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Workforce issues related to: Physical and behavioral healthcare integration: Specifically substance use disorders and primary care discount 1 mg warfarin prehypertension 34 weeks pregnant. A national review of state alcohol and drug treatment programs and certification standards for substance abuse counselors and prevention professionals generic warfarin 2mg visa heart attack vol 1 pt 3. Prescription drug monitoring programs: An assessment of the evidence for best practices trusted 2 mg warfarin heart attack feat mike mccready money mark. Evaluation of the Medicaid health home option for beneficiaries with chronic conditions: Final annual report - base year. Cost, utilization, and quality of care: An evaluation of Illinois’ Medicaid primary care case management program. Joint principles: Integrating behavioral health care into the patient-centered medical home. Accountable health communities — Addressing social needs through Medicare and Medicaid. On the road to better value: State roles in promoting accountable care organizations. Community‐clinical linkages to improve hypertension identification, management, and control. Institute of Medicine, Roundtable on Population Health Improvement, & Board on Population Health and Public Health Practice. Integrating buprenorphine maintenance therapy into federally qualifed health centers: Real-world substance abuse treatment outcomes. Health coaching via an internet portal for primary care patients with chronic conditions: A randomized controlled trial. Eligible professional meaningful use table of contents core and menu set objectives. Meaningful adoption: What we know or think we know about the fnancing, effectiveness, quality, and safety of electronic medical records. Challenges and opportunities for integrating preventive substance-use-care services in primary care through the Affordable Care Act. Personal health record reach in the Veterans Health Administration: A cross- sectional analysis. Electronic patient portals: evidence on health outcomes, satisfaction, efciency, and attitudes: A systematic review. Integrating information on substance use disorders into electronic health record systems. Development of a prescription opioid registry in an integrated health system: Characteristics of prescription opioid use. Alcohol and drug use and aberrant drug-related behavior among patients on chronic opioid therapy. Opioid overdose prevention programs providing naloxone to laypersons— United States, 2014. Integrated treatment continuum for substance use dependence “Hub/Spoke” Initiative—Phase 1: Opiate dependence. Embedding prevention, treatment, and recovery services into the larger health care system will increase access to care, improve quality of services, and produce improved outcomes for countless Americans. A national opioid overdose epidemic has captured the attention of the public as well as federal, state, local, and tribal leaders across the country. Ongoing efforts to reform health care and criminal justice systems are creating new opportunities to increase access to prevention and treatment services. Health care reform and parity laws are providing signifcant opportunities and incentives to address substance misuse and related disorders more effectively in diverse health care settings. These changes represent new opportunities to create policies and practices that are more evidence-informed to address health and social problems related to substance misuse. The moral obligation to address substance misuse and substance use disorders effectively for all Americans also aligns with a strong economic imperative. Substance misuse and substance use disorders are estimated to cost society $442 billion each year in health care costs, lost productivity, and criminal justice costs. More than 10 million full-time workers in our nation have a substance use disorder—a leading cause of disability —and3 studies have demonstrated that prevention and treatment programs for employees with substance use disorders are cost effective in improving worker productivity. It aims to understand and address and Related Consequences” in Chapter 1 - Introduction and Overview. The following fve general messages described within the Report have important implications for policy and practice. These are followed by specifc evidence-based suggestions for the roles individuals, families, organizations, and communities can play in more effectively addressing this major health issue. Both substance misuse and substance use disorders harm the health and well-being of individuals and communities. Substance misuse is the use of alcohol or illicit or prescription drugs in a manner that may cause harm to users or to those around them. Harms can include overdoses, interpersonal violence, motor vehicle crashes, as well as injuries, homicides, and suicides—the leading causes of death in adolescents and young adults (aged 12 to 25). These disorders involve9 See Chapter 2 - The Neurobiology of impaired control over substance use that results from Substance Use, Misuse, and Addiction. Substance use disorders 1 occur along a continuum from mild to severe; severe substance use disorders are also called addictions. Because substances have particularly powerful effects on the developing adolescent brain, young adults who misuse substances are at increased risk of developing a substance use disorder at some point in their lives. Implications for Policy and Practice Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it. Although they cannot address the chronic, severe impairments common among individuals with substance use disorders, education, regular monitoring, and even modest legal sanctions may signifcantly reduce substance misuse in the wider population. Many policies at the federal, state, local, and tribal levels that aim to reduce the harms associated with substance use have proven very effective in preventing and reducing alcohol misuse (e. These programs also provide the opportunity to engage people who inject drugs in treatment. These types of effective prevention policies can and should be adapted and extended to reduce the injuries, disabilities, and deaths caused by substance misuse. Highly effective community-based prevention programs and policies exist and should be widely implemented. This Report describes the signifcant advances in prevention science over the past two decades, including the identifcation of major risk and protective factors and the development of more than four dozen research-tested prevention interventions that can be delivered in households, schools, clinical settings, and community centers.

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Mita verenpainelaakkeita kaytatalla 2 en hetkella (tarkistakaa nimeja annostukseb) yhden (saman) rveydenhoitajan luona? Kaytko verenpaineenne vuoksi Laake Haittavaikutus a) laakarissa 1 6 kertaa vuodessa tai useammin 2 4 - 5 kertaa vuodessa 3 2 - 3 kertaa vuodessa 4 kerran vuodessa 5 noin joka toinen vuosi 6 harvemmin 10 warfarin 2mg amex blood pressure going up. Onko laakari keskuslluidan kanssanne seuraavista verenpaineenne hoitoon liittyvista a) rveydenhoitajan luona asioista? Oletko hoitavan laakarinne kanssa Tupakoinnin lopettaminen 1 2 3 sopinuverenpainearvosta discount warfarin 2 mg otc heart attack medication, johon idan Saannollinen liikunta 1 2 3 hoidossanne olisi pyrittava? Verenpainelaakkeiden 1 kylla on sovittu warfarin 5 mg generic arrhythmia emedicine, tavoitena on paasta saannollinen kaytto 1 2 3 arvoon / mmHg 2 on puhuttu verenpaineen alentamisen Saannollisetarpeesta ilman tarkkaa rajaa verenpainekontrolli1 2 3 3 ei ole sovittu mitaan Suolan kayton vahentaminen 1 2 3 11. Oletko sopinuhoitavan laakarinne kanssa kanssanne seuraavista verenpaineenne idan tavoitena olevasta kolesroli- hoitoon liittyvista asioista? Kylla Ei Ei koske 1 kylla on keskusltu, tavoitena on minua kohdallani paasta lukemaan_____mmol/l Vaharasvainen ruoka 1 2 3 2 on puhuttu kolesrolin alentamisen Laihduttaminen 1 2 3 tarpeesta ilman tarkkaa tavoitta 3 ei ole keskusltu kolesrolin alentamisen Alkoholin kaytto 1 2 3 tarpeesta Tupakoinnin lopettaminen 1 2 3 Saannollinen liikunta 1 2 3 Verenpainelaakkeiden 17. Min hoidakorkeaa kolesrolianne saannollinen kaytto 1 2 3 (tassa voivalita useita kohtia)? Saannollise1 en minkaan verenpainekontrolli1 2 3 2 ruokavaliolla Suolan kayton 3 laakkeilla vahentaminen 1 2 3 4 muulla tavalla, milla? Kaytatko talla hetkella kolesrolia missa mittauksissa viimeksi kuluneen vuoden alentavia laakkeita? Oletko kayttanyviimeksi kuluneen vuoden (12 kk) aikana verenpainelaakkeita Laake Vahvuus (mg) Annostus vahemman kuin mita laakari on maarannyt? Mita ilman laakemaaraysta saatavia laakkeita vuoden (12 kk) aikana kolesrolia alentavia olekayttanyvahintaan kahdesti viimeksi laakkeita vahemman kuin mita laakari on kuluneen viikon (7 vrk) aikana? Ovatko laakkeiden kokonaiskustannukse(kaikkien laakkeiden kustannukset) vaikutta- neeviimeksi kuluneen vuoden (12 kk) aikana laakkeiden kayttoonne? Onko illa koskaan todettu tai hoidettu mitaan useita vaihtoehtoja) seuraavista sairauksista? Mita muita laakarin maaraamia laakkeita virtsatietulehduksia, munuaiskivi) kuin verenpainelaakkeeja kolesrolilaak- 13 kihti keeolekayttanyvahintaan kahdesti viimeksi kuluneen viikon (7 vrk) aikana? Tarkistakaa omasta Kela-kortistanne, mitka seuraavista erityiskorvattaviin laakkeisiin oikeuttavista numeroista ilta loytyvaja rengastakaa numerot. Kuinka monta vuotta yhensa olekayny2 en ole viimeksi kuluneen vuoden paatoimisesti koulua tai opiskellulamanne aikana enaa kayttanyalkoholia 3 kaytan alkoholia ja keskimaarainen aikana? Lakritsin syonti voi vaikuttaa veren- 7 ansiosidonnainen tyottomyyspaivaraha paineeseen. Kaykaa seuraavaasiakohta kohdalta lapi rengastaen kustakin vaittamasta idan mielipidettanne vastaava numero (siis yksi numero joka rivilta). Taysin Jokseenkin Jokseenkin Taysin Ei samaa samaa eri eri koske mielta mielta mielta mielta minua En ole saanulaakarilta kunnon ohjeita verenpaineeni hoitoon. Olkaa hyva ja ottakaa kantaa seuraaviin vaittamiin ajallen omaa verenpaineenne hoitoa. Rengas- takaa kustakin vaittamasta mielipidettanne vastaava numero (siis yksi numero joka rivilta). Taysin Jokseenkin Jokseenkin Taysin Ei samaa samaa eri eri koske mielta mielta mielta mielta minua Olen erittain tyytyvainen laakarini tapaan hoitaa verenpainettani. Pitaa Ei pida Ei koske paikkaansa paikkaansa minua Minun on hankala paasta haluamalleni laakarille. Levels of evi- accompanied by aleasone other urinary symptom: persis- dence and grades of recommendation were assigned for nurgency or urinary frequency. This is the defnition thawill Much confusion regarding the diagnosis of this clinical syn- be referred to for the purpose of this guideline. In addition, the condition is dramatically anti-infammatory drugs, cyclophosphamide, and ketamine), under-repord in men. A musculoskeletal age time of three to seven years from the time of presentation and focused neurological exam may also be contributory. Disease How they can be excluded or diagnosed* The location of pain, relation to bladder flling/emptying Endometriosis Pain worse during menses (vs. Patients may describe �fares,� or periods Overactive voids to avoid incontinence (vs. Common triggers include cof- Worse with sitting, positional dependency Pudendal nerve fee, alcohol, citrus fruits, tomatoes, carbonad beverages, suggests a neurogenic or musculoskeletal 15 entrapmenand spicy foods. Glucose, leukocys, hematuria, nitris, and perineum, in combination with a weak or absenanal refex, osmolality may be simply screened for. Prostatic Corynebacrium species, Candida species, and Mycoplasma massage could be considered if pain appears to be more tuberculosis if srile pyuria persists. This scan easily be reasonable to recommend cystoscopy to assisin making a performed afr cystoscopy and can provide both relief to diagnosis before initiating therapy, especially if there is any the patient, as well as provide diagnostic information and indication on history, physical examination, urinalysis, or guide future therapy. A patienxperiencing relief from cytology suggesting thaother diseases need to be ruled out. Resolution of the pain by dysfunction (pelvic foor examination is easily added to a intravesical local anesthesia can be both diagnostic and cystoscopic examination) will directreatmenstragies. Sixty-eighpercenxperienced a reduc- diagnostic purposes may be appropria in certain situations. All non-responders were These may include: when a patienis unable to tolera subsequently diagnosed with non-bladder pathology causing cystoscopy under local anesthetic and is having a general their pelvic pain. Conservative therapies infammation are nospecifc, overlapping with other eti- ologies, and they correla poorly to cystoscopic fndings 1. Based on besvidence principles, initial managemenHowever, correlations have been found with specifc should focus on conservative stragies. Dundore eal found no signifcandifference in masUp to 90% of patients have exacerbations of their symp- cell counts in the lamina propria or detrusor on Giemsa- toms afr ingesting certain foods or drinks. The goal is to reduce voiding frequency, pontially treatmenshould be maximizing symptomatic control and increase bladder capacity, and reduce the need to void in quality of life while avoiding adverse events and treatmenresponse to urgency or pain. Timed voiding or scheduled complications, recognizing thathere is no curative treat- voiding involves urinating aregular seinrvals thadis- menfor this condition. Distraction (counting backwards) conditions with early referral to other specialists for multi- or relaxation (deep breathing) chniques may be used.

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Discontinue this medication if your pet stops eating or starts vomiting order 5 mg warfarin with visa blood pressure norms chart, and notify your veterinarian immediately buy discount warfarin 5 mg line heart attack yahoo answers. Spironolactone also blocks the adverse effects of aldosterone on the heart muscle generic warfarin 5mg mastercard arterial duplex. Some adverse effects associated with spironolactone include dehydration, low blood pressure, high blood potassium, lethargy, vomiting and diarrhea. Thiazide diuretics can cause low blood potassium and sodium levels, leading to weakness, lethargy and inappetance. Careful monitoring of electrolytes is necessary, and is done with periodic blood testing. Some adverse effects associated with Aldactazide include dehydration, low blood pressure, blood salt (electrolyte) disturbances, lethargy, vomiting and diarrhea. They are commonly used as adjunctive therapy in patient suffering from congestive heart failure. They may be used in patients that have overt high blood pressure (systemic hypertension). Some are used specifically for patients with elevated blood pressure in the lungs (pulmonary hypertension). Occasionally, direct- acting vasodilators are used in cases of severe heart failure or systemic hypertension. Periodic monitoring of the blood pressure is advised, especially if high doses are used to control severe hypertension. Generally, if a patient taking an antihypertensive drug suddenly becomes very weak, lethargic, or collapses, then it is advisable to discontinue the drug and notify the veterinarian immediately. These drugs decrease the formation of compounds and hormones that constrict blood vessels in animals with heart and vascular disease. These drugs also reduce the concentrations of harmful chemicals and hormones that injure heart muscle in animals with heart failure. Enalapril and benazepril may relax blood vessels to such a degree that some animals become weak from low blood pressure. If this is a new medication for your pet a blood profile must be checked in 1-2 weeks before the dose is increased to twice a day in dogs (cats typically receive the medication no more than once daily). The dose must be adjusted for each individual and requires reevaluation of blood pressure at 12-24 hours post- pill every 1-2 weeks until the correct dose of drug is established. Rarely, side effects may include gastrointestinal upset or hypotension (weakness and inappetance may be symptoms). Careful monitoring of the blood pressure is required in patients taking hydralazine. Side effects include a fast heart rate (tachycardia), gastrointestinal upset (vomiting, diarrhea), weakness, lethargy and collapse. If your pet experiences any of these symptoms, it is best to discontinue this medication and notify your veterinarian immediately. It is used in dogs for the treatment of pulmonary hypertension, a disease in which the arteries supplying blood to the lungs become constricted either for unknown reasons or secondary to chronic lung disease, heartworm disease, etc. Side effects are typically secondary to an excessively low blood pressure, and may include lethargy, weakness or collapse. If your pet experiences any of these symptoms, it is best to discontinue the drug and notify your veterinarian immediately. Inodilators are drugs that not only increase the contractile force of the heart, but also relax the peripheral arteries. Some of these drugs are useful only in a hospital setting, and these include dobutamine and dopamine. Some are used in an oral formulation to help treat patients suffering from congestive heart failure. Digoxin is a positive inotropic drug and pimobendan is classified as an inodilator. Digoxin will also reduce nerve stimulation to the heart that would normally result in an increased heart rate. Effective use of the drug must be monitored by a test that measures concentration blood. When first starting this medication, a blood level must be measured in 1-2 weeks at 8-10 hours post- medication. High doses of digoxin can lead to adverse effects, including cardiac arrhythmias, loss of appetite, vomiting and diarrhea. If your pet experiences any of these symptoms, stop the drug and contact your veterinarian immediately. Termed an inodilator, pimobendan combines the effects of increasing heart muscle pump strength and acts as a vasodilator to decrease the workload the heart is pumping against. This drug is intended to be used in complement to the traditional heart failure treatment. Also known as blood thinners, these drugs are most commonly used in cats with severe heart disease at risk for stroke formation. Due to their metabolism, cats cannot take aspirin daily, and are usually put on an every 2 – 3 day regimen. Side effects include inappetance, vomiting (especially any coffee ground like material) or discolored (dark, tarry) stool. If any of these occur while your pet is taking aspirin, it is best to discontinue the drug and notify your veterinarian. Do not combine with a steroid (such as prednisone, prednisolone) as serious gastrointestinal ulceration may result. Clopridogrel inhibits platelet aggregation, which leads to the formation of a clot. Side effects are typically milder that those seen with aspirin, but may include inappetance, vomiting and some blood cell dyscrasias. If any of these occur while your pet is taking clopridogrel, it is best to discontinue the drug and notify your veterinarian. There are four general classes of antiarrhythmic drugs, however some have crossover class action. Class I antiarrhythmics are sodium-channel blockers, and include procainamide and mexilitine. Most antiarrhythmics help control the heart rate, and may be prescribed to patients with rapid heart rates (tachycardia).

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Tey also highlight the need for the services generic warfarin 2mg amex blood pressure and caffeine, the completeness of estimates also has a large participation of all the stakeholders order warfarin 1mg without prescription blood pressure chart bpm, including civil society buy warfarin 5mg mastercard hypertension jama, impact. In current estimates, drug treatment and other in the implementation and evaluation of interventions. In some countries, Public spending on responses to the drug problem is only standards are linked to service delivery and are used to part of the cost borne by society in relation to illicit drugs. Tey are also being used as a To this can be added the costs borne by the individual, requirement for participation in competitions for service such as private contributions to medical care, and external contracts and as instruments for service-level self- costs to society, such as losses of productivity and the assessment. Assessment of these wider costs to society may allow resources to be more efectively targeted. In the l Delivering prevention: a systems approach European countries for which information is available, the social cost of illicit drugs is estimated to be between 0. Environmental and universal approaches target entire populations, selective prevention targets vulnerable groups who may be at greater risk of developing drug use problems, and indicated prevention focuses on at-risk individuals. Quality standards currently exist in most European countries 63 European Drug Report 2017: Trends and Developments Many diferences exist between European countries in the Prevention approaches that target high-risk way prevention is addressed, with some tending to adopt neighbourhoods have been implemented in some broader community-based and environmental approaches countries, utilising new methods such as the redesigning (e. Provision for these types of interventions is based prevention programmes, characterised by strictly reported to be highest in the north and west of Europe (see defned content and delivery, can be an efective way to Figure 3. Provision Other countries have prioritised a broader systems of this type of intervention is limited in Europe, with only 4 approach to their prevention interventions, focusing not countries reporting that indicated prevention programmes just on individual programmes, but also on factors such as are available to the majority of those in need. Tis approach, developed in the United States, is based on the premise that a Brief interventions aim to prevent or delay substance use, reduction in the prevalence of health and behavioural reduce its intensity or prevent escalation into problem use. Current data indicate that brief interventions are not widely l Addressing vulnerability and risk implemented in Europe, with 3 countries reporting full and extensive provision of such interventions in schools, and 2 Selective prevention responses for vulnerable groups are reporting that level of provision in low-threshold services. At the local level, such approaches can involve low-cost, with the potential for delivery in multiple settings multiple services and stakeholders (e. Examples youth and police), and are common in the Nordic countries of brief interventions implemented in several countries are and Ireland, as well as parts of Spain and Italy. Tis form of referral, which also includes referral Drug treatment is the primary intervention utilised for by family members or friends, accounted for around half of individuals who experience problems with their drug use, those entering specialised drug treatment in Europe in including dependence, and ensuring good access to 2015. An additional 25 % of clients were referred by health appropriate treatment services is a key policy aim. In a number of countries, schemes the treatment journeys that clients take and adjusting are in place to divert drug ofenders away from the criminal services to better ft observed needs. Tis may involve a court order to attend treatment or a suspended sentence conditional on treatment; in some countries diversion is also possible at earlier stages of the criminal justice process. In 2015, cannabis clients were the most likely to be referred by the criminal justice system; in Hungary, around 80 % of cannabis treatment referrals came from this source. Client pathways through drug treatment are often characterised by the use of diferent services, multiple entries and varying lengths of stay. An insight into treatment journeys is provided by results from an analysis of specialised treatment data from 7 European countries in 2015. Of the 400 000 clients reported in treatment in these countries during that year, just under 20 % had entered treatment for the frst time in their life; around 30 % had re-entered treatment, having received treatment in an earlier year; and around half had been in continuous treatment for more than 1 year. Most of the clients in continuous treatment were males, in their late 30s, had been in treatment for more than 3 years and had problems related to opioid use, especially heroin. While many countries psychoactive medicines, including antidepressants, ofer treatment for people with cannabis problems within anxiolytics and mood stabilisers. To date, results have generic substance use programmes, around half have been inconsistent, and no efective pharmacological developed some cannabis-specifc treatment options. Although most treatment for this group takes place in community or Drug treatment: mainly provided in community outpatient settings, around one in fve people entering l settings specialist inpatient drug treatment services reported a primary cannabis-related problem. Opioid users psychosocial approaches; family-based interventions are represent the largest group undergoing specialised often used for adolescents and cognitive-behavioural treatment and consume the greatest share of available interventions for adults. Te available evidence supports treatment resources, mainly in the form of substitution the use of a combination of cognitive-behavioural therapy, treatment. Cannabis and cocaine users are the second motivational interviewing and contingency management and third largest groups entering these services approaches. Internet and digital-based interventions countries can be very large, however, with opioid users are increasingly employed to reach cannabis users, and accounting for more than 90 % of treatment entrants in studies to measure the efects of this type of interventions Estonia and less than 5 % in Hungary. Tis category includes general practitioners’ surgeries, which are important prescribers of opioid substitution treatment in some large countries such as Germany and France. Elsewhere, for example in Slovenia, mental healthcare centres may play a key role in outpatient treatment provision. Te relative importance of outpatient and communities (27 900) inpatient provision within national treatment systems Prisons varies greatly between countries. Internet-based interventions have the potential to extend the reach and geographical coverage of treatment programmes to people experiencing drug use problems who may not otherwise access specialist drug services. Te available evidence supports this approach, with positive outcomes found in respect to A comparison with current estimates of the number of treatment retention, illicit opioid use, reported risk high-risk opioid users in Europe would suggest that half behaviour, drug-related harms and mortality. However, these fndings An estimated 630 000 opioid users received substitution must be interpreted cautiously for methodological reasons. Te trend shows an increase Methadone is the most commonly prescribed opioid in clients up to a peak in 2010, followed by a 6 % decline to substitution drug, received by around two thirds (63 %) of 2015. A further 35 % of clients are treated in 12 countries, with the largest (decreases of more than with buprenorphine-based medications, which is the 25 %) reported by Spain, Hungary, the Netherlands and principal substitution drug in 8 countries (Figure 3. Tis decline may be explained by factors related Other substances, such as slow-release morphine or to demand or provision, including a falling population of diacetylmorphine (heroin), are more rarely prescribed, ageing, chronic opioid users or shifts in treatment goals in being received by an estimated 2 % of substitution clients some countries. In the 9 countries for which data community settings and continuity of care after prison are available, between 1 % and 26 % of all opioid users in release. Te availability of opioid substitution treatment in treatment receive interventions not involving opioid prisons is reported by 28 of the 30 countries monitored by substitution (Figure 3. Detoxifcation, individual and group counselling, and therapeutic communities or special inpatient wards are available in most countries. Many l Prisons: low availability of hepatitis C treatment European countries have established interagency partnerships between prison health services and providers Prisoners report higher lifetime rates of drug use and more in the community, in order to facilitate delivery of health harmful patterns of use (including injecting) than the education and treatment interventions in prison and to general population, making prisons an important setting ensure continuity of care upon prison entry and release. Many prisoners have complex healthcare needs, and assessment of drug use and drug-related problems is an important part of the health screening at prison entry in many countries. Te Hospital emergency data can provide an insight into acute provision of clean injecting equipment is less common, drug-related harms. Te 5 054 presentations Preparation for prison release, including social recorded by the project in 2015 had a median age of reintegration, is carried out in most countries. Nearly two information and the provision of naloxone upon prison thirds of presentations (65 %) involved the use of release.

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