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Clive Flashman

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  1. Clive Flashman
    Dr Penny Kechagioglou, Chief Clinical Information Officer and Deputy Chief Medical Officer at University Hospitals Coventry and Warwickshire, kindly shared her thoughts on digitising patient reported outcome measures in a blog for HTN.
    The UK digital transformation wave is mainly characterised by the roll-out of electronic health records and is an opportunity to transform patient care by collecting and analysing patient reported outcome measures digitally.
    A recent study at the European Society of Medical Oncology open journal (Modi, 2022) showed that patient reported outcome measures are predictive of cancer patient treatment response and quality of life for physical and mental parameters. The knowledge of patient reported outcomes (PRO) and experience (PRE) measures can be valuable in the monitoring of individual patient symptoms in clinic or remotely in the community and also for aggregating and interpreting population health data.
    To read the full article, click here
  2. Clive Flashman
    A hospice is using virtual reality (VR) to help patients relax and transport them away from their beds.
    St Giles Hospice, which has bases in Lichfield and Sutton Coldfield, said the headsets allowed patients "to escape the realities of their present situation".
    "I've never experienced anything quite like it in my life - I was totally lost in the moment," Janet, 71, said.
    The VR experiences include cities of the world, space, and wildlife.
    Beth Robinson, Occupational Therapist at St Giles Hospice, said the VR headsets helped patients "immerse themselves into a calming space".
    To read the full article, click here
  3. Clive Flashman
    Monitoring heart patients via a smartphone app prevented readmissions and sped up discharges in a pilot scheme that its developers hope will be introduced across the country.
    Patients sent data including their blood pressure, heart rate, oxygen levels and details of developing symptoms to their clinical team on an app.
    The figures were collated on a “dashboard”, which flagged any signs that a patient might need medical help, allowing doctors and nurses to bring them into hospital or alter their medication as required.
    The 12-week pilot by Huma, a healthcare technology company based in London, involved 40 patients at Cwm Taf Morgannwg University Health Board in south Wales and Betsi Cadwaladr University Health Board in north Wales.
    Click here to read full article (paywalled)
     
  4. Clive Flashman
    New study results in more precise language in the federally mandated warning about this possibility. (Article from the USA)
    Women who choose to use an intrauterine device, or IUD, for birth control should be aware of the very small possibility that the device could puncture their uterus. They should know how to recognize that circumstance if it occurs, according to a new study published in The Lancet.
    The U.S. Food and Drug Administration mandated the study to evaluate women's risks when an IUD is placed in the year after giving birth and when an IUD is placed during the period that a woman is breastfeeding a baby. These results were compared, respectively, with non-postpartum insertions and insertions in non-breastfeeding individuals, explained UW Medicine’s Dr. Susan Reed, the study’s lead author.
    Across the study cohort of 327,000 women, the percentage of perforation cases diagnosed within five years of IUD insertion was 0.6 %, the study concluded.
    The risk of perforation increased by nearly seven times if it was inserted between four days and six weeks postpartum, and increased by about one-third if inserted during the span of breastfeeding. The risk of an IUD-related perforation was relatively lower when inserted in women who were more than a year beyond delivery, in women who had never had a baby, and when the insertion occurred at delivery. Read full article here
  5. Clive Flashman
    In the older European population, men, as well as those with lower socioeconomic status, weak social ties, and poor health, might experience more difficulties getting informal support and are considered to have a higher risk of worsening frailty state and lower quality of life. This reality is shown in a new doctoral thesis at Umeå university.
    Read the full article here
  6. Clive Flashman
    Steve Gulati, Associate Professor and Director of Healthcare Leadership at HSMC (University of Birmingham) discusses the concept of "time to care" within healthcare.
    A UK-wide poll of healthcare workers revealed that most NHS staff think they have too little time to help patients and the quality of care that services provide is falling. This reported reduction in the time to care is perhaps inevitable after almost a decade of health funding failing to keep up with increases in demand, and is a cause for concern for all of us – patients, carers or those working in the NHS. Where does this fit in to the wider picture – and can anything be done about it?
    It is not just NHS workers who are feeling the pinch – levels of public satisfaction with the NHS are at an all-time low. Interestingly, the two most cited reasons relate to access (difficulties or delays in getting appointments) and, tellingly, to staff shortages. Even against this gloomy backdrop, the collectivised funding model upon which the NHS is founded continues to find significant public support. All of this points towards a painful congruence – NHS staff feel that they do not have enough time to care, and the public is noticing.
    Is ‘time to care’ an outdated concept, harking back to an age of long patient stays, a paternalistic bedside manner and unrealistic expectations? Both staff and patient experience suggest not. Although technology plays an increasing role in healthcare diagnostics, treatment and recovery, delivering care remains a deeply human phenomenon and is essentially a relational and personal task. Recognising that frontline healthcare workers need time to care is not a new phenomenon. Influenced by service improvement methodologies, the ‘productive ward’ initiative in the mid-2000s placed an explicit emphasis on using efficiency techniques for the express purpose of releasing nursing staff to have “time to care”. It was acknowledged that productivity was more than metrics around bed occupancy and throughput, for example, and that the driving purpose of service improvement was to time to care. Whilst research indicated a nuanced impact, the principle is long recognised.
    If solutions to these problems were easy, they would have been implemented by now. There is no doubt that on one level, it really is a matter of resources – no system can carry a vacancy factor of around 10% for any length of time without there being an evident impact. However, even within an environment of constrained resources, choices are made every day by caregivers and leaders alike about what receives attention and what is allowed to move into the ‘important but not urgent’ category. That is in no way to blame the hard-pressed caregivers, but instead to indicate that even when it really does not feel like it, every individual has a level of agency.
    Feeling as though one does not have time to do one’s job is, put simply, unpleasant for all workers but should especially concern us in care environments. The impact on clinical safety and quality is an obvious starting point, but it is also important to recognise the impacts on care workers themselves with regard to emotional labour and the impact on the psychological contract that working in a caring profession, when people feel that they don’t have enough time to care, must have. As eloquently stated by the Vice-President of the Royal College of Physicians in Wales, it is “…very clear that good clinicians, be they nurses, doctors, therapists or pharmacists, need time to train, time to care and time to rest”. Even in challenging times, self-care and compassionate, values driven leadership can make a difference. Caring is everyone’s business.
    Link to original article: https://www.birmingham.ac.uk/news/2023/healthcare-workers-need-more-time-to-care
  7. Clive Flashman
    The Government has decided to cut the fee GPs are paid per Covid vaccination by a quarter, prompting BMA to issue a patient safety warning.
    NHS England has published the new enhanced service specification for Covid vaccines to be delivered between 1 September and 31 March next year, setting out that GPs will be paid £7.54 for each vaccine administered – down from £10.06 – and continue to be paid £10 for each housebound patient.
    The fee had already been reduced from £12.58 last year, when the BMA advised GPs to review whether they were still able to fulfil the ES commitments.
    The new specification said that practices with ‘sufficient workforce capacity so as not to impact the delivery of essential services and appropriately trained and experienced staff’ must indicate their willingness to participate in the programme before 5pm on 29 August.
    The Item of Service fee for flu remains £10.06 of each vaccine delivered, according to the new specification published last week.
    But the BMA said that that NHS England’s decision to reduce the Covid fee ‘undervalues general practice and threatens the safety of vulnerable patients’.
    Read the full article here: https://www.pulsetoday.co.uk/news/clinical-areas/respiratory/25-cut-to-covid-vaccine-ios-threat-to-patient-safety-bma-warns/ 
  8. Clive Flashman
    Videos circulating on the social media platform claim that castor oil can help to treat dryness, floaters, cataracts, poor vision and even glaucoma.
    Doctors have issued a warning not to use castor oil as a way to treat vision problems following claims on TikTok.
    Castor oil is a type of vegetable oil traditionally used to treat a range of issues like skin infections. It is even a common ingredient in some over-the-counter eye drops. But dozens of TikTok videos have gone one step further, claiming that by rubbing the oil over eyelids, eyelashes and under the eye, it helps to treat dryness, floaters, cataracts, poor vision and even glaucoma. One woman said that after two weeks of use, she doesn't need to wear reading glasses as often, while another said it prevented an eye infection from progressing.
    Now, doctors in the US have said the oil is "not going to seep in and dissolve or fix anything". They warned that some unsterilised bottles on shop shelves may even cause irritation or infection if put directly into the eye. "Castor oil is not a cure-all. If you have concerns about your eyes, you need to see an optician," Dr Ashley Brissette, a spokesperson for the American Academy of Ophthalmology. She said they cannot make recommendations as studies that look at the effects of eye drops which contain castor oil on dry eyes and blepharitis are of low quality, involving small sample sizes and no control groups.
    Dr Vicki Chan, a practising optician in Los Angeles added that castor oil has no effect on conditions that affect the inside of the eyeball. These include cataracts - an age-related condition that causes cloudy vision - floaters, and glaucoma, which occurs when fluid accumulates and damages the optic nerve. Dr Brissette added that ignoring early symptoms of glaucoma, or waiting to see it castor oil improves conditions such as cataract, can lead to permanent vision loss or complications with surgery. Instead, eating a healthy balanced diet; removing all make up before bed; wearing sunglasses outdoors and attending regular eye examinations are alternative ways to maintain eye health.
  9. Clive Flashman
    Teens who have been bullied by their peers, or who have considered or attempted suicide, may be more likely to have more frequent headaches than teens who have not experienced any of these problems, according to a study published in the August 2, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study does not prove that bullying or thoughts of suicide cause headaches; it only shows an association.
    “Headaches are a common problem for teenagers, but our study looked beyond the biological factors to also consider the psychological and social factors that are associated with headaches,” said study author Serena L. Orr, MD, MSc, of the University of Calgary in Canada. “Our findings suggest that bullying and attempting or considering suicide may be linked to frequent headaches in teenagers, independent of mood and anxiety disorders.”
    The study involved more than 2.2 million teens with an average age of 14 years. 
    Read the full article here: https://www.eurekalert.org/news-releases/997216
  10. Clive Flashman
    After generations of inaction and very few novel ideas, researchers and activists are hopeful a new path is being charted in understanding and treating the crippling chronic condition
    “There’s an excitement at the moment,” says Andrew Horne. After decades of inaction, something is happening in endometriosis.
    Now, says the professor of gynaecology and reproductive sciences at the University of Edinburgh, “I do think things are changing. There are more people working on it, so it’s bringing in people from different disciplines with new ideas.”
    In the space of a few months, from gatherings in Edinburgh and Washington DC, labs in Sydney and Japan, there is a sense that new ideas are bubbling to the surface, including a fundamental rethinking of endometriosis not as a disease of the pelvis, but rather, says Horne, “a whole-body disease”. It’s hard to pinpoint the exact moment when despair turned to hope in the research and patient community. There was no single breakthrough. No one person responsible.
    In March, the largest ever study on the genetics of endometriosis was published in Nature Genetics, which found genetic links to 11 other pain conditions as well as other inflammatory conditions. The study, involving DNA from more than 760,000 women, found ovarian endometriosis is genetically distinct from other types and indicated there may be a genetic predisposition to excessive inflammation in people with the condition. One of the researchers, Dr Nilufer Rahmioglu from the University of Oxford, described the data as a “treasure trove of new information”.
    Weeks later on the other side of the world, researchers from Sydney’s Royal Hospital for Women attracted international attention after they grew tissue from different types of endometriosis and compared how each responded differently to treatments. Jason Abbott, professor of obstetrics and gynaecology at the hospital, likened the development to those made in the treatment of breast cancer three decades ago.
    Two weeks on from the Australian discovery, Japanese researchers found a common form of bacteria may be contributing to the growth of endometriosis via inflammation.
    The frisson was, by then, hard to miss.
    Read the full article here: https://www.theguardian.com/society/2023/aug/10/its-really-only-the-beginning-are-we-on-the-cusp-of-a-breakthrough-in-endometriosis 
  11. Clive Flashman
    The Care Quality Commission (CQC) has published a report on Stoke Mandeville Hospital, part of Buckinghamshire Healthcare NHS Trust following a recent inspection in June.
    CQC carried out a focused inspection of the trusts children’s emergency department in response to concerns raised about the safety and quality of the service. Inspectors found children and young people received safe care. However, the trust needs to review its systems to make sure potential serious incidents are managed in a way that allows any lessons learned to be shared, to reduce the risk of them happening again.
    Link to the full report  (opens in a new browser window)
  12. Clive Flashman
    Despite regular MRI scans at the Royal Preston Hospital showing that the tumour was growing, May Ashford was not offered surgery until five years later.
    A woman died unnecessarily after doctors failed to operate soon enough on a growing brain tumour, according to the health complaints service.
    May Ashford, from Blackpool, was diagnosed with a brain tumour in 2010 after experiencing headaches and seizures.
    Despite regular MRI scans at the Royal Preston Hospital showing that the tumour was growing, she was not offered surgery until five years later.
    An investigation by the Parliamentary and Health Service Ombudsman (PHSO) said the treatment was too late as medical staff had failed to monitor the scan results properly.
    Medical experts said Mrs Ashford should have been operated on at least three years earlier, before the tumour had time to grow and affect the surrounding area of the brain.
    She tragically died aged 71 from a stroke following surgery.
    Link to full article here
  13. Clive Flashman
    As junior doctors begin a four-day strike today with a two-day strike by consultants a fortnight later, Sir Julian Hartley, chief executive of NHS Providers, said:

    "Trust leaders are very worried about six more days of severe disruption across the NHS this month.

    "We could be close to a tipping point. Trusts and staff are pulling out all the stops to reduce waiting times for patients but with no end to strikes in sight the sheer volume of planned treatment being put back due to industrial action will make it almost impossible for trusts to cut waiting lists as much as the government wants.

    "Waiting lists are now at a record high of 7.57 million, the pressure on urgent and emergency care services is relentless and an already stretched NHS is gearing up for another high-demand winter as pressure on tight budgets mounts.

    "A string of strikes – which have led to more than 835,000 routine treatments and appointments being put back since December – is estimated to have cost the NHS around £1bn already including lost income and hiring expensive staff cover.

    "The number of rescheduled appointments could be close to 1 million after this month's strikes and consultants have called another two-day strike in September. There will be a long-lasting effect on patients who have had treatment delayed and on already low staff morale.

    "Concerns are mounting too over how patient safety will be maintained during August's strikes as many NHS services will be even more stretched as many staff are on much-needed summer holidays and cover is harder to secure.

    "It's vital that the government and unions find a breakthrough urgently. Trust leaders understand the strength of feeling among striking staff and why they're taking action. Everyone in the NHS wants to concentrate on treating more patients more quickly rather than spend days making plans to cope with strikes.

    "People can still rely on the NHS during strikes, calling 999 in an emergency. For less urgent cases people should use 111 online for help and advice."
  14. Clive Flashman
    A group of potent synthetic opioids called nitazenes have been linked to a rise in overdoses and deaths in people who use drugs, primarily heroin, in England over the past two months, drug regulators have warned.
    The Office for Health Improvements and Disparities has issued a National Patient Safety Alert on potent synthetic opioids implicated in heroin overdoses and deaths.
    In the past 8 weeks there has been an elevated number of overdoses (with some deaths) in people who use drugs, primarily heroin, in many parts of the country (reports are geographically widespread, with most regions affected but only a few cities or towns in each region).
    Testing in some of these cases has found nitazenes, a group of potent synthetic opioids. Nitazenes have been identified previously in this country, but their use has been more common in the USA. Their potency and toxicity are uncertain but perhaps similar to, or more than fentanyl, which is about 100x morphine.
    The National Patient Safety Alert provides further background and clinical information and actions for providers.
  15. Clive Flashman
    Making data on medical interventions easier to collect and collate would increase the odds of spotting patterns of harm, according to the panel of a recent HSJ webinar
    When Baroness Julia Cumberlege was asked to review the avoidable harm caused by two medicines and one medical device, she encountered no shortage of data.
    “We found that the NHS is awash with data, but it’s very fractured,” says Baroness Cumberlege, who chaired the Independent Medicines and Medical Devices Safety Review and now co-chairs the All-Party Parliamentary Group which raises awareness of and support for its findings.
    And it is that fracturing that can make patterns of harm difficult to spot. The report concluded that many women and children experienced avoidable harm through use of the hormone pregnancy test Primodos, the epilepsy drug sodium valproate, and the medical device pelvic mesh – simply because it hadn’t been possible to connect the dots.
    “It’s very hard to collect things together and to get an overall picture. And one of the things that we felt very strongly about was that data should be collected once, but used often,” said Baroness Cumberlege at a recent HSJ webinar. Run in association with GS1 UK, the event brought together a panel to consider how better data might help address patient safety challenges such as problems with implants.
    “But the big problem was they couldn’t identify who had which implants. No doubt somebody somewhere had written this down with a fountain pen and then someone spilt the tea over it and the unique information was lost,” recalled Sir Terence Stephenson , now Nuffield professor of child health at Great Ormond Street Institute of Child Health and chair of the Health Research Authority for England.
    The review he chaired therefore suggested establishing a concept of person, product place – “for everybody who had something implanted in them, we should have their name, the identifier of what had been put in, and where it had been put in. And one of my panel members said: ‘Well, how are we going to record this? We don’t want the fountain pen and the teacup.’”
    Ultimately the answer suggested was barcode scanning. By scanning the wristband of a patient, that on the product being implanted, and one for the hospital theatre or department at which it was being implanted, the idea was to create an immediate and easy-to-create record.
    For those long convinced of the virtues of barcode scanning in health, it is a welcome development
    Two years later, the then Department of Health launched the Scan4Safety programme, in which six “demonstrator sites” implemented the use of scanning across the patient journey. At these organisations, barcodes produced to GS1 standards – meaning they are globally unique – are present on patient wristbands; on equipment used for care, including implantable medical devices; in locations; and sometimes on staff badges.
    Link to full article here (paywalled)
  16. Clive Flashman
    The exodus of healthcare workers from Nigeria, Ghana and Zimbabwe continues, despite the WHO red list and a range of laws to keep them at home.
    It took nearly three hours of queueing in Ikorodu general hospital in Lagos state, Nigeria, before Hadijat Hassan, a retired civil servant, could see a nurse. The 66-year-old has attended the clinic for health checks since being diagnosed with diabetes nearly 10 years ago. But since May, she says, the delays, often while suffering from excruciating pain in her legs, are worse than ever.
    “You can get there [the hospital] and meet about 50 people waiting to be attended to,” Hassan says. “They said all of their nurses and doctors have been leaving for abroad. Just a few are left.”
    In Nigeria, there is one doctor for every 5,000 patients, whereas the average in developed countries is one doctor for about every 254 people.
    A hospital official said the Ikorodu management get resignation notices from nurses and doctors almost every month.
    “Many leave for the US, Canada, UK and, most recently, Australia,” says the official, who asked to remain anonymous.
    The National Association of Nigeria Nurses and Midwives has reported there is now a ratio of one nurse to 1,160 patients. Its president, Michael Nnachi, said that more than 75,000 nurses had left Nigeria since 2017.
    “If you look at the conditions of service of health workers generally, you’ll see the difficult challenges complicated by the current economic realities,” he said, adding that rising inflation has compounded the problems.
    The World Health Organization predicts a worldwide shortage of 10 million health and care workers by 2030 – mostly in low-income countries, where people are leaving for opportunities abroad.
    This is despite the WHO’s introduction of a safeguard list to stop rich countries poaching from poorer countries with staff shortages.
    The “red list”, launched in 2020 with plans to update it every three years, includes Nigeria, Ghana, Zimbabwe and 34 other African countries. Yet the UK’s nursing regulator, the Nursing and Midwifery Council, says more than 7,000 Nigerian nurses relocated to the UK between 2021 and 2022.
    Data from the Ghana Registered Nurses and Midwives Association shows that nearly 4,000 nurses left the country in 2022. In Zimbabwe, more than 4,000 health workers, including 2,600 nurses, left in 2021 and 2022, the government said.
    The WHO has no powers to prohibit recruitment of doctors from countries on the list, but recommends “government-to-government health worker migration agreements be informed by health labour market analysis and the adoption of measures to ensure adequate supply of health workers in the source countries”.
    Read the full article here
  17. Clive Flashman
    Presymptom Health’s technology provides early and reliable information about infection status and severity in patients with non-specific symptoms, helping doctors make better treatment decisions. The company’s tests can be run on NHS PCR platforms, which were widely deployed during the COVID pandemic and are now often under-utilised. By detecting true infection and sepsis earlier, it’s possible to save lives and significantly reduce the incorrect use of antibiotics.
    When it comes to sepsis, Presymptom’s technology could revolutionise treatment. According to The UK Sepsis Trust, every 3 seconds, someone in the world dies of sepsis. In the UK alone, 245,000 people are affected by sepsis with at least 48,000 people losing their lives in sepsis-related illnesses every year.
    This is more than breast, bowel and prostate cancer combined. When diagnosed at a late stage, the likelihood of death increases by 10% for every hour left untreated. Yet, for many patients, with early diagnosis it is easily treatable.
    “We’re confident that our first product can play a big part in tackling Anti-Microbial Resistance (AMR), which has been identified by the World Health Organisation as  one of the top 10 global public health threats,” said Dr Iain Miller, CEO of Presymptom Health.
    “By understanding the presence, or absence, of infection as early as possible, doctors can be more confident in their diagnosis and avoid unnecessarily prescribing antibiotics – something that is a growing concern in the NHS and globally.
    “If we take Sepsis as an example. Sepsis diagnostics hasn’t moved on in more than a century, and currently doctors can only diagnose it when advanced symptoms and organ failure are present – which is often too late. Our technology enables doctors to diagnose both infection and sepsis up to three days before formal clinical diagnosis, radically transforming the process and preventing unnecessary deaths.
    The science behind Presymptom’s technology is based upon 10 years of work conducted at Defence Science and Technology Laboratory (Dstl) and originated from £16m of sustained Ministry of Defence investment in a programme of research designed to help service personnel survive infection from combat injuries.
    The technology is currently undergoing clinical trials at nine NHS hospitals in the UK, with results anticipated later in 2024. In addition, Presymptom is working on additional UK and EU trials.
  18. Clive Flashman
    One of the best doctors in the UK died on an understaffed Manchester hospital ward after falling sick with a condition he was an expert in treating, an inquest has heard.
    Professor Amit Patel was among the ‘best doctors in the UK’, the first person in the country to be qualified in stem cell transplantation and cellular therapy, and intensive care medicine. He was also a beloved husband and father-of-two.
    “He looked liked a corpse, 70 per cent of his blood was in his lungs, he was freezing cold and he looked like he was dead," his heartbroken wife told an inquest at Manchester Coroners Court. "I told my daughters, ‘daddy is dead’ – I didn’t have much hope he would be able to come out of that.”
    Professor Patel's condition was being investigated by doctors at Wythenshawe Hospital, Manchester Royal Infirmary, and across the country. But, he was in the unimaginable position of being a nationally recognised expert in the illness. During his career, he had formed ‘national guidance’ on the illness and sat on the national multi-disciplinary panel to which the most serious cases, including his own, were referred.
     The court heard how he was experiencing the symptoms of hemophagocytic lymph histiocytosis (HLH) – a rare and life-threatening immune disorder where the body reacts inappropriately to a 'trigger’, such as an infection or cancer, and leads to inflammation. Patients can be predisposed to HLH by Still’s disease, another rare autoimmune condition also causing inflammation, which Professor Patel was suspected to have had.
    Full article here.
  19. Clive Flashman
    Female health monitoring apps are putting women at risk by "coercing" them into disclosing - and then poorly handling - highly sensitive data, according to new research.
    The study examined the privacy policies and data safety labels of 20 of the most popular of these kind of apps, which are commonly used to help women conceive. It found a host of poor data-management practices, including some apps not having a delete function, even for highly personal information such as menstrual cycles and miscarriages. Its authors say it is the most extensive evaluation its kind completed to date. They say the apps are used by hundreds of millions of people.
    The BBC has contacted a number of app providers - none have responded to a request for comment.
    "While female health apps are vital to the management of women’s health worldwide, their benefits are currently being undermined by privacy and safety issues," the lead author of the study, Dr Ruba Abu-Salma, from King's College London, told the BBC.
    Other key findings from the study include:
    35% of apps claimed not to share personal data with third parties but contradicted this in their privacy policies 50% assured users that health data would not be shared with advertisers, but were ambiguous about other data collected 45% of privacy policies denied responsibility for third-party practices, despite claiming to vet them. Female-focused technology has boomed in recent years, with the market expected to exceed $75 billion by 2025. But Lisa Malki, another of the study's authors, said the industry needed to get better at protecting the women whose data it was using.
    Read full article on the BBC here.
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