Science
A mother's loss launches a global effort to fight antibiotic resistance
In November 2017, days after her daughter Mallory Smith died from a drug-resistant infection at the age of 25, Diane Shader Smith typed a password into Mallory’s laptop.
At this point, keeping myself alive is a full-fledged mission, enlisting all of my energy and hours every day. I need to fight the chronic deadly resistant bacteria eating away at my fragile, scarred lungs. Fight the billions of bacteria overtaking my lungs and clear out the mucus so I don’t feel like I’m breathing through a straw with a boulder weighing on my chest.
— Mallory Smith, Oct. 16, 2014
Her daughter gave it to her before undergoing double-lung transplant surgery, with instructions to share any writing that could help others if she didn’t survive.
Had this idea today that I wanted to write down before it leaves my mind or I stop feeling inspired or I forget it or something inside me tells me it’s not possible. I want to start an online media source (podcast? website?) that tells the stories of people who have struggled with something in their life and found hope somewhere.
— Mallory Smith, July 20, 2015
The transplant was successful, but Burkholderia cepacia — an antibiotic-resistant bacterial strain that first colonized her system when she was 12 — took hold. After a lifetime with cystic fibrosis, and 13 years battling an unconquerable infection, Mallory’s body could take no more.
Cepacia has taken over, and it’s time to figure out a transplant option. I realize I want to write my story.
— Mallory Smith, July 29, 2016
In the haze of grief and pain, Shader Smith found herself looking through 2,500 pages of a journal her daughter had kept since high school. It chronicled Mallory’s hopes and triumphs as an ebullient, athletic student at Beverly Hills High School and Stanford University, and her private despair as bacteria ravaged her systems and sapped her considerable strength.
In the years since, the journal has become a source of solace for Shader Smith as she has traveled the globe speaking about the growing threat of antimicrobial resistance. It is also now the inspiration for two new projects she hopes will spark greater understanding of the public health crisis that ended her daughter’s life prematurely and could claim millions more.
On Tuesday, Random House published “Diary of a Dying Girl,” a selection of Mallory’s journal entries. The same day saw the launch of the Global AMR Diary, a website collecting the worldwide stories of people battling pathogens that can’t be defeated by our current pharmaceutical arsenal.
An estimated 35,000 people die in the U.S. each year from drug-resistant infections, according to the U.S. Centers for Disease Control and Prevention. Worldwide, antimicrobial resistance kills an estimated 1.27 million people directly every year and contributes to the deaths of millions more.
Despite the mounting toll — and the prospect of an eventual surge in superbug fatalities — the development of new antibiotics has stagnated.
Shader Smith is acutely aware of what we stand to lose when medicine can no longer save us.
“I don’t want to live in a post-antibiotic world,” Shader Smith said. “Until people understand what’s at stake, they’re not going to care. My daughter died from this. So I care deeply.”
Over the last 50 years, opportunistic pathogens have evolved defenses faster than humans can develop drugs to combat them.
Misuse of antibiotics has played a large part in this imbalance. Bugs that survive antibiotic exposure pass on their resistant traits, leading to hardier strains.
Crucial as they are, antibiotics don’t have the same financial incentives for developers that other drugs do. They aren’t meant to be taken over the long term, as are medications for chronic conditions such as diabetes or high blood pressure. The most powerful ones have to be used as rarely as possible, to give bacteria fewer opportunities to develop resistances.
“The public does not understand [the] scope of the problem. Antimicrobial resistance truly is one of the leading public health threats of our time,” said Emily Wheeler, director of infectious disease policy at the Biotechnology Innovation Organization. “The pipeline for antibiotics today is already inadequate to address the threats that we know about, without even considering the continuous evolution of these bugs as the years go on.”
Despite the global nature of the threat, Shader Smith said, the response from public health officials is curiously disjointed.
For one, no one can agree on a single name for the problem, she said. Different agencies address the issue with an “alphabet soup” of acronyms: the World Health Organization uses AMR as shorthand for antimicrobial resistance, while the CDC prefers AR. Medical journals, doctors and the media refer alternately to multidrug resistance (MDR), drug-resistant infections (DRI) and superbugs.
“It doesn’t matter what you call it. We just have to all call it the same thing,” said Shader Smith, who works as a publicist and marketing consultant.
Since Mallory’s death, Shader Smith has made it her mission to get the people and organizations working on antimicrobial resistance to talk to one another. For the Global AMR Diary, she enlisted the help of a dozen agencies working on the issue, including the CDC, WHO, the European Center for Disease Prevention and Control (the European Union’s equivalent of the CDC), the Biotechnology Innovation Organization and others.
Antimicrobial resistance can “feel abstract given the scale of the problem,” said John Alter, head of external affairs of the AMR Action Fund, one of the organizations involved with the project. “To know there are millions of families at this very moment going through struggles similar to what Mallory experienced is simply unacceptable,” he said.
“Not only does this firsthand experience help others who might be going through something similar, but it also reminds those tasked with creating solutions and care who they are working for. They aren’t just test tubes or charts,” said Thomas Heymann, chief executive of Sepsis Alliance, another contributor.
The stories in the online diary are often harrowing. A 25-year-old pharmacist in Athens had to put her cancer treatment on hold when an extremely resistant strain of Klebsiella attacked. A veterinarian in Kenya suffered permanent disability after contracting resistant bacteria after hip surgery. Around the world, routine outpatient procedures and illnesses have rapidly become life-threatening when opportunistic bugs take hold.
Mallory was 12 when her doctor called to confirm that her cultures were positive for an extremely resistant strain of cepacia, a form of bacteria found widely in soil and water. The pathogen can be deadly to people with underlying conditions such as cystic fibrosis, a genetic disorder that impairs the cells’ ability to effectively flush mucus from the lungs and other body systems.
Life expectancies for people with cystic fibrosis have grown since Mallory’s diagnosis in 1995, with many people of them living into their 40s and beyond. The cepacia curtailed that possibility for her.
“This is all we’re ever going to have,” Mallory wrote in June 2011, at the end of her freshman year at Stanford, “so if you’re not actively pursuing happiness then you’re insane. And I don’t think I would have this perspective if I didn’t have resistant bacteria that will likely kill me.”
A shrine to Mallory Smith. She fought a drug-resistant bacteria from age 12 to 25, all through high school, then at Stanford. (Genaro Molina / Los Angeles Times)
Mallory’s intuition that her journal could be valuable to others was prescient. “People can easily understand and relate to actual experiences,” said Michael Craig, director of the CDC’s Antimicrobial Resistance Coordination and Strategy Unit. “The Global AMR Diary takes this approach and expands on it with a global lens — increasing the potential to get these critical messages to more people around the world.”
An earlier version of Mallory’s diaries was published in 2019 as “Salt in My Soul: An Unfinished Life.” The new book includes entries that Shader Smith said she wasn’t ready to grapple with in the immediate aftermath of Mallory’s passing: ones addressing depression and private despair, concerns about relationships and body image issues complicated by chronic illness.
It also includes a coda about phage therapy, a promising advance against AMR.
As cepacia overwhelmed Mallory’s system in the weeks after her transplant, her family secured an experimental dose of phage therapy. Widely used to treat infection before the advent of antibiotics, phages are viruses that destroy specific bacteria. The treatment arrived too late to save Mallory’s life, Shader Smith writes in a last chapter of the book, but her autopsy revealed that the phages had started to work as intended.
The systems that bring new drugs to patients move slowly, Shader Smith said, and “Mallory might have been saved if they had moved faster.” Her mission now is to make sure that they do.
“Mallory died six years ago. Six years is a long time, day in and day out,” she said. “And I’ve never taken my foot off the pedal.”
Science
2024 Brought the World to a Dangerous Warming Threshold. Now What?
At the stroke of midnight on Dec. 31, Earth finished up its hottest year in recorded history, scientists said on Friday. The previous hottest year was 2023. And the next one will be upon us before long: By continuing to burn huge amounts of coal, oil and gas, humankind has all but guaranteed it.
The planet’s record-high average temperature last year reflected the weekslong, 104-degree-Fahrenheit spring heat waves that shuttered schools in Bangladesh and India. It reflected the effects of the bathtub-warm ocean waters that supercharged hurricanes in the Gulf of Mexico and cyclones in the Philippines. And it reflected the roasting summer and fall conditions that primed Los Angeles this week for the most destructive wildfires in its history.
“We are facing a very new climate and new challenges, challenges that our society is not prepared for,” said Carlo Buontempo, director of the Copernicus Climate Change Service, the European Union monitoring agency.
But even within this progression of warmer years and ever-intensifying risks to homes, communities and the environment, 2024 stood out in another unwelcome way. According to Copernicus, it was the first year in which global temperatures averaged more than 1.5 degrees Celsius, or 2.7 degrees Fahrenheit, above those the planet experienced at the start of the industrial age.
For the past decade, the world has sought to avoid crossing this dangerous threshold. Nations enshrined the goal in the 2015 Paris agreement to fight climate change. “Keep 1.5 alive” was the mantra at United Nations summits.
Yet here we are. Global temperatures will fluctuate somewhat, as they always do, which is why scientists often look at warming averaged over longer periods, not just a single year.
But even by that standard, staying below 1.5 degrees looks increasingly unattainable, according to researchers who have run the numbers. Globally, despite hundreds of billions of dollars invested in clean-energy technologies, carbon dioxide emissions hit a record in 2024 and show no signs of dropping.
One recent study published in the journal Nature concluded that the absolute best humanity can now hope for is around 1.6 degrees of warming. To achieve it, nations would need to start slashing emissions at a pace that would strain political, social and economic feasibility.
But what if we’d started earlier?
“It was guaranteed we’d get to this point where the gap between reality and the trajectory we needed for 1.5 degrees was so big it was ridiculous,” said David Victor, a professor of public policy at the University of California, San Diego.
The question now is what, if anything, should replace 1.5 as a lodestar for nations’ climate aspirations.
“These top-level goals are at best a compass,” Dr. Victor said. “They’re a reminder that if we don’t do more, we’re in for significant climate impacts.”
The 1.5-degree threshold was never the difference between safety and ruin, between hope and despair. It was a number negotiated by governments trying to answer a big question: What’s the highest global temperature increase — and the associated level of dangers, whether heat waves or wildfires or melting glaciers — that our societies should strive to avoid?
The result, as codified in the Paris agreement, was that nations would aspire to hold warming to “well below” 2 degrees Celsius while “pursuing efforts” to limit it to 1.5 degrees.
Even at the time, some experts called the latter goal unrealistic, because it required such deep and rapid emissions cuts. Still, the United States, the European Union and other governments adopted it as a guidepost for climate policy.
Christoph Bertram, an associate research professor at the University of Maryland’s Center for Global Sustainability, said the urgency of the 1.5 target spurred companies of all kinds — automakers, cement manufacturers, electric utilities — to start thinking hard about what it would mean to zero out their emissions by midcentury. “I do think that has led to some serious action,” Dr. Bertram said.
But the high aspiration of the 1.5 target also exposed deep fault lines among nations.
China and India never backed the goal, since it required them to curb their use of coal, gas and oil at a pace they said would hamstring their development. Rich countries that were struggling to cut their own emissions began choking off funding in the developing world for fossil-fuel projects that were economically beneficial. Some low-income countries felt it was deeply unfair to ask them to sacrifice for the climate given that it was wealthy nations — and not them — that had produced most of the greenhouse gases now warming the world.
“The 1.5-degree target has created a lot of tension between rich and poor countries,” said Vijaya Ramachandran, director for energy and development at the Breakthrough Institute, an environmental research organization.
Costa Samaras, an environmental-engineering professor at Carnegie Mellon University, compared the warming goals to health officials’ guidelines on, say, cholesterol. “We don’t set health targets on what’s realistic or what’s possible,” Dr. Samaras said. “We say, ‘This is what’s good for you. This is how you’re going to not get sick.’”
“If we were going to say, ‘Well, 1.5 is likely out of the question, let’s put it to 1.75,’ it gives people a false sense of assurance that 1.5 was not that important,” said Dr. Samaras, who helped shape U.S. climate policy from 2021 to 2024 in the White House Office of Science and Technology Policy. “It’s hugely important.”
Scientists convened by the United Nations have concluded that restricting warming to 1.5 degrees instead of 2 would spare tens of millions of people from being exposed to life-threatening heat waves, water shortages and coastal flooding. It might mean the difference between a world that has coral reefs and Arctic sea ice in the summer, and one that doesn’t.
Each tiny increment of additional warming, whether it’s 1.6 degrees versus 1.5, or 1.7 versus 1.6, increases the risks. “Even if the world overshoots 1.5 degrees, and the chances of this happening are increasing every day, we must keep striving” to bring emissions to zero as soon as possible, said Inger Anderson, the executive director of the United Nations Environment Program.
Officially, the sun has not yet set on the 1.5 target. The Paris agreement remains in force, even as President-elect Donald J. Trump vows to withdraw the United States from it for a second time. At U.N. climate negotiations, talk of 1.5 has become more muted compared with years past. But it has hardly gone away.
“With appropriate measures, 1.5 Celsius is still achievable,” Cedric Schuster, the minister of natural resources and environment for the Pacific island nation of Samoa, said at last year’s summit in Azerbaijan. Countries should “rise to the occasion with new, highly ambitious” policies, he said.
To Dr. Victor of U.C. San Diego, it is strange but all too predictable that governments keep speaking this way about what appears to be an unachievable aim. “No major political leader who wants to be taken seriously on climate wants to stick their neck out and say, ‘1.5 degrees isn’t feasible. Let’s talk about more realistic goals,’” he said.
Still, the world will eventually need to have that discussion, Dr. Victor said. And it’s unclear how it will go.
“It could be constructive, where we start asking, ‘How much warming are we really in for? And how do we deal with that?’” he said. “Or it could look very toxic, with a bunch of political finger pointing.”
Science
U.S. Efforts to Cut Emissions Stalled in 2024 as Power Demand Surged
America’s efforts to cut its climate change pollution stalled in 2024, with greenhouse gas emissions dropping just a fraction, 0.2 percent, compared to the year before, according to estimates published Thursday by the Rhodium Group, a research firm.
Despite continued rapid growth in solar and wind power, emissions levels stayed relatively flat last year because demand for electricity surged nationwide, which led to a spike in the amount of natural gas burned by power plants.
The fact that emissions didn’t decline much means the United States is even further off-track from hitting President Biden’s goal of slashing greenhouse gases 50 percent below 2005 levels by 2030. Scientists say all major economies would have to cut their emissions deeply this decade to keep global warming at relatively low levels.
Since 2005, United States emissions have fallen roughly 20 percent, a significant drop at a time when the economy has also expanded. But to meet its climate goals, U.S. emissions would need to decline nearly 10 times as fast each year as they’ve fallen over the past decade. That seems increasingly unlikely, experts say, especially since President-elect Donald J. Trump has promised to dismantle Mr. Biden’s climate policies and promote the production of fossil fuels, the burning of which generates greenhouse gases.
“On the one hand, it is notable that we’ve now seen two years in a row where the U.S. economy grew but emissions went down,” said Ben King, an associate director at the Rhodium Group. “But it’s far from enough to achieve our climate targets.”
The biggest reason that U.S. emissions have fallen in recent years is that electric utilities have been retiring their older, dirtier coal-fired power plants and replacing them with cheaper and less-polluting natural gas, wind and solar power. That trend mostly continued last year, with a few unexpected ups and downs.
The nation’s demand for electricity, which has stayed more or less flat for two decades, suddenly jumped by roughly 3 percent in 2024, in large part because scorching heat during the summer caused many Americans to crank up their air-conditioners. A smaller factor was that tech companies have been building more energy-hungry data centers in states like Virginia and Texas.
While power companies installed large numbers of wind turbines, solar panels and batteries last year to meet rising demand, natural gas use also rose to record highs, while coal use declined only slightly. The net result was that emissions from the power sector increased an estimated 0.2 percent, according to the Rhodium Group.
At the same time, transportation, the nation’s largest source of greenhouse gases, saw an 0.8 percent rise in emissions last year. Gasoline and jet fuel consumption both increased as Americans continued to drive and fly more after the pandemic. Nearly 10 percent of new car sales in 2024 were less-polluting electric vehicles, but those models still make up a small fraction of total cars on the road and have yet to put a major dent in transportation emissions.
On the flip side, emissions from America’s industrial sector — which includes steel, cement and chemicals — fell by 1.8 percent in 2024. Some of that may have been the result of lost output, as two hurricanes and a strike at the nation’s ports disrupted some factory activity in the fall, Mr. King said.
“It’s a reminder that there’s always some bumpiness in emissions,” Mr. King said. “It’s not just a question of how many electric vehicles are on the road or how much solar we’ve installed. A big portion of our economy still relies on fossil fuels.”
One of the most striking findings in this year’s data was that emissions from oil and gas operations dropped roughly 3.7 percent in 2024. Even though the United States produced record amounts of oil and near-record amounts of natural gas last year, many companies appear to have curbed leaks of methane, which is the main ingredient in natural gas and which can seep into the atmosphere and contribute significantly to global warming.
Over the past few years, the Biden administration and several states have adopted new regulations that require oil and gas producers to detect and fix methane leaks. Many companies also have financial incentives to capture methane to sell rather than vent it into the air.
Between 2014 and 2024, U.S. companies appear to have reduced the amount of methane that escaped, per each cubic feet of gas they produced, by 40 percent, according to the Rhodium Group.
Several experts have estimated that greenhouse gases generated in the United States could start dropping sharply in the years ahead if many clean energy policies stay in place, particularly the 2022 Inflation Reduction Act that pumped hundreds of billions of dollars into low-carbon energy technologies such as electric vehicles, wind turbines, solar panels, nuclear reactors, green hydrogen and batteries.
While Mr. Trump has pledged to scrap many of Mr. Biden’s subsidies and tax credits for electric vehicles and low-carbon energy, it remains to be seen whether Congress will agree.
That law has not yet had a major impact on the country’s emissions, said Mr. King, since it takes time for new factories to open and power plants to get built. But, he said, data shows that low-carbon energy and transportation now make up fully 5 percent of total U.S. private investment.
“That’s a leading indicator that things are changing quickly,” he said.
Science
How to protect yourself from the smoke caused by L.A. wildfires
You don’t have to live close to a wildfire to be affected by its smoke. With severe winds fanning the fires in and around Pacific Palisades, the Pasadena foothills and Simi Valley, huge swaths of the Southland are contending with dangerous air quality.
Wildfire smoke can irritate your eyes, nose, throat and lungs. The soot may contain all kinds of dangerous pollutants, including some that may cause cancer. The tiniest particles in smoke can travel deep into your lungs or even enter your bloodstream.
Conditions like these aren’t good for anyone, but they’re particularly bad for people in vulnerable groups, including children, those with asthma or other respiratory conditions, people with heart disease and those who are pregnant.
Here’s what you should know to keep yourself safe.
Stay indoors
Minimize your exposure to unhealthy air by staying inside and keeping your doors and windows shut.
If you have a central heating and air conditioning system, you can keep your indoor air clean by turning it on and keeping it running. Make sure the fresh-air intake is closed so that you’re not drawing in outdoor air.
Keep your pets inside
They shouldn’t breathe the unhealthy air either.
Check your air filters
Clean filters work better than dirty ones, and high-efficiency filters work better than regular ones. The California Air Resources Board and the South Coast Air Quality Management District recommend filters with a MERV rating of 13 or higher.
You might consider using portable high-efficiency air cleaner in a room where you spend the most time. The U.S. Environmental Protection Agency has information about them here, and CARB has a list of certified cleaning devices here.
Don’t pollute your indoor air
That means no burning candles or incense. If your power is out and you need to see in the dark, you’re much better off with a flashlight or headlamp.
If you’re cold, bundle up. This is not the time to start a cozy fire in the fireplace. Don’t use a gas stove or wood-fired appliances, since these will make your indoor air quality worse, not better, the AQMD says.
The CDC also advises against vacuuming, since it can stir up dust and release fine particles into the air.
Take care when cleaning up
You don’t want your skin to come into contact with wildfire ash. That means you should wear long sleeves, pants, gloves, socks and shoes. The AQMD even wants you to wear goggles.
If you’re sweeping up ash outdoors, get a hose and mist it with water first. That will keep it from flying up in the air as you move it around. Once the ash is wet, sweep it up gently with a broom or mop. Bag it up in a plastic bag and throw it away.
It’s a good idea to wash your vehicles and outdoor toys if they’re covered in ash. Try not to send ashy water into storm drains. Direct the dirty water into ground areas instead, the AQMD advises.
Those with lung or heart problems should avoid clean-up activities.
Discard spoiled food…
If you lost power for a significant length of time, the food in your refrigerator or freezer may be spoiled.
Food kept in a fridge should stay safe for up to four hours if you’ve kept the door closed. If you’ve been without power for longer than that, you’ll need to toss all perishable items, including meat, poultry, fish, eggs, milk and cut fruits and vegetables. Anything with “an unusual smell, color, or texture” should be thrown out as well, according to the U.S. Centers for Disease and Control Prevention.
Refrigerated medicines should be OK unless the power was out for more than a day. Check the label to make sure.
…even if it was in the freezer
Your freezer may be in better shape, especially if it’s well-stocked. Items in a full freezer may be safe for up to 48 hours if it’s been kept shut, and a half-full freezer may be OK for up to 24 hours. (The frozen items help keep each other cold, so the more the better.)
If items have remained below 40 degrees Fahrenheit (4 degrees Celsius) or you can still see ice crystals in them, they may be OK to use or refreeze, according to the federal government’s food safety website.
Ice cream and frozen yogurt should be thrown out if the power goes out for any amount of time. Meat, poultry, seafood, eggs, milk and most other dairy products need to go if they were exposed to temperatures above 40 degrees F for two hours or longer. The same goes for frozen meals, casseroles, soups, stews and cakes, pies and pastries with custard or cheese fillings.
Fruit and fruit juices that have started to thaw can be refrozen unless they’ve started to get moldy, slimy or smell like yeast. Vegetables and vegetable juices should be discarded if they’ve been above 40 degrees F for six hours or more, even if they look and smell fine.
Breakfast items like waffles and bagels can be refrozen, as can breads, rolls, muffins and other baked goods without custard fillings.
Consider alternative shelter
If you’ve done everything you can but your eyes are still watering, you can’t stop coughing, or you just don’t feel well, seek alternative shelter where the air quality is better.
Hold off on vigorous exercise
Doing anything that would cause you to breathe in more deeply is a bad idea right now.
Mask up outdoors
If you need to be outside for an extended time, be sure to wear a high-quality mask. A surgical mask or cloth mask won’t cut it — health authorities agree that you should reach for an N95 or P-100 respirator with a tight seal.
Are young children at greater risk of wildfire smoke?
Very young children are especially vulnerable to the effects of wildfire smoke because their lungs are still rapidly developing. And because they breathe much faster than adults, they are taking in more toxic particulate matter relative to their tiny bodies, which can trigger inflammation, coughing and wheezing.
Any kind of air pollution can be dangerous to young children, but wildfire smoke is about 10 times as toxic for children compared to air pollution from burning fossil fuels, said Dr. Lisa Patel, clinical associate professor of pediatrics at Stanford Children’s Health. Young children with preexisting respiratory problems like asthma are at even greater risk.
Patel advises parents to keep their young children indoors as much as possible, create a safe room in their home with an air purifier, and try to avoid using gas stoves to avoid polluting the indoor air.
Children over the age of 2 should also wear a well-fitting KN95 mask if they will be outdoors for a long period of time. Infants and toddlers younger than that don’t need to mask up because it can be a suffocation risk, Patel said.
What are the risks for pregnant people?
Pregnant people should also take extra precautions around wildfire smoke, which can cross the placenta and affect a developing fetus. Studies have found that exposure to wildfire smoke during pregnancy can increase the risk of premature birth and low birth weight. Researchers have also linked the toxic chemicals in smoke with maternal health complications including hypertension and preeclampsia.
What about other high-risk populations?
Certain chronic diseases including asthma, chronic obstructive pulmonary disease or other respiratory conditions can also make you particularly vulnerable to wildfire smoke. People with heart disease, diabetes and chronic kidney disease should take extra care to breathe clean air, the CDC says. The tiny particles in wildfire smoke can aggravate existing health problems, and may make heart attacks or strokes more likely, CARB warns.
Get ready for the next emergency
Living in Southern California means another wildfire is coming sooner or later. To prepare for the bad air, you can:
- Stock up on disposable respirators, like N95 or P-100s.
- Have clean filters ready for your A/C system and change them out when things get smoky.
- Know how to check the air quality where you live and work. The AQMD has an interactive map that’s updated hourly. Just type in an address and it will zoom in on the location. You can also sign up to get air quality alerts by email or on your smartphone.
- Know where your fire extinguisher is and keep it handy.
- If you have a heart or lung condition, keep at least five days’ worth of medication on hand.
Times staff writer Karen Garcia contributed to this report.
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