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Haciabbasoğlu R, Araci A, Günizi H. Are Telerehabilitation Exercise Practices Effective in Patients Diagnosed with Benign Paroxysmal Positional Vertigo? Indian J Otolaryngol Head Neck Surg 2023; 75:557-567. [PMID: 37200900 PMCID: PMC10016185 DOI: 10.1007/s12070-023-03631-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/23/2023] [Indexed: 03/17/2023] Open
Abstract
The aim of this study was to investigate the effectiveness of classical Vestibular Rehabilitation Exercises (Control Group-CG) given as home exercise program and VR + balance exercises (Experimental Group-EG) applied with telerehabilitation method on patients with Benign Paroxysmal Positional Vertigo (BPPV). Material and Methods: The patients were randomly divided into 2 therapy groups in the ALKU Hospital (CG; 21 patients, and EG;22 patients). Pre- and post-test experimental design was adopted and a six-week training was offered. The participants' balance ability (Romberg, tandem and semi-tandem tests), vertigo severity (Vertigo Symptom Scale-VSS, VAS), vertigo-related disability level (Dizziness Handicap Inventory-DHI), anxiety (Beck Anxiety Inventory-BAI) and quality of life (Vertigo Dizziness Imbalance Questionnaire-VDI) were assessed. Regarding the balance ability, findings in tandem and semi-tandem tests were significantly increased in the EG compared to CG (p < 0.05). According to VAS, the severity of dizziness decreased significantly compared to the CG (p < 0.05). Regarding the DHI score, symptoms of vertigo were reduced considerably after the treatment compared to the CG (p < 0.05). A significant improvement was observed in the quality of life of the EG group according to VDI scoring (p < 0.05). Although gains were observed in both groups, it was observed that the EG group obtained more effective improvement in the severity of vertigo, disability level due to vertigo, and quality of life compared to the home exercise group.These results confirmed the hypothesis that EG applications are effective and clinically applicable in patients with BPPV.
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Affiliation(s)
- Reyyan Haciabbasoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Üsküdar University, Istanbul, Turkey
| | - Ayça Araci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Alanya Alaaddin keykubat University (ALKU), Kestel mh. Cimento cd no:80, Alanya, Antalya Turkey
| | - Hüseyin Günizi
- Department of Otolaryngology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey
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Ke Y, Ma X, Jing Y, Diao T, Yu L. Risk factors for residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:3237-3256. [PMID: 35218384 DOI: 10.1007/s00405-022-07288-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the risk factors for residual dizziness (RD) in patients with benign paroxysmal positional vertigo (BPPV) after successful repositioning. METHODS Searches were performed in PubMed, Embase, Cochrane library, Web of Science, Chinese National Knowledge Infrastructure, and Sino Med up to March 7, 2021 and references of relevant articles were screened. Data from eligible studies were meta-analyzed using Stata version 16.0 and Review Manager 5.4. RESULTS In this systematic review and meta-analysis of 4487 patients from 31 studies, the prevalence of RD was 43.0% (95% CI 39.0-48.0%). Age (MD 4.17; 95% CI 2.13-6.21, P = 0.000), female gender (OR = 1.28, 95% CI 1.11-1.47, P = 0.001), secondary BPPV (OR 1.88; 95% CI 1.27-2.77, P = 0.001), a longer duration of BPPV before treatment (MD 3.45; 95% CI 1.87-5.02, P = 0.000), abnormal ocular vestibular evoked myogenic potential (OVEMP, OR 4.34; 95% CI 2.78-6.78, P = 0.000), abnormal cervical vestibular evoked myogenic potential (CVEMP, OR 2.48; 95% CI 1.54-3.99, P = 0.000), higher Dizziness Handicap Index (DHI) score before treatment (MD 10.88; 95% CI 5.96-15.80, P = 0.000), anxiety (OR 9.58; 95% CI 6.32-14.52, P = 0.000), osteopenia (OR = 4.40, 95% CI 2.17-8.96, P = 0.000), onset in winter (OR 7.27; 95% CI 2.38-22.24, P = 0.001) and with a history of BPPV (OR 1.79; 95% CI 1.06-3.04, P = 0.03) are the risk factors for RD in patients with BPPV after successful repositioning. The affected side, location or type of semicircular involvement, hyperlipidemia, diabetes, hypertension, heart disease, migraine, sleep disorders, canalolithiasis/cupulolithiasis, the number of times the canalith repositioning procedures (CRPs) were performed and number of vertigo attacks did not correlate with the occurrence of RD. CONCLUSIONS Despite successful treatment, nearly half of the BPPV patients developed RD. RD seems to be a syndrome caused by multiple factors. The pathogenesis of most factors can be explained by psychological and/or physical disorders. Early recognition of these risk factors contributes to the prevention and treatment of RD.
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Affiliation(s)
- Yujie Ke
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Tongxiang Diao
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China.
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Sim E, Tan D, Hill K. Poor Treatment Outcomes Following Repositioning Maneuvers in Younger and Older Adults With Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2020; 20:224.e1-224.e23. [PMID: 30691621 DOI: 10.1016/j.jamda.2018.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This systematic review aimed to methodically review the available evidence on poor treatment outcomes after repositioning maneuver treatments in adults with BPPV and whether there are differences in the outcomes for older and younger adults. DATA SOURCES Embase, CINAHL, Scopus, PsycINFO (Ovid), Central Register of Controlled Trials (CENTRAL), and PubMed. REVIEW METHODS Studies were included if they were prospective experimental or observational studies with a minimal follow-up of 1 month; the subjects were at least 18 years old, had BPPV, and were treated with repositioning maneuvers. Studies were excluded if they were not available in English full text and if the outcomes used were confined to positional tests and subjective vertigo rating. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Meta-analysis was performed to compare outcomes for younger and older (≥60 years) subjects where multiple studies utilized similar outcomes. RESULTS Thirty-five studies were selected. The methodological quality was poor in more than 60% of the studies. Treatment efficacy, based on positional test results and symptom resolution and recurrence were the most common outcomes. Balance and quality of life measures improved after treatment but were not always normalized. Residual symptoms and psychoemotional consequences persisted in some subjects, despite BPPV resolution. Meta-analyses indicated poorer dynamic balance recovery and increased self-perceived level of handicap in the older group relative to the younger group. CONCLUSIONS AND IMPLICATIONS Although repositioning maneuvers were effective in BPPV management, some patients experienced residual dizziness, postural instability, recurrences, and psychoemotional consequences at least 1 month after repositioning. Moreover, older adults experienced less improvements in dynamic balance and self-perceived handicap rating compared with younger people. These issues may further impact on older adults with BPPV physically and mentally and should be addressed by future better-quality research and interventions.
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Affiliation(s)
- Eyvonne Sim
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
| | - Dawn Tan
- Physiotherapy Department, Singapore General Hospital, Singapore; SIT Health & Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Keith Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2019; 276:711-718. [DOI: 10.1007/s00405-019-05297-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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Strout TD, Hillen M, Gutheil C, Anderson E, Hutchinson R, Ward H, Kay H, Mills GJ, Han PKJ. Tolerance of uncertainty: A systematic review of health and healthcare-related outcomes. PATIENT EDUCATION AND COUNSELING 2018; 101:1518-1537. [PMID: 29655876 DOI: 10.1016/j.pec.2018.03.030] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND Uncertainty tolerance (UT) is thought to be a characteristic of individuals that influences various outcomes related to health, healthcare, and healthcare education. We undertook a systematic literature review to evaluate the state of the evidence on UT and its relationship to these outcomes. METHODS We conducted electronic and bibliographic searches to identify relevant studies examining associations between UT and health, healthcare, or healthcare education outcomes. We used standardized tools to assess methodological quality and analyzed the major findings of existing studies, which we organized and classified by theme. RESULTS Searches yielded 542 potentially relevant articles, of which 67 met inclusion criteria. Existing studies were heterogeneous in focus, setting, and measurement approach, were largely cross-sectional in design, and overall methodological quality was low. UT was associated with various trainee-centered, provider-centered, and patient-centered outcomes which were cognitive, emotional, and behavioral in nature. UT was most consistently associated with emotional well-being. CONCLUSIONS Uncertainty tolerance is associated with several important trainee-, provider-, and patient-centered outcomes in healthcare and healthcare education. However, low methodological quality, study design limitations, and heterogeneity in the measurement of UT limit strong inferences about its effects, and addressing these problems is a critical need for future research.
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Affiliation(s)
- Tania D Strout
- Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, 47 Bramhall Street, Portland, ME, 04102, USA.
| | - Marij Hillen
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Caitlin Gutheil
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA
| | - Eric Anderson
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA
| | - Rebecca Hutchinson
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA; Hospice and Palliative Medicine, Maine Medical Center, Portland, ME, USA
| | - Hannah Ward
- University of Rochester, School of Medicine & Dentistry, Rochester, NY, USA
| | - Hannah Kay
- Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | | | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA
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The Longitudinal Effect of Vertigo and Dizziness Symptoms on Psychological Distress: Symptom-Related Fears and Beliefs as Mediators. J Nerv Ment Dis 2018; 206:277-285. [PMID: 29394194 DOI: 10.1097/nmd.0000000000000791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the frequent observation that vertigo and dizziness (VD) disorders may trigger or exacerbate secondary psychiatric comorbidities, there is limited understanding of the mechanisms underlying this development. To address this gap, we investigated whether symptom-related fears and cognitions as indicated by questionnaire-based measures are mediators of the longitudinal effect of VD symptoms on anxiety and depression after 1 year. We analyzed data from a large study with patients of a treatment center specialized in vertigo (N = 210). Simple and multiple parallel mediation models strengthened our hypothesis that fear of bodily sensations and cognitions about these symptoms play a mediating role in the relationship between VD symptoms and psychopathology at follow-up after baseline scores of the outcome were controlled for. Results are discussed within a cognitive theory framework and point to the potential benefits of interventions that modify symptom-related beliefs and fears via cognitive psychotherapy in this therapeutically underserved population.
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Stewart VM, Mendis MD, Low Choy N. A systematic review of patient-reported measures associated with vestibular dysfunction. Laryngoscope 2017; 128:971-981. [DOI: 10.1002/lary.26641] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Vicky M. Stewart
- Gold Coast University Hospital, Physiotherapy Department; Southport Queensland Australia
- School of Physiotherapy; Faculty of Health Sciences, Australian Catholic University; Brisbane Queensland Australia
| | - M. Dilani Mendis
- Centre for Musculoskeletal Research; Mary Mackillop Institute for Health Research, Australian Catholic University; Brisbane Queensland Australia
- Physiotherapy Department; Mater Health Services; South Brisbane Queensland Australia
| | - Nancy Low Choy
- School of Physiotherapy; Faculty of Health Sciences, Australian Catholic University; Brisbane Queensland Australia
- Physiotherapy Department; Prince Charles Hospital; Chermside Queensland Australia
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Martellucci S, Pagliuca G, de Vincentiis M, Greco A, De Virgilio A, Nobili Benedetti FM, Gallipoli C, Rosato C, Clemenzi V, Gallo A. Features of Residual Dizziness after Canalith Repositioning Procedures for Benign Paroxysmal Positional Vertigo. Otolaryngol Head Neck Surg 2016; 154:693-701. [DOI: 10.1177/0194599815627624] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/29/2015] [Indexed: 11/15/2022]
Abstract
Objectives To assess factors related to residual dizziness (RD) in patients who underwent successful canalith repositioning procedures (CRPs) for benign paroxysmal positional vertigo (BPPV). Study Design Prospective cohort study. Setting Academic center. Subjects and Methods Ninety-seven consecutive patients with BPPV of the posterior semicircular canal were initially enrolled. Diagnosis was assessed according to clinical history and bedside evaluation. All patients were treated with CRPs until nystagmus disappeared. Three days after the successful treatment, presence of RD was investigated. If RD was present, patients were monitored every 3 days until the symptoms disappeared. Subjects who required ≥4 CRPs or who failed to meet the follow-up visit were excluded. The Dizziness Handicap Inventory (DHI) was obtained from patients at the time of diagnosis and at every subsequent visit. Results At the end of selection, 86 patients were included; 33 (38.36%) reported RD after successful treatment. A significant difference in the incidence of RD was observed in consideration of the age of the subjects ( P = .0003) and the DHI score at the time of diagnosis ( P < .001). A logistic regression analysis showed that the probability of RD occurrence increased with the increase of the emotional subdomain score of the DHI questionnaire. Conclusion RD is a common self-limited disorder, more frequent in the elderly, which may occur after the physical treatment for BPPV. The DHI score at the time of BPPV diagnosis represents a useful tool to quantify the impact of this vestibular disorder on the quality of life and to estimate the risk of RD after CRPs.
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Affiliation(s)
- Salvatore Martellucci
- Department of Surgical Biotechnologies and Science, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Giulio Pagliuca
- Department of Surgical Biotechnologies and Science, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Marco de Vincentiis
- Department of Sensorial Organs, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sensorial Organs, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Armando De Virgilio
- Department of Sensorial Organs, ENT Section, Sapienza University of Rome, Rome, Italy
- Department of Surgical Science, Sapienza University of Rome, Rome, Italy
| | | | - Camilla Gallipoli
- Department of Surgical Biotechnologies and Science, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Chiara Rosato
- Department of Surgical Biotechnologies and Science, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Veronica Clemenzi
- Department of Surgical Biotechnologies and Science, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Andrea Gallo
- Department of Surgical Biotechnologies and Science, ENT Section, Sapienza University of Rome, Rome, Italy
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Abstract
This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.
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Affiliation(s)
- H K Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
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Effectiveness of the Parnes particle repositioning manoeuvre for posterior canal benign paroxysmal positional vertigo. The Journal of Laryngology & Otology 2015; 129:1188-93. [PMID: 26456180 DOI: 10.1017/s0022215115002704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Benign paroxysmal positional vertigo is a common vestibular disorder that negatively affects an individual's health-related quality of life. This study aimed to examine the effectiveness of the Parnes particle repositioning manoeuvre as an intervention for individuals with posterior canal benign paroxysmal positional vertigo. METHODS The de-identified records of 155 individuals treated with the Parnes manoeuvre were examined. Descriptive statistics were calculated, including the frequency and valid per cent of participants whose nystagmus was resolved with the Parnes manoeuvre. RESULTS In all, nystagmus was resolved with the Parnes manoeuvre in 145 participants (93.5 per cent). The mean number of manoeuvres needed to resolve the nystagmus was 1.3. CONCLUSION The Parnes manoeuvre proved to be as effective as the Epley canalith repositioning manoeuvre, currently the most common intervention, in treating individuals with posterior canal benign paroxysmal positional vertigo.
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Abstract
Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo characterized by brief episodes provoked by head movements. The first attack of BPPV usually occurs in bed or upon getting up. Because it often begins abruptly, it can be alarming and lead to emergency department evaluation. The episodes of spinning often last 10 to 20 seconds, but may occasionally last as long as 1 minute. There are several forms of BPPV. In nearly all cases, highly effective treatment can be offered to patients. This article reviews the current state of our understanding of this condition and its management.
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Feral-Pierssens AL. Réduction aux urgences des vertiges positionnels paroxystiques bénins. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vertigo “In the Pink”: The Impact of Female Gender on Psychiatric-Psychosomatic Comorbidity in Benign Paroxysmal Positional Vertigo Patients. PSYCHOSOMATICS 2014; 55:280-8. [DOI: 10.1016/j.psym.2013.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 02/06/2013] [Accepted: 02/07/2013] [Indexed: 11/20/2022]
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Fatigue during an episode of benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2014; 272:2129-33. [DOI: 10.1007/s00405-014-3041-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/30/2014] [Indexed: 11/25/2022]
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