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Gamification in healthcare:
challenges and opportunities
Department of Communication and Art, University of Aveiro
Digital...
Aveiro, Portugal
University of Aveiro, campus
Department de Communication and Art
University of Aveiro
http://www.ua.pt
DigiMedia
Digital Media and Interaction Research...
Gamification
1. What is?
2. What is not?
3. Why gamification?
4. Examples in health
5. References
Ana Isabel Veloso aiv@ua...
What is Gamification?
“The use of game elements and game design techniques in non-
game contexts.” (Werbach, & Hunter, 201...
Game design process
Ana Isabel Veloso aiv@ua.pt, University of Aveiro
1
https://goo.gl/vHQFrn https://goo.gl/ybqPZ
MDA framework
Mechanics is related with the functioning components of the game. They
enable the designer to control the ga...
Game Elements
“A design pattern that can be incorporated into a game. Game elements are
the pieces that a game designer as...
game elements (Points)
> Cash: how much money you have in the bank, status objects
(social)…
> Social networking score: nu...
Points system:
1.  Experience points, XP: translates the player's progress in a playing
position and they are aligned with...
Game elements (Levels)
> Back in the 80, in arcade games, the main aim of game
developers was to decrease the time of play...
Game elements (Leaderboards)
> The leaderboards aim to make comparisons between players,
taking into account the performan...
Game elements (Badges)
The Badges are representations of something won by the player.
Eventually, they function as visual ...
Game elements (Avatars)
> Identity Element (empathy with the game character)
> Enable you to assume different perspectives...
Game elements (Challenges | Quests )
> Set of pre-defined
challenges with goals and
rewards;
> Usually follow the structur...
Game-elements (Resources)
> Resources are elements in the game that can be managed (e.g.
number of lives) or collectibles ...
Game elements (Social Graph)
> Social Graphs show the network of relationships among friends
(e.g. Facebook connection, tw...
Game techniques
Having a "Game thinking"
(1) Thinking about the problem / motivation for ‘gamification’
(2) Converting a d...
Areas >> Non-entertainment context
- Marketing, Sales Products, Advertising;
- Human resources (recruitment, incentives, c...
Gamification is not “playful design”; incorporanting a game aesthetic
in a daily object is not gamification.
2
play (infor...
Gamification != is not PBL (Points, Badges and LeaderBoards)
2 What is not Gamification?
Ana Isabel Veloso aiv@ua.pt, Univ...
To be or not to be, that’s the
question
2
10 top gamification exameples and Fun theory - https://www.youtube.com/watch?v=C...
How do you motivate people
to change their behavior or to
solve a problem?
> Intrinsic motivation
> Extrinsic motivation
3...
> Extrinsic motivation:
They are external to the
individual (external reward
associated to an action)
E.g.: Points, reward...
Why gamification?3
https://goo.gl/GcWCZt
TTM
Transtheoretical
Model
(Prochaska et et, 1992)
Why gamification?3
Malone’s question (1980):
What make things fun to learn?
fantasy
curiositychallenge
(Malone, 1980)
Ana ...
4
Nike+
https://www.youtube.com/watch?v=BSWeAUA4uVk
Zombies, Run!
https://zombiesrungame.com/
Examples (Behavior changes)
...
Other examples of problems
•  videogames and cognitive rehabilitation
>> perceptual disorders, conceptual thinking, attent...
Stroke incidence rates in Portugal (per 100 000)
(Truelsen, Ekman, & Boysen, 2005)
Spasticity
20 39 149
390
1431
3193
4143...
Effective recovery is dependent on high volumes of motor practice, using physiotherapy,
promoting neural plasticity, a for...
Examples (Stroke Rehabilitation)4
(Ribeiro, Veloso, & Costa, 2016)
Examples (Stroke Rehabilitation)4
(Ribeiro, Veloso, & Costa, 2016)
Examples (Stroke Rehabilitation)4
(Ribeiro, Veloso, & Costa, 2016)
(Ribeiro, Veloso, & Costa, 2016)
Other examples of problems
•  videogames and therapeutic benefits in the elderly
>> concentration, attention, hand-eye coo...
(Terra, 2012)
http://www.seduce.pt/SITE_PT/videos/vjogo%20Ivan_RDAY.mp4
Other examples of problems
•  videogames and health care
>> education and disease management
(Griffiths et al., 2013)
4
Examples (games > healthy eating habits > kids)4
Overweight
and Obesity
Children
https://goo.gl/czEYwK
Examples (games > healthy eating habits > kids)4
WHO
European
Childhood
Obesity
Surveillance
Initiative
(COSI)
Examples (games > healthy eating habits > kids)4
Other examples of problems
•  videogames as physiotherapy and occupational therapy
>> cerebral palsy, finger and hand func...
Other examples of problems
•  videogames and impulsivity/attention deficit disorders
>> children with attention deficit di...
‪Virtual Reality Exposure Therapy for PTSD and VR Resilience
Training‬
https://www.youtube.com/watch?v=nrgUPVFY44o
References5
Bartle, R. (1996). Hearts, clubs, diamonds, spades: Players who suit MUDs. Journal of MUD
research, 1(1), 19.
...
References5
Griffiths, M., Kuss, D. J. & Ortiz de Gortari, A. B., (2013) Videogames as Therapy: A review of the
Medical an...
References5
Kim, A. J. (2015). Secrets of Game Thinking http://goo.gl/wxHggf (8 de fevereiro de 2015)
Kim, A. J. (2014). B...
References5
Schell, J. (2010). Designing Oustide the Box. DICE 2010
https://www.youtube.com/watch?v=nG_PbHVW5cQ (8 de feve...
Thank you J
aiv@ua.pt
Department of Communication and Art, University of Aveiro
Digital Media and Interaction Research Ce...
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Gamification in Healthcare: Challenges and Opportunities 10 oct 2017

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Gamification in Healthcare: Challenges and Opportunities
Lecture at Coventry University
10 oct 2017

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Gamification in Healthcare: Challenges and Opportunities 10 oct 2017

  1. 1. Gamification in healthcare: challenges and opportunities Department of Communication and Art, University of Aveiro Digital Media and Interaction Research Center Ana Isabel Veloso aiv@ua.pt
  2. 2. Aveiro, Portugal
  3. 3. University of Aveiro, campus
  4. 4. Department de Communication and Art University of Aveiro http://www.ua.pt DigiMedia Digital Media and Interaction Research Centre http://digimedia.joanabeja.com
  5. 5. Gamification 1. What is? 2. What is not? 3. Why gamification? 4. Examples in health 5. References Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  6. 6. What is Gamification? “The use of game elements and game design techniques in non- game contexts.” (Werbach, & Hunter, 2012, p.26) The first use of gamification in its current sense apparently occurred in 2003, when Nick Pelling, a British game developer, had set up a consulting firm to create game-like interfaces for electronic devices. (Werbach, & Hunter, 2012, p.25) https://www.youtube.com/watch?v=h-bwMTR4tfg (min 16:41) 1 Jesse Schell - “Thinking outside the box” https://www.youtube.com/watch?v=nG_PbHVW5cQ (min 20:37) Ana Isabel Veloso aiv@ua.pt, University of Aveiro https://goo.gl/2QDx5z
  7. 7. Game design process Ana Isabel Veloso aiv@ua.pt, University of Aveiro 1 https://goo.gl/vHQFrn https://goo.gl/ybqPZ
  8. 8. MDA framework Mechanics is related with the functioning components of the game. They enable the designer to control the game, giving the ability to guide player’s actions. Dynamics are the player’s interactions with those mechanics. They determine what each player is doing in response to the mechanics of the system, both individually and with other players. Aesthetics of the system is how the game makes the player feel during the interaction. It determines what each player is doing in response to the mechanics of the system, both individually and with other players.A D M (Werbach, & Hunter, 2012, p.78-82) Ana Isabel Veloso aiv@ua.pt, University of Aveiro 1
  9. 9. Game Elements “A design pattern that can be incorporated into a game. Game elements are the pieces that a game designer assembles in creating an engaging experience.” e.g. of game elements: points, levels, leaderboards, badges, avatars, challenges/quests and resources Excerpt: Werbach, K., & Hunter, D. (2012). For the win: How game thinking can revolutionize your business. Wharton Digital Press. Gabe Zichermann. “Gabe Zichermann, Christopher Cunningham- Gamification by Design_ Implementing Game Mechanics in Web and Mobile Apps - O'Reilly Media (2011).epub.” iBooks. Werbach, K., & Hunter, D. (2012). For the win: How game thinking can revolutionize your business. Wharton Digital Press. Page 72-80 Fullerton, T. (2014). Game design workshop: a playcentric approach to creating innovative games. CRC press. Page 72-73; Page 96-99 Ana Isabel Veloso aiv@ua.pt, University of Aveiro https://goo.gl/DJmgLV 1.1
  10. 10. game elements (Points) > Cash: how much money you have in the bank, status objects (social)… > Social networking score: number of followers, number of certain members clan / group > Virtual economy: allows a designer to bring a lot of money and control how it goes out (ex.: Farmville – promotion 7-Eleven + Slurpee = Farmville credits) (ex.: Dual economy – tell 3 friends and get 200 points In the game) 1.1 Assassin’s creed - Pontuação em cash Facebook - Pontuação social/Ranking FarmVille - Ex. economia virtual e dual (Zichermann & Cunningham, 2011, p. 111) What is Gamification? (points | levels | leaderboards | badges | avatars | challenges/ quests | resources) (Werbach, & Hunter, 2012, p.72-74) Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  11. 11. Points system: 1.  Experience points, XP: translates the player's progress in a playing position and they are aligned with the goals and player’s behaviors 2.  Redeemable points, RP: these may vary during the game and they are used for exchanging, etc. 3.  Skill points: points associated to specific activities 4.  Karma points: points related to the game “check in”; used to create a behavioral path to user reward; 5.  Reputation points: points to represent trust between the parts involved 1.1 Pokémon - Ex. economia virtual e dual Spring bonus- Ex. pontos resgatáveis Eve online - Ex. skill points (Zichermann & Cunningham, 2011, p. 115) What is Gamification? (points | levels | leaderboards | badges | avatars | challenges/ quests | resources) Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  12. 12. Game elements (Levels) > Back in the 80, in arcade games, the main aim of game developers was to decrease the time of playing in order to loose the game quickly. That way, players had to insert additional coins in the machine (more complicated levels were at the beginning). > Currently, the gaming industries choose to adopt levels of progression and the difficulty level increases in accordance with the players’ performance in the game progression bar Angry birds - Níveis (Zichermann & Cunningham, 2011, p. 133) What is Gamification? (points | levels | leaderboards | badges | avatars | challenges/ quests | resources) Ana Isabel Veloso aiv@ua.pt, University of Aveiro 1.1
  13. 13. Game elements (Leaderboards) > The leaderboards aim to make comparisons between players, taking into account the performance and the activity of each player > They can act as a social incentive: the player's friends are ordered by score (top 10, top20 ...) Other leaderboards types: no-disincentive; infinite; dribble - ranking de contribuições (Zichermann & Cunningham, 2011, p. 144) What is Gamification? (points | levels | leaderboards | badges | avatars | challenges/ quests | resources) Ana Isabel Veloso aiv@ua.pt, University of Aveiro 1.1
  14. 14. Game elements (Badges) The Badges are representations of something won by the player. Eventually, they function as visual cues of the player's progress (e.g. reached certain level, completed the mission, achieved certain goal ...) > These are flexible (adapted to different missions) and they can be customized, symbolizing the importance of certain activity. They are collectible and encourage a social status. (Zichermann & Cunningham, 2011, p. 153) What is Gamification? (points | levels | leaderboards | badges | avatars | challenges/ quests | resources) Ana Isabel Veloso aiv@ua.pt, University of Aveiro 1.1
  15. 15. Game elements (Avatars) > Identity Element (empathy with the game character) > Enable you to assume different perspectives on behavior- changing / game-playing activity; The principles associated with a game character (Isbister, 2006): (A) Reacting to Social Surface; (B) Attractiveness (halo effect); (C) Babyfaces; (D) Stereotypes.In Better Game Characters by Design - Isbister (2010) What is Gamification? (points | levels | leaderboards | badges | avatars | challenges/ quests | resources) (Isbister, 2006, pp. 5-16) Ana Isabel Veloso aiv@ua.pt, University of Aveiro 1.1
  16. 16. Game elements (Challenges | Quests ) > Set of pre-defined challenges with goals and rewards; > Usually follow the structure: Narrative > Goal > Reward; Narrative Goal Reward Forge of Empires - Ex. quests Here Be Monsters - Ex. quests What is Gamification? (points | levels | leaderboards | badges | avatars | challenges/ quests | resources) (Zichermann & Cunningham, 2011, p. 173) Ana Isabel Veloso aiv@ua.pt, University of Aveiro 1.1
  17. 17. Game-elements (Resources) > Resources are elements in the game that can be managed (e.g. number of lives) or collectibles (e.g. art pieces, treasures...) > The game designer should take into account the following resource attributes: scarcity, function, location. Example of resources: number of lives, units, health, money... Assassin’s creed - Mapa com recursos colecionáveis Assassin’s creed - Mapa de tesouro What is Gamification? (points | levels | leaderboards | badges | avatars | challenges/quests | resources) Ana Isabel Veloso aiv@ua.pt, University of Aveiro 1.1
  18. 18. Game elements (Social Graph) > Social Graphs show the network of relationships among friends (e.g. Facebook connection, twitter feeds) ; > It is an important element to encourage social activities and changes in behaviours (through competition or collaboration) Safari Kingdom - Ex. Social Graph What is Gamification? (points | levels | leaderboards | badges | avatars | challenges/quests | resources) Ana Isabel Veloso aiv@ua.pt, University of Aveiro 1.1
  19. 19. Game techniques Having a "Game thinking" (1) Thinking about the problem / motivation for ‘gamification’ (2) Converting a daily activity into a game-playing activity (3) Focusing on the player experience or in the “Player journey” 1.2 In Secrets of Game Thinking - Amy Jo Kim http://goo.gl/wxHggf (Kim, 2010) What is Gamification? (Werbach, & Hunter, 2012, p.40-50) Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  20. 20. Areas >> Non-entertainment context - Marketing, Sales Products, Advertising; - Human resources (recruitment, incentives, crowdsourcing); - Changing behavior (health and wellness, sustainability, activism, social participation...); - Education… 1.3 What is Gamification? (Werbach, & Hunter, 2012, p.29) (Zichermann, & Linder, 2013) Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  21. 21. Gamification is not “playful design”; incorporanting a game aesthetic in a daily object is not gamification. 2 play (informal play, playfulness) versus game (formal play, formal elements)In Gamification and Playful design http://goo.gl/KCX0fC What is not Gamification? Ana Isabel Veloso aiv@ua.pt, University of Aveiro A playful design: KUB+ Coffee Table - Fábio Teixeira Twitter - Ex. error animations
  22. 22. Gamification != is not PBL (Points, Badges and LeaderBoards) 2 What is not Gamification? Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  23. 23. To be or not to be, that’s the question 2 10 top gamification exameples and Fun theory - https://www.youtube.com/watch?v=CFeeSANGGlA Can these projects be considered an example of gamification? > Yes, if we consider that there were changes in people’s behaviours (encourage physical exercise, choose to use the stairs) > No, if we consider that they are only a decorative element and the main purpose is not to change behaviours- “playful design” Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  24. 24. How do you motivate people to change their behavior or to solve a problem? > Intrinsic motivation > Extrinsic motivation 3 Why gamification? (Werbach, & Hunter, 2012, p.56-60) Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  25. 25. > Extrinsic motivation: They are external to the individual (external reward associated to an action) E.g.: Points, rewards, levels ... 3 > Intrinsic motivation: They are internal to the individual (internal reward associated to an action) E.g.: Autonomy, sense of belonging to the community, learning ... Why gamification? (Werbach, & Hunter, 2012, p.56-60) (Zichermann & Cunningham, 2011, p. 83) Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  26. 26. Why gamification?3 https://goo.gl/GcWCZt TTM Transtheoretical Model (Prochaska et et, 1992)
  27. 27. Why gamification?3 Malone’s question (1980): What make things fun to learn? fantasy curiositychallenge (Malone, 1980) Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  28. 28. 4 Nike+ https://www.youtube.com/watch?v=BSWeAUA4uVk Zombies, Run! https://zombiesrungame.com/ Examples (Behavior changes) Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  29. 29. Other examples of problems •  videogames and cognitive rehabilitation >> perceptual disorders, conceptual thinking, attention, concentration, memory, spatial cognition, mental rotation, stroke rehabilitation 4 (Griffiths et al., 2013)
  30. 30. Stroke incidence rates in Portugal (per 100 000) (Truelsen, Ekman, & Boysen, 2005) Spasticity 20 39 149 390 1431 3193 4143 47 93 362 842 2299 3769 4262 0 1250 2500 3750 5000 25-34 35-44 45-54 55-64 65-74 75-84 85+ Numberofoccurrencesper 100000people Age Man Woman Stroke problem4 (Ribeiro, Veloso, & Costa, 2016)
  31. 31. Effective recovery is dependent on high volumes of motor practice, using physiotherapy, promoting neural plasticity, a form of cortical “re-wiring”, allowing the central nervous system to respond and adapt to damage in motor networks sustained from stroke. Now: 32 movement repetition per session Optimal average: 3000 a 4000 movements (Lang et al., 2009) (Kleim, Barbay, & Nudo, 1998) (Ribeiro, Veloso, & Costa, 2016)
  32. 32. Examples (Stroke Rehabilitation)4 (Ribeiro, Veloso, & Costa, 2016)
  33. 33. Examples (Stroke Rehabilitation)4 (Ribeiro, Veloso, & Costa, 2016)
  34. 34. Examples (Stroke Rehabilitation)4 (Ribeiro, Veloso, & Costa, 2016)
  35. 35. (Ribeiro, Veloso, & Costa, 2016)
  36. 36. Other examples of problems •  videogames and therapeutic benefits in the elderly >> concentration, attention, hand-eye coordination, memory, decision-making, and speed reactions 4 (Griffiths et al., 2013)
  37. 37. (Terra, 2012) http://www.seduce.pt/SITE_PT/videos/vjogo%20Ivan_RDAY.mp4
  38. 38. Other examples of problems •  videogames and health care >> education and disease management (Griffiths et al., 2013) 4
  39. 39. Examples (games > healthy eating habits > kids)4 Overweight and Obesity Children https://goo.gl/czEYwK
  40. 40. Examples (games > healthy eating habits > kids)4 WHO European Childhood Obesity Surveillance Initiative (COSI)
  41. 41. Examples (games > healthy eating habits > kids)4
  42. 42. Other examples of problems •  videogames as physiotherapy and occupational therapy >> cerebral palsy, finger and hand function, rheumatology •  videogames as distractors in the role of pain management >> cancer chemotherapy in children, adolescents and adults •  videogames and the development of social and communication skills among the learning disabled >> autism 4 (Griffiths et al., 2013)
  43. 43. Other examples of problems •  videogames and impulsivity/attention deficit disorders >> children with attention deficit disorders •  videogames in psychotherapeutic settings >> ice-breaker and rapport builder with children in therapy and behavior management •  videogames and anxiety disorders >> several phobias, post-traumatic stress disorder 4 (Griffiths et al., 2013)
  44. 44. ‪Virtual Reality Exposure Therapy for PTSD and VR Resilience Training‬ https://www.youtube.com/watch?v=nrgUPVFY44o
  45. 45. References5 Bartle, R. (1996). Hearts, clubs, diamonds, spades: Players who suit MUDs. Journal of MUD research, 1(1), 19. Deterding, S., Dixon, D., Khaled, R., & Nacke, L. (2011, September). From game design elements to gamefulness: defining gamification. In Proceedings of the 15th international academic MindTrek conference: Envisioning future media environments (pp. 9-15). ACM. ExpertiseCentrum Games En Game-Design (2013). Gamification and Playful Design. Handout EGG. Retrieved from http://www.expertisecentrumgames.nl/app/webroot/userfiles/files/ handout_EGG_gamification_and_playful_design-3-1%285%29.pdf (8 de fevereiro de 2016) Fadel L.M., Ulbrich V.R., Batista C.R., Vanzin B. (2016). Gamificação na Educação. Pimenta Cultural. ISBN: 978-66832-13-6 Fullerton, T. (2014). Game design workshop: a playcentric approach to creating innovative games. CRC press. Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  46. 46. References5 Griffiths, M., Kuss, D. J. & Ortiz de Gortari, A. B., (2013) Videogames as Therapy: A review of the Medical and Psychological Literature . In Cruz-Cunha, M. M., & Miranda, I. M., (2013) Handbook of Research on ICTs and Management Systems for Improving Efficiency in Health Care and Social Care. IGI Global Press. Hunicke, R., LeBlanc, M., & Zubek, R. (2004, July). MDA: A formal approach to game design and game research. In Proceedings of the AAAI Workshop on Challenges in Game AI (Vol. 4, p. 1). Retrieved fom http://www.aaai.org/Papers/Workshops/2004/WS-04-04/WS04-04-001.pdf (8 de fevereiro de 2016) Isbister, K. (2006). Better game characters by design: A psychological approach. Elsevier/Morgan Kaufmann. Kapp, K. M. (2012). The gamification of learning and instruction: game-based methods and strategies for training and education. John Wiley & Sons. Kim, A. J. (2011, March 23). Gamification 101: Designing the player journey. Google Tech Talk. https://www.youtube.com/watch?v=B0H3ASbnZmc&feature=youtu.be (8 de fevereiro de 2015) Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  47. 47. References5 Kim, A. J. (2015). Secrets of Game Thinking http://goo.gl/wxHggf (8 de fevereiro de 2015) Kim, A. J. (2014). Beyond Player Types: Kim’s Social Action Matrix http://amyjokim.com/blog/ 2014/02/28/beyond-player-types-kims-social-action-matrix/(Data do último acesso: 8 de fevereiro de 2015) Malone, T. W. (1980, September). What makes things fun to learn? Heuristics for designing instructional computer games. In Proceedings of the 3rd ACM SIGSMALL symposium and the first SIGPC symposium on Small systems (pp. 162-169). ACM. Norman, D. A. (2005). Emotional design: Why we love (or hate) everyday things. Basic books. Ribeiro, T., Veloso, A. I. and Costa, R. (2016) Conceptualization of PhysioFun game: A low-cost videogame for home-based stroke rehabilitation DOI: 10.1109/TISHW.2016.7847787 http://ieeexplore.ieee.org/document/7847787/ Terra, I. (2012) “Videojogo com paradigma de interação o gestual adaptado a seniores. Multimédia Communication Master dissertation. Universidade de Aveiro. http://www.seduce.pt/SITE_PT/documentos/t4/t4_total.pdf Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  48. 48. References5 Schell, J. (2010). Designing Oustide the Box. DICE 2010 https://www.youtube.com/watch?v=nG_PbHVW5cQ (8 de fevereiro de 2015) Werbach, K., & Hunter, D. (2012). For the win: How game thinking can revolutionize your business. Wharton Digital Press. Zichermann, G., & Linder, J. (2013). The gamification revolution: How leaders leverage game mechanics to crush the competition. McGraw Hill Professional. Zichermann, G., & Cunningham, C. (2011). Gamification by design: Implementing game mechanics in web and mobile apps. " O'Reilly Media, Inc.”. Ana Isabel Veloso aiv@ua.pt, University of Aveiro
  49. 49. Thank you J aiv@ua.pt Department of Communication and Art, University of Aveiro Digital Media and Interaction Research Center Ana Isabel Veloso aiv@ua.pt

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