social service providers, and 17 health information booklets for transgender people and loved ones. The materials address issues in adolescent health, clinical advocacy, hormone therapy, mental health, primary medical care, speech/voice change, and surgery. To view the guidelines go to http://www.vch.ca/transhealth/resources/tcp.html
Transitioning Our Shelters - A GUIDE TO MAKING HOMELESS SHELTERS SAFE FOR
TRANSGENDER PEOPLE: by Lisa Mottet and John M. Ohle;
This issue of Transitions offers factual information about the lives of
and risks to gay, lesbian, bisexual, transgender, and questioning (GLTBQ)
youth and practical advice for providers specifically about serving
HIV-positive youth and about making emergency contraception available to LGBTQ
youth: http://www.advocatesforyouth.org/publications/transitions/transitions1404_2.htm "Understanding Children's Atypical Gender Behavior: A
model support group helps parents learn to accept and affirm their
gender-variant children." Article
from the American Psychological Association's journal, Monitor
on Psychology (Volume 34, No. 8 September 2003, p. 40): http://www.apa.org/monitor/sep03/children.html Using Lesbian, Gay,
Bisexual Youth Data from the Oregon Healthy Teens Survey to Address Health
Inequities: Based on the 2007 Oregon Healthy Teens Survey, this
http://www.safeschoolscoalition.org/LGBdata-fromOregonHealthyTeensFinal.ppt - shares findings, reaches these conclusions:
You know different:
The National Youth Advocacy Coalition with support from the
Centers for Disease Control and Prevention Division of HIV/AIDS,
Capacity Building Branch, has created a national strategy to
increase HIV testing rates among youth. This project is a
youth-driven effort to provide communities with materials that
promote HIV testing among youth in an empowering and authentic
way, recognizing the skills, determination and ability of young
people to mobilize, talk honestly and take action to stop the
spread of HIV among their peers, families, and communities.
This project includes a community level mobilization effort
where youth serving agencies partner with AIDS service
organizations in a planning process to identify strategies to
promote HIV testing to youth and young adults.
Transitioning Our Shelters - A GUIDE TO MAKING HOMELESS SHELTERS SAFE FOR
TRANSGENDER PEOPLE: by Lisa Mottet and John M. Ohle;
2003,National Gay and Lesbian Task Force Policy Institute National Coalition. http://thetaskforce.org/downloads/reports/reports/TransitioningOurShelters.pdf (pdf format)
Transitions: This issue of Transitions offers factual information about the lives of and risks to gay, lesbian, bisexual, transgender, and questioning (GLTBQ) youth and practical advice for providers specifically about serving HIV-positive youth and about making emergency contraception available to LGBTQ youth: http://www.advocatesforyouth.org/publications/transitions/transitions1404_2.htm
"Understanding Children's Atypical Gender Behavior: A model support group helps parents learn to accept and affirm their gender-variant children." Article from the American Psychological Association's journal, Monitor on Psychology (Volume 34, No. 8 September 2003, p. 40): http://www.apa.org/monitor/sep03/children.html
Using Lesbian, Gay,
Bisexual Youth Data from the Oregon Healthy Teens Survey to Address Health
Inequities: Based on the 2007 Oregon Healthy Teens Survey, this
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