Free Offer To Experience Prospective Health Planning Online.

Posted on | January 23, 2012 | No Comments

Mike Magee

Imagine you are a college student, a nursing student or a medical student, and you were suddenly confronted with a newly conceived child, with a known due date who was totally your responsibility. And imagine that you were charged to create a 100+ year life plan for this child now that would allow her or him to reach full human potential. Finally, imagine that you were only given the opportunity to list 25 actions or interventions – and instructed that these must be the most important – those ideas that you believe will have the greatest positive impact on this new life. What would make it to your list?

What I have just described is the Healthy Person Project©- a new online program that we have now tested on three different populations: a group of 330 college students (mostly 1st year); a group of 200 graduate and undergraduate nursing students; and a group of 58 medical students.

Before I describe a few of the findings, let me offer you – as a member of HealthCommentary – the opportunity to try the program yourself, FOR FREE. It’s a very interesting experience and will take you only 1 hour online. (Sneak it into the work day or skip Facebook or TV tonight.) At the end, you are able to see your own results alongside cumulative group results presented in real time. All data is de-identified and privacy protected.

If you’d like to begin to feel what it would be like to be a personalized and prospective health planner and health coach, go to: http://www.healthypersonproject.org/welcome/freetrial and register.

If you enjoy the experience, and think it might have value at your organization (it’s currently being incorporated into health curriculum from high school up through health professional training programs), you can learn more about how to become involved at: Healthy Person Project.

Here are a few of the findings so far:

1. All three groups of students (college, nursing, medicine) agree in large numbers (>90%) that health is a human right.

2. They differ some what however in how to get there. Medical and nursing students showed a greater degree of “medicalization” of their strategic health plans than did the college students, categorizing their over 15,000 chosen actions as medical tests or procedures 43% and 46% of the time compared to college students 16%.

3. All three groups heavily weighted early childhood interventions. Of over 15,000 action entries, medical, nursing and college students timed their actions to occur between conception and 10 years of life 44%, 48%, and 39% respectively.

To view more results, go here.

For HealthCommentary, I’m Mike Magee.

Reverend King, President Obama and Quiet Change

Posted on | January 18, 2012 | No Comments

Mike Magee

This week, the celebration of Martin Luther King Jr. had little chance of competing with the continued debate around who should be the Republican nominee for President of the United States. While that decision may still be weeks or even months in coming, what is clear is who will be running for President on the Democratic side and why he will be running for a second term.

It is in remembering Rev. King that we can best define President Obama’s continued purpose.  President Obama has now fully inherited the moral position of Martin Luther King and channeled it into his presidency. As he strides toward the tough campaign ahead, he likely will recall Rev. King’s approach to  another podium in front of the Lincoln Memorial. Dr. King’s staff have recalled that he was very satisfied with their planning for the march on that day. Originally intended to terminate at the Congressional steps, the Kennedy administration, which was pursuing the historic Civil Rights Bill at the time, felt this site would be too provocative to members of Congress and lobbied with Civil Rights leaders successfully to shift the venue.

So, as Rev. King shared the same view of the crowds that day along with “The Great Emancipator”, he was pleased, except for one thing. He had hoped that at least 1/3 of the crowd would be white, and by all reports only about 1/4 were.  Now decades later, we remain a diverse nation, on some scales deeply divided, weakened by indecision, nostalgic for “the past”.

And yet, on another level, as we look back a half century later, it is impossible to not marvel at what leadership, personal and individual leadership, can do for a nation, and how resilient and committed are American individuals, families and communities – of all races, creeds and colors.

Of course, as  Rev. King well understood, the struggle is not over. It may never be over. The ‘promised land” will likely always be a bit out of reach. We should not be surprised. This is after all a human endeavor.

Governing a nation is not a simple affair, and legislating is about as messy as parenthood. When you strip away all of the pain and suffering tied to our financial collapse, and ignore all the nonsense and theatrics associated with endless primary debates, in reality, America is finally facing change  head-on. We instinctively know that the status-quo is no longer an option. And we know that change is painful. We can feel it. But even in the midst of that pain, we are beginning to feel ourselves slowly rebounding – ahead of a struggling Europe, and a stuttering China and India.

We may not like it, we may hate its slow and uneven pace,  but we’re on the right track and headed in the right direction. What  Martin Luther King sought, was a better America and better Americans – reaching for their full potential in  medicine, nursing, law, education, manufacturing, energy and the environment and others.

To reach our full potential, we need grown-up leaders who are full bodied, well trained, committed, and empathetic. In each of our individual sectors, we need  voices that have not only mastered their own areas of expertise, but also the fact that their sector is intimately interwoven with all other sectors and with the fabric of society itself.

Our President is not perfect.  Why should he be? He and his wife are human beings like the rest of us. But he is an optimist, a realist and a pragmatist – as was Dr. King himself.

AU2009051102477.html

None should underestimate our President’s focus – it is on us, as it was for Martin Luther King.  It has been and continues to be about who we are as Americans, what are our ideals, how will we care for each other, and whether we as a nation will reach our full human potential.

Our progress may be slow, but it is forward facing, not backward. Some of us think we need a change – a new face. But its useful to remind ourselves that new is never old, and change is never easy, especially when your dream is as big as the American dream.

For Health Commentary, I’m Mike Magee.

The Drip, Drip, Drip of Health Care Reform: Insights From The Pitch Drop Experiment

Posted on | January 11, 2012 | No Comments

MikeMagee

If you look in the Guiness Book of Records, you will discover that the record for the world’s longest running laboratory experiment is held by the Pitch Drop Experiment at the University of Queensland in Brisbane, Australia. The experiment was begun in 1927 by physics professor Thomas Parnell who wished to demonstrate how viscous a liquid could be and still be “liquid”. (1,2)
Dr. Parnell poured hot tar pitch into a glass vessel and let it cool for three years. He then cut open the funnel shaped bottom of the vessel and allowed the tar to flow. Demonstrating that patience truly is a virtue when it comes to observational science, the first drop fell eight years later.  Over the past eighty-five years, eight drops have fallen, roughly one drop per decade. This has allowed physicists to calulate the viscosity of this black goo to be 230 billion times the viscosity of water.(3)
Over the years, many individuals have reflected on the lessons learned from this experiment. For example, “change does occur, but often at its own pace” or “what will happen next is easier to predict than when it will happen” or ” there is only “time before and time after.”
Professor John Mainstone, who has overseen the experiment since 1961 recently commented that, “It is only when the drop has happened that what has gone before makes sense in the flow of time. That is I don’t become aware of what was going on just before the drop until after the drop occurs.”(3)
These drops were large, accumulating mass over time. And their relative infrequency added to their dramatic effect. But what of a constant flow is smaller, more viscous, more ordinary droplets? Do they create a “before” and “after” reality change. Or do they simply cause a series of relatively non -transparent counter-droplets designed to re-establish the status-quo?
For roughly the same amount of time as the Pitch Drop Experiment has existed, modern health care delivery in the United States has conducted its own experiment. Here are just a few droplets over the past 100 years as outlined in the PBS documentary(4) on the US health care crisis:
1900:
American Medical Association(AMA) becomes a powerful national force.
In 1901, AMA reorganizes as the national organization of state and local associations. Membership increases from about 8,000 physicians in 1900 to 70,000 in 1910 — half the physicians in the country. This period is the beginning of “organized medicine.”
Surgery is now common, especially for removing tumors, infected tonsils, appendectomies, and gynecological operations.
Doctors are no longer expected to provide free services to all hospital patients.
America lags behind European countries in finding value in insuring against the costs of sickness.
Railroads are the leading industry to develop extensive employee medical programs.

1910:
American hospitals are now modern scientific institutions, valuing antispetics and cleanliness, and using medications for the relief of pain.
American Association for Labor Legislation (AALL) organizes first national conference on “social insurance”.
Progressive reformers argue for health insurance, seems to be gaining support.
Opposition from physicians and other interest groups, and the entry of the US into the war in 1917 undermine reform effort.

1920:
Consistent with the general mood of political complacency, there is no strong effort to change health insurance.
Reformers now emphasize the cost of medical care instead of wages lost to sickness – the relatively higher cost of medical care is a new and dramatic development, especially for the middle class.
Growing cultural influence of the medical profession – physicians’ incomes are higher and prestige is established.
Rural health facilities are clearly inadequate.
General Motors signs a contract with Metropolitan Life to insure 180,000 workers.
Penicillin is discovered, but it will be twenty years before it is used to combat infection and disease.

1930:
The Depression changes priorities, with greater emphasis on unemployment insurance and “old age” benefits.
Social Security Act is passed, omitting health insurance.
Push for health insurance within the Roosevelt Administration, but politics begins to be influenced by internal government conflicts over priorities.
Against the advice of insurance professionals, Blue Cross begins offering private coverage for hospital care in dozens of states.

1940:
Penicillin comes into use.
Prepaid group healthcare begins, seen as radical.
During the 2nd World War, wage and price controls are placed on American employers. To compete for workers, companies begin to offer health benefits, giving rise to the employer-based system in place today.
President Roosevelt asks Congress for “economic bill of rights,” including right to adequate medical care.
President Truman offers national health program plan, proposing a single system that would include all of American society.
Truman’s plan is denounced by the American Medical Association (AMA) , and is called a Communist plot by a House subcommittee.

1950:
At the start of the decade, national health care expenditures are 4.5 percent of the Gross National Product.
Attention turns to Korea and away from health reform; America will have a system of private insurance for those who can afford it and welfare services for the poor.
Federal responsibility for the sick poor is firmly established.
Many legislative proposals are made for different approaches to hospital insurance, but none succeed.
Many more medications are available now to treat a range of diseases, including infections, glaucoma, and arthritis, and new vaccines become available that prevent dreaded childhood diseases, including polio. The first successful organ transplant is performed.

1960:
In the 1950s, the price of hospital care doubled. Now in the early 1960s, those outside the workplace, especially the elderly, have difficulty affording insurance.
Over 700 insurance companies selling health insurance.
Concern about a “doctor shortage” and the need for more “health manpower” leads to federal measures to expand education in the health professions.
Major medical insurance endorses high-cost medicine.
President Lyndon Johnson signs Medicare and Medicaid into law.
“Compulsory Health Insurance” advocates are no longer optimistic’.
The number of doctors reporting themselves as full-time specialists grows from 55% in 1960 to 69%.

1970:
President Richard Nixon renames prepaid group health care plans as health maintenance organizations (HMOs), with legislation that provides federal endorsement, certification, and assistance.
Healthcare costs are escalating rapidly, partially due to unexpectedly high Medicare expenditures, rapid inflation in the economy, expansion of hospital expenses and profits, and changes in medical care including greater use of technology, medications, and conservative approaches to treatment. American medicine is now seen as in crisis.
President Nixon’s plan for national health insurance rejected by liberals & labor unions, but his “War on Cancer” centralizes research at the NIH.
The number of women entering the medical profession rises dramatically. In 1970, 9% of medical students are women; by the end of the decade, the proportion exceeds 25%.
World Health Organization declares smallpox eradicated.

1980:
Corporations begin to integrate the hospital system (previously a decentralized structure), enter many other healthcare-related businesses, and consolidate control. Overall, there is a shift toward privatization and corporatization of healthcare.
Under President Reagan, Medicare shifts to payment by diagnosis (DRG) instead of by treatment. Private plans quickly follow suit.
Growing complaints by insurance companies that the traditional fee-for-service method of payment to doctors is being exploited.
“Capitation” payments to doctors become more common.

1990:
Health care costs rise at double the rate of inflation.
Expansion of managed care helps to moderate increases in health care costs.
Federal health care reform legislation fails again to pass in the U.S. Congress.
By the end of the decade there are 44 million Americans, 16 % of the nation, with no health insurance at all.
Human Genome Project to identify all of the more than 100,000 genes in human DNA gets underway.
By June 1990, 139,765 people in the United States have HIV/AIDS, with a 60 percent mortality rate.

2000:
Health care costs are on the rise again.
Medicare is viewed by some as unsustainable under the present structure and must be “rescued”.
Changing demographics of the workplace lead many to believe the employer-based system of insurance can’t last.
Human Genome Project to identify all of the more than 100,000 genes in human DNA is expected to be completed a full two years ahead of schedule, in 2003.
Direct-to-consumer advertising for pharmaceuticals and medical devices is on the rise.

And since that PBS special, a few more drips: Medicare Part D passes; PDUFA reauthorization means industry funds 20% of the FDA budget; Patient Protection and Affordable Care Act passes and states mount legal challenges.
Any insights here? Big drops versus small drops? Short versus long-term planning? How comfortable are we with messy, back and forth unpredictability?
Professor Mainstone expects the next pitch drop to fall in 2013. He, for one, is excited. “Unpredictability is one of the great things about nature. It’s the spice of life. Just look at the due dates of babies. We so rarely get even that right.”
For Health Commentary, I’m Mike Magee.
References:
3.Paumgarten N. Countdown. The New Yorker. January 2, 2012. http://www.newyorker.com/talk/2012/01/02/120102ta_talk_paumgarten
4. PBS Documentary: Health Care Crisis. http://www.pbs.org/healthcarecrisis/history.htm

Should Bird Flu Research Be Suppressed?

Posted on | January 4, 2012 | No Comments

Mike Magee

Several years ago, Bird Flu (avian flu, H5N1), was the hottest topic in science reporting. We covered it closely from 2005 to 2009.(1) There were three major threads to our reporting: 1) H5N1 is a deadly virus. Since discovered in 1997, it has killed some 600 people. 2) H5N1 is not as dangerous  as the 1918 Spanish Flu because is is not generally transmissible through the air. 3) If H5N1 ever gains that capability, watch out.

Well, H5N1 is back in the news – not because it is transmissable in humans – but because a number of studies are beginning to reveal that, with a few critical genetic mutations, this could occur.(2) The fact that this has not yet occurred naturally is reassuring. But what concerns the government and the World Health Organization is that, in the wrong hands, genetic engineering could “arm” H5N1 as a weapon.(3,4,5) They are therefore opposed to publishing details of experiments that might provide a road map for terrorists.

The broad facts are already fully available. Clearly, the capacity to unleash a pandemic is related to person to person transmission of the virus. Factors affecting H5N1 transmission include site of entry of the virus, cell location of the reproducing virus, and the manner in which it is expelled from the host individual.

H5N1 likes two things. First, it prefers warmer temperatures like those found in animals GI tracts. Secondly, it likes a certain type of cell receptor – the alpha-2,3 receptor (prominently present in avian digestive tracts). Lucky for us, the human nose and throat provides cooler temperatures and utilizes alpha-2,6 receptors. As a result, it’s been very difficult for the virus to move from one human to another.

Of course, in science, nothing is impossible if one comes armed with the basic science knowledge and molecular tools in hand. Bottom line, the PB2 gene activated can allow H5N1 to replicate at lower temperatures, and a mutated HA gene could allow H5N1 to attach to different receptors.

Up till now, the rare unlucky human to catch H5N1 harbored the virus deep in the lung tissue (where temperatures are higher and there are some alpha-2,3 receptors) usually as a result of transmission from a close family member or from occupational contact with infected birds. 50% of those infected died, but they generally did so without passing on the virus to another human. Thus, no pandemic.

Argument against revealing results of the H5N1 genomic studies: “It plays into the hands of terrorists.”

Argument for both the studies and their release: “Bad guys are going to do this anyway. You won’t be able to hide the results. And the knowledge will lead to readiness with an appropriate antidote which will act as a preventive determinant. And – suppression of publications would have a chilling effect on scientific progress overall.”

Complicated! What do you think?

For Health Commentary, I’m Mike Magee.

References:

1. Magee M. When flu returns in the fall, how bad will it be? HealthCommentary.org. June 9, 2009. http://healthcommentary.org/?p=144

2. Erasmus Medical Center, Rotterdam, release: “Virologists to observe bioterrorism recommendation of the US.” December, 2011.
http://www.erasmusmc.nl/corp_home/corp_news-center/2011/2011-12/virologen.respecteren.advies.bioterror/?lang=en

3. Purvis C.  US goverment asks science journals to redact flu research. Security Management. January 3, 2012.
http://www.securitymanagement.com/news/us-government-asks-science-journals-redact-flu-research-009394

4. Ledford H. Call to censure bird flu studies draws fire. Scientific American. January 3, 2012.
http://www.scientificamerican.com/article.cfm?id=call-to-censor-bird-flu-studies

5. WHO Press Release.  WHO concerned that new H5N1 research could undermine the 2011 pandemic influenza preparedness framework. December 30, 2011.http://www.who.int/mediacentre/news/statements/2011/pip_framework_20111229/en/index.html

Happy, Healthy 2012

Posted on | December 31, 2011 | No Comments

Whatever the shape or size, may your 2012 be filled with good news and many blessings!

(Baby Elephant in Utero)

ACO’s – Rise or Fall – 2012 Will Be A telling Year.

Posted on | December 28, 2011 | No Comments

Mike Magee

One year ago, health policy expert John Iglehart recently wrote, “One of the few major provisions of the Affordable Care Act (ACA) with solid bipartisan support establishes a new delivery model: the accountable care organization (ACO). Congress directed the Department of Health and Human Services (DHHS) to develop an ACO program to improve the quality of care provided to Medicare beneficiaries and reduce its costs while retaining fee-for-service payment. Under this program, medical groups would have to take responsibility for achieving these goals and would share in any savings derived by Medicare.” (1)

With health systems racing to comply, Elliott Fisher, who has been credited with creating the label ACO, is uncertain about their future. He says, “Whether ACOs achieve their ambitious promise remains far from certain …The notion of accountable care has broad appeal. But only a robust, comprehensive, and transparent performance measurement system can reassure the public, physicians, hospitals, others who deliver care, and payers that ACOs are worthy of the name.” (2)

Of course, such performance presumes a knowledge of what measures matter. Given that, you need organizational capacity, real time data, and a reliable 24/7  service continuum.(3,4) And this requires a strong backbone of electronic medical records. It also requires a workforce tilted to primary care according to University of Maryland’s John Kastor. “The concept presumes that the professionals and hospitals (in ACOs that include both) will work together closely — ideally, as single governing units.”(3)

With ACO’s about to launch into a three year trial on risk sharing, health policy experts Sara Singer and Stephen Shortell recently weighed in on what could go wrong.(5)  Here are just 10 items that are at the top of their list:

1. Overestimation of Ability to Manage Risk.

“This is perhaps the major lesson to be drawn from the experimentation with capitated managed care in the 1990s. Organizations frequently overestimate their abilities, particularly when potential rewards are at stake. Some physician organizations have the ability to manage and measure ambulatory care. Some hospitals have the ability to manage and measure inpatient care. But the Medicare shared savings program and many private payer demonstrations require a single risk bearing entity, the ACO, to manage the entire care continuum.”

2. Overestimation of Ability to Use Electronic Health Records.

“Implementation of electronic health records will be more challenging than most believe, despite financial support offered by CMS and others. Most clinicians are inadequately trained and supported in the use of electronic health records.”

3. Overestimation of Ability to Report Performance Measures.

“Experience with pay-for-performance programs suggests the challenge of collecting, analyzing, and reporting performance data. For most ACOs, reporting capability will evolve slowly over time.”

4. Overestimation of Ability to Implement Standardized Care Management Protocols.

“For protocols to work, clinicians must be substantially involved in their development, data must exist to assess protocol implementation and outcomes, and the protocols must allow for tailoring to individual patient needs and preferences.  This takes time.”

5. Failure to Balance the Interests of Hospitals, Primary Care Physicians, and Specialists.

“Historically, relationships between hospitals and physicians often have been strained. Participants may view ACOs simply as an opportunity to achieve greater market power rather than to improve the overall value of care delivered.”

6. Failure to Sufficiently Engage Patients in Self-care Management and Self-determination.

“Patients and family members can provide considerable care particularly in managing multiple, complex chronic conditions. Patients need to be both considered a key part of the care team and educated about taking responsibility. Many potential ACOs have little experience with this degree of patient engagement.”

7. Failure to Make Contractual Relationships With the Most Cost-Effective Specialists.

“Unlike primary care physicians, specialists are not required to limit their activity to a single ACO. Nor are patients confined to a single ACO. Thus, referral relationships become critically important to overall ACO performance… Entrenched relationships with high-cost specialists will be a stumbling block for some ACOs.”

8. Failure to Navigate the New Regulatory and Legal Environment.

“Compliance with new regulatory requirements will require unprecedented levels of transparency and cooperation among hospitals, physician organizations, and payers.”

9. Failure to Integrate Beyond the Structural Level.

“Structural and contractual mechanisms may be in place to provide more coordinated care, but ACOs may lack the change management and implementation skills…Improvement will require engaging a wide spectrum of health professionals in the change-management process and aligning shared interests and rewards.”

10. Failure to Recognize the Interdependencies.

“Overestimating an organization’s ability to manage risk (the first mistake) will be exacerbated by the other mistakes, particularly the failure to implement electronic health records, which will affect the ability to develop and report performance measures and will result in less learning from feedback.”

As for me, one piece of advice after 30 plus years at this, successful new delivery models require two things – patient support and physician support. On both counts, 2012 will be a telling year

For Health Commentary, I’m Mike Magee
References:

  1. Iglehart JK. Assessing an ACO Prototype – Medicare’s Physician Group Practice Demonstration. NEJM 2011; 364:198-200, January 20, 2011. http://www.nejm.org/doi/full/10.1056/NEJMp1013896
  2. Fisher ES and Shortell SM.Accountable Care Organizations: Accoutable For What, To Whom, And How. JAMA 2010;304:1715-1716. http://jama.ama-assn.org/content/304/15/1715.extract
  3. Kastor JA. Accountable Care Organizations at Academic Medical Centers. NEJM. February 2, 2011.http://www.nejm.org/doi/pdf/10.1056/NEJMp1013221
  4. Lee TH, Casalino LP, Fisher ES, Wilensky GR. Creating Accountable Care Organizations. NEJM 2010;363:e23; October 7, 2010.http://www.nejm.org/doi/full/10.1056/NEJMp1009040
  5. Singer S, Shortell SM. Ten Potential Mistakes and How To Learn From Them. JAMA. August 8, 2011.http://jama.ama-assn.org/content/early/2011/08/05/jama.2011.1180.full

Desegregating Health Ed On College Campuses: The Healthy Person Project

Posted on | December 15, 2011 | No Comments

Mike Magee

In 2010 the Institute of Medicine (IOM) issued their report, The Future of Nursing: Leading Change, Advancing Health. A central theme was its appeal to a new approach to caring where “interprofessional collaboration and coordination are the norm.” This year the Robert Wood Johnson Foundation’s reinforced this message as part of their Charting Nursing’s Future (CNF) series focusing on the elimination of silo approaches.

Walking this theme back, it’s clear that health professional segregation begins on the undergraduate level. The RWJ report notes that some campuses are trying to change that. They site the following:

·”Maine’s University of New England has developed a common undergraduate curriculum for its health professions programs in nursing, dental hygiene, athletic training, applied exercise and science, and health, wellness and occupational studies.”

· “Vanderbilt University is pursuing an interprofessional education initiative that unites students from the medical and nursing schools with graduate students pursuing degrees in pharmacy and social work at nearby institutions.”

Positive Medicine Inc. has taken this one step further with its’ “Healthy Person Project”. Tested this fall at St. Thomas Aquinas College in Sparkill, NY, the online program has involved 350 incoming freshman students from all disciplines. It defines health as “the capacity to reach full human potential – mind, body, and spirit. Health then is a liberal arts concept and a strategic planning challenge.

Students were asked to take responsibility for the health and human potential of an online child conceived on October 4, 2011. Using the interactive online life planning tool, each student identified the top 25 actions or interventions that they believed would allow this online child, to be born on July 4, 2012, to reach her or his full human potential. They placed each idea at the appropriate location on a 120 year dynamic time line. Drop down menus asked them to categorize their ideas and reveal where the actions will take place (home, school, health care office, etc.)

The program contains a real-time smart online database that is able to capture and analyze the rich array of information collected. Each participant enters privacy protected, de-identified demographic data and completes an introductory 10 question health opinion survey which can be cross-corollated with the results of the simulator exercise. Using online algorithms, the system generates a variety of reports that are available in real time to online participants. Presentation slide decks are part of the package as well to promote class room dialogue.

In 2012, Positive Medicine Inc. will make the Healthy Person Project available to campuses nationwide. The live database will allow participants to see how their health priorities over a life time match up with their school’s vision and with the nation as a whole. What this program acknowledges is that team work and collaboration must begin with a common definition and vision of health. Using this powerful application, an entire community can be efficiently canvassed and united (with privacy protections) online with de-identified results available in real time.

Why is the Healthy Person Project important? Because it acknowledges that, while collaboration and teamwork are critical in the pursuit of health, these efforts must be built on a strong foundation. That foundation requires a common understanding of what health means and what are the lead priorities in assuring that each individual reaches full human potential.

For more information on the Healthy Person Project, press HERE.

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