Cohort Studies

Getting feedback from cohort studies

The people we spoke to had different views on how much feedback they wanted or expected from the cohort studies they took part in. There were two main types of feedback talked about:
 
Individual feedback about their test results and personal health; and
Study findings on the data collected from all participants.

Linda felt it was appropriate that most of the feedback is about the findings of the birth cohort in general, rather than about her as an individual. She had also taken part in a separate study at a memory clinic.

Linda felt it was appropriate that most of the feedback is about the findings of the birth cohort in general, rather than about her as an individual. She had also taken part in a separate study at a memory clinic.

Age at interview: 65
Sex: Female
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It’s been more sort of general what they found. You’re never going to, apart from the memory clinic stuff, it’s never been personal feedback about what you’ve done, but that, that’s okay because you can’t have it both ways. You can’t be anonymous in a study and expect to get feedback, so it’s, yeah, you just know that it’s going into a collective pool to be used for whatever purpose.

But what about getting sort of feedback about the study, sort of in general, have you got those?

Well, I think it’s always been made available. You can go on the websites and things if you’re so interested. I think I’ve definitely been sent stuff to read. Maybe once a year you get, you get some feedback and I’ve probably read it, but then just put it to one side. In terms of retention for me, I’ll have moved onto the next thing.

Ian often asks the researchers at study visit appointments about their work and what they are finding out. He has learnt about advances that he would otherwise not know about.

Ian often asks the researchers at study visit appointments about their work and what they are finding out. He has learnt about advances that he would otherwise not know about.

Age at interview: 54
Sex: Male
Age at diagnosis: 51
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I think there are two sides of it. Can we find out about MND [motor neurone disease] in someone at an earlier stage? And, of course, is there a cure? That’s got to be the ultimate. Or is there something that can stop it from spreading so quickly or happening so quickly? I mean they, one of the things that I found very interesting was when they compared MND with polio. Now, that’s something that I wouldn’t have found out without talking to the team about, and they were explaining that they’ve looked at people with polio, and polio tends to affect either a right or a left hand side of the body. Whereas MND crosses from the right and left and it can hit any, any limb at any time, and they don’t know why. So trying to be very open about how they’re looking at these things and explaining these things to you. I find it great, you know, you just feel that you’re part of the team.

 

Do you think you’re also getting sort of privileged access to information about the latest research?

 

I’ve no doubt about that, yes. I mean, they’re, any question I’ve asked they’ve never been afraid to answer. I mean for instance, there’s been this lithium test, this new, a drug based around lithium, I think it is? And I was put forward originally, to be part of a group that was going to try it out, and unfortunately, because of my medical history they weren’t able to accept me into the group. But I’m still allowed to ask lots of questions, you know. It materialised I think in Italy and now in America and the UK it’s being widely tested on people to see whether there is an effect that’s coming out of it. But I wouldn’t have known about this if they hadn’t been open and discussed these things. So yes, it’s educational as well as anything.

 
Not all studies will provide individual feedback. Jenny, a senior researcher, explained that the researchers may pick up a health problem for a participant through tests and study activities “but overall the cohort study is to change our understanding for people in the future, rather than the people who are participating”. This is usually discussed when people are first invited to join a cohort study.
 
Cohort studies can run for a long time and this often means that the overall findings are not available as quickly as some people would like. Malcolm thought that it would help keep participants interested and keen to stay involved if the study team kept in touch about their progress.
 
Some people wanted feedback of both types, whilst others were content not to receive much, if any at all. For Teresa, the level of feedback from her study was enough and she was “not inundated”. Luke felt it was important that participants should be able to choose for themselves how much information and detail about the study findings they want to delve into, and that the research teams support their decision. This might include choosing to read the study newsletter, look for more detailed information, and talking to research staff at study visits.

Ian is very happy with the amount of feedback he gets from the research team.

Ian is very happy with the amount of feedback he gets from the research team.

Age at interview: 54
Sex: Male
Age at diagnosis: 51
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I do, yes, and very good feedback. In fact, we’ve had some very strong feedback from some of the tests that have been going on, particularly around some of the investigation in how the brain works. And I know there’s been a big breakthrough, as far as the research is going, in finding out more about how the right and the left side of the brain communicate. And that’s all come back to, you know, we’ve been told about it. I mean, silly little thing like being sent photographs of my own brain, “Would you like to see what it looks like? And, by the way, you were one of twenty-five people that came, helped us with this data, that’s now led us to be able to put an article together and put it forward. And again, by doing that it gives us more of a chance with the medical research funding us with further things going forward”. Now all that things, all those things have been explained to us, websites to have a look at and see where this research is being discussed. I don’t necessarily spend all day going through those websites and having a look at, and finding out for myself. I do occasionally out of curiosity. But just with the very knowledge that we’re being told that it’s useful, and it’s leading to better things.

 
But some people were disappointed by how little feedback they had been given. Margaret Ann didn’t have much information back from the researchers which left her wondering “what do they do with it [our data]?”
 
Feedback on personal health
 
Through various tests and other activities involved in study participation, some people received results about their personal health. Some said this was a key benefit of taking part in a cohort study and motivated them to do so. For Gareth, results from his blood tests and a scan of his body fat distribution was “the amount of feedback that I wanted from it”.
 
Other people didn’t want or expect feedback about their individual results, and not every study gave this type of feedback. Some people were happy with this arrangement and recognised that the main focus of a cohort study was on collecting together data from lots of people. Luke didn’t expect much feedback on his personal health and instead emphasised that studies like this are really “going to be that sort of aggregated population level” data. Douglas took part in a study where some results were kept “all terribly secret”, but he did receive feedback on other aspects of his health such as his platelet level. But Emily found it “a bit disappointing” when “sometimes they say, ‘I’m sorry, we’re just going to do this test and we’re not going to tell you [the outcome]’”.
 
People who were enrolled into a study because they had a diagnosis (such as motor neurone disease/MND) or had experienced a medical event (such as a transient ischaemic attack/TIA – a ‘mini stroke’) often hoped that they would get some extra information, feedback and support with their health. They had wanted more information about why they had become unwell and access to extra monitoring of their health. Some people felt that being in a study gave them a direct line to research-active healthcare professionals so that they could get advice or be seen quicker.

Alan Y contacted the research team because he has a history of transient ischaemic attack (TIA) and was worried about his eye. The extra tests were reassuring for him, and he thinks the results will be useful to the study too.

Alan Y contacted the research team because he has a history of transient ischaemic attack (TIA) and was worried about his eye. The extra tests were reassuring for him, and he thinks the results will be useful to the study too.

Age at interview: 68
Sex: Male
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And how do you feel the fact that you have a number, a contact that if you, kind of that you can call?

Oh, I think it’s reassuring and it’s reassuring because I know they can get on the computer or open the draw and my file is there and they can go, “Oh yes, yes, you had that”.

Okay.

And they will call me back in as they did with this eye thing. “Come in, have the test”.

Okay and they provide advice over the phone?

Yeah, yeah, advice and the advice is normally, “Come in and we’ll see you”. So, it’s always, it’s always there. I know I can go in. It will get seen. They’ll do all the tests. They looked at my eye and did a scan and-, and found there wasn’t a TIA there. It was something else.

Okay, so it’s more than just getting information or advice over the phone.

You can go in and they will do all the tests that are needed and then it eliminates because I’ve had one TIA, is it another? No, it wasn’t a TIA, so it eliminates that which allowed the optic or the eye hospital to eliminate something from.

And how did you feel having that support?

Yeah, it’s really good. Yeah, it’s again, it’s that reassurance. I know I can go in and get that good advice and they would do all the tests because I assume it’s good for them as well because it’s all part of their research.

 
Feedback on personal health was sometimes given to the participant by a research professional at the time of a study visit. Other times the person was sent a letter afterwards to thank them for taking part and summarise their individual results. Nadera received a letter with graphs to say “everything is normal” but she felt more explanation was needed and so “I went back myself, researched it” to understand the information better. Some people had taken test results from the study to their GP, to help them better understand the information or to flag concerns.

Keith completed some cognitive tests about thinking, reasoning and memory. Sometimes he was given feedback on how he did, but other times he wasn’t told.

Keith completed some cognitive tests about thinking, reasoning and memory. Sometimes he was given feedback on how he did, but other times he wasn’t told.

Age at interview: 68
Sex: Male
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Well I went blank on the reasoning test that, all the other ones I managed quite well. There was some I suppose understanding the meaning of words which I think I didn’t, well I think I didn’t have any problems with it because they didn’t tell us whether we were right or wrong which was a bit disappointing anyway but there was one with reasoning, moving counters which had a blank there for a while and I sort of picked up again. You’re under pressure with time as well I think for certain, so it was quite testing, it was quite testing and I was very glad I was in a booth with nobody watching [laughter].

But they, they didn’t give you a kind of overall kind of…

No, no.

…score or anything like?

Some of them did, some of them did. There were scores at the end there so you could see how well you’d done or not.

Okay.

But some, some they didn’t so. I think it tied in with the fact that they were going to, you know, unless there was any information that was critical as it were, not critical but serious they weren’t going to give that information it was just going on to the, and that was made perfectly clear so, you know, no complaints about that.

The feedback Malcolm receives in a heart health study has become more detailed over time.

The feedback Malcolm receives in a heart health study has become more detailed over time.

Age at interview: 75
Sex: Male
Age at diagnosis: 48
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Have you received feedback from the first time did you, did they send you?

Yeah they sent me just a...

A letter?

…a summary of the data and it went to the GP as well the first time yes it was just, just confirming that my heart was normal and thanking me for taking part in the tests. It was very useful to have that information, that sort of thing. But not a great detail about the reasons for the test and the reasons for the, or the results, just the fact that everything was normal.

Okay, would you have liked more reasons why they were doing it and...?

Yes very much so, yes I think that’s a good point and one that was obviously was-, was evident in the latest, the latest test because they sent me much more information and they sent me the detail of the, of the results which, some of which I understood some of which I didn’t but I’m sure the doctor would have-, would have called me if there was anything to be concerned about. I think their only concern was there was, all of the valves were normal except the one atrium valve, atrium valve was slightly distended but, but nothing, nothing to worry about.

 
Quite often, people were told they wouldn’t be contacted directly but that their GP or another healthcare professional might be sent the information. Alan Z thought this was “perfectly adequate,” because of the large number of participants. Alan Y agreed to his individual test results (like results from blood samples and blood pressure readings) being added to his medical records. In some studies, people were advised that their GP would only be contacted if there was something ‘concerning’. Keith was told that his GP would be notified if there was “something amiss”; at first, he had wanted to see the scan results but now he is “very happy to assume that’s alright”. Nadera felt it was a missed opportunity that blood test results from one sub-study she took part in wouldn’t be shared with her healthcare professionals.
 
Sometimes a lack of feedback on personal health caused worry. Iram had a hair sample taken as part of a cohort study which she thought was being analysed to look for cancer risks. She hadn’t heard back and thought “it could be that they still haven’t found out [results] yet”. Lucy wasn’t sure whether she or her GP would be told about any health concerns found through the research, and this caused her concern.

Lucy hoped that she and her GP would be told if the researchers found something “dodgy looking” in their study about moles and freckles, but she didn’t know if this was the case. She was disappointed when she asked for advice.

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Lucy hoped that she and her GP would be told if the researchers found something “dodgy looking” in their study about moles and freckles, but she didn’t know if this was the case. She was disappointed when she asked for advice.

Age at interview: 30
Sex: Female
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In terms of what the researchers might have found whilst looking at my skin, yes, I would have liked them to tell me if there was anything that didn’t look healthy and also to contact my GP about it. It’s tricky because some of the things like them telling me about the study and whether or not they would give me feedback if they saw a dodgy looking mole may have happened and I may have forgotten them and they didn’t seem relevant at the time, but I sort of think you need to re-consent young adults each time you see them, if it’s every few years. I guess because you don’t know at what point they are transitioning over responsibility for being in the study or if even they understand that it is a study.

I had a really big mole on my back that was right by a bra strap and I kept catching it. And this had been going on for probably a few years at that point and I’d-, I’d basically accidentally ripped it off actually at one point and it was quite disgusting and sort of dangling off [laugh] and I’d stuck it back down and hoped it healed. But I became quite anxious about that being something dangerous and that I could’ve started a mutation off with the cells, and I was asking the researchers, you know, “What do you think I should do? Should I get it cut off, should I get it removed?” and I remember them being quite-, well I suppose I thought it was unhelpful at the time, but they didn’t really say either way. And just kind of left it up to me about what I did with it. And yeah, I suppose that was them being neutral in their research but I remember sort of thinking-, feeling like I just wanted a bit more direction about whether it was okay or whether I should be concerned about it, and if it kept happening would something serious happen with it, mutating and sort of developing into a cancerous mole.

 
Richard and Luke felt that the research activities of cohort studies shouldn’t be seen as a robust way to monitor a person’s health. Richard, who decided not to take part in a biobanking study, thought the NHS should be providing “tests more routinely” rather than studies being seen as a way for people to get a health check-up.

Luke thinks that researchers sometimes frame cohort studies as ‘health MOTs’ to appeal to participants. He cautions that this type of research shouldn’t be relied on for “health monitoring”.

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Luke thinks that researchers sometimes frame cohort studies as ‘health MOTs’ to appeal to participants. He cautions that this type of research shouldn’t be relied on for “health monitoring”.

Age at interview: 35
Sex: Male
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Well part of that, and this is true of many studies, part of the consent process is that if they do find anything unusual that would then be reported to my GP. But I’ve never been in that position and so there’s a certain amount of trust and faith that that would be the case and also perhaps, you know, whether it’s- blood pressure, there’re sort of such simple clinical endpoints or things that they monitor. Yeah, I don’t turn to my participation in the study for health monitoring and I don’t think it would be wise to. Although that is one of the things that they promise to their, you know, new recruits, that they say, “We’ll provide you an MOT” which I’m not sure they should do that but that’s just one of their kind of one liners, you know, that they essentially provide a kind of supplementary sort of health monitoring service as part of the study.

I mean of course you will have full bloods, monitoring, you-, and reporting, I mean they’re interested in your weight loss or gain. They’re-, because of course it’s, the clinical visits are done at four yearly intervals they can provide some kind of, they can judge changes in your, well I don’t know what you’d call it, health indicators would be at its broadest. How meaningful those changes are is not something they’re providing an interpretation of.

 
Overall study findings
 
The wish to help improve knowledge and benefit future generations was very motivating for many people we spoke to. Receiving feedback on study findings helped some feel part of a group and that taking part was worthwhile.
 
Study findings were sometimes shared with participants at study visits, through newsletters sent in the post, or signposted to online (for example, on a website run by the research team or through their social media accounts and groups). Some birth cohort studies sent people an annual Christmas or birthday card with a newsletter inside. Isobel and Ronald thought it was important not to forget about sharing findings with participants who don’t have access to a computer or use social media. Salma encouraged researchers to communicate their findings in “simple terms” and to be aware that English is a second language for some people.
 
As well as hearing about study findings directly from the research team, Gareth and Luke had seen them reported in the news. Gareth was pleased because it showed the work was valued and “nationally recognised”. But Luke felt frustrated with the way the media sometimes interpreted and represented the results of a study he is part of.

Luke is impressed with the level of feedback he gets from a twins study he is part of. He thinks this helps keep participants enrolled.

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Luke is impressed with the level of feedback he gets from a twins study he is part of. He thinks this helps keep participants enrolled.

Age at interview: 35
Sex: Male
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I think this study is, you know, again this is something I’ve learned over time. I think this study is quite good at this and that they do put a lot of thought into providing information at summary level rather than-, they don’t provide an awful lot of information in terms of individual level data or findings but they do provide a lot of summary level information and news about what kinds of studies they’re doing.

And I think that they’re to be commended for that because I know that there are other less well-resourced cohorts who have to focus on the day to day management of their studies and less on the-, on that sort of dialogue or exchange of information with participants. And, and that, there may be a reason I speculate with you now is that I think that with the twin studies there is an issue about retention and I may be a little bit different to a birth cohort where you feel like you’re a, a kind of, you were born into a study and you feel a sense of loyalty to that study. With a twin study it’s slightly different, you’re affiliated because you feel that being a twin may make you well, you know, like a special kind of research subject but it’s very easy to ignore their messages, to ignore their invitations for further study or for further clinical visits. So I think the efforts that they put in to communicate what they’re doing is necessary, they need to retain their subjects.

Louise used to receive Christmas cards and newsletters but now she looks on the cohort study team’s Facebook page and website. She was invited to participate in a sub-study through the Facebook page.

Louise used to receive Christmas cards and newsletters but now she looks on the cohort study team’s Facebook page and website. She was invited to participate in a sub-study through the Facebook page.

Age at interview: 64
Sex: Female
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They used to send us much more sort of things like-, they used to send us Christmas cards every Christmas with a newsletter and updating us. Now we’ve got to be more proactive; got to keep up with their Facebook page or go onto their website and check out what’s there.

Okay.

So it’s depends how, how-, I don’t know what’s the word, yes, you’ve got to be more proactive. They’re not telling you and I perfectly understand that, so I’ve got to keep reminding myself every so often, ‘Right, Louise, if you want to find out any more about this you’ve got to make an effort’, you know.

Look on the website?

Yes, and it’s not a big deal but it’s sometimes easy to forget.

Anne receives a Christmas card with a newsletter from the birth cohort study team. She sees it is a “courtesy” that fits with the study’s interest in “how you were brought up” in the 1950s.

Anne receives a Christmas card with a newsletter from the birth cohort study team. She sees it is a “courtesy” that fits with the study’s interest in “how you were brought up” in the 1950s.

Age at interview: 68
Sex: Female
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And I think it’s harking back to how things used to be in a way and that it’s almost quite old fashioned. It’s almost, like a curtesy that it’s just keeping in touch, so that it’s, you know, just letting you know what’s happening. So, it is feedback, but it’s got that kind of old fashioned traditional kind of context to it that we were somehow, that’s how you were brought up, so you let people know every so often or it’s, so, you know…

Okay.

...so, I think that’s really appreciated probably by others as well as myself.

 
Not everyone had received study findings, and some people couldn’t remember if they had or not. Derek and Ronald both receive cards every year from a birth cohort study team but didn’t think these included newsletters. Jess was also part of a birth cohort study and knew of friends who the research team had stayed in touch with, but she herself hadn’t been contacted or invited to a reunion event.
 
Some people who had received only little or no feedback on study findings said they would have liked a short summary update every year to learn what the study is finding out, how they are using the data and future plans. Steve had only received occasional feedback over the years and said that “a yearly bulletin would be fantastic because then I would feel I’m actually part of this”. For Malcolm, participants “deserve” to hear about findings and this doesn’t have to be much: “just little updates, not in-depth, just a few lines, a few pages of report maybe”.

Malcolm feels it is polite to give some general feedback on the study and that a short summary every year would be well-received.

Malcolm feels it is polite to give some general feedback on the study and that a short summary every year would be well-received.

Age at interview: 75
Sex: Male
Age at diagnosis: 48
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Yeah if you’re volunteering yourself and your information for a study, you know, it’s only, it’s only sort of, well it’s nice to be able to be informed about it. It’s polite, isn’t it, to give some feedback other than just results on your own physical test.

Just little updates not in-depth just a few lines, a few pages of report maybe or a page of a report, an update, a few bullet points. It’s quite easy to produce a report in an easier understanding format that anybody can understand.

 
A few of the birth cohort studies had organised special ‘get-together’ events for participants. For studies that had been running many decades, these meet-ups typically marked a milestone in terms of how long the study had been running and the birthdays of participants. Linda had been to a reunion where she learnt more about how the researchers had been using the data and she enjoyed talking with fellow participants. Another study, which had begun more recently and enrolled parents and children, held a yearly festival or picnic.

Linda attended an event to mark a milestone for a birth cohort study. She found it interesting talking to other participants and reflecting on their upbringings.

Linda attended an event to mark a milestone for a birth cohort study. She found it interesting talking to other participants and reflecting on their upbringings.

Age at interview: 65
Sex: Female
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That’s right we had discussions in groups, and we were mixed up. We weren’t, you weren’t sitting necessarily with people that you were at school with. Although we did meet up with people we were at school because I think they did, they did our school, they did a photograph of groups of people from different schools, I remember that. It was quite, it was quite general discussions. I don’t think, I can’t remember if we had topics that we had to discuss on the table, but it was basically just going round the room and just talking about our experiences of growing up in the fifties, what it was like; our schooling, you know, our homelife. Just, just how different it is to, you know, children growing up today really. I mean, it’s so totally different.

What it was like to grow-up and live in the 1950’s

I mean when you think about it, the war had only been finished a few years earlier. I think by the time I was born rationing was finished, but yeah, so it was, times were tough.

 
Many people spoke about wanting to receive timely information about the study findings from the researchers, but also suggested why this might not be possible. Gareth recognised that it may be many years before findings can be drawn from a cohort study because of how long the data collected period often is. Keith, Gill and Brian thought that cost and time might be factors. They agreed they would rather funding and staff resources were focused on doing the research rather than sending findings to participants. Mr S thought feedback on a study might be lacking because of low enrolment numbers or if the results were not very “concise”.

Mr S understands that the researchers can’t give a specific timeline for when study results will be available. He thinks it would be good to update participants though.

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Mr S understands that the researchers can’t give a specific timeline for when study results will be available. He thinks it would be good to update participants though.

Age at interview: 35
Sex: Male
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Yeah, that was the thing when they took my saliva sample, mine and my wife’s saliva sample, they said, “Oh look, we’re going to take this for research”.

But it was just like you didn’t know when the results were going to come out and you didn’t get a timescale like that. It was just the results will come out and then you’ll get to know, that was about it really. I can’t remember what further was said but they said we’re going to use your results and your research towards this and then we’ll, they promote, not promote but they just send out not confirmation but it was like, this will be used but we don’t know when the results will be out or anything like that. I didn’t get, that was the vague part of it, was that I didn’t know what was going to happen afterwards and what the results would be and whether or not the results have created an accurate response of what has happened basically really.

I think, results-wise, I think that was the only thing I was a bit, because it’s been four years, I haven’t heard anything back about that so I thought it would have been nice to just say, “Look from the results that you’ve provided and all that, we’ve just, this is what’s happened”.

The result side I think that’s where there is a bit lacking, that you’re not getting the response regarding the results of what’s happened after or ‘You participated in this, these are the results and this is what we found out. We just want to let you know that this is still ongoing or-’. They also have that peace of mind that look, you know, they haven’t forgotten, as they say.

 
The impact of receiving feedback
 
Sometimes feedback from a study had quite an impact on the people who took part. This included finding out news about their personal health, which might require more tests, treatments or changes in their diet and lifestyle. Gareth had some results about his cholesterol levels and a scan of his body fat distribution which made him think “that’s where I’ve got to put a bit of exercise in at the gym”. Alan Y felt that his study had made him more aware of diet and the importance of taking care of himself.
 
Those who had been in birth cohorts for many decades often said they were interested to see how life had developed for their fellow participants and how it compared to their own. Reminiscing was enjoyable for some but, as Steve pointed out, it is also important to recognise “the bad things that we went through and how it affected people”. For some, it highlighted opportunities they were grateful to have had and accomplishments they were proud of.

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