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Demings 14 Principles
Background
Recent changes in regulatory
requirements for clinical trials pose
considerable challenges for the clinical
research community. The clinical research
Quality Assurance (QA) profession as a whole
has not historically utilised quality management
tools, and QA professionals may have little to
no formal training in continuous improvement
methods, to be aware of their value in assessing
and improving the impact and value of the QA
department to any organisation. This article will
present Demings 14 Principles for Management,
paraphrasing them to demonstrate how easily they
can apply to the clinical trial project management,
Contract Research Organisation (CRO) and clinical
department management.
Demings 14 Principles
Dr. William Edwards Deming is known as the father of the
Japanese post-war industrial revival and was regarded by
many as the leading quality guru in the United States.
Deming created 14 Principles for Management that
summarised his business philosophy. The principles became
a basis for transformation of industry. The 14 principles apply
anywhere, from small organisations to large ones, to the
service industry as well as to manufacturing. They apply to
any division within a company.
Feature
5. Improve Constantly and Forever
Quality starts with the intent of management. Management is
obligated to continually look for ways to improve quality.
First of all, teamwork in clinical trial project planning is
fundamental. Second, we must remember that chronic
problems have chronic causes. Treating the symptoms does not
solve the problem. Putting out fires is not improvement of the
process. Improvement efforts must shift focus from improving the
personnel to improving the processes.
We must identify the systemic policies, practices, belief systems
etc. that are dysfunctional and change them. As long as these
systemic causes remain, the resulting systemic problems will
remain. One of the most efficient tools to reveal the causes
is quality audit followed by corrective actions that include
investigation, a.k.a. root cause analysis. Clinical trial audits and
system audits may open our eyes and indicate the process
deficiencies and flaws. Appropriate handling of the latest will
inevitably lead to improvement.
6. Institute Training
If people are inadequately trained, they will not all work the same
way, and this will introduce variation.
In our business, every new project calls for study specific training,
even when very experienced personnel are involved, both
in-house and at site. The more we invest in the development
of an extensive and comprehensive training programme, the
more field, office and site staff are trained, training effectiveness
evaluated and re-training carried out when the need is
identified, the more uniformity in results, meaning statistically we
will achieve valid clinical data.
Management must remove the inhibitors to good work and
provide the setting where workers can be successful.
7. Institute Leadership
Deming makes a distinction between leadership and mere
supervision.
First of all managers, or should we say leaders, must know the
work they supervise. That will assist them to know the difference
between special and common cause of variation, or in other
words to distinguish between a mere mistake and a weakness of
a process.
CRA Managers or Study Managers are not policemen, neither
are QA personnel. We all have a common goal to complete our
clinical trial in time, at the lowest possible cost, with scientifically
valid results, while strengthening the relationships with
investigators and subcontractors/clients. Its everyones job and
everyones responsibility. When the management message, not
verbal but though action devoted to quality, it will make its way
to the field personnel, also reaching to the sites staff.
Feature
12 Quasar
Author Biog
13. Institute Education and Self-improvement
Invest in the education of your work forces (including sub-contractors), encourage
self-education and introduce training programmes, worship knowledge and
professionalism. This is the only recipe for commitment to lifelong employment and
business success.
As the CRA (that does not necessarily have a clinical background) aquires more
knowledge, of the therapeutic area of the study protocol, the better the CRO
team is trained on the internal sponsors processes (SOPs, internal communication
lines, etc.), as the site staff have more understanding in regulations, the more study
management is educated in the topics like teamwork, statistical techniques, risk
management, project management and, of course, quality tools, the more chances
that our mission - to complete our clinical trial in time, at the lowest possible cost,
with scientifically valid results while strengthening the relationships with investigators
and sub-contractors/clients will be successfully accomplished.
Summary
Deming preached that to achieve the highest level of performance requires
more than a good philosophy the organisation must change its behaviour and
adopt new ways of doing business. Indeed, his 14 Principles pose a challenge for
many companies to figure out how to apply them in a meaningful way; however
CRO or clinical departments will benefit immeasurably by finding this way and
implementation of the principles in the management practice.
Rita Gabay
Rita is currently owner and manager of QA INSIGHT
- a company providing independent QA, GCP and
ISO 13845 consultancy and audit services.
With a clinical background, and a MSc in Quality
Assurance and Reliability, Rita has over 20
years of experience in marketing, Clinical Quality
Assurance, and management of Quality Systems
compliant with ISO 9001:2008 and 13485:2003.
She served as QA Manager and Auditor in
pharmaceutical, medical devices and in-vitro
diagnostic companies.
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14
Institute training
Adopt and institute leadership
Quasar 13
INTRODUCTION
JURANS CONTRIBUTIONS TO
QUALITY MANAGEMENT
Although his 1945 book discussed management
issues, Jurans serious entry into the field of quality
management was the publication in 1951 of the first
edition of the Quality Control Handbook. This seminal book, edited by Juran with numerous chapters
written by him, propelled Juran to the forefront of
the field and caught the attention of Japanese industrialists. Although there is a clear evolution and maturing of the field over the years, the combined content
of the five editions of the Juran Quality Handbook
(Juran, 1962; 1947; 1988b) issued roughly every 10
years since 1951 constitute an essential source for
Jurans thinking about quality management and for
the entire field. All five editions are significantly different. Each contains different materials. All are worthwhile reviewing. As indicated above, Juran did not
write everything himself. However, he supposedly
exercised strong editorial control and was very
S. Bisgaard
Economic Model
Jurans definition of quality and the two subsidiary
definitions as features and deficiencies provide the
basis for understanding the business economics of
quality. Typically, improving (design) quality in
terms of features will increase the cost of producing
a product or service. However, it will also allow the
company to charge a higher price and may increase
sales volume. In accounting parlance, added or
improved features have a beneficial top-line effect.
On the other hand, improving (delivery) quality by
reducing the number of errors and deficiencies will
usually dramatically reduce costs. Thus, it has a
(c) cost reduction. In generic terms, these three functions are concerned with (a) planning, (b) control,
and (c) improvement. Juran suggested that quality
management likewise should be organized into three
equally important functions, (a) quality planning, (b)
quality control, and (c) quality improvement. Table 1,
based on Juran (1989) but adapted and modified,
outlines the tasks and responsibilities of these three
functions.
It may seem logical to implement quality planning
before engaging in quality control and quality
improvement. However, Juran suggested that it is
more pragmatic to start with quality improvement.
Any existing organization will be able to make substantial improvements right away with a small
upfront investment. This will help establish quick
wins and early employee buy-in. This is psychologically important for any change management program; see Kotter (1995). Nevertheless, we discuss
below Jurans Trilogy in the logical order of
planning, control, and improvement.
Quality Planning
To stay competitive, we must do more than just
remove deficiencies. We must develop new products
and services with new features that appeal to an
evolving customer taste and continue to be better
than the competitors offerings. Moreover, we must
do so without repeating the mistakes of the past
and without designing deficiencies into the product
(i.e., a product can also be a service or process).
Juran motivated this, by the analogy of an alligator
hatchery. If we are up to our waist in alligators, it
is not enough to kill the alligators around us. We
must also go after the production of new alligators,
the alligator hatchery. In other words, at the product
design stage we must proactively try to prevent the
need for subsequent quality improvement.
Quality planning is the process of preparing the
launch of new competitive products, services, and
processes that meet customers needs and expectations, minimize product and service dissatisfaction,
avoid costly deficiencies, optimize company performance, and provide participation from those
affected by the product or service. Quality planning
is essentially a marriage of the traditional marketing
function with the research and development or
engineering design function assisted by the quality
Quality Management and Jurans Legacy
TABLE 1 The Juran Trilogy Consisting of the Three Functions of Quality Planning, Quality Control and Quality Improvement. This Table
is Based on Juran (1989, p. 22) but Modified and Adapted
Quality management: Jurans Trilogy
Quality planning
Determine who the customers are;
classify customer segments
Determine what the needs of each
customer segment are
Design products with features and
specifications that satisfy the needs
of the customer segments
Develop products and processes that are
capable of delivering the product or
service
Develop metrics and control mechanisms
for monitoring and control
Provide training in the delivery processes
Quality control
Planning for control:
Develop an understanding of
what needs to be controlled
relative to customer needs
Develop a process flow diagram
Choose what and where to
control; control points
Establish measures
Establish goals and standards of
performance
Executing control:
Evaluate actual outcomes
Compare actual outcome to goals
Take action on the difference
function to provide tools, formal standards, measurements, and data on performance. In this view, Juran
is even today at the cutting edge if not ahead of modern thinking relative to innovation and commercialization of new products; see, for example, Kotler
(2003).
Typically, quality planning involves developing
new or updating existing products to meet evolving
market demands or take advantage of new or emerging technologies. Table 1 as well as Figure 3 summarize the steps of the quality planning processes.
Quality improvement
Establish infrastructure for
improvement
Identify improvement projects
Establish improvement teams
Provide teams with resources,
training, and motivation:
Diagnose root causes
Find remedies; improve
Establish controls to institutionalize
and hold on to the gains
Disband the team
Quality planning starts with establishing a team project. Next, the cross-functional team needs to identify
the customers, discover the customers needs,
develop the product or service, develop the process
for the delivery of the product or service, develop
the controls, and transfer to operations. Upper
management must take responsibility for initiating,
supporting, provide resources and monitor the
quality planning process.
397
have the authority to change. Hence, systems problems should be the responsibility of upper management, not lower level workers. Anything else is
unfair, unreasonable, and counterproductive; see
Deming (1986).
Quality Improvement
We now consider Jurans insight to how to organize and implement quality improvement. In Juran
(1993), he explained how he personally came to realize that quality control without quality improvement
was ineffective, if not futile. He related the story
about a Western Electric production process of a certain circuit breaker produced in large volume where
the defect rate was 15%. A statistical investigation
revealed that the copper wire exhibited excessive
variability from coil to coil, causing many out of spec
products. A remedy was subsequently developed to
compensate for the excessive variability. Eventually
this problem was permanently removed and the
defect rate reduced virtually to zero. Thus, rather
than a chronic waste of 15% of labor cost, materials,
and costly inspection, the cost of poor quality was
essentially permanently eliminated. Guided by this
watershed experience, in 1954 Juran explained to
Japanese executives that if they were serious about
quality, they should not just rely on inspection and
quality control. Rather, they should aggressively
pursue a strategy of quality improvement by
permanently removing chronic problems and waste.
Such a strategy would have an extraordinary return
on the investment, he promised. However, it would
require the executives to be involved, make quality
a strategic issue, break down barriers between
departments, and make quality a company-wide
effort.
It is likely that Juran was not the first to
recognize that quality improvement needs to be
done via special projects. However, his declaration
that Quality is improved project-by-project and in
no other way sums up his point. He has more
succinctly than anyone formulated the basic principles for how to implement and organize for quality
improvement.
Juran outlined a universal roadmap for quality
improvement that is analogous to detective work.
The initial steps are first to gather information on
needs, for example, on a cost-of-poor-quality basis,
S. Bisgaard
Terminology
A more subtle but important contribution to quality management is Jurans work on definitions and
terminology. Any scientific field requires its own
precise and well-defined terminology. Terminology
and definitions are fundamental to any science. Without it, confusion prevails. For example, a lay person
will not be particularly careful about using heat
and temperature synonymously. However, a
well-trained physicist, chemist, or engineer would
be abhorred. For them these terms have precise
and very different meanings.
In the honorable scientific tradition of the French
chemist Lavoisier and the English physicist Faraday,
Juran recognized that for the nascent science of
quality management to become on a sound footing,
he needed to develop terms and define new concepts. For example, as we already alluded to Juran
pointed out that cost of quality was an ambiguous
term. The cost-of-quality concept is too confusing
and difficult to narrow down. It fails to distinguish
between the cost of providing quality features and
the cost of deficiencies. Cost of poor quality, on the
other hand, can be precisely defined as the sum of
all costs that will disappear if the deficiencies are
removed.
399
CONCLUSION: AN APPRECIATION OF
JURANS IMPACT NOW AND IN THE
FUTURE
According to the economist Schumpeter (1950),
in a free market, economic reality is distinguished
by competition from new commodities, new
technologies, new sources of supply, new types of
organizationcompetition that commands a decisive cost or quality advantage. Innovation-based
competition is extremely effective and strikes not
at the margins of existing firms but at their foundations and threatens their survival. New innovations
render older innovations obsolete. Schumpeter
(1950) referred to this as the perennial gale of
creative destruction.
Quality is about innovationinnovation of better
products, better services, better processes, and better
organizational structures. We used to think of quality
as only related to deficiencies and only related to
production floor problems. Modern quality management defines quality more broadly as fitness for
use with the subsidiary meaning of features and
deficiencies. This expanded definition puts the customer front and center and implies the need for
developing innovative ways to retain existing and
attract new customers with competitive market offerings. Improvements aimed at eliminating chronic
sources of deficiencies from products and processes
are innovations that reduce cost and improve our
competitive position. But we cannot only rely on
reducing deficiencies. We must also compete on product innovations that involve new featuresdesign
and develop new products or services that provide
better value to the customersmarket offerings that
better solve the customers problems. Juran (1989)
called the process of innovating new market offerings quality planning. In Six Sigma terminology
this is called Design for Six Sigma (DFSS), but the
Quality Management and Jurans Legacy
ACKNOWLEDGMENTS
The author thanks Professor Xavier Tort and two
anonymous referees for very useful comments that
helped improve this article. The work on this article
400
was supported by the Isenberg Program for Technology Management, the Isenberg School of
Management, University of Massachusetts Amherst.
REFERENCES
Bisgaard, S., Freiesleben, J. (2004). Six Sigma and the bottom line. Quality
Progress, 37(9):5762.
Campanella, J., Ed. (1990). Principles of Quality Costs, 2nd ed.
Milwaukee, WI: ASQC Quality Press.
Crosby, P. B. (1980). Quality Is Free. New York: Penguin.
Deming, W. E. (1986). Out of the Crisis. Cambridge, MA: MIT Center for
Advanced Educational Services.
Drucker, P. F. (1974). Management: Task, Responsibilities and Practices.
New York: Harper & Row, Publishers.
Feigenbaum, A. V. (1951). Total Quality Control. New York: McGraw-Hill.
401
TOTAL
QUALITY
CONTROL
By Armand V. Feigenbaum
To design, process, and sell products competitively in the 1956 market place, American
businessmen must take full account of these
crucial trends;
e Customers both industrial and consumer
have been increasing their quality requirements
very sharply in recent years. This tendency is
likely to be greatly amplified by the intense competition that seems inevitable in the near future.
For example, the electrical relay that could command the lion's share of the 1950 industrial market is no longer acceptable for 1956 operating
needs. Consumers are progressively more minute
in their examination of the finish of appliances,
or in their judgment of the tone of a radio or television set. Even for military products on which
quality has always been the major consideration
e.g., jet engines, airborne electronics, and ordnance
specifications are continually being made more
rigorous.
and physically to assure that it is beryllium copper instead of phosphor bronze. At the same time,
automation, in which rapid quality evaluation is a
pivotal point, has magnified the need for mechanization of inspection and test equipment much
of which is now in the hand-tool stage. Indeed,
the qualit}' control content of the manufacturing
equipment investment dollar may well double in
the next decade to purchase the benefit of this
mechanization.
Quality costs have become very high. For
many companies they may he much too high if
these companies are to maintain and improve their
competitive position over the long run.
In fact, quality costs (inspection, testing, laboratory checks, scrap, rework, customer complaints,
and similar expenses) have crept up to become a
multimillion-dollar item. For many businesses they
are comparable in degree with total direct labor
dollars, with distribution dollars, or with purchased
material dollars! While I can find no documented
research on the subject, evidence points strongly
to the fact that many businesses have quality-cost
expenditures representing 7 % , 8 % , 10%, and
even more of their cost of sales!
e Taken together, these three trends spell out
the twin quality objective that 1956 competitive
conditions present to American business management: (a) considerable improvement in the quality
of many products and many quality practices, and,
at the same time, (b) substantial reductions in the
over-all costs of maintainijtg quality.
93
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Broad Scope
Fortunately, there is a way out of the dilemma imposed on businessmen by increasingly
demanding customers and by ever-spiraling costs
of quality. This "way out" seems to lie in a new
kind of quality control, which might be called
"total quality control."
The underlying principle of this total quality
view and its basic difference from all other
concepts is that, to provide genuine effectiveness, control must start with the design of the
product and end only when the product has
been placed in the hands of a customer who remains satisfied.
The reason for this breadth of scope is that
the quality of any product is affected at many
stages of the industrial cycle:
(1) Marketing evaluates the level of quality
which customers want and for which they are willing to pay.
(2) Engineering reduces this marketing evaluation to exact specifications.
(3) Purchasing chooses, contracts with, and retains vendors for parts and materials.
(4) Manufacturing engineering selects the jigs,
tools, and processes for relay production.
(5) Manufacturing supervision and shop operators exert a major quality influence during parts
making, subassembly, and final assembly.
(6) Mechanical inspection and functional test
check conformance to specifications.
(7) Shipping influences the caliber of the packaging and transportation.
In other words, the determination both of
quality and of quality cost actually takes place
throughout the entire industrial cycle. This is
the reason why real quality control cannot be
accomplished by concentrating on inspection
alone, or design alone, or reject trouble-shooting
alone, or operator education alone, or statistical
analysis alone important as each of these individual elements is.
The breadth of the job makes quality control
a new and important business management
function. Just as the theme of the historical inspection activity was "they (i.e., bad parts) shall
Engineering Component
The true nerve center of the total quality
control function is the engineering component.
Its activities in each of the four broad quality
control jobs deserve examination in some detail.
New Design Control
In this area, quality control engineering provides three main activities:
1. Preproduction service to design engineering and inannfacturing engineering in analyzing
96
ACTIVITIES
Rectivinq a Inapc1inq
Quality Moteriot
Manufacturing Quality
Por)8 a Productj
Infptctinq BTntlnq
Ouaftty Product
PRODUCT CONTROL
Ouoljty
Producti'
Product Control
In this area, quality control engineering carries on the cost measurement and quality cost
reduction project activity required for over-all
Specialized Activity
Certain elements of this quality control engineering work have previously been performed
on a sporadic or divided basis. But the quality
control engineer himself is something new under
the sun. For quality control engineering is not
merely a new label for the inspection planning
package, nor a fresh designation for the test
equipment engineer, nor yet a technologically
fiavored title for the industrial statistician. It
is, instead, a specialized activity with a character all its own, calling for a unique combination
of skills.
Quality control engineering work is the product of the cross-fertilization of modern developments in several fields in statistical methodology, in fast-response high-precision inspection
and testing equipment, in management understanding of the nature of the control function
in modern business. Altogether, it has the attributes of a genuinely new sector of the engineering profession.
In experience, education, aptitude, and attitude, the man entering quality control engineering work today is, in fact, not very different from
the man entering other longer established major
technical fields as, for example, product engineering or manufacturing engineering. He must
possess, or have the capacity to acquire, the
necessary product and process background. He
must have the personal characteristics to work
effectively in a dynamic atmosphere with people
of diverse interests. He must possess the technical background which will enable him to ac-
98
Organizational Problem
In organizing a modern quality control function, the first principle to recognize is that quality is everybody's job.
In defiance of this principle, there have been
many business experiments over the years which
have attempted to make the quality activity
cycle less of a decentralized, Tinkers-to-Eversto-Chance sequence. Often these attempts have
taken the form of centralizing all quality responsibility by organizing a component whose
job was handsomely described as "responsibilit)'
for all factors affecting product quality."
These experiments have had a life span of as
long as six months when the job incumbent
had the advantage of a strong stomach, a rhinoceros hide, and a well-spent and sober boyhood. Others not similarly endowed did not
last even that long.
The simple fact of the matter is that the
marketing man is in the best position to evaluate adequately customer's quality preferences;
the design engineer is the only man who can
effectively establish specification quality levels;
the shop supervisor is the individual who can
best concentrate on the building of quality.
Total quality control programs therefore require,
as a first step, top management's re-emphasis
on the responsibility and accountability of all
company employees in new design control, incoming material control, product control, and
special process studies.
The second principle of total quality control
organization is a corollary to the first one. It is
that because quality is everybody's job, it may
become nobody's job. Thus the second major
step required in total quality programs becomes
clear. Top management must recognize that
the many individual responsibilities for quality
will be exercised most effectively when they are
buttressed and serviced by a well-organized,
genuinely modern management function whose
only area of specialization is product quality,
and whose only area of operation is in the quality control job.
Location of the Function
In view of these two organizational principles,
where should the quality control function be
placed in the larger structure of company or-
The Results
Experience in an increasing number of companies shows that operation of a total quality
control program has paid off in six ways:
1. Improved product quality.
2. Reduced scrap, complaint, inspection, and
other quality costs.
100
area. EXHIBIT II shows how one company expects to cut its quality costs by switching from
a mild version of the inspection view to total
quality control. The company anticipates that
total quality expenses will drop from the current
high of 7% of sales to 5%, with declines
achieved both in failure and appraisal costs
while prevention costs increase from only 0.70%
of sales to a still modest 1.25%. In this example, the cost savings budgeted are rather moderate, owing to the presence of complicating
factors such as the following:
An anticipated 50% increase in sales over the
next five years from $50 million to $75
million.
Planned additions to a product line that is
already highly technical and diversified, hence
accompanied by major quality problems.
Such a planned 30% improvement in quality
cost ratios is feasible, indeed conservative, with
a successful total quality control program
even with a 50% business expansion and even
with counterbalancing quality eost increases
brought about by the introduction of new produets. While the company in the example may
not be typical (probably there is no such thing
as a typical business enterprise), it is at least
illustrative of the good results that can be
achieved even when circumstances pose unusual difficulties.
Conclusion
Total quality control thus represents another
forward step in management science. Its integration of design-througb-shipment control of
the many elements in the quahty picture makes
it much more effective than the unlinked fragmentary controls of the past. As a major new
business management activity, it provides professional effort in meeting the objective of assured product quality at minimum quality cost.
With this concept, inspection and test have
EXHIBIT I I . BUDGETED QUALITY COSTS AND SAVINGS UNDER TOTAL QUALITY CONTROL
Quality
cost element
Failure
Appraisal
Prevention
Total
Total dollars
Present
S-year goal
Present
S-year goal
$ 2 ,275,000
875,000
350,000
$2,062,500
750,000
937.500
4-55%
1-75
65%
55%
0.70
2.75%
1.00
1.25
25
10
20
25
$ 3 ,500,000
$3,750,000
7.00%
5.00%
roo%
100%
Present
S-year goal
OREMEN recognized that in the last analysis quality performance is a matter of attitudes, of both the individual worker and the group as a whole.
Foremen who were prone to consider a lack of interest in quality as some
innate attribute of workers were also likely to be the ones who tried to dictate
a "you-do-it-this-way-or-else" policy. Those foremen who assumed that the
average man wanted to do a good job, who gave careful training to the new
operator, and who helped outfall of their operators when they needed it were
more likely to he rewarded with good quality work.
The present study lends support to the administrative principle of delegating responsibility to hourly wage earners and especially to utility men. Those
foremen most highly thought of by management were those who freely admitted that they could not possibly check on all the quality problems throughout the workin'a day. It was their conviction that a foreman must depend
upon his whole"team his utility man and his other operators to speak
up on quality problems and so prevent bad work from going through to the
inspector Quality consciousness, it may be inferred, is not somethmg developed solely between a foreman and the individual worker. The men must
take on a self-disciplinary s,roiip responsibility for doing a good )ob and doing
it for a foreman who is their leader in fact as well as m tttle.
Charles R. Walker, Robert H. Guest, and Arthur N. Turner, The Foreman
on tke Assembly Line
, ,, .
. ^
/Cambridge, Harvard University Press, 1956, p. 75.
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Defect 3:
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Defect 1:
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Defect 4:
Defect 5:
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other
quality
Upper Control Limit
Machine
Setup
Machine
Parts
Defective
Check
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Good
Figure 4Flowcharts
Elii^abeth Ma^e-Emery is a quality professional from Di/yton, OH. For more information iihout quality tools or related topics,
e-mail her at ema^eemery@jiu. edu.
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