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  1. Article ; Online: Medical Home Implementation Gaps for Seniors: Perceptions and Experiences of Primary Care Medical Practices.

    Hoff, Timothy / DePuccio, Matthew

    Journal of applied gerontology : the official journal of the Southern Gerontological Society

    2016  Volume 37, Issue 7, Page(s) 817–839

    Abstract: Objective: The study objective was to better understand specific implementation gaps for various aspects of patient-centered medical home (PCMH) care delivered to seniors. The study illuminates the physician and staff experience by focusing on how ... ...

    Abstract Objective: The study objective was to better understand specific implementation gaps for various aspects of patient-centered medical home (PCMH) care delivered to seniors. The study illuminates the physician and staff experience by focusing on how individuals make sense of and respond behaviorally to aspects of PCMH implementation.
    Method: Qualitative data from 51 in-depth, semi-structured interviews across six different National Committee for Quality Assurance (NCQA)-accredited primary care practices were collected and analyzed.
    Results: Physicians and staff identified PCMH implementation gaps for their seniors: (a) performing in-depth clinical assessments, (b) identifying seniors' life needs and linking them with community resources, and (c) care management and coordination, in particular self-management support for seniors. Prior experiences trying to perform these aspects of PCMH care for older adults produced collective understandings that led to inaction and avoidance by medical practices around the first two gaps, and proactive behavior that took strategic advantage of external incentives for addressing the third gap.
    Conclusion: Greater understanding of physician and staff's PCMH implementation experiences, and the learning that accumulates from these experiences, allows for a deeper understanding of how primary care practices choose to enact the medical home model for seniors on an everyday basis.
    MeSH term(s) Aged ; Aged, 80 and over ; Attitude of Health Personnel ; Geriatric Assessment ; Humans ; Interviews as Topic ; Organizational Innovation ; Patient Care Management ; Patient-Centered Care/organization & administration ; Qualitative Research
    Language English
    Publishing date 2016-03-22
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 155897-3
    ISSN 1552-4523 ; 0733-4648
    ISSN (online) 1552-4523
    ISSN 0733-4648
    DOI 10.1177/0733464816637850
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts.

    Breton, Mylaine / Sullivan, Erin E / Deville-Stoetzel, Nadia / McKinstry, Danielle / DePuccio, Matthew / Sriharan, Abi / Deslauriers, Véronique / Dong, Anson / McAlearney, Ann Scheck

    BMC family practice

    2021  Volume 22, Issue 1, Page(s) 192

    Abstract: Background: The COVID-19 pandemic has driven primary healthcare (PHC) providers to use telehealth as an alternative to traditional face-to-face consultations. Providing telehealth that meets the needs of patients in a pandemic has presented many ... ...

    Abstract Background: The COVID-19 pandemic has driven primary healthcare (PHC) providers to use telehealth as an alternative to traditional face-to-face consultations. Providing telehealth that meets the needs of patients in a pandemic has presented many challenges for PHC providers. The aim of this study was to describe the positive and negative implications of using telehealth in one Canadian (Quebec) and one American (Massachusetts) PHC setting during the COVID-19 pandemic as reported by physicians.
    Methods: We conducted 42 individual semi-structured video interviews with physicians in Quebec (N = 20) and Massachusetts (N = 22) in 2020. Topics covered included their practice history, changes brought by the COVID-19 pandemic, and the advantages and challenges of telehealth. An inductive and deductive thematic analysis was carried out to identify implications of delivering care via telehealth.
    Results: Four key themes were identified, each with positive and negative implications: 1) access for patients; 2) efficiency of care delivery; 3) professional impacts; and 4) relational dimensions of care. For patients' access, positive implications referred to increased availability of services; negative implications involved barriers due to difficulties with access to and use of technologies. Positive implications for efficiency were related to improved follow-up care; negative implications involved difficulties in diagnosing in the absence of direct physical examination and non-verbal cues. For professional impacts, positive implications were related to flexibility (teleworking, more availability for patients) and reimbursement, while negative implications were related to technological limitations experienced by both patients and practitioners. For relational dimensions, positive implications included improved communication, as patients were more at ease at home, and the possibility of gathering information from what could be seen of the patient's environment; negative implications were related to concerns around maintaining the therapeutic relationship and changes in patients' engagement and expectations.
    Conclusion: Ensuring that health services provision meets patients' needs at all times calls for flexibility in care delivery modalities, role shifting to adapt to virtual care, sustained relationships with patients, and interprofessional collaboration. To succeed, these efforts require guidelines and training, as well as careful attention to technological barriers and interpersonal relationship needs.
    MeSH term(s) COVID-19 ; Canada ; Humans ; Pandemics ; Physicians, Primary Care ; Primary Health Care ; Quebec ; SARS-CoV-2 ; Telemedicine
    Language English
    Publishing date 2021-09-26
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2041495-X
    ISSN 1471-2296 ; 1471-2296
    ISSN (online) 1471-2296
    ISSN 1471-2296
    DOI 10.1186/s12875-021-01543-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Disparities in Stage-Specific Guideline-Concordant Cancer-Directed Treatment for Patients with Pancreatic Adenocarcinoma.

    Hamad, Ahmad / DePuccio, Matthew / Reames, Bradley N / Dave, Apeksha / Kurien, Natasha / Cloyd, Jordan M / Shen, Chengli / Pawlik, Timothy M / Tsung, Allan / McAlearney, Ann Scheck / Ejaz, Aslam

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

    2021  Volume 25, Issue 11, Page(s) 2889–2901

    Abstract: Background: The utilization of cancer-directed treatment for patients with all stages of pancreatic cancer in the USA is unknown. This study sought to examine national practice patterns and identify patient, hospital, regional, and other factors ... ...

    Abstract Background: The utilization of cancer-directed treatment for patients with all stages of pancreatic cancer in the USA is unknown. This study sought to examine national practice patterns and identify patient, hospital, regional, and other factors associated with disparities in the use of guideline-concordant cancer-directed therapy.
    Methods: Patients diagnosed with PDAC between 2004 and 2015 were queried from the National Cancer Data Base. Standard of care cancer-directed treatment was defined as surgical resection plus chemotherapy or chemoradiation for patients with stage 1 and 2 disease, chemotherapy for patients with metastatic disease (stage 4), and chemotherapy with or without surgery or chemoradiation for patients with locally advanced stage 3 disease.
    Results: A total of 336,629 patients with stage 1 (n = 38,443, 11.4%), stage 2 (n = 93,923, 27.9%), stage 3 (n = 37,492, 11.1%), or stage 4 metastatic (n = 166,771, 49.5%) disease were identified. Adherence with stage-specific standard of care treatment occurred in only 45.3% (n = 152,560) of patients among the entire cohort and varied by stage of disease (stage 1: 14.6% vs. stage 2: 39.9% vs. stage 3: 67.6%, vs. stage 4: 50.9%). Older age (OR 0.95, 95%CI 0.94-0.95; p < 0.001), female sex (OR 0.94, 95%CI 0.943-0.97; p < 0.001), African Americans (OR 0.89, 95%CI 0.87-0.91; P < 0.001), and increasing comorbidity burden (Charlson-Deyo score ≥3: OR 0.52, 95%CI 0.50-0.55; P < 0.001) were associated with a lower likelihood of receiving stage-specific standard of care treatment. Conversely, treatment at a high-volume center (quartile 4: OR: 1.13, 95%CI 1.10-1.16; P < 0.001) and higher education level (OR 1.32, 95%CI 1.28-1.36; p < 0.001) was associated with higher likelihood of receiving stage-specific standard of care treatment. Patients who received standard of care treatment had a 47% lower risk of death compared with patients who did not receive standard of care treatment (HR 0.53, 95%CI 0.52-0.53; P < 0.001).
    Conclusion: Pancreatic adenocarcinoma is a complex disease requiring a multi-disciplinary approach for optimal outcomes. Receipt of stage-specific standard of care treatment for PDAC is associated with improved long-term oncological outcomes, but is only achieved in less than half of patients. Further studies are needed to evaluate interventions to address these treatment disparities for patients with PDAC.
    MeSH term(s) Adenocarcinoma/drug therapy ; Black or African American ; Aged ; Chemoradiotherapy ; Databases, Factual ; Female ; Healthcare Disparities ; Humans ; Pancreatic Neoplasms/drug therapy
    Language English
    Publishing date 2021-03-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2012365-6
    ISSN 1873-4626 ; 1934-3213 ; 1091-255X
    ISSN (online) 1873-4626 ; 1934-3213
    ISSN 1091-255X
    DOI 10.1007/s11605-021-04984-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Dietary pomegranate by-product improves oxidative stability of lamb meat.

    Natalello, Antonio / Priolo, Alessandro / Valenti, Bernardo / Codini, Michela / Mattioli, Simona / Pauselli, Mariano / Puccio, Mario / Lanza, Massimiliano / Stergiadis, Sokratis / Luciano, Giuseppe

    Meat science

    2019  Volume 162, Page(s) 108037

    Abstract: This study investigated the effect of including whole pomegranate by-product in lamb diet on meat oxidative stability. Seventeen lambs were assigned to two experimental treatments and fed a cereal-based concentrate (CON) or the same concentrate where 200  ...

    Abstract This study investigated the effect of including whole pomegranate by-product in lamb diet on meat oxidative stability. Seventeen lambs were assigned to two experimental treatments and fed a cereal-based concentrate (CON) or the same concentrate where 200 g/kg DM of cereals were replaced by whole pomegranate by-product (WPB). Meat from WPB-fed lambs had a greater concentration of vitamin E (α- and γ-tocopherols), polyunsaturated fatty acids (PUFA), highly peroxidizable PUFA and a higher peroxidability index (P < .05). Feeding WPB limited the formation of metmyoglobin (P = .05) and reduced lipid oxidation (TBARS values) after 7 days of storage for raw meat (P = .024) or 4 days for cooked meat (P = .006). Feeding WPB increased meat antioxidant capacity (ORAC assay) in the lipophilic fraction (P = .017), but not in the hydrophilic. These results suggest that vitamin E in the pomegranate by-product contributed to the higher antioxidant capacity of meat from the WPB-fed lambs.
    MeSH term(s) Animal Feed/analysis ; Animals ; Diet/veterinary ; Fatty Acids, Unsaturated/analysis ; Food Storage ; Male ; Oxidation-Reduction ; Pomegranate ; Red Meat/analysis ; Sheep, Domestic/physiology ; Thiobarbituric Acid Reactive Substances/analysis ; Vitamin E/analysis
    Chemical Substances Fatty Acids, Unsaturated ; Thiobarbituric Acid Reactive Substances ; Vitamin E (1406-18-4)
    Language English
    Publishing date 2019-12-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 753319-6
    ISSN 1873-4138 ; 0309-1740
    ISSN (online) 1873-4138
    ISSN 0309-1740
    DOI 10.1016/j.meatsci.2019.108037
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The patient-centered medical home: a review of recent research.

    Hoff, Timothy / Weller, Wendy / DePuccio, Matthew

    Medical care research and review : MCRR

    2012  Volume 69, Issue 6, Page(s) 619–644

    Abstract: The patient-centered medical home is an important innovation in health care delivery. There is a need to assess the scope and substance of published research on medical homes. This article reviews published evaluations of medical home care for the period ...

    Abstract The patient-centered medical home is an important innovation in health care delivery. There is a need to assess the scope and substance of published research on medical homes. This article reviews published evaluations of medical home care for the period 2007 to 2010. Chief findings from these evaluations as a whole include associations between the provision of medical home care and improved quality, in addition to decreased utilization associated with medical home care in high-cost areas such as emergency department use. However, fewer associations were found across evaluations between medical home care and enhanced patient or family experiences. The early medical home research appears to reflect both the wide variation in how medical homes are being designed and implemented in practice and in how researchers are choosing to evaluate patient-centered medical home design and implementation. While some aspects of medical home care show promise, continued evolution of medical home evaluative research is needed.
    MeSH term(s) Delivery of Health Care/organization & administration ; Health Services Research ; Humans ; Patient-Centered Care/organization & administration ; Quality of Health Care/organization & administration ; United States
    Language English
    Publishing date 2012-12
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1232314-7
    ISSN 1552-6801 ; 1077-5587
    ISSN (online) 1552-6801
    ISSN 1077-5587
    DOI 10.1177/1077558712447688
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Care Team Perspectives About an Inpatient Portal: Benefits and Challenges of Patients' Portal Use During Hospitalization.

    McAlearney, Ann Scheck / Hefner, Jennifer L / MacEwan, Sarah R / Gaughan, Alice / DePuccio, Matthew / Walker, Daniel M / Hogan, C Tory / Fareed, Naleef / Sieck, Cynthia J / Huerta, Timothy R

    Medical care research and review : MCRR

    2020  Volume 78, Issue 5, Page(s) 537–547

    Abstract: While current research about inpatient portals has focused largely on the patient perspective, it is also critical to consider the care team point of view, as support from these individuals is essential to successful portal implementation and use. We ... ...

    Abstract While current research about inpatient portals has focused largely on the patient perspective, it is also critical to consider the care team point of view, as support from these individuals is essential to successful portal implementation and use. We held brief in-person interviews with 433 care team members across a six-hospital health system to explore opinions about patients' use of an inpatient portal as perceived by care team members. Using the Inpatient Portal Evaluation Framework, we characterized benefits and challenges of portal use that care team members reported affected patients, themselves, and the collaborative work of these care teams with their patients. Interviewees noted inpatient portals can improve patient care and experience and also indicated room for improvement in portal use for hospitalized patients. Further understanding of the care team perspective is critical to inform approaches to inpatient portal implementation that best benefit both patients and providers.
    MeSH term(s) Hospitalization ; Humans ; Inpatients ; Medical Assistance ; Patient Care Team ; Patient Portals
    Language English
    Publishing date 2020-06-17
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1232314-7
    ISSN 1552-6801 ; 1077-5587
    ISSN (online) 1552-6801
    ISSN 1077-5587
    DOI 10.1177/1077558720925296
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: The cancer cachexia syndrome.

    Puccio, M / Nathanson, L

    Seminars in oncology

    1997  Volume 24, Issue 3, Page(s) 277–287

    Abstract: The cancer cachexia syndrome is clinically characterized by anorexia, wasting, weight loss, weakness, fatigue, poor performance status, and impaired immune function, which are unresolved by forced caloric intake. Diminished nutritional intake, ... ...

    Abstract The cancer cachexia syndrome is clinically characterized by anorexia, wasting, weight loss, weakness, fatigue, poor performance status, and impaired immune function, which are unresolved by forced caloric intake. Diminished nutritional intake, maladaptive metabolic processes, and increased metabolic expenditure all play roles in the development of this syndrome. Multiple mediators of both tumor and host cell origin are mechanistic in its etiology. Treatment is not entirely satisfactory and should be directed toward improvement in the quality of life of the patient and should often include nutritional counseling. It should take into consideration both disease and treatment related factors as well as the cachexia syndrome itself. Use of progestogens (megesterol acetate, medroxyprogesterone), corticosteroids (decadron, prednisone), metoclopramide, tetrahydrocannabinol (dronabinol), and possibly anabolic steroids (nandrolone decanoate, oxandrolone), melatonin, and eicosapentaenoic acid, may yield therapeutic benefit.
    MeSH term(s) Anorexia/etiology ; Appetite Stimulants ; Cachexia/diagnosis ; Cachexia/etiology ; Cachexia/physiopathology ; Cachexia/therapy ; Humans ; Neoplasms/complications ; Nutritional Support ; Syndrome
    Chemical Substances Appetite Stimulants
    Language English
    Publishing date 1997-06
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 189220-4
    ISSN 1532-8708 ; 0093-7754
    ISSN (online) 1532-8708
    ISSN 0093-7754
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: The Rapid Assessment of Aggregated Wastewater Samples for Genomic Surveillance of SARS-CoV-2 on a City-Wide Scale.

    Rouchka, Eric C / Chariker, Julia H / Saurabh, Kumar / Waigel, Sabine / Zacharias, Wolfgang / Zhang, Mei / Talley, Daymond / Santisteban, Ian / Puccio, Madeline / Moyer, Sarah / Holm, Rochelle H / Yeager, Ray A / Sokoloski, Kevin J / Fuqua, Joshua / Bhatnagar, Aruni / Smith, Ted

    Pathogens (Basel, Switzerland)

    2021  Volume 10, Issue 10

    Abstract: Throughout the course of the ongoing SARS-CoV-2 pandemic there has been a need for approaches that enable rapid monitoring of public health using an unbiased and minimally invasive means. A major way this has been accomplished is through the regular ... ...

    Abstract Throughout the course of the ongoing SARS-CoV-2 pandemic there has been a need for approaches that enable rapid monitoring of public health using an unbiased and minimally invasive means. A major way this has been accomplished is through the regular assessment of wastewater samples by qRT-PCR to detect the prevalence of viral nucleic acid with respect to time and location. Further expansion of SARS-CoV-2 wastewater monitoring efforts to include the detection of variants of interest/concern through next-generation sequencing has enhanced the understanding of the SARS-CoV-2 outbreak. In this report, we detail the results of a collaborative effort between public health and metropolitan wastewater management authorities and the University of Louisville to monitor the SARS-CoV-2 pandemic through the monitoring of aggregate wastewater samples over a period of 28 weeks. Through the use of next-generation sequencing approaches the polymorphism signatures of Variants of Concern/Interest were evaluated to determine the likelihood of their prevalence within the community on the basis of their relative dominance within sequence datasets. Our data indicate that wastewater monitoring of water quality treatment centers and smaller neighborhood-scale catchment areas is a viable means by which the prevalence and genetic variation of SARS-CoV-2 within a metropolitan community of approximately one million individuals may be monitored, as our efforts detected the introduction and emergence of variants of concern in the city of Louisville. Importantly, these efforts confirm that regional emergence and spread of variants of interest/concern may be detected as readily in aggregate wastewater samples as compared to the individual wastewater sheds. Furthermore, the information gained from these efforts enabled targeted public health efforts including increased outreach to at-risk communities and the deployment of mobile or community-focused vaccination campaigns.
    Language English
    Publishing date 2021-10-01
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2695572-6
    ISSN 2076-0817
    ISSN 2076-0817
    DOI 10.3390/pathogens10101271
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: The Rapid Assessment of Aggregated Wastewater Samples for Genomic Surveillance of SARS-CoV-2 on a City-Wide Scale

    Rouchka, Eric Christian / Chariker, Julia H. / Saurabh, Kumar / Waigel, Sabine / Zacharias, Wolfgang / Zhang, Mei / Talley, Daymond / Santisteban, Ian / Puccio, Madeline / Moyer, Sarah / Holm, Rochelle / Yeager, Ray / Sokoloski, Kevin J / Fuqua, Joshua / Bhatnagar, Aruni / Smith, Ted

    medRxiv

    Abstract: Throughout the course of the ongoing SARS-CoV-2 pandemic there has been a need for approaches that enable rapid monitoring of public health using an unbiased and minimally invasive means. A major way this has been accomplished is through the regular ... ...

    Abstract Throughout the course of the ongoing SARS-CoV-2 pandemic there has been a need for approaches that enable rapid monitoring of public health using an unbiased and minimally invasive means. A major way this has been accomplished is through the regular assessment of wastewater samples by qRT-PCR to detect the prevalence of viral nucleic acid with respect to time and location. Further expansion of SARS-CoV-2 wastewater monitoring efforts to include the detection of variants of interest / concern through next-generation sequencing have enhanced the understanding of the SARS-CoV-2 outbreak. In this report we detail the results of a collaborative effort between public health and metropolitan wastewater management authorities and the University of Louisville to monitor the SARS-CoV-2 pandemic through the monitoring of aggregate wastewater samples over a period of 28 weeks. Our data indicates that wastewater monitoring of water quality treatment centers and smaller neighborhood-scale catchment areas is a viable means by which the prevalence and genetic variation of SARS-CoV-2 within a metropolitan community of approximately one million individuals may be monitored. Importantly, these efforts confirm that regional emergence and spread of variants of interest / concern may be detected as readily in aggregate wastewater samples as compared to the individual wastewater sheds.
    Keywords covid19
    Language English
    Publishing date 2021-08-20
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2021.08.17.21262170
    Database COVID19

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  10. Article: Clinical evaluation and long-term follow-up of dogs having coronoidectomy for elbow incongruity.

    Puccio, Margaret / Marino, Dominic J / Stefanacci, Joseph D / McKenna, Brian

    Journal of the American Animal Hospital Association

    2003  Volume 39, Issue 5, Page(s) 473–478

    Abstract: A retrospective study was performed describing the clinical presentations, radiographic findings, and surgical outcomes of 17 dogs (18 elbows) following medial coronoidectomy for the treatment of elbow joint incongruity as a sole disease entity. Complete ...

    Abstract A retrospective study was performed describing the clinical presentations, radiographic findings, and surgical outcomes of 17 dogs (18 elbows) following medial coronoidectomy for the treatment of elbow joint incongruity as a sole disease entity. Complete resolution of lameness was achieved in 100% of the cases. The mean radiographic arthrosis grade progressed in 70% of the cases. Results of this study indicate that resolution of clinical lameness may be achieved with medial coronoidectomy in dogs with elbow incongruity; however, progression of degenerative joint disease with unknown, long-term clinical significance can be expected after surgery.
    MeSH term(s) Animals ; Dog Diseases/diagnostic imaging ; Dog Diseases/epidemiology ; Dog Diseases/pathology ; Dog Diseases/surgery ; Dogs ; Female ; Follow-Up Studies ; Forelimb ; Joint Deformities, Acquired/complications ; Joint Deformities, Acquired/epidemiology ; Joint Deformities, Acquired/veterinary ; Lameness, Animal/etiology ; Longitudinal Studies ; Male ; Medical Records ; New York/epidemiology ; Osteotomy/veterinary ; Radiography ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome
    Language English
    Publishing date 2003-09
    Publishing country United States
    Document type Evaluation Studies ; Journal Article
    ZDB-ID 410383-x
    ISSN 1547-3317 ; 0587-2871 ; 1062-8266
    ISSN (online) 1547-3317
    ISSN 0587-2871 ; 1062-8266
    DOI 10.5326/0390473
    Database MEDical Literature Analysis and Retrieval System OnLINE

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