Archive for the ‘philosophy’ Category

One day I looked out over the vineyards and I saw this cloud formation. It looked like a tornado, but it wasn’t.

Now that I see it again, as a photo, I realise that this particular view, due to the phenomenon of perspective, makes this band of cloud look cone shaped.

But it wasn’t cone shaped. It was a band of dark cloud, like a wide path, moving across the sky.

That got me thinking about the whole phenomenon of how things appear to us….how everything has a distinct shape, or form, or looks patterned in a particular way….but that is always informed, or even, determined, by where we are standing….we the observers.

I think we tend to forget about that. Especially with social media where echo chambers are created as the algorithms push similar viewpoints and opinions towards us.

The truth is that we humans see reality most clearly when we share perspectives and communicate them without judging them.

We would all benefit from more diversity in science, in education, in health care, in government. Multidisciplinary and rich, inclusive teams, groups and communities offer us the chance to see the world as it really is….not just the way we are used to seeing it from only our own viewpoints.

After all, there’s a huge difference between a band of cloud, and a tornado!

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In the midst of this pandemic many people are beginning to despair. People are asking questions like “Is this the new normal?”, or “Is it always going to be this way now?”

My hunch is…in response to both these questions….no.

Sure, as we look ahead it can seem like we see more of the same as far as we can see. We humans are great at spotting patterns, but we’re often not so great at letting go of them.

We turn repetitions into habits and rituals. Habits into ruts. Rituals into blinkers. We see the future as being full of what we are seeing in the present. And, maybe, in many cases things can seem like this. But the truth is these repetitions, these habits, these already noticed and entrenched patterns are never permanent.

In the history of the planet there hasn’t been an epidemic, or a pandemic, which didn’t go away. I’m not saying the coronavirus will go away, but like pretty much every other bug, it’ll settle in at a lower level. The pandemic will give way to background presence with outbreaks and flares…much the same way as influenza, colds, and even serious diseases like Ebola. Look what’s happened with HIV? Aids hasn’t gone away but learning how to minimise its spread and discovering better ways to treat it has transformed the part it plays in the world now.

So, I remain optimistic, even if there are days when I’m feeling quite despairing. Who knows how long it will be till it all quietens down, and who knows just what the “new normal” will look like when that time comes?

We just have to be wary of getting stuck into the thought patterns which blind us to the nature of Life – a complex, emergent phenomena which is constantly changing and developing, going ways it’s never gone before.

Life is adaptive and creative. It never just keeps on behaving the way it always used to.

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We make sense of the world holistically. It might not seem like that sometimes, but, even when we put on blinkers, turn abstraction up to the max, and go all in on reductionism, ultimately, reality leaps up and let’s us know…..there’s something else you need to consider here.

There is always something else.

Knowledge is never complete. Truth is never fully known. Understanding is never full.

I love this photo of a crystal because you can see how the sphere contains a multiple of facets, and you can see that through each facet you can see the others. I think reality is like this. Multifaceted, multidimensional, massively interconnected. There are no clear beginnings, no clear endings, nothing is entirely separate and detached, nothing is closed. Life is an “open system” of continuous flow and change, unceasingly responsive and adaptive to environments, contexts and signals.

Human beings are relational, social creatures. None of us live in isolation. We find our uniqueness in our complex webs of relationships, memories, experiences and imaginings. There isn’t a single facet, or aspect, or characteristic, or feature which makes us unique. Our uniqueness is found in our connections.

And so, this is how we make sense of the world – through pattern spotting and recognition, through images, words, myths and symbols, through abstraction and reflection, and synthesis and integration.

Sense making is holistic.

I think that realisation should keep us humble. It should remind us that none of us ever know all there is to know about anyone or anything.

A couple of the most common things patients said to me at the end of a consultation were “I’ve never told a single other person what I’ve just told you”, and, “You know me better now than anyone else does”. And I understood what they meant…..that they had revealed an important, powerful secret, or memory, which they had felt unable to reveal to anyone else, and the revelation was enlightening……or that they felt they had been heard, understood, even known better than ever before. Yet, I would think “Well, how much life have you and I shared through these consultations? (whether this was the first consultation or the tenth one) And how big a proportion of your whole life do those few hours represent?” Because even when I felt we’d achieved a new, and deeper, level of understanding, I still knew that I only knew a little part of this person’s life.

There is always more to know.

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We humans have invented incredible cultural tools which help us to make sense of the world, to bring about changes, to create connections, and to express ourselves. Alphabets, language, words, symbols and art are some of the ones I’ve written about over the last few days, but there is another class of cultural tool entirely – numbers.

We love to make measurements. Well, some of us love it more than others I suspect, but how often do you hear questions such as “How big is it?” “How heavy is it?” “How long is it?” and so on…..?

I can see the point of favouring measurements when it comes to building and maintaining houses and machines, but I find them partial, or even distracting once we try to apply them to non-physical, invisible phenomena…..like subjective experience, qualities and time.

This photo is of an astonishingly beautiful, elaborate clock. Have you ever stopped to wonder about this idea of measuring time? It’s a complete invention because time isn’t a phenomenon which can be measured. We arbitrarily agreed to divide the day into small pieces, 24 hours, each of 60 minutes, which each has 60 seconds. But why those figures? Why those “units of time”? Other creatures deal with time without making measurements which produce figures. They deal with the natural periods of time, from sunrise to sunset, sunset to sunrise, from one solstice to another, from one equinox to another. They live according to the rhythms of Nature’s cycles and the rotations of the Earth, both on its own axis, and in its orbit around the Sun. They live according to the rhythms of the Life in each of their cells. We do too, but we stand apart from all that, or at least we try to, and we impose a human invention instead – measured time.

The thing about measured time is it can’t tell you anything about the quality of the time. It can’t tell you the difference between a “good time” and a “bad time”. It can’t tell you about the “best time of my life” or the “worst time of my life”. It can’t tell you about the experience of “passing the time”, “wasting time”, or “saving time”. It’s not enough to measure the number of minutes a consultation lasts, you have to know what the doctor and patient are doing and experiencing during that consultation.

I heard a story once. It was told to me by a dentist who was running a Facial Pain Clinic. He said he’d taken the clinic over from the colleague who had created it, once that colleague retired. He told me about his first day in the clinic. When the first patient came in, he introduced himself, asked the patient how they were and they replied “14”. He was a bit puzzled but let it pass and carried on with the rest of the consultation. The next patient did the same strange thing, telling him “9” before telling him anything else. When it happened with the third patient he asked the nursing staff if they knew what was going on. Oh, yes, he was told, the previous colleague had invented a numerical scale of pain severity, from 0 to 20. He trained all the patients to tell him what number they were applying to their level of pain each time they came for a check up. He was a pretty intimidating and demanding man and the nurse said that if a patient started by telling them what had been happening in their life since the last visit, he’d say “Stop! I want the next thing to come out of your mouth to be a number!” They all learned to comply!

Well there’s a whole movement within Medicine to try to quantify qualitative phenomena – ie symptoms, like pain, dizziness, nausea and so on, symptoms which can’t be “seen” or “measured” in any other way.

What do you think of that?

Both of these examples, the measurement of time, and the measurement of pain, highlight an important division in our values – do we pay more attention to numbers, to what can be measured, or to which we can invent and apply artificial measures? Or do we pay more attention to the lived experience? That is, do we favour the quantitative over the qualitative or vice versa?

I find some people fall into the former camp, whilst others fall into the latter. You know what I’m going to say, don’t you? “And not or”! I think both can be helpful. It depends on context. If we are dealing with machines, I can see that the quantitative approach is really helpful…..if we are dealing with human beings…..not so much! By that, I don’t mean there is no point in measuring somebody’s blood pressure, checking their haemoglobin levels, etc. I just mean the numbers are never enough. They always, and, yes, I believe that’s the right word, always, need to be put into the context of this individual, unique human being’s life……and we do that by paying attention to the qualitative.

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“Words were originally magic”

Have you ever read that sentence before? It was coined by Freud in 1915, and used by Steve de Shazer as the title of his book about his “solution focussed approach” to brief psychotherapy.

Do you think writing “freedom” repeatedly over the front of this office block works some magic? Who decided to write this in this particular place? Were they being ironic? Pointing to the fact that offices are actually soul-less, regimented places of control….the antithesis of freedom? Or were they trying to cast a spell….to make people feel more free by presenting the word to them?

I don’t know. I don’t know the history of this office block in Malmo.

We are told we now live in a world of “post truth” where words are used to confuse, misdirect, obscure, lie and evade…..where words are used to persuade and manipulate……where words are propaganda….ways to influence and control whole populations one three word slogan at a time. “Take back control”, “Get Brexit done”, “Build, build, build”………

Well it seems that words are losing their magical power when they are used so cynically and when they aren’t backed up with actions. But still, they work a magic over millions of people who voluntarily give up their freedoms and quality of life for the sake of a privileged few (just as Montaigne’s friend, √Čtienne de La Bo√©tie, described in “Discourse on Voluntary Servitude” back in 1577)….inequalities are increasing massively, wealth and power is becoming ever more concentrated while “strong men” narcissists bewitch large numbers of people into supporting them.

Ok, political rant over! Back to health care….my specialist subject! As a doctor you have to be really careful about the words you use. Telling someone they have X months to live can become a self-fulfilling spell. People give up, or gain hope, depending on the words the doctor uses….and how they use them (by which I mean the contexts in which they use them, and whether or not they are used within already established relationships of trust). In a good consultation the doctor is on the alert for specific words which the patients might use, words which might hold the key to both diagnosis and prognosis. Which words does the doctor pick up on, and ask you to say more about?

We have to be especially careful of using words as labels…..such labels can put people into boxes. It’s a danger in health care, but also in wider society….the fast track path to prejudice and injustice.

Words are still magic. They still have enormous power. It’s worthwhile staying aware of that……

Be a hero, not a zombie!

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Here’s Hermes in Copenhagen. He gets around. I wonder if he is one of the most commonly represented gods from Greek mythology? Probably you’re more likely to encounter him in Europe! Hermes, the Greek god, was known as Mercury to the Romans, who also associated him with the Germanic god, Odin. He’s a complex god with layers and layers of meanings which human beings have attributed to him through their stories and myths.

He’s maybe best known as the Messenger God – able to cross boundaries and connect the conscious to the unconsciousness worlds, the living world and the underworld of the dead, the physical world to the spirit world.

But he’s also known as a God of Fertility, a Protector of shepherds, thieves and tricksters. A great orator or communicator, who helps to persuade people. But also a healing god.

The symbol of healing – the staff with the entwined snake, is doubled in Hermes hand, to have two snakes entwined with each other, but people often mix those two symbols up and use the “hermetic” one, the caduceus, when they mean the symbol of healing, “the rod of Asclepius“, which only had one snake, and no wings! But I think this just shows how fluid and changeable symbols can be.

I wonder what people intend when they place a statue of Hermes in the middle of a city like this? Is there a hope that the inhabitants will see it and think of communication, connections and healing? Is he there as a reminder that there is more to life than the physical, conscious world reveals?

Does he do anything for you? Would you like to have his image somewhere in your personal environment to help you make sense of the world?

I’ve just picked Hermes here as an example. If you look around I’m pretty sure you’ll come across other characters from stories in your environment and in your daily life……maybe characters from myths, religious texts, folklore….or maybe more modern characters from literature and art. Here’s my challenge – see how many you can spot in your own life this week. Note them down, find out about them, and see what comes up for you.

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One of the unique ways we humans make sense of the world is through art, particularly through visual art. There are many examples of cave wall art in France, although, so far, the only one I’ve visited personally is Lascaux. Those prehistoric paintings are astonishing. Nobody really knows why the people who created them exerted such an immense amount of time and energy into painting them. Mostly, they are drawings of the animals which lived in that part of the world. But why spend hours underground painting the images of them, using only basic candle light to show them what they were doing?

There’s something about making images, making likenesses, which is a kind of magic. The images change our experience of time and place. They are a way for human beings to deepen their lives, to imbue them with more mystery, more beauty, more delight, more meaning….

Living with images, created works of art, changes our lives. That’s partly why we like them, why we enjoy them, why we support the activities of these artists.

This photo is of a mural I spotted in Malmo three years ago. It’s by a South African street artist, “Faith 47”. I don’t know anything about this artist, or this particular work of art, and, probably, most people who see this haven’t read anything about it. It works as itself. It works as an image.

So, what do you see here? What I notice first, is the main subject, the woman with the long dark hair. She’s wearing robes, holding a lit candle on a candle stick, and she’s gazing down, as if in contemplation. This evokes a sense of Spirit, doesn’t it? In fact, the way she is holding the candle is quite unusual….open palmed, with the palm turned upwards….isn’t it just as we see in some statues of the Buddha? Well, it seems like that to me. It’s a gesture which is “not grasping”, not holding onto, not clinging….a gesture of non-attachment, of waiting to receive whatever is offered, of openness. In her other hand she has a string of beads. Strings of beads like this continue the theme of Spirit, with both Buddhist and Christian traditions containing the use of beads in relation to prayer. Maybe other religions do that too, I don’t know. But hanging around her left arm is also a chain with an “ankh” symbol attached to it….the ancient Egyptian symbol for “Life”.

Up above the main figure is the symbol of “Alpha and Omega”, a traditional symbol of God and Christ. Then behind the main subject there appears to be a kind of work in progress…..overlapping circles. The overlapping circles I know best are the ones used in the “Seed of Life”, and the “Flower of Life”. Overlapping circles like this have been used in a huge number of different cultures and traditions…if you’d like to read more about them, check out this article.

Two overlapping circles are often representative of a union of opposites, of the masculine and the feminine, of heaven and earth, of spirit and body. I like that this one isn’t complete. That evokes the Japanese preference for the “unfinished”, which is related to the issue of transience and beauty….leaving the observer to “complete” the image for themselves.

Well, there you have it. This single image evokes Spirit in human culture and tradition for me. It evokes the union of opposites, or, as I would prefer – integration…..the creation of mutually beneficial bonds between well-differentiated parts! It evokes the Spirit of the Divine Feminine for me too. It’s a peaceful, contemplative image which stops you in your tracks and takes you both deeper and higher at once, puts you in touch with meaning and purpose in the busy ordinary day.

How about you? How do you find this image? If you were to pass it as you walked through the city, don’t you think it could make your day a bit different?

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I’ve had a couple of days thinking about beginnings, so it seemed kind of obvious to have one about endings!

This photo shows a number of berries, all part of the same plant, even the same part of the same plant, but each in a different stage of maturation. Some are still green, some have turned yellow, some red, and some are even beginning to get wrinkled (like me, ha! ha!) and so appear the most mature.

When I think about beginnings, I realise that they are all pretty arbitrary – a beginning is where we begin – if you pick a thread or two you’ll always find your way back to an earlier beginning.

I don’t think that means there are no beginnings. I think there are. All the time. Every day. Every moment of every day. There are beginnings. There are phenomena and experiences which have only this moment come into being for the first time ever. It’s pretty great to notice that.

Endings have exactly the same quality. It’s not that there aren’t any. There are endings all the time. Every day. Every moment of every day. There are endings. There are phenomena and experiences which have only this moment slipped into the past. You’ll never have them again. It’s pretty great to notice that.

Outcomes, targets and goals

In Medicine, there is a lot of focus on “outcomes”, sometimes called “clinical outcomes”, which, somehow are a bit different from “patient reported outcomes” (“PROMS”). These are all endings. They are points to be reached. Measurements to be attained, or ratings to be completed. But when your working life is that of a family doctor, (a “GP”), then you’re never done with outcomes. The patients don’t reach the intended outcomes then go away. Life, it turns out, goes on. What was an ending today, turns out to be just another chapter in an ongoing story, just another time and place sensitive reading in the midst of a flow of a whole life.

Oh, yes, you’ll say, but there is one outcome which isn’t like that isn’t there? Death. The final outcome. The ultimate ending. Except it’s not really, is it? Well, it is for the physical body of the person who has died, but we are more than physical bodies aren’t we? We are experiences, stories, events and memories, aren’t we? And those continue long after the physical body has gone. Are the people you loved who are no longer alive completely gone from your life? I don’t think so. Their life continues to influence our lives. The experiences we shared, the memories we made, whatever we created together, the stories told, the photographs taken, the objects held…….

Have you ever seen a BBC TV programme called “The Repair Shop”? I love it. People bring old objects to a workshop of artisans. The old objects are usually in a poor state of repair, but they mean something to the person who has them. Once restored by the craftsmen and women, the person comes back to reclaim the object, and time and time again, it is an immensely emotional experience. They are put in touch, deeply, and significantly with a loved one, long gone. It’s lovely to watch and it shows how a person, an individual, continues to influence others long after they’ve gone. How their “presence” I suppose you could say, is made more real through what they’ve touched, what they’ve handled, what they played with, or made.

Targets are a kind of outcome. They are useful as ways of getting you to somewhere you want to get. For example if you want to save up a certain amount of money then setting a target of that amount is a good aid to getting there. The trouble is that targets are used inappropriately. Whose targets are they? And are they the same, most important targets, which others want to achieve? Because the selection of targets is an individual, value-based, subjective, exercise of choice. But if they are set for others then they direct the efforts and lives of others towards those targets instead of others. I’m not a fan of targets. At least, not ones I don’t have a say in the creation of!

Goals are a bit like targets. I’d say the same about them. They can be helpful to get us to places we want to get to. But they are aspirations, not predictions. And they are not endings. Or at least, they are not final endings. Are they?

I think this unique and unpredicted pandemic is forcing us to face up to the reality of beginnings and endings. It’s making us more aware of connections, of webs of influence, of the non-linear, multifactorial, dynamic, ever flowing, ever changing nature of reality.

This morning I read an article in Le Monde about how management methods are already starting to change in the light of this experience. Here’s the main point I got in that article – management is having to move away from “control” to “coaching”. Three things have come to the fore – the need for individual autonomy, the need for good team working and relationships between workers, and the need for transparency.

Well that all seems pretty good to me! I look forward to seeing the end of de-humanising “Taylorism” and “command and control”, and the beginning of an emphasis of autonomy, relationships and transparency. Imagine if we governed countries according to those principles?!

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Here in Europe the school year is starting and for most children they haven’t been to school since about March or April because of this pandemic. Although we know now that children under the age of 14 seem to be almost unaffected by COVID-19 there is a lot of anxiety about children spreading the virus through the community, and, perhaps more specifically, to the adults who work in the schools. So each country has been making cautious preparations for the re-opening of its schools, looking at everything from cleaning regimes, the use of hand gels and masks, and the way children spend their time in the school buildings.

Out of all this, at least in the UK, has emerged a concept of “bubbles”. The idea is to have children spend most of their school day with a small group of other children and teachers…..often much smaller than a regular class size. The same concept of “bubbles” has also been used for the wider community in the UK, with lockdown rules easing gradually to allow slightly more people to interact on a daily basis – two households meeting up, then three perhaps; limitations to the number of people who can gather in any one place but allowing particular groups or families to meet up and spend regular time together.

I think it’s an interesting idea. And, as this photo shows, a potentially beautiful one. This photo is of breaking waves on a beach in Western France where the land meets the Atlantic. The bubbles forming in the surf are just gorgeous, aren’t they?

It strikes me that this bubbles idea highlights a major issue for our societies and the way we organise our daily lives. It’s the issue of size. Mass gatherings, mass transport, mass tourism, have been shown to be amongst the most vulnerable points for us…..the circumstances which lead to most infections. The social distancing measures that each country has brought in have been based on the understanding that the more you keep people together in closed spaces the more the disease spreads.

So now we are seeing a huge increase in “home working”, and, it would seem, a large number of people find they actually prefer that to spending time every day packed onto buses or trains with hundreds of strangers, then working all day in the shared spaces of offices. People are learning to live locally, enjoying their local parks, shops, cafes etc now, instead of traveling long distances to share time with masses of strangers in huge workplaces, shopping centres and so on.

I’ve decided to re-read a book which made a huge impact on me when I young – “Small is Beautiful” by E F Schumacher. It’ll be interesting to revisit it in the light of what we’ve learned since it was written in 1974, and in the light of our experience of this pandemic. What I remember of the book is the key point that big is not best…..that we should try to create societies at human scales instead of around mass production and mass consumption.

Maybe the “new normal” will involve a lot less “mass” anything – maybe we will move towards a more human scale everywhere, overturning the industrialised principles of the last century to abandon so called “efficiencies of scale” (which have probably only ever been useful in the manufacture and delivery of products). Maybe we will start to create smaller schools, smaller classes, smaller hospitals, smaller communities. Maybe we will move towards more diversity and less uniformity.

We are more able to do that now. We now understand that complex systems are like vast interconnected networks of nodes and links. We know that the most robust and most resilient systems are diverse and adaptable. We know that distributed power and responsibility produces more sustainable systems and organisations than hierarchical, command and control, massively scaled ones.

Integration is the creation of mutually beneficial bonds between well differentiated parts. It’s how the body works. Not with a command centre, but with interconnected, responsive, open networks. It’s how Nature works, through inter-dependent, diverse elements within ecosystems.

Is this our model for a “new normal”?

Human scale. Small. Diverse, open and healthily inter-connected? Can we see a future way to live in this beautiful image of bubbles?

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Yesterday I wrote about new beginnings, about choosing what and when to start, but I’ve been thinking about it since then and I realise beginnings are paradoxical. They are both easy to find and impossible to find. Why do I say that?

Well they are easy to find because every action, every thought, every experience is, in fact, brand new. Life moves and flows continuously. This present moment has never existed before, not for you, not for anyone you know, not for the planet, not for the universe. So every present moment is a beginning (and, yes, it’s an ending too, because no experiences are exactly repeatable)

They are also impossible to find because everything is connected. We human beings are “complex adaptive systems”. That is we are massively interconnected, both in our own being, and in our contexts, relationships and environments. We are “open systems”. That is there are no impermeable barriers between an individual and the rest of the universe. The atoms, molecules and cells which make up our bodies are changing all the time, as we breathe in, ingest and absorb new materials, and breathe out, expel and excrete other ones. Energy and information flow into and through us continuously.

So what? Well, all this means it can be very hard to trace back from now to a “start point”, or a “beginning”. For example, when a patient would come to see me and complain about a particular problem, and I diagnosed a certain disease, where did that disease start? With the first symptom? With the first symptom which was troublesome? With the pre-conditions before the first symptom began? I was taught to explore a patient’s “past history” to see how this illness might fit in the trajectory of their life. I was taught to explore their “family history” to see if there were family patterns or dispositions. I was taught to explore their “social history” to find out what was happening in their work and social life. I could go on……

A beginning is pretty much arbitrary. It’s where we choose to begin. Think how you would tell your life story to another person. What would you say first?

As I progressed in my work experience I changed my introductory question to each patient, from something like “What’s the problem?”, or “How can I help you?” to “Tell me your story”.

Yep, “tell me your story”. Sometimes a patient would be a bit taken aback with that beginning, but I’d just maintain eye contact, show I was listening and wait. Sometimes I’d have to say a little more to get things going, for example to explain that I wanted to understand what they were experiencing and how it might have come about so I’d like them to just tell me about it in their own way, but usually, people would just start to speak.

Where a person chose to start, and how they told their unique story, was always interesting and relevant. As the consultation progressed I’d often ask another question “When did you last feel completely well?” This was a particularly useful question to be followed up with “Tell me about the weeks and months leading up to that time”.

Those were beginnings. Different beginnings. All useful and all relevant.

I came across this photo of the seed head of a poppy the other day and it’s so beautiful that I just decided I’d like to share it with you. How does it fit with today’s thoughts about beginnings? Well, all plants live cyclical lives, with phases passing through seed, germination, growth, perhaps blossoming or fruiting, and scattering the new seed before dying back for the next cycle. Does the beginning of that cycle start with the seed in the ground, or the seed in the seed head waiting to be dispersed? Or somewhere else?

So, back to beginnings. Whatever you want to begin, begin today. Even if its a habit, a routine, a task you’ve experienced before and stopped, because even when you stop, you can start again. You can start today. After all, you’ve never lived this day before.

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