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Advances in Human Factors and Ergonomics in Healthcare (eBook)

Proceedings of the AHFE 2016 International Conference on Human Factors and Ergonomics in Healthcare, July 27-31, 2016, Walt Disney World®, Florida, USA
eBook Download: PDF
2016 | 1st ed. 2017
XIII, 465 Seiten
Springer International Publishing (Verlag)
978-3-319-41652-6 (ISBN)

Lese- und Medienproben

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This book discusses the latest advances in human factors and ergonomics, focusing on methods for improving quality, safety, efficiency, and effectiveness in patient care.  By emphasizing the physical, cognitive and organizational aspects of human factors and ergonomics applications, it reports on various perspectives, including those of clinicians, patients, health organizations and insurance providers. The book describes cutting-edge applications, highlighting the best practices of staff interactions with patients, as well as interactions with computers and medical devices. It also presents new findings related to improved organizational outcomes in healthcare settings, and approaches to modeling and analysis specifically targeting those work aspects unique to healthcare. Based on the AHFE 2016 International Conference on Human Factors and Ergonomics in Healthcare, held on July 27-31, 2016, in Walt Disney World®, Florida, USA, the book is intended as timely reference guide for both researchers involved in the design of healthcare systems and devices and healthcare professionals aiming at effective and safe health service delivery. Moreover, by providing a useful survey of cutting-edge methods for improving organizational outcomes in healthcare settings, the book also represents an inspiring reading for healthcare counselors and international health organizations.

Preface 8
Contents 10
Human Factors and Ergonomics in Surgery 15
1 Analysis of Surgeons’ Muscle Activity During the Use of a Handheld Robotic Instrument in Laparoendoscopic Single-Site Surgery 16
Abstract 16
1 Introduction 16
2 Materials and Methods 17
2.1 Participants 17
2.2 Handheld Robotic Instrument 18
2.3 Training Environment 18
2.4 Experimental Animal Model 19
2.5 Surface Electromyography Protocol 20
2.6 Statistical Analysis 21
3 Results 21
3.1 Training Environment 21
3.2 Experimental Animal Model 22
4 Discussion 24
Acknowledgments 26
References 26
2 Assessing the Influence of Personal and Organizational Factors on Surgeon’s Performance: A Study on Surgeons’ Perceptions 29
Abstract 29
1 Introduction 29
2 Study Methodology 31
2.1 Qualitative Study: Focus Group and Individual Interview 31
2.2 Survey Method 32
3 Results 33
3.1 Focus Group and Individual Interviews 33
3.2 Survey Results 33
4 Conclusion 37
References 37
3 Human Reliability Analysis (HRA) for Surgery: A Modified HEART Application to Robotic Surgery 39
Abstract 39
1 Introduction 39
2 Method 40
2.1 Modified HEART for Integration with a New Taxonomy of IFs in Surgery 41
2.2 Study Methodology 41
3 Results 42
3.1 Selection of Generic Task Category 42
3.2 Correspondence Between EPCs and IFs 43
3.3 Identification and Assessment of IFs Through HEART Calculation 43
3.4 Sensitivity Analysis on Single IFs and Reference Scenarios 45
4 Conclusions 48
References 48
4 Prospects and Problems of Smart Glasses as Tools for Surgery 50
Abstract 50
1 Introduction 50
2 Materials and Methods 51
3 Results 52
4 Discussion 53
5 Conclusion 56
References 56
Human Factors and Ergonomics and Healthcare Professionals 57
5 A New Elderly Clothing Design Reduces Nurse Aides’ Occupational Injury in Nursing Homes 58
Abstract 58
1 Introduction 58
2 Research Methods 59
2.1 Preliminary Investigation 59
2.2 Design Clothing 60
3 Result 61
3.1 Preliminary Investigation 61
3.2 Design Clothing 62
4 Discussion 64
4.1 Interview 64
4.2 Test 65
5 Conclusion 67
References 67
6 Bedside Dialysis and the Occupational Safety and Health Impact on the Healthcare Worker in an Acute Hospital 69
Abstract 69
1 Introduction 69
2 Methodology 70
3 Results 70
3.1 Workload 70
3.2 Machine Dimensions and Load 70
3.3 Force Measurements 71
4 Conclusion 73
5 Discussion 73
Acknowledgments 74
Reference 74
7 Biomechanical Evaluation of Patient Handling Jobs in Healthcare: A Case Study in India 75
Abstract 75
1 Introduction 76
2 A Framework for Biomechanical Analysis of Patient Handling Jobs 77
3 Study Methodology 78
3.1 Selection of Subjects and Tasks 78
3.2 Biomechanical Modelling 78
3.3 Data Collection for Biomechanical Evaluation 79
3.4 Data Analysis for Biomechanical Evaluation 79
4 Results and Discussion 80
5 Conclusion 81
References 81
8 Difference in Problem-Solving Thought Concerning the Infection Control of Japanese Nurse and Indonesian Nurse: Comparison of the Result by 4M4E Matrix Analysis 83
Abstract 83
1 Introduction 83
2 Purpose 84
3 Methods 84
3.1 Subject 84
3.2 Data Collection Method 84
3.3 Data Analyzing Method 85
3.4 Ethical Considerations 85
4 Results 85
4.1 The Factor Analysis of Steps Based on 4E 86
4.2 The Analysis of Steps Based on 4E 87
5 Discussion 87
5.1 Differences of the Consciousness to the Problem 87
5.2 The Difference in Thought of the Problem Solution 88
6 Conclusion 88
References 88
9 Examination of the Validity of Anatomical Knowledge Associated with Daily Lifestyle Issues: A Comparison Between Perspectives of Anatomy and Nursing Researchers 89
Abstract 89
1 Introduction 89
2 Purpose 90
3 Methods 91
3.1 Subjects 91
3.2 Data Collection Method 91
3.3 Data Analysis Methods 91
4 Results 91
4.1 Description of the Nursing and Anatomy Researchers 91
4.2 Differences in Perspectives Between Nursing and Anatomy Researchers 93
5 Discussion 94
5.1 Learning Content Validity 94
5.2 Features of Ideas by Academic Field 94
6 Conclusions 95
References 95
10 Study of Suitability of Computer Workstations Design for Nurses’ Work Content 96
Abstract 96
1 Introduction 97
2 Objective 98
3 Literature Review 98
4 Methods 100
5 Results 101
6 Discussion 104
7 Conclusion 106
References 107
Human Factors and Ergonomics in Healthcare Systems 109
11 A Flexible Toolkit for Evaluating Person-Centred Digital Health and Wellness at Scale 110
Abstract 110
1 Introduction 111
2 Background 112
3 Evaluation Framework 113
3.1 Study Design 114
3.2 Multidimensional Evaluation Aims 114
3.3 Theoretical Underpinning 115
4 Evaluation Toolkit 115
4.1 Descriptive Evaluation: Tracking the Evolution of Products and Services 116
4.2 Counting Users and Measuring Reach 116
4.3 Process Evaluation 117
4.4 Measuring Outcomes 119
4.5 Measuring Usability and User Experience 120
4.6 Measuring Quality of Life and the Value of ‘Wellness’ 120
5 Conclusion and Future Work 121
References 122
12 Application of Lean Six Sigma Concepts to Medicine Dispensation of Public Health Centers 124
Abstract 124
1 Introduction 124
2 Literature Review 125
2.1 Lean Healthcare 125
2.2 Six Sigma 126
3 Methodology 127
3.1 Study Object 127
3.2 Data Collection 127
3.3 Data Analysis 128
4 Results and Discussion 128
5 Conclusion 131
References 132
13 Lean Healthcare as a Tool for Improvement: A Case Study in a Clinical Laboratory 133
Abstract 133
1 Introduction 133
2 Lean Healthcare 134
2.1 Waste According to Lean 136
2.2 Application in Laboratories 136
3 Research 138
3.1 Applied Methodology 138
3.2 Research Site 138
3.2.1 Pre-analytical Phase 139
3.2.2 Analytical Phase 139
3.2.3 Post-analytical Phase 140
3.3 Achieved Results 141
4 Conclusion 142
Appendix: Value Stream Mapping Current Scenario 143
References 144
14 Virtual Communities of Practice Success in Healthcare Sector: A Comparative Review 145
Abstract 145
1 Introduction and Background 145
2 The Concept, Nature, and Use of VCoPs 147
3 Method 148
4 The Results 149
4.1 Content Analysis 149
4.2 Literature Review 151
5 Discussion 154
6 Conclusion and Future Research 155
References 155
15 Overlook of Patient Time Log Entry Errors During Emergency Department Processes 158
Abstract 158
1 Introduction 158
2 Methods 159
2.1 Patient Time Logs 159
2.2 Time Log Entry Errors 160
3 Results 161
4 Discussions and Conclusions 163
References 163
16 Incentives for the Acceptance of Mobility Equipment by Elderly People on the Basis of the Kano Model: A Human Factors Perspective for Initial Contact with Healthcare Products 164
Abstract 164
1 Introduction 165
2 Theoretical Background 166
2.1 Levels of Quality 166
2.2 Satisfaction Measurement 167
3 Methodology 167
3.1 Dependent Variables 169
3.2 Questionnaire 170
3.3 Participants 170
4 Results 171
5 Conclusion 172
6 Limitations and Outlook 173
Acknowledgments 173
References 174
Human Factors and Ergonomics in Healthcare Safety 175
17 Engaging and Effective Staff Training to Improve Patient Safety and Satisfaction 176
Abstract 176
1 Introduction 176
2 Healthcare Facility Cultural Change 178
3 Why Animation? 179
4 The Power of Animation 180
5 Why Animation for Staff Training? 181
6 The Power of Story 182
7 The No Pass Zone and UC Health West Chester Hospital 183
7.1 The Process 183
7.2 The Results 184
References 186
18 Methodology of Care Humanitude in Promoting Self-care in Dependent People: An Integrative Review 187
Abstract 187
1 Introduction 187
2 Methodology 188
3 Presentation and Discussion of Results 189
4 Conclusion 193
References 193
19 Application of User Experience Map and Safety Map to Design Healthcare Service 194
Abstract 194
1 Introduction 194
2 The Challenge for Healthcare Service Design 195
3 Previous Research of Healthcare Service Design 196
3.1 Service Design Approach 196
3.2 Experience-Based Co-design (EBCD) 197
3.3 Failure Mode and Effects Analysis (FMEA) 197
4 Case Study 198
4.1 Research 199
4.2 Improve 199
4.3 Measure 200
5 Discussion 201
References 203
20 An Assessment on the Level of Knowledge of Biosecurity Measures in the Academic Environment 204
Abstract 204
1 Introduction 205
2 Methodological Description 206
2.1 Sample and Bioethical Control 207
2.2 Data Collection Procedures 207
3 Results 207
3.1 Knowledge of Term ‘Biosecurity’ 208
3.2 Means of Protection Used in Practice 209
3.3 Accidents and Risk of Accidents in the Academic Environment 211
4 Conclusions 211
References 212
21 Methods to Characterize Operating Room Variables in Robotic Surgery to Enhance Patient Safety 213
Abstract 213
1 Introduction 214
1.1 Background and Significance 215
2 Methods 216
2.1 Observation of Robotic Surgical Cases 216
2.2 Task Excursion Analysis 218
2.3 Disseminate Results to Surgical Teams 219
3 Example Use Case 220
4 Discussion 220
References 221
22 Low-Fidelity Simulation Versus Live Human Arms for Intravenous Cannulation Training: A Qualitative Assessment 222
Abstract 222
1 Introduction 222
2 Literature Review 223
3 Methods 224
3.1 Procedures 224
3.2 Instrumentation 225
3.3 Software 226
3.4 Data Analysis 226
4 Results 226
5 Discussion 229
6 Limitations 230
7 Conclusions 230
Acknowledgments 231
References 231
Medical Device Design 233
23 Improving the User Experience of Medical Devices with Comparative Usability Testing 234
Abstract 234
1 Introduction 234
2 Case Study 235
3 Best Practices 235
3.1 Defining and Recruiting Participants 235
3.2 Training Researchers 237
3.3 Usability Test Location and Space 238
3.4 Training Test Participants 238
3.5 Waiver and Consent Forms 239
3.6 Methodology for Executing Test Sessions 240
3.7 Analysis 242
4 Summary 243
References 244
24 & You: Design of a Sensor-Based Wearable Device for Use in Cognitive Behavioral Therapy
Abstract 245
1 Introduction 245
2 Background 246
3 Design and Operation 248
3.1 Use Cycle 250
4 Discussion and Future Work 251
References 253
25 Framework Proposal Including HFE in Product Development Process: A Suitable Approach for the Brazilian Medical Equipment Industry 255
Abstract 255
1 Introduction 256
2 Literature Review 257
2.1 The Brazilian Scenario 259
2.2 Brazilian Legal Requirements 261
2.3 The Usability Engineering Standards Requirements 261
3 Proposed Framework 262
4 Conclusion 265
Acknowledgments 266
References 266
26 A Systematic Approach to Improve the Reprocessing of Surgical Instruments 268
Abstract 268
1 Introduction 268
1.1 Background 268
1.2 Goal 269
1.3 Challenges 270
1.4 Literature Review 270
2 Methods 270
2.1 Process Flow Analyses 270
2.2 Cleanability Index 271
2.3 Instrument Set Reconfiguration 272
3 Results 274
3.1 Process Flow Analyses 274
3.2 Cleanability Index 274
3.3 Instrument Set Reconfiguration 275
4 Discussion 276
4.1 Future Work 277
Acknowledgments 277
Appendix: CSPD Current State Process Map 278
References 279
27 Building Safety into Medical Devices: The Non-injectable Arterial Connector Preventing Wrong Route Drug Administration 280
Abstract 280
1 Introduction 280
2 Never Events: Arterial Line Safety 282
3 Methods 282
4 Results 283
5 Discussion 284
References 286
28 Mobile Technology Improves Therapy-Adherence Rates in Elderly Patients Undergoing Rehabilitation—A Crossover Design Study 287
Abstract 287
1 Introduction 288
1.1 Objective 289
2 Materials and Methods 289
2.1 Ethics 289
2.2 Participants 289
2.3 Apparatus and Inductor Session to User 290
2.4 Study Design 291
2.5 Questionnaires 292
2.6 Objective Indicators for Technology Adherence 293
2.7 Data Collection and Analysis 293
3 Results 293
3.1 Subjective Adherence 293
3.2 Objective Adherence 294
3.3 Technical Affinity 295
3.4 Impact of Comorbidities on Usage 296
3.5 Interviews on User Experience 296
4 Discussion 297
4.1 Limitations 298
4.2 Interpretation 298
References 299
29 Development of the Elderly Healthcare Monitoring System with IoT 301
Abstract 301
1 Introduction 302
2 Background 303
2.1 Aging in Korea 303
2.2 Elderly Smart Healthcare Monitoring System 304
2.3 IoT-Based Elderly Smart Healthcare Monitoring System 304
2.4 Application Areas for IoT-Based Elderly Smart Healthcare Monitoring System 305
3 Conclusion 305
Acknowledgments 305
References 306
30 Development of an Intermittent Pneumatic Compression System to Manage Soft Tissue Mechanical Properties 308
Abstract 308
1 Introduction 309
2 Methods 309
2.1 Compression System 310
2.2 Soft Tissue Property Measurement 310
2.3 Motor-Driven Ultrasound Indentation System 310
2.4 Data Analysis 312
3 Results and Discussion 312
4 Conclusion 314
Acknowledgments 314
References 315
Healthcare Testing 317
31 Ergonomic Performance Measurement and Evaluation for Worksystems in Healthcare 318
Abstract 318
1 Introduction 318
2 Objectives 320
3 Ergonomics Performance Measurement System: Characteristic Features 320
3.1 F1. Pace or Speed of Work Under the Control of the Operator 321
3.2 F2. Adequacy of Fatigue Allowances for Jobs 321
3.3 F3. Workers Away from Their Workplace During Work 321
3.4 F4. Occurrence of “Human” Errors 322
3.5 F5. Frequency of Lifting of Weights 322
3.6 F6. Force Required to Push or Pull Objects 322
3.7 F7. Movements of Human Body 323
3.8 F8. Assessment of Visual Environment in the Workplace 323
3.9 F9. Engineering Anthropometry 323
3.10 F10. Work Posture 323
3.11 F11. Assessment of Thermal Environment in the Workplace 324
3.12 F12. Workers’ Complaints About Physical Environment in Their Workplaces 324
3.13 F13. Tasks Resulting in Excessive Material Wastes 324
3.14 F14. Repetitive Motions/Frequent Use of Hand Tools/Both Hands and Feet Operating/Same Posture/Information Overload/Insufficient Time to Sense and Respond to Signals/Physical Fitness/Knowledge of Training 325
3.15 F15. Assessment of Auditory Environment 325
4 Methodology for Measuring Ergonomic Performance 325
4.1 Identification of Ergonomic Factors 326
4.2 Identification of Design and Performance Factors 326
4.3 Development of Interaction Matrix 326
4.4 Design of the Assessment Tool 326
4.5 Testing and Validation of Assessment Tool in Varied Situations and Worksystems 326
5 Applications in Healthcare 327
6 Determination of Ergonomic Performance for a Worksystem in Healthcare 328
7 Conclusion 331
References 331
32 Development of a New Psychometric Scale (PYTHEIA) to Assess the Satisfaction of Users with Any Assistive Technology 332
Abstract 332
1 Introduction 333
2 Methodology 335
2.1 Statistical Analysis 336
3 Results 337
3.1 Exploratory Factor Analysis 338
3.2 Reliability 338
3.3 Validity 339
4 Discussion 340
5 Conclusion 340
Acknowledgments 341
References 341
33 A Study on the Methodology to Analyse and Prevent Medical Errors Due to Non-observance 343
Abstract 343
1 Introduction 344
2 Previous Studies 344
3 Method to Analyze Violations 344
3.1 Consideration of Violation Mechanism 344
3.2 Case Study Analysis 345
3.3 Viewpoints of Analysis 346
4 Results of Analysis 347
4.1 Behavioral Characteristics 347
4.2 Behaviour-Induced Factors 349
5 Discussion 350
5.1 Significance of the Study 350
5.2 Approach to Actions Against Violations 351
6 Conclusion 351
References 352
Human Factors and Ergonomics in Environmental Design 353
34 Ergonomic Design of Bathrooms for People with Cerebral Palsy in the Philippines 354
Abstract 354
1 Introduction 355
1.1 Background of the Study 355
1.2 Problem Statement 355
1.3 Objectives 355
1.4 Scope and Limitations 355
2 Review of Related Literature 356
2.1 Cerebral Palsy Background and Definition 356
2.2 Risks and Hazards in the Bathroom 356
2.3 Anthropometry 356
2.4 Biomechanics 357
3 Methodology 357
3.1 Qualitative Measure of Loughborough University 357
3.2 Sample Size Determination 357
3.3 Anthropometric Measurements 358
3.4 Biomechanical Measurements 358
4 Analysis of Data 358
4.1 Survey Results 358
4.2 Sample Size and Acceptable Fraction 359
4.3 Recommended Dimensions 359
5 Results and Discussion 361
6 Conclusion and Recommendations 362
Acknowledgments 363
References 363
35 The Place of Health Design for Health Promotion: The Pediatrics Design Process Focus in Humanization at Santa Casa’s Hospital Montes Claros—Brazil 364
Abstract 364
1 Introduction 364
2 Humanization 366
2.1 The Humanization Process 366
2.2 Pediatric Wing Requirements 368
3 Context 370
3.1 The Santa Casa Hospitals in Brazil 370
3.2 The Santa Casa de Montes Claros-MG Hospital—Brazil 370
3.3 Pediatrics in Santa Casa de Montes Claros-MG Hospital—Brazil 371
4 Materials and Methods 372
4.1 Study Lineation 372
4.2 Research Place 372
4.3 Participants 373
4.4 Data Collection 373
4.5 Tools 373
5 Expected Results 374
6 Final Considerations 375
References 375
36 Supporting Phobia Treatment with Virtual Reality: Systematic Desensitization Using Oculus Rift 377
Abstract 377
1 Introduction 377
2 Background 378
2.1 Virtual Reality 378
2.2 Phobia Treatment 379
2.3 Oculus Rift 380
2.4 Virtual Reality Applied to Phobia Treatment 380
3 Prototype Implementation 382
4 Evaluation 384
5 Discussion 385
6 Conclusion and Future Work 386
Acknowledgments 386
References 386
37 Intelligent Nano-Worlds: A New ICT Based Tool for Mental Health Care of Children Living Under Social Vulnerability 388
Abstract 388
1 Introduction 389
2 Related Work 390
3 Intelligent Nano-Worlds: A New Approach for Psychological Diagnosis and Intervention with Children Under Social Vulnerability 391
3.1 Theoretical Psychological Basis: The Draw-A Person Test and the Draw-A-Family Test 391
3.2 Psychological Profiles 391
3.3 General System Design 392
3.4 Diagnosis and Intervention Process 394
4 Intelligent Nano-Worlds: A New Approach for Psychological Diagnosis and Intervention with Children Under Social Vulnerability 394
5 Conclusions and Future Work 396
Acknowledgments 397
References 397
Healthcare Communications and Logistics 398
38 Application of the Delphi Method in the Development of a Triage Method for Vulnerable People in Disaster 399
Abstract 399
1 Introduction 400
2 A Proposed Triage Method 400
3 Online Triage Simulation with Delphi Method 401
3.1 Scenario-Based Triage Simulation 402
3.2 The Delphi Method 402
3.3 Online Triage Simulation Using the Delphi Method 402
4 Results and Discussions 403
4.1 Setting 403
4.2 Convergence of Answers 404
4.3 Exceptional Cases 405
5 Conclusions 407
Acknowledgments 407
References 407
39 Usability Testing an Electronic Health Record: Lessons Learned and Ethical Considerations 408
Abstract 408
1 Introduction 408
2 The Usability Assessment 409
2.1 Method 409
2.2 Test Metrics 411
2.3 IRB 411
3 Lessons Learned 412
3.1 Test Plan 412
3.2 Scenario Development 413
3.3 Participant Recruitment 413
3.4 Ethical Considerations 414
3.5 Unexpected Findings 414
4 Discussion 414
Acknowledgments 415
References 415
40 Demographics, Military Status, and Physical Health as Indicators of Personal Resilience Among U.S. Active Duty Service Members and Veterans 416
Abstract 416
1 Introduction 416
2 Methods 417
2.1 Participants 417
2.2 Surveys 418
2.3 Statistics 419
3 Results 419
3.1 Descriptive, Correlation, and Group Comparisons 419
3.2 Regression 422
4 Discussion 422
5 Limitations 424
6 Conclusions 424
Acknowledgments 425
References 425
41 Language Sample Analysis Framework Utilizing the Natural Language Toolkit and Social Media 427
Abstract 427
1 Introduction 427
2 Background 429
2.1 Fragile X Syndrome 429
2.2 Natural Language Toolkit 430
2.3 Language Sample Analysis 430
3 Framework 431
3.1 Tokens, Words, Sentences, Stems and Lemmas 431
3.2 Complexity and Diversity 432
3.3 Frequency Distribution 432
3.4 Part of Speech Tags 434
3.5 Misspellings 434
3.6 Stopwords 435
4 Case Study 436
4.1 Overview 436
4.2 Results 436
5 Conclusion 437
References 437
42 Georeferencing in Logistics Transplant 439
Abstract 439
1 Introduction 439
2 Artifact 440
3 Geolocation 441
4 Usability 442
5 Design Science Research 443
6 Outcome 444
7 Conclusion 445
References 446
43 Erratum to: Examination of the Validity of Anatomical Knowledge Associated with Daily Lifestyle Issues: A Comparison Between Perspectives of Anatomy and Nursing Researchers 448
Erratum to: “Examination of the Validity of Anatomical Knowledge Associated with Daily Lifestyle Issues: A Comparison Between Perspectives of Anatomy and Nursing Researchers” in: V.G. Duffy and N. Lightner (eds.), Advances in Human Factors and Ergonomics in Healthcare, Advances in Intelligent Systems and Computing 482,& #6

Erscheint lt. Verlag 26.7.2016
Reihe/Serie Advances in Intelligent Systems and Computing
Advances in Intelligent Systems and Computing
Zusatzinfo XIII, 465 p. 96 illus., 65 illus. in color.
Verlagsort Cham
Sprache englisch
Themenwelt Mathematik / Informatik Informatik
Medizin / Pharmazie
Technik
Schlagworte AHFE 2016 Proceedings • E-Health • Healthcare Information Technology • Healthcare Monitoring • Healthcare Service • Healthcare systems • health information technology • Home Healthcare • Human Factors in Surgery • Human Performance • Medical Device Design • medical errors • Medication Impairment • Nursing Education and Training • occupational therapy • Operating Room Design • Patient Handling • Patient Safety Systems • Privacy and Security
ISBN-10 3-319-41652-9 / 3319416529
ISBN-13 978-3-319-41652-6 / 9783319416526
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