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How To Use a Car Seat Harness Correctly

It’s Child Passenger Safety Awareness Week and I have decided to talk a little about the car seat harness. The car seat harness holds a child down in the car seat so they cannot slide up, forward and out the car seat in the event of a crash.

There are two different types of harnesses; the 5-point and 3-point harness. What this really means is that the harness comes into contact with your child in 5 or 3 points. The 5-point harness has straps over both shouldres, both hips and one between the legs whereas the 3-point harness only has straps over the shoulders and one between the legs. Not only is a 5-point harness more secure but it also allows the forces from an accident to be distributed more evenly across the body.

Using the harness incorrectly is one of the most common mistakes parents make. In this short post I have outlined 3 really simple steps to take to correctly position your child in a car seat. Please remember to always check the manufacturer’s instructions first before using your car seat.

  1. Place your child all the way back in the car seat

Your child must sit snugly in the car seat with the bum and back firmly against the backrest.

  1. Correctly position the shoulder straps

Rear-facing car seats: the shoulder straps should be at or just below shoulder level (+- 2.5 cm)

Forward-facing car seats: the shoulder straps should be at or just above the shoulder level (+- 2.5 cm)

Image: Diono.com

  1. Tighten harness straps snugly

The straps should be tight enough so there is no excess webbing (check this using the pinch test).

Image: Diono.com

The harness should also not be too tight that it pinches your child’s skin or forces them into an unnatural position.

HARNESS RETAINER CLIPS

Image: safekids.org

Car seats made in Europe, Australia and South Africa do not come with harness retainer clips. You will most likely only see these clips if you are in the United States or Canada. These clips are not for added safety and are not designed to keep your child in their car seat in the event of a crash. In fact they are more likely to open up from the impact and slide down the straps. These clips are positioning devices and used to keep the shoulder straps in position pre-crash.

South Africa adheres to European car seat safety standards so you will not find car seats in this country with retainer clips. European regulation requires all car seat harnesses to be released in one motion and therefore a chest clip is simply not allowed. European car seats use other methods to keep the harness in place.

There are many other gadgets and devices available to use together with your harness to provide added comfort or extra protection. These are generally not safe since most of them are not crash tested and therefore can cause serious harm in the event of a motor vehicle accident.

RESOURCES

https://cpsboard.org/cps/wp-content/uploads/2014/01/Technician-Guide_March2014_Module-8.pdf

https://csftl.org/chest-clip-myths-busted/

 

 

Sea Creatures To Avoid At The Beach

I am really looking forward to taking my little one to the beach for the first time this year. Whilst the beach is great fun for any child there are a few sea creatures that can ruin a holiday.

If your child gets stung by one of these little guys try not to panic. Most stings cause nothing more than a localised skin reaction and a whole lot of pain. If your child is prone to allergic reactions there is a possibility they could however develop a severe allergic reaction and you will have to be on the lookout for this.

There are many dangerous marine animals but fortunately South Africa doesn’t have too many that your little ones will come across on the beaches and in rockpools. Below, I will describe how to manage the stings and bites of the most common sea creatures on South Africa’s shores.

  1. JELLYFISH

There are over 2000 different species of jellyfish and the toxins vary among them.

The nematocysts (cells inside the tentacles that release the toxin) from different species of jellyfish are either inhibited or stimulated to release more toxin depending on what first aid is applied which can make initial management challenging.

The jellyfish we encounter in South African waters are most commonly a relatively harmless type of box jellyfish. They most often only cause immediate pain, redness, tingling and itchiness.

How to treat jellyfish stings:

There is some debate as to how to treat jellyfish stings. Some suggest rinsing the wound in seawater others suggest vinegar or hot water and then there also seems to be some confusion about the order of steps. Based on a systematic review, which provides the best evidence, I have outlined the management of a jellyfish sting:

  1. Always provide Basic Life Support first. Don’t try remove any tentacles unless your child is responsive and stable.
  2. Flush the area with seawater to remove the tentacles that are stuck to the skin. You can use tweezers to gently remove tentacles whilst flushing. You can also use your hands provided you wear gloves. Don’t scrape away tentacles or rub with sand as the pressure will only release more toxin. Do not use fresh water as this causes more toxin to be released.
  3. Apply a paste of bicarb (50% bicarb of soda and 50% seawater) for several minutes and rinse off with seawater.
  4. Immerse the area in hot water (as hot as possible without burning the skin). Heat will help to reduce the pain. Apply for 30-90 minutes either in a hot shower, bath or by using heat packs.
  5. If heat has not helped the pain apply ice packs.
  6. Oral analgesics, anti-inflammatories and antihistamines are all effective.
  7. Monitor for a severe allergic reaction.

Jellyfish sting don’t’s:

Vinegar: I don’t recommend rinsing with vinegar. Vinegar is only effective for certain species of jellyfish and since it is very difficult to identify the species responsible for a sting I would avoid it. Vinegar can cause nematocysts to release more toxin causing significantly more pain.

Tweezers: Trying to remove stingers with tweezers or by scraping can also cause them to discharge more toxin. It is now recommended to avoid this.

  1. BLUEBOTTLE

The blue bottle, also known as the Pacific or Portuguese  man-o’-war, is very common along the coast of South Africa. Management of these stings is similar to that of the jellyfish sting described above.

  1. SEA URCHIN

These spikey creatures are like the hedgehogs of the sea and are commonly found in rock pools. If your little ones accidentally step on one or touch one, the urchin will shoot out some of their spines.

As with most sea creatures some are more poisonous than others, but most sea urchins cause nothing more than a painful puncture wound similar to that of a splinter. On the odd occasion there may be also be burning, swelling and numbess of the area that lasts a few hours.

What to do if your child comes into contact with a sea urchin:

  1. Remove all the spines with tweezers or your hands if large enough. Do this very carefully as the spines are fragile and can break easily.
  2. Stop any bleeding with firm pressure.
  3. Rinse the wound with salt water.
  4. Soak the wound in vinegar throughout the day or apply a cloth soaked in vinegar over the wound to dissolve any spines you were unable to remove.
  5. Follow with warm compresses to help with the pain and swelling.
  6. Analgesics and anti-inflammatories such as Ibuprofen.

If you don’t manage to remove the spines and they don’t fully disolve with vinegar they may need to be removed by a medical practitioner.

The spines would also have caused puncture wounds into the skin so its important to keep the area clean and watch out for any signs of infection.

  1. SEA ANEMONE

These beautiful creatures, which live in rock pools, can be very tempting for our kids and thankfully most of their stings are harmless.

What to do if your child has been stung by an anemone:

  1. Flush the area with seawater to remove as many stingers as you can.
  2. Immerse area in hot water for up to 90 minutes.
  3. Apply ice packs if heat does not help.
  4. Oral analgesics, anti-inflammatories and antihistamines.
  5. Monitor for a severe allergic reaction.

WHEN YOU NEED TO SEEK MEDICAL HELP:

  • Difficulty breathing
  • Confusion and/or loss of consciousness
  • Chest pain
  • Nausea and vomiting
  • Muscles cramps severe bleeding
  • Severe pain that won’t go away
  • Stings on a large surface area, the face, throat or genitalia
  • Signs of infection over the next few days: increased pain, redness, swelling, pus and/or fever

SIMPLE SAFETY TIPS

  • Look for any warning signs at the beach about jellyfish and other dangerous marine life in the area and AVOID.
  • If you find any jellyfish or blue bottles on the beach it’s likely there will be more floating around in the breakers. Rather avoid the water.
  • Never touch a jellyfish or blue bottle, even if it looks dead. The tentacles can still sting even if they aren’t attached to the body.
  • Invest in some good quality swim shoes. They can be worn in and out of the water. These have a rubber sole and will protect little feet from nasties they may step on, as well as the hot beach sand, which can burn.
  • Don’t forget that tetanus prophylaxis is important for any break in the skin. Refer to my previous blog for more information.

It’s important your kids respect the little animals they may come across at the beach. Teach your children to look but NOT touch. There are so many fun things to do at the beach so don’t let bluebottles and sea urchins scare you. Just keep an eye out and initiate immediate first aid to prevent a small injury from turning into something much bigger.

Keep on hand my on-the-go first aid MikiKit. It is compact and will fit perfectly into your beach bag https://www.oneaid.co.za/shop/

RESOURCES:

http://www.ambulance.nsw.gov.au/Media/docs/090730bluebottle-eee3bc83-ce7c-4281-a095-b427eb01e6d0-0.pdf

https://www.mdpi.com/1660-3397/14/7/127

https://www.merckmanuals.com/professional/injuries-poisoning/bites-and-stings/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640396/

https://www.nsri.org.za/2012/02/how-jellyfish-sting/

https://www.racgp.org.au/afp/2015/januaryfebruary/marine-envenomations/

 

How To Keep Your Children Safe In The Sun

1. SUNSCREEN, SUNSCREEN AND MORE SUNSCREEN!

I cannot stress this enough. The damage that causes skin cancer in adulthood can start in childhood. Every child needs sunscreen, regardless of skin tone. Melanin is a pigment found in the skin that absorbs UV rays. The darker the skin, the more melanin there is, therefore the more UV rays are absorbed. This simply means that the skin will take longer to burn BUT it will burn.

How does sunscreen work?

Most sunscreens contain organic and inorganic chemicals. The inorganic chemicals act as a physical barrier and don’t get absorbed into the skin. These are known as physical sunscreens and work by reflecting UV rays, which is what used to make sunblock look white on the skin. Modern day sunblock no longer leaves this white residue on the skin.

The organic chemicals actually absorb UV rays, much like melanin, and then disperse the energy as heat. These chemicals get absorbed into the skin and are known as chemical sunscreens. 

What is the difference between UVA and UVB rays?

 UVB rays are the main cause of redness of the skin and sunburn. These rays damage the superficial layers of the skin.

UVA rays penetrate deeper into the skin and cause the tanned look by increasing the amount of melanin in the skin. This is a how the skin protects itself from further damage. There is no way to tell how much UVA damage the skin has endured. 

How to choose the right sunscreen?

It does not matter if you use a lotion, cream, gel, spray or stick. They are all equally effective. What is important is that you apply a sunscreen with at least an SPF 30.

To get the most protection, you need a broad-spectrum sunscreen. This means the sunscreen must protect against UVA and UVB rays. No sunscreen can block 100 percent of UVB rays; SPF 15 blocks 93 percent of UVB rays, SPF 30 blocks out 97% and SPF 50 blocks 98%.

Using a water-resistant sunscreen is probably a better idea especially if your little ones are running around sweating a lot or swimming.

What is SPF?

Sun protection factor (SPF) is a measure of how long a sunscreen will protect you before you burn. SPF is a measure of UVB rays only.

So how does the factor in SPF work? If you normally burn after 20 minutes (without sunblock) and you apply an SPF 15 it will take 15 times longer to burn. This means that you should theoretically be protected for 5 hours (20 x 15 = 300/60 = 5 hours) If you use an SPF 30 then it should take 30 times longer and therefore 10 hours before you burn. However, it is impossible to expect a sunscreen to be effective for 5 hours never mind 10 so the SPF model is not 100% fail proof.

How common is sunscreen allergy?

It is uncommon to have an allergy to sunscreen. If there is a real allergy towards a sunblock it is usually towards one of the organic chemicals found in the cream. It’s a good idea to test the sunblock out first on a small area of the skin to see if an allergy will occur, before applying sunblock to the whole body. Sunscreens for sensitive skin are readily available. Physical sunscreens are not known to cause allergies. Make sure to check the label so you know what you are getting.

Sunscreen everywhere!

Be sure to put sunscreen on all exposed areas. Don’t forget the tops of the feet, back of the hands, the ears, back of the neck, hairline, lips and nose.

Reapply often!

Remember to apply sunscreen 20-30 minutes before going out into the sun. All sunscreens, regardless of strength, need to be reapplied every 2 hours. Reapply more frequently if swimming and/or sweating a lot. Sand and water also reflects more light so your children will burn more easily when at the beach, swimming or playing water sports. Remember, no sunscreen is waterproof.

2. COVER UP

You should never rely on sunscreen alone to keep your children safe from the harmful UV rays. There are other additional measures you can take to protect your children from the sun and heat. Have your children wear loose cotton clothing so that they don’t overheat and avoid sheer fabrics as UV rays can penetrate these.

Clothing that contains Ultraviolet Protection Factor (UPF) is becoming more readily available. UPF fabric is very tightly woven and uses dyes that disrupt UV light, which prevents the penetration of both UVA and UVB rays. Look for UPF clothing with a rating of 50+. Don’t forget about hats. Wide brimmed hats are better as they also protect the ears and back of the neck.

If the skin needs protecting so do the eyes. Whilst Sunglasses these days are much more of a fashion statement they are actually very important in protecting eyes against UV rays. UV rays can cause a number of eye problems later in life such as cataracts, retinal damage, pterygium formation and skin cancer of the eyelids. Short-term exposure can also burn the cornea, which is extremely painful and causes blurred vision. I have seen various sunglasses that are available for children. When buying sunglasses make sure though that they protect against both UVA and UVB rays.

6. NEWBORNS AND YOUNG CHILDREN 

Babies younger than 6 months should be kept out of the direct sunlight. The skin is thinner and the melanin is not properly developed. If this is not possible, use a sunscreen that contains either zinc oxide or titanium dioxide only (a physical barrier cream only). These are less likely to irritate your baby’s sensitive skin, as they do not get absorbed. Still, make sure that you keep them out of the sun during the harmful peak hours mentioned below.

4. STAY HYDRATED

Prevent heat-related illnesses such as heat cramps, exhaustion and stroke. Make sure your children drink plenty of fluids before and during outdoor activities in hot weather. Thirst is a late sign of dehydration.

 5. OPT FOR SHADE

 Your children should try stay in the shade during dangerous peak times, 11am – 3pm, when UVB rays are the strongest. Kids should also take regular breaks from the sun and go into the shade to cool down and prevent overheating.

6. CLOUDY, OVERCAST WEATHER

This is a common problem. One thinks because there is no visible sun the clouds offer protection but in fact the clouds only manage to filter a small percentage of UV rays. Children can still get sunburnt when it is cloudy. Even though you may not be able to see the sun, the sun’s UV rays still reach the earth.

7. SET AN EXAMPLE

Make sure you always wear sunscreen and sunglasses. Let your kids help rub it in on your shoulders. Avoid tanning and limit your time in the sun so that your children can learn correct behaviours from you.

I know that some of these tips may seem obvious but I continue to see children playing outdoors without any sunscreen or sunhats. In a climate like what we have in South Africa we need to be more aware of the dangers the sun and heat create for our little ones.

RESOURCES

https://www.cdc.gov/cancer/skin/basic_info/children.htm

https://www.preventblindness.org/how-can-uv-rays-damage-your-eyes

How Safe Is Your Car Seat?

We all know how long it can take for a child to fall asleep. So when you reach your destination and your little one has finally fallen asleep you couldn’t feel more relieved. You wouldn’t dream of disturbing them by removing him or her from the car seat. Instead you do what is the most convenient, and move your child from your car into a pram chassis or straight into your home without ever moving them from the car seat.

Whilst car seats have saved many lives, they do have some hidden dangers. A study in 2015 found that out of all the sitting and carrying devices for young children, car seats were responsible for the most number of deaths. Hypoxia and suffocation from either poor positioning in the car seat or strangulation by the straps and buckles was the cause of death in all these cases.

HYPOXIA

This is when there is a loss of oxygen in the blood which reduces the amount of oxygen reaching the tissues. When there is an extreme loss of oxygen a child will suffocate.

The developing brain is very sensitive to a decrease in oxygen. Loss of oxygen can cause brain injury and result in a range of developmental problems as well as seizures.

POSITIONING

The position of your car seat is important. The Recline Angle of a rear-facing car seat is critical and an angle between 30-45o from the vertical is recommended. A recline angle more than 45o offers very little protection in the event of a crash.

A newborn or young infant’s head is heavy and the neck muscles are weak. If the recline angle becomes less and the car seat more upright, the head will flop down and obstruct the airway. A newborn should therefore be positioned in the lowest possible position, which still offers crash protection. As babies grow their neck muscles get stronger and the angle of the car seat can become more upright since their head and neck control improves.

 

The recline angle of a rear-facing car

 

A number of studies have looked at the level of oxygen in an infant’s blood whilst in their car seat. A level of oxygen less than 90% is considered dangerous. It was shown that children’s oxygen levels dropped as far down to 83.7% when in incorrectly positioned car seats. The authors also found that the longer the child remained in the car seat the lower the oxygen level would drop.

Another study found that a child in a correctly placed rear-facing car seat is still at risk of suffocation. The vibration produced by a car could cause newborns and young children’s head and shoulders to fall forward, despite correct use of the straps and buckles. This risk was also similar for both term and preterm infants.

Some specialists recommended that young babies spend no more than 30 minutes to an hour in a car seat at a time. If a long journey is unavoidable it may be wise for someone to sit in the back with your child to keep an eye out.

STRAPS AND BUCKLES

Always make sure your child is properly securely in a car seat. If the straps are too loose a child can easily slip or even wriggle down far enough to become strangled by the straps. If the child falls lower down in the seat the child may also suffocate from an obstructed airway if the head falls onto the chest.

NEVER

  • Never place your baby in a car seat on a soft surface such as a bed or couch. This type of surface could cause the recline angle to change resulting in your child’s head falling forward and obstructing the airway.
  • Never loosen or unbuckle any straps if you do decide to keep your baby in a car seat outside of the car. A child can wriggle and slip down far enough to be strangled by the straps and even fall out of the car seat altogether.
  • Never leave an infant or young child unsupervised in a car seat if they are asleep or even if they are awake.
  • Never place your baby in a car seat on an elevated surface such as a table. A baby can wriggle enough to cause the seat to move and fall off the surface.
  • Never place your baby in a car seat on the floor without looking at the recline angle. Some car seats may become more upright when placed on the floor.

Always make sure your car seat is installed correctly. Most car seats come with a built-in indicator that allows you to see if the seat is installed at the proper angle.

Read the manual carefully and if in doubt contact the local manufacturer or distributor. You can also contact Julie at Precious Cargo (www.preciouscargo.co.za) to book a professional car seat installation.

RESOURCES

Arya, R., Williams, G. and Kilonback, A. et al. (2017) Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle. Arch Dis Child Fetal Neonatal Ed, [online] 102, pp. 136-141. Available from: https://fn.bmj.com/content/fetalneonatal/102/2/F136.full.pdf [Accessed 13 September 2018].

Batra, E.K., Midgett, J.D. and Rachel Y. Moon (2015) Hazards Associated with Sitting and Carrying Devices for Children Two Years and Younger. The Journal of Pediatrics, [online] 167, pp. 183-187. Available from: http://dx.doi.org/10.1016/j.jpeds.2015.03.044 [Accessed 13 September 2018].

CPSBestPractice (2018). Rear-facing restraint recline angle. [image] Available at: https://sites.google.com/a/umich.edu/cpsbestpraci/resources/rear-facing-child-restraints [Accessed 14 Sep. 2018].

NHS (2016) Warning over babies sleeping in car seats. [online] Available from: https://www.nhs.uk/news/pregnancy-and-child/warning-over-babies-sleeping-in-car-seats/ [Accessed 13 September 2018].

Rholdon, R. (2017) Understanding the Risks Sitting and Carrying Devices Pose to Safe Infant Sleep. Nursing for Women’s Health, [online] 21 (3), pp. 225-230. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28599744 [Accessed 13 September 2018].

Everything You Need To Know About Safe Babywearing

Babywearing is becoming increasingly more popular with many different types and brands to choose from. All over the world women have fashioned slings out of various blankets, fabrics and cloths.

THE BENEFITS OF BABYWEARING

  1. It is great for bonding with your baby.
  2. It supports breastfeeding.
  3. It helps reduce symptoms of reflux and indigestion in your baby.
  4. It provides deep touch pressure which helps calm your baby. Deep touch pressure affects the nervous system slows the heart rate and results in a calming affect.
  5. It provides vestibular-proprioceptive stimulation which also helps calm your baby by inhibiting the movement muscles and relaxing the body.
  6. It is convenient to have free hands.

HOW TO WEAR A BABY CARRIER

Before you buy a carrier it is important that you know how to wear one correctly so that your baby can be kept safe. Regardless of whether you decide to wear your baby on your back or in the front, facing in or facing out, Airway and Position are the two most important things you have to remember.

Keep Your Baby’s Airway Clear:

Young babies do not have good neck control. The head and neck need to be supported to keep the airway open as there is a real risk of suffocation in a baby carrier.

  • The chin must not rest on the chest but rather be angled up.
  • The face must not be pressing into the chest. Rather position the ear against chest.
  • Make sure there is no fabric covering the face. The face must be visible.
  • Carry your baby close and tight against your body. If your baby is loose, he or she can slide down in the carrier and obstruct their airway.

Position your baby properly:

Improper positioning can also result in airway compromise as well as increase the risk of hip dysplasia. 

  • Keep your baby upright at all times, except when breastfeeding (remember to reposition your baby again afterwards).
  • Position baby high enough to be able to kiss his or her forehead.
  • Your baby’s knees should be positioned higher than his or her bottom and the legs must be spread in order to support the hips and spine (much like a frog).

The Consortium of UK Sling Manufacturers and Retailers have developed an acronym (T.I.C.K.S) to help you remember the correct way to carry your child.

Tight

In view at all times

Close enough to kiss

Keep chin off the chest

Supported back

 

HIP DYSPLASIA EXPLAINED

Hip dysplasia is an abnormality of the hip joint where the ball part of the joint does not sit securely in its socket. An infant’s hip joint is made up of mostly soft cartilage unlike an adult’s hard bone. Therefore it’s easier for the ball part of the joint to slip out. Chronic poor positioning is an important risk factor for the development of hip dysplasia in infants, especially in the first 6 months of life. When the hips are not supported and the legs are kept straight the resulting forces make the joint unstable (fig. 1). As a child gets older the bones start to harden and the joint becomes more stable.

Fig.1: Understanding Position and Hip Dysplasia

CONCERNS ABOUT SLINGS

A sling is basically a tubular piece of fabric in which a baby nestles. They are great for skin-to-skin contact and bonding, however there are a few safety concerns:

  • It is difficult to support and control the position of the head and neck.
  • There is a risk of restricting airflow if the fabric completely encases the baby.
  • There is a risk of obstructing the airway if the face presses up against the fabric.
  • Slings do not allow for proper support of the hips and therefore there is a risk for hip dysplasia.

Fig.2: Incorrect

 

Fig.3: Correct

 

 

CHOOSING A BABY CARRIER

Make sure it is suitable for your baby’s age: Slings and outward facing carriers are not recommended for newborns up to around 4 months of age.

Make sure it can provide proper positioning:Some carriers do not support the spine and hips adequately. Take your baby along when buying a carrier and test it out. Have a look at the sitting position your baby adopts in both inward and outward facing positions. Some carriers are better for inward facing than outward facing. It is easier for an inward facing baby to lean against you and assume a frog-like position with the hips bent. In an outward facing position the hips may not be supported as much and the legs can then hang straight.

Make sure it is comfortable for you to wear: Babies grow very fast in the first few months. Make sure you choose a carrier that is ergonomic and helps take the increasing weight off your back.

Make sure the carrier is ASTM approved: Many baby products have to adhere to strict safety standards and baby carriers are no exception.

DOS AND DON’TS 

  • Do not drink hot fluids while wearing your baby.
  • Do not drive a car or ride a bicycle while wearing your baby.
  • Do not do any form of intense exercise while wearing your baby.

Whatever carrier you do go for, remember to wear it safely!

RESOURCES

Babyslingsafety, (n.d.) The T.I.C.K.S Rule for Safe Babywearing. [Online]. Available from: http://babyslingsafety.co.uk [Accessed15 August 2018].

Esposito, G. et al., (2013) Infant Calming Responses during Maternal Carrying in Humans and Mice. Current Biology. [Online] 23, pp. 739-745. Available from: http://dx.doi.org/10.1016/j.cub.2013.03.041 [Accessed 14 August 2018].

International Hip Dysplasia Institute, (2015) Baby Carriers, Seats, & Other Equipment. [Online]. Available from: http://hipdysplasia.org/developmental-dysplasia-of-the-hip/prevention/baby-carriers-seats-and-other-equipment/ [Accessed 14 August 2018].

Ludington-Hoe, S.M. (2011) Evidence-Based Review of Physiologic Effects of Kangaroo Care. Current Women’s Health Reviews. [Online] 7, pp. 243-253. Available from: http://eurekaselect.com/88428 [Accessed 14 August 2018].

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