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The Impact of Grief, Loss, and Death on Individual and Family Development

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Stephanie Hartman

on 27 October 2012

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Transcript of The Impact of Grief, Loss, and Death on Individual and Family Development

What is Grief? An emotion of extreme anguish, generally in association with a major loss. (urbandictionary.com) (wikipedia.org) Grief is a multi-faceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, and grief is the reaction to loss. 1 obsolete : grievance
2 a : deep and poignant distress caused by or as if by bereavement
b : a cause of such suffering
3 a : an unfortunate outcome : disaster —used chiefly in the phrase come to grief
b : mishap, misadventure
c : trouble, annoyance
d : annoying or playful criticism
(merriam-webster.com) Loss? the act of having something.. and then suddenly not having it anymore (urbandictionary.com) (wikipedia.org) A negative difference between... 1 : destruction, ruin
2 a : the act of losing possession
b : the harm or privation resulting from loss or separation
c : an instance of losing
3 : a person or thing or an amount that is lost
4 a : failure to gain, win, obtain, or utilize
b : an amount by which the cost of something exceeds its selling price
5 : decrease in amount, magnitude, or degree
6 a : uncertain as to how to proceed
b: unable to produce what is needed
(merriam-webster.com) Death? (urbandictionary.com)
The end of all. The opposite of life. Death is the permanent cessation of all biological functions that sustain a living organism. (wikipedia.org) 1 a : a permanent cessation of all vital functions : the end of life b : an instance of dying 2 a : the cause or occasion of loss of life b : a cause of ruin
3 capitalized : the destroyer of life represented usually as a skeleton with a scythe
4 : the state of being dead
5 : the passing or destruction of something inanimate
(merriam-webster.com) - Formal operational
(thinks abstractly) (Piaget)
- Minimal magical thinking
- Finding balance between
independence and dependence (Erikson)
- Peer relationships
- Self esteem 7 – 12 years - Continue to meet needs
- Maintain routine
- Use correct vocabulary
- Answer questions
- Encourage emotional expression
and show it yourself
- Journal, make memory book
- Play How to help 3 – 6 years - No concept of death
- Can sense something is different
(especially if caregiver is gone)
- Can sense caregiver’s emotions

(Lucas) Concepts of death Birth – 3 years - Be available
- Reduce expectations (with behavior/school)
- Communicate with school
- Journal
- Find new ways to communicate - Answer questions
- Maintain routine
- Take child to funeral/allow them to help in preparations
- Be honest and factual
- Use correct vocab
- Encourage emotional expression
and show it yourself
- Play How to help - Problems in school
- Problems with relationships
- Antisocial behavior
- Suicide Possible long term effects “Adolescents are often at a loss with regard to expressing their grief. Common expressions include exhibiting behavior and performance problems at school, missing classes, failing to complete assignment, reduced quality of academic performance, rebellious behavior, withdrawal into depression, ego deficits, expression of inferiority in relation to others with intact families, low self-esteem, and bewilderment and frustration. Other expressions include poor problem-solving abilities, feelings of guilt and anger, difficulty in relationships with parents or other family members, difficulty in relating to peers, and dealing with fears of one’s own or other’s death.” Comstock page 262 - May appear fine
- Irritability
- Changes in sleep, eating, school and social settings
- Attached to caregiver
- Concern for the future
- Take on the role of deceased
- Struggle between needing support and not wanting it Grief issues - Death is final
- Realization of own mortality
- May feel he/she caused death
- Physical/biological aspects of death
- Understanding of what loss is
and what it will mean in the future Concepts of death Teen years - May appear fine
- Irritability
- May regress
- Changes in sleep, eat and play
- Stigma
- Concern for the future
- Acting out
- Curious
- Attached to caregiver

(Max/Cooper) Grief issues - Ghosts
- Death is final
- Interest in biological and
physical aspects of death
- May feel he/she caused death Concepts of death - Cause and effect
- Concrete-operational
(concrete ideas) (Piaget)
- Magical thinking lessons
- Play
- Peer relationships
- Self esteem Development “children feel a need to shield and protect their parents from hurt by discussing painful realities. Warding off further loss, children internalize their feelings and present flat or even cheerful demeanors in the face of adversity and loss. Afraid of discussing their hurts, they develop patterns of hiding their feelings and vulnerabilities. Loosing touch with themselves, they are later at an even greater loss to manage life and all that it brings.” Comstock page 256 - Irritability
- Changes in sleep, play and eating
- May regress
- Show feelings through play
- Repeated questions
- Curiosity
- Acting out
- Attached to caregiver
- May appear fine Grief issues - Beginning to have concept of death
- Magical thinking
(death could be caused by thoughts)
- Interest in biological aspects of
death/dead body
- Death = sleep
- Continue to sense caregiver’s emotions
(Genevieve) Concepts of death - Egocentric (Piaget)
- Inanimate things can be alive
- Continue to learn through senses
- Play (Vygotsky)
- Continue to develop trust
- Magical thinking – just thinking about
something can make it happen Development - Mistrust and attachment problems
- Taking on the victim role
(disruption of ego development)
- Poor coping skills
- May think self “bad” due to
magical thinking Possible long term effects - Changes in sleep, play and eating
- May regress
- May search for caregiver
and become very attached
(fear of separation) Grief issues - Experience world through senses (Schachtel)
- Attachment (Bowlby/Ainsworth)
- Trust vs. Mistrust (Erikson) Development Development References Comstock, D. (2005). Diversity and development: Critical contexts that
shape our lives and relationships. Belmont, CA:Thompson
Brooks/Cole.
Edwards, D. (20012). How men and women grieve differently.
Value Options. Retrieved on October 18, 2012 from
https://www.achievesolutions.net/achievesolutions/en/Content.do?contentId=11038
Kanel, K. (2012). A guide to crisis intervention. Belmont, CA:
Brooks/Cole.
Jeffreys, S. J. (2005). Helping grieving people: When tears are not enough.
New York, NY: Brunner-Routledge. Counseling Considerations Mode of Death
Grief Counseling
Support Groups
Being comfortable with silence
Psychoeducation
Creative Therapies
Screening Tools
Family Therapy
“out of synch”-special groups (Walters & McCoyd, 2009).
Attachment styles Coping Dive into projects
Becoming consumed with work
Finding new hobbies
Exercising
Substance Abuse
Support groups
Books References Cont. Stroebe, M., Schut, H., & Stroebe, W. (2005). Attachment
in coping with bereavement: A theoretical integration. Review of
General Psychology, 9 (1), 48-66. doi: 10.1037/1089-2680.9.1 .48
Walter, C. & McCoyd, J. (2009). Grief and loss across the lifespan. New
York, NY: Springer Publishing.
Wayment, H.A., & Vierthaler, J. (2002). Attachment style and
bereavement reactions. Journal of Loss and Trauma, 7 (2), 129-149.
doi: 10.1080/153259292753472291
Wright, P., Hogan, N. (2008). Grief theories and models. Journal of
Hospice and Palliative Nursing, 10 (6), 350-356. Retrieved from
http://www.nursingcenter.com/_PDF_.aspx?an=00129191200811000-00008 Heartbeat
Phone: (970) 227-1450
Address: 311 Mapleton Avenue Boulder, CO 80304
HospiceCare of Boulder and Broomfield Counties: Adult Parent Loss GroupPhone: 303-604-5300
Meets 2nd and 4th Tuesday of every month from 6:30 pm. - 8:00 pm
HospiceCare of Boulder and Broomfield Counties: Boulder Grief Support Group
Meets 1st and 3rd Thursday of every month from 6:30 pm. - 8:30 pm. Heartland Hospice Services
Bereavement Support Group
8774 Yates Drive Suite 100 Westminster, CO 80031
Meets 1st & 3rd Wednesday of month at 10:30am
303-926-1001
www.heartlandhospice.com
Loss of a Child Compassionate Friends Boulder
Address: 1820 15th Street Boulder, CO 80302
Phone: (303) 652-3274 Support Groups (Walter & McCoyd, 2009) Young Adulthood Young adults- thought to be starting new marriages, children, working, and managing household
Death of a Parent
Erikson’s Intimacy vs. Isolation
Fear of another loss of a loved one
Pushing a young adult forward in development
Loss of a Spouse
Hopes, plans, dreams of the future
Loneliness, isolation, identity shift from “We” to “I”
Changing relationships, taking responsibility of self
Out of synch of development and what is suppose to happen
Issues of dating- loyalty, betrayal, moving forward (Jeffreys, 2005) Nature of the Death Natural
More accepting
Homicide
Rage, legal procedures keeping it alive, possible unsolved or unprosecuted = endless grief
Suicide
Difficult and complex grief journey. Parents-rage, guilt, shame, and fear. Survivor’s guilt
Sudden
No preparation time, no chance to say goodbye
Terminal Illness
Provide time to prepare, physically and emotionally exhausted, reactions may happen later (Kanel, 2012) Normal Grief Feelings: sadness, anger, guilt, loneliness, fatigue, numbness, anxious
Physical Sensations: hollowness in the stomach, tightness in the chest and throat, sense of depersonalization, breathlessness, weakness in muscles
Cognitions: Disbelief, confusion, preoccupation, sense of presence, hallucinations
Behaviors: Sleep disturbances, absent minded, social withdrawal, sighing or crying, fear of losing memories Giraffe (Kanel, 2012) Theories Cont. Kubler-Ross’s 5 stages of death and dying
Denial: Helps people deal with the initial shock
Anger: Frequently follows denial as one begins to accept the reality of death. There may be rage, envy, resentment, bitterness, hostility. “Why me?”
Bargaining: A person seeks an extension of time or at least freedom from pain and discomfort . Secret pacts with God.
Depression: When death is recognized as inevitable
Acceptance: Being able to accept the inevitable Theories Charles Darwin-1872
Commented on the separation reactions as being innate (Kanel, 2012).
Freud-1917
First introduced the concept of bereavement. In order to recover, one needs to emotionally detach from the deceased (Wright & Hogan, 2008).
John Bowlby
Phase I- Numbing: Initial period of denial and shutdown
Phase II- Yearning and Searching-attempt to recover the person
Phase III- Disorganization and Despair: Reality hits
Phase IV- Reorganization: If successful with last phases, reorganizing life without the loved one (Jeffreys, 2005). Compassion In Practice, LLC
950 Logan St. Suite 104 Denver, Co 80203
303-990-8363
www.heatherlachancephd.com
Dr. Veronica Bergeron
12200 E. Briarwood Ave. Suite 294 Centennial, CO 80112
720-838-6679
Michael Moats, PsyD, Inc.
224 E. Willamette Ave. Colorado Springs, CO 80903
719-355-8081
www.therapeuticencounter.com Dr. Sarah Lamm-White
8095 E. Prentice Ave. Greenwood Village, CO 80111
720-316-3772
One Day at a Time Counseling, LLC
8000 E. Prentice Ave. Ste. B2 Greenwood Village, CO 80111
720-488-0878
www.onedaycounseling.com
Creative & Caring Counseling, LLC
8089 S. Lincoln St. Suite 203 Littleton, CO 80122
720-316-4386
http://www.creativeandcaringcounseling.com/ Counselors The Denver Hospice
501 S. Cherry Street, Suite 700 Denver, CO 80246
303-321-2828
www.thedenverhospice.org
Pathways Hospice: Community Care for Northern Colorado
305 Carpenter Rd. Fort Collins, CO 80525
970-663-3500
www.pathways-care.org
Agape Hospice Services
6041 South Syracuse Way, Suite 220
Greenwood Village, CO 80111
720-482-1988
www.agape-hospice.com Evercare Hospice and Palliative Care
6455 S. Yosemite Street 6th Floor Englewood, CO 80111
303-872-9952
Exempla Lutheran Hospice
3210 Lutheran Parkway Wheat Ridge, CO 80033
303-425-8000
www.exempla.org
www.griefintheworkplace.com
Judi’s House
1741 Gaylord Street Denver, CO 80206
720-941-0331
www.judishouse.org
Grief in the Workplace
342 Cook Street Denver, CO 80206
303-619-3547 Community Resources (Edwards, 2012) Speak openly about their grief
Grieve Publicly
Direct Route
Anger-seen as inappropriate, keeping it bottled up
More likely to seek support
Feel more depressed
Abandonment Do not grieve openly
Grieve Privately
Indirect Route
Exercising, doing projects, throwing themselves into their work
Anger-easily expressed
Their support is usually found in their most trusted relationships
Feel more tense and restless
Lost a part of himself
Their apparent Self-Control may be viewed as a lack of compassion feeling-Spouse Men vs. Women (Comstock, 2005; Kanel, 2005) Parental Grief Protector-when other children are still in the home
Disbelief, lack of control, guilt, intense anxiety, loss of sleep, lack of appetite, lethargy, withdrawal, and suicidal thoughts
Loss of the future
Weakened relationship
Fear of losing other children (Stroebe, Schut, Wayment & Vierthaler, 2002) Attachment Secure
“Normal” reaction to loss
Lower levels of depression
Will experience and express more grief
React emotionally to the loss but not feel overwhelmed
Anxious-Ambivalent
Higher levels of depression and grief reactions
Very emotional and preoccupied after the loss
Chronic grieving- Can’t cope alone
Rumination and preoccupations with thoughts of the deceased
Avoidant
Somatic symptoms
Avoid experiencing emotional distress
Show little signs of grieving
Inhibited, absent or delayed grief (in extreme cases)
Disorganized
May have anxiety or PTSD as a disorder
Unable to respond coherently to the loss experience
Unable to cope in any effective manner
High levels of anxiety/panic, depression/medication, and alcohol consumption (Kanel, 2012) Determinants of Grief A person’s response to loss can depend on several factors:
The Relationship
Nature of the attachment
Age
Prior Grief Experiences
Religious beliefs
Old Childhood Messages
The mode of death
Attachment Styles (Jeffreys, 2005) Complicated Grief Occurs when one avoids or holds on
Greif that escalates to problematic proportions
It is extreme in the severity of symptoms, durations of sever symptoms, and level of dysfunction socially, occupationally, and with daily living activities.
Emotional
Deep feelings of guilt and regrets
High anxiety about the safety, health, and possible death of self and love ones
Feelings of despair, hopelessness, and apathy about the future-”What’s the use?”
Intense acute grief triggered by visual cues, musical sounds, and even smells that recall the person or lost event
Cognitive
Suicidal thoughts and/or plans to act upon the thoughts
Inability to concentrate or learn new information and inability to recall previously known information
Avoidance of discussion of the loss and avoidance of all sings, symbols, and mention of death and death-associated activities
Major shift in personality style- introvert to extrovert of vice versa
Behavioral
Self-destructive behaviors
Radical and sudden changes in lifestyle that shocks family and/or friends
Imitating the speech, dress, and behaviors of the lost person
Physical
Physical symptoms that imitate those of the deceased
Major disturbances in sleeping and eating- too much or too little (Jeffreys, 2005) Thomas Attig- Relearning the World-Care Providers
“Make Sense”
Reinvent Self
Continuing Bonds Robert Neimeyer-Meaning Reconstruction in the Post-Loss World
Restructure Meaning of life Theories Cont. (Jeffreys, 2005) Margaret Stroebe-
Dual Process Model of Grief
Loss-Oriented Focus
Behaviors that express feelings of grief
Restoration-Oriented Process
Behaviors that reorganize the self in the new, post-lost world Therese Rando- Phases and Processes of Mourning
Avoidance
1.Recognizing the loss
Confrontation
2. Reacting to the separation
3. Re-experiencing
4. Relinquishing old attachments
Accommodation
5. Readjusting
6. Reinvesting Energy Theories Cont. (Jeffreys, 2005; Comstock, 2005) William Worden-2002
Task I- To Accept the Reality of the Loss
Loss is irreversible
Task II- To Work Through the Pain of Grief
Need to experience the various pain
Task III- To Adjust to New Environment After Loss
External, internal, spiritual
Task IV- To Emotionally Relocate the Deceased and Move on With Life
Hold on internally and function in a changed world Parkes and Weiss-1983
Task I- Intellectual Recognition and Explanation of Loss
Task II- Emotional Acceptance of the Loss
Repeatedly confront memories and express feelings of pain
Task III- Assumption of a New Identity
Transition to a new way of thinking of oneself
Emotional release and creating a new identity Theories Cont. Brittany Singha Spirituality Carl Jung said that “with increasing age, contemplation, and reflection the inner images naturally play an ever greater part in man’s life…In old age one begins to let memories unroll before the minds eye. The old person tries to understand the nature of life in the face of death (Crain p. 347). ”
Carl Jung believed that we cannot face death in a healthy way unless we have some image of the hereafter (Crain p. 347). Facing Death Things to think about when working with this population
Ageism
Discrimination
Be aware of biological, psychological, and social changes that accompany aging as well as the types of psychopathology that older adults experience.
Mental Deterioration and Incompetence
Eg. Alzheimer’s and Dementia
Family Interventions
Abuse and Neglect
Substance abuse
Depression and Suicide
Sexuality
Grief experienced by the client
Fear of death and the unknown
Teaching multiple coping strategies is important for the grieving elderly Considerations for Counselors working with the Elderly and their Families Erickson’s last two stages
Generativity versus Stagnation
Late Adulthood
Hope to leave a legacy in which others can role model after
Ego Integrity versus Despair
Approaching Death
Reflection on life Developmental Stages of the Elderly There has been very little research conducted that address the issue of spiritual development in adulthood.
Jung’s theory and other views of spiritual development in later adulthood see this time in life as being the most important for spiritual growth.
One model views spiritual growth as the positive outcome of the maturation process.
The other model views spiritual growth suggests that ageism and age discrimination push many older adults to spirituality seemingly by fostering disengagement and curtailing lie choices.
Archley (1997) constructed a theory on an Eastern perspective stating that “spirituality is not an activity or an idea but instead is an experience (Comstock, p. 325)”
Stokes (1990) stated that “changes in faith tend to occur more during periods of transition, change and crisis than during times of relative stability (Comstock, p. 325)
This is characterized in late adulthood when friends and loved ones are passing away more frequently and people are beginning to retire.
One longitudinal study showed a significant increase in spirituality for people in their mid 50’s and on into their 70’s.
Erickson’s developmental theory is the only one in traditional psychology that touches on spirituality in his final stage; Integrity versus Despair.
Spiritual Development in
Later Adulthood The model most often cited as a basis for spiritual development is James Fowler’s stages of faith model in which Fowler drew upon Kohlberg’s moral development and Piaget’s cognitive development model.
Fowler’s six stages of faith
Intuitive-projective faith
Faith of young child up to early verbal stages
Ex. Belief in Santa Clause
Mythic-literal faith
Represents the verbal young child up to later childhood.
Ex. Belief in parental image of God as one who punishes the bad and rewards the good
Synthetic-conventional faith
Stage of older child
Ex. Adolescents don’t acknowledge other faith practices and believe their faith is the only true one
Individual-reflective faith
Stage may begin in adolescents or older
Ex. When a person begins to critically examine their beliefs and reflect on values, ideals, and meaning
Conjunctive faith
The individual acknowledges the paradoxes inherent within the faith journey.
Person willing to respect the validity of another’s “truth” even when it contradicts their own, while simultaneously being able to communicate one’s own “truth”
Universalizing faith
Viewed as a category of individuals whose examples of faith have a profound impact on other’s faith journeys.
Ex. People such as Mother Teresa, Martin Luther King Jr., Gandhi
(Comstock, p. 323,324)
Spiritual Development http://www.helpguide.org/mental/depression_elderly.htm Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
Reduced sense of purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
Fears – Fear of death or dying; anxiety over financial problems or health issues.
Recent bereavement – The death of friends, family members, and pets; the loss of a spouse or partner. Causes of Depression in Elderly Relationships
Activity
Losses
Physical capabilities
Death of Loved Ones
Widowed
Depression
Suicide/Substance Abuse
Facing Death Common Grief Issues for the Elderly Brittany Singha Elderly Experiences with Grief Loss and Death http://counselingoutfitters.com/vistas/vistas07/Daneker.htm Provide culturally sensitive care
Counselors need to respectful y inquire about the dying client’s belief system, past spiritual experiences, and current spiritual needs.
Increase quality of life
Counselors can help by allowing clients the opportunity to talk about life in spiritual terms, the counselor adds to the client’s understanding of what is happening currently, and what he or she would like to happen in the future.
Alleviate anxiety
Counselors’ work with dying clients can provide a way of coming to terms with spiritual concerns through experiential methods such as guided imagery, artwork, poetry, religious ritual, breathing exercises, and progressive desensitization.
Provide comfort and personal contact
The counselor provides the dying client with a safe environment in which to consider spiritual aspects of the dying process.
Promote meaning, significance and hope
Counselor can help by allowing the client time and space to process his or her story, the counselor provides an opportunity to discover a new sense of meaning in the client’s experiences.
Promote informed decisions congruent with spiritual values
Counselors help clients consider their spiritual values and thus they may become more aware of what they do and do not want to have happen during their dying process.
Increase caregiver confidence
The counselor can also help the client, the client’s family, and other concerned health caregivers, by increasing caregiver confidence that the client’s spiritual needs are being addressed throughout the dying process and the counselor can help communicate their clients spiritual needs and desires to their loved ones.
Considerations for Counselors working with the Spiritual Needs of the Dying Spirituality is defined many different ways
Ingersoll (1995)
“Spirituality is an organism construct endemic to human beings”
Faiver et al. (2001) built on Ingersoll’s definition
“Spirituality is an innate human quality…the experience of spirituality is greater than ourselves and helps us transcend and embrace life situations.”
Elkins et al. (1988)
“Spirituality is a way of being and experiencing that comes about through awareness of a transcendent dimension and is characterized by certain identifiable values in regard to self, others, nature, life, and whatever one considers to be the Ultimate.”
Pearlman and Saavitne (1995)
View spirituality as a frame of reference through which individuals interpret experiences

(Comstock, p. 321, 322 ) Defining Spirituality Common fears of death include
The Process of Dying
Will death be painful?
How will I get through this?
Loss of Control
Must I give up independence?
Can I cope with being dependent on others?
Loss of Loved Ones
What is going to happen to them?
How will they manage without me?
Isolation
What if my visits with health care professionals and friends decrease?
Will I die alone?
The Unknown
What can I expect?
Will there be life after death?
Life Has Been Meaningless
What did I accomplish during my life?
Did I have a positive impact on the world?

http://www.agingcare.com/elderly-fear-of-death Elderly Fears of Dying Grieving can be very different for the elderly who have experienced loss many times over.
The elderly bereaved often do not feel motivated to engage in the painful process of grieving since they do not foresee much in the way of time or future opportunities.
At this final stage in life the capacity to mourn in a respectable number of seniors has long been developed and many painful losses have already been grieved.
Many times they choose to maintain the
emotional investment in the deceased
relationship especially if it is their spouse. Grieving Process For Elderly Staying active in meaningful pursuits is very important for the aging populations health and contentment.
Activities used just to keep them busy like arts and crafts are generally not rewarding and elevating to self-esteem unless it is a true interest or need, not just an activity.
Once again meaningful interaction with family and friends is most beneficial.
The amount of activities continually
decrease with age and losses of
mobility. Activities There is tremendous importance that meaningful attachments play in the lives of the elderly.
Having a strong relationship with at least one person is more important than any other factor in predicting those elderly persons who could remain in the community and those who would be institutionalized.
The addition of a pet to an elderly person living alone can contribute to a sense of well-being and the feeling of being needed
Developing and maintaining relationships become more difficult for the aged. They become more disengaged socially the older they get. Relationships Did I do anything meaningful with my life?
Can I respect myself and love myself in the face of what my life has been?
Am I still a person?
Was it worthwhile?
Did it have a positive influence on the lives of others? Questioning Their Own Life Suicide risk is high among the elderly
19% of all suicide deaths are people ages 65 and up.
When losses of loved ones begin to pile up and combine with other stressors in life suicidal ideations may occur.
Substance Abuse
Prescription Medications
Alcohol Suicide/Substance Abuse Physical capabilities
Grieving Death of Loved Ones
Parents
Spouse
Friends/Peers
Siblings
Children Losses
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