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Performance of a Glaucoma Screening Program Compared With Opportunistic Detection in China. J Glaucoma 2023; 32:80-84. [PMID: 36223297 DOI: 10.1097/ijg.0000000000002125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/16/2022] [Indexed: 01/26/2023]
Abstract
PRCIS Health examination center-based screening provide a good supplement to clinic-based glaucoma care by detecting early-stage glaucoma, especially those with normal intraocular pressure (IOP) and less visual impairment. PURPOSE Opportunistic glaucoma screening for early case identification is of great value in the prevention of severe visual impairment, however, novel, low-cost models are needed. We aimed to determine whether health examination center-based glaucoma screening identifies diseases earlier than outpatient cases in China. MATERIALS AND METHODS In this case-control study, 76 patients with primary glaucoma identified from a health examination center-based glaucoma screening program and 272 consecutive outpatient cases at the same hospital were enrolled from March 21 to September 30, 2016. Demographic characteristics, best-corrected visual acuity, IOP, mean deviation (MD), and pattern standard deviation (PSD) on Humphrey visual field testing in the better-seeing eye were compared between groups. RESULTS Screening-detected glaucoma patients had significantly lower IOP (18.3±4.2 mm Hg) than out-patient cases (26.7±12.6 mm Hg, P <0.001). Most (71.1%) of the screening-detected patients had IOP<21 mm Hg compared with 37.1% in the clinic group ( P <0.001). Seventy-five patients (98.7%) in the screening group were diagnosed as primary open angle glaucoma, compared with 44.1% in the clinic group ( P <0.001). Screening-detected patients had significantly less visual impairment than the clinic group (6.6% vs. 38.6%, P <0.05). Mean MD (-4.4±5.0 dB) and PSD (4.4±3.6 dB) for the screening group were superior to the clinic group (MD: -16.5±10.5 dB, P <0.001; PSD: 6.5±3.7 dB, P <0.001). CONCLUSION The glaucoma screening program was effective at detecting early disease, especially normal tension glaucoma and supplemented opportunistic detection of glaucoma.
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Lin S, Hu Y, Ye C, Congdon N, You R, Liu S, Liu C, Lv F, Zhang S. Detecting eyes with high risk of angle closure among apparently normal eyes by anterior segment OCT: a health examination center-based model. BMC Ophthalmol 2022; 22:513. [PMID: 36577987 PMCID: PMC9798562 DOI: 10.1186/s12886-022-02739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The main barriers keeping individuals with high-risk of angle closure from seeking eye-care service are the absence of both disease awareness and convenient and low-cost access to the ocular health care system. Present study described the efficacy of a health examination center-based screening model designed to detect eyes with high risk of angle closure (HRAC) among healthy individuals using anterior segment optical coherence tomography (AS-OCT). METHODS From March 1 to April 30, 2017, consecutive individuals aged ≥ 40 years undergoing routine physical examinations at a health examination center were invited to enroll. Presenting visual acuity (PVA), intraocular pressure (IOP) measurement, non-mydriatic fundus photography and AS-OCT were performed by three trained nurses. Participants with PVA < 6/12 in the better-seeing eye, IOP ≥ 24 mmHg, or abnormal fundus photography in either eye were referred to the outpatient clinic, but not included in the analysis. Eyes with HRAC were defined as having trabecular-iris angle < 12 degrees in ≥ 3 quadrants. Configuration of the iris was classified into flat, bowing, bombe, thick peripheral iris and mixed mechanism. RESULTS Altogether, 991 participants (77.3%) with readable OCT images (mean age 55.5 ± 9.0 years; 58.4% men) were included. HRAC was diagnosed in 78 eyes (7.9%, 61.3 ± 8.2 years, 41.0% men). The prevalence of HRAC increased with age (p < 0.001) and was much higher among women (11.2%) than men (5.5%) (p = 0.001). The mixed mechanism iris configuration was most common among eyes with HRAC (37/78, 47.4%). CONCLUSION HRAC is prevalent among asymptomatic Chinese adults undergoing routine health screening. Health examination center-based eye screening with AS-OCT administered by non-specialists may be a good model to screen narrow angles in the population at large.
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Affiliation(s)
- Sigeng Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No.270 Xueyuanxi Street, Lucheng District, Wenzhou, 325027, Zhejiang, China.,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Ying Hu
- Department of Ophthalmology, The Forth People's Hospital of Shenyang, Huanggu District, NO. 20 Huanghenan Street, Shenyang, 110031, Liaoning, China
| | - Cong Ye
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No.270 Xueyuanxi Street, Lucheng District, Wenzhou, 325027, Zhejiang, China.,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Orbis International, New York, NY, USA
| | - Ruirong You
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No.270 Xueyuanxi Street, Lucheng District, Wenzhou, 325027, Zhejiang, China.,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Shanshan Liu
- Department of Ophthalmology, The Forth People's Hospital of Shenyang, Huanggu District, NO. 20 Huanghenan Street, Shenyang, 110031, Liaoning, China
| | - Chi Liu
- Department of Ophthalmology, The Forth People's Hospital of Shenyang, Huanggu District, NO. 20 Huanghenan Street, Shenyang, 110031, Liaoning, China.
| | - Fan Lv
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No.270 Xueyuanxi Street, Lucheng District, Wenzhou, 325027, Zhejiang, China.,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Shaodan Zhang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No.270 Xueyuanxi Street, Lucheng District, Wenzhou, 325027, Zhejiang, China. .,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China. .,National Clinical Research Center for Ocular Diseases, Wenzhou, China.
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Buttan S, Gascoyne B, Das S, Schmidt E. Piloting targeted glaucoma screening: experiences of eye care services in Ganjam district, Odisha state, India. Int Health 2022; 14:i29-i36. [PMID: 35385872 PMCID: PMC8986354 DOI: 10.1093/inthealth/ihab078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background The number of patients with visual impairment and blindness from glaucoma is rapidly increasing with wide-ranging impacts for individuals and societies. However, the disease often goes undiagnosed for a long time, especially in low- and middle-income countries where healthcare services are limited. This paper presents the results of a pilot programme, which integrated targeted glaucoma screenings of people aged ≥40 y in community-based eye care services in the Ganjam district of Odisha state, India. Methods Using routine programme data, descriptive statistics were produced for the characteristics of patients participating in the screening programme and the rate and uptake of glaucoma referrals. Bivariate analysis was used to examine associations between patient characteristics, clinical risk factors and glaucoma diagnosis. Results Out of 23 356 individuals aged ≥40 y screened for glaucoma over a period of 18 mo, 2219 (9.5%) were referred and 2031 presented for further examination. Among them, almost half (n=968, 48%) were diagnosed with glaucoma, representing a screening to diagnosis conversion rate of 4.14% (95% CI 3.9 to 4.4%). A positive diagnosis of glaucoma among suspects was associated with female sex, age >60 y, visual impairment, vertical cap-to-disc ratio ≥0.6:1, intraocular pressure ≥30 mmHg and shallow anterior chamber (p<0.001). Conclusions The importance of targeted screening for glaucoma using simple referral criteria to identify patients at high risk of vision loss who can benefit from treatment is critical to slow the progression of the disease and the prevention of blindness. Further studies assessing costs of the targeted screening, the role of technology in improving programme effectiveness and efficiency and the longer term compliance with treatment are needed to support glaucoma policy frameworks, guidelines and clinical practice.
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Affiliation(s)
| | - Ben Gascoyne
- Sightsavers, 35 Perrymount Road, Haywards Heath RH16 3BZ, UK
| | - Sudeep Das
- Sankara Eye Hospital, Samarjhola, Odisha 761101, India
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Guo J, Dong Q, Liu M. Effect of Intraocular Lens Biomaterials on the Treatment of Primary Angle Closure Glaucoma. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To explore the effect of phacoemulsification along with intraocular lens (IOL) implantation on the treatment of primary angle closure glaucoma (PACG), a total of 50 patients (54 eyes) with PCG who had undergone surgery were selected as the research objects, in which, there were 16 eyes
with the acute PACG in pre-clinical stage, 20 eyes with acute PACG during acute attack, and 18 eyes with chronic PACG, and all patients received phacoemulsification along with IOL implantation therapy. The patient’s best corrected visual acuity, anterior chamber (AC), anterior depth,
intraocular pressure (IOP), visual field, and fundus conditions were measured during the operation, after the operation, and during the follow-up period. The postoperative visual acuity of the patients with three types of PACG was greatly corrected, in which 30 eyes had corrected visual acuity
above 0.5, and there were statistically significant differences (SSDs) (P < 0.05); angle closure of 54 eyes had different degrees of improvement, the opening degree of the acute angle closure is better than that of the chronic angle closure, and there were SSDs (P < 0.05);
each of 54 eyes showed different degrees of deepening in the central AC, and there were SSDs (P < 0.05); postoperative IOP decreased greatly in all 54 eyes, and there were SSDs (P < 0.05). In conclusion, the IOL implantation based on phacoemulsification can effectively
treat the PACG, at the same time reduce IOP, promote angle opening, enhance vision field of the patients, and ultimately achieve the purpose of improving surgical success.
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Affiliation(s)
- Jianlian Guo
- Department of Ophthalmology, Lixia People’s Hospital of Jinan, Jinan, 250000, Shandong, China
| | - Qiang Dong
- Department of Ophthalmology, Lixia People’s Hospital of Jinan, Jinan, 250000, Shandong, China
| | - Min Liu
- Department of Ophthalmology, Lixia People’s Hospital of Jinan, Jinan, 250000, Shandong, China
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Xiao B, Mercer GD, Jin L, Lee HL, Chen T, Wang Y, Liu Y, Denniston AK, Egan CA, Li J, Lu Q, Xu P, Congdon N. Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China. PLoS One 2022; 17:e0266380. [PMID: 35442967 PMCID: PMC9020743 DOI: 10.1371/journal.pone.0266380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Poor access to existing care for diabetic retinopathy (DR) limits effectiveness of proven treatments. OBJECTIVES We examined whether outreach screening in rural China improves equity of access. DESIGN, SETTING AND PARTICIPANTS We compared prevalence of female sex, age > = 65 years, primary education or below, and requiring referral care for DR between three cohorts with diabetes examined for DR in neighboring areas of Guangdong, China: passive case detection at secondary-level hospitals (n = 193); persons screened during primary-level DR outreach (n = 182); and individuals with newly- or previously-diagnosed diabetes in a population survey (n = 579). The latter reflected the "ideal" reach of a screening program. RESULTS Compared to the population cohort, passive case detection reached fewer women (50·8% vs. 62·3%, p = 0·006), older adults (37·8% vs. 51·3%, p < 0·001), and less-educated persons (39·9% vs. 89·6%, p < 0·001). Outreach screening, compared to passive case detection, improved representation of the elderly (49·5% vs. 37·8%, p = 0·03) and less-educated (70·3% vs. 39·9%, p<0·001). The proportion of women (59.8% vs 62.3%, P>0.300) and persons aged > = 65 years (49.5% vs 51.3%, p = 0.723) in the outreach screening and population cohorts did not differ significantly. Prevalence of requiring referral care for DR was significantly higher in the outreach screening cohort (28·0%) than the population (14·0%) and passive case detection cohorts (7·3%, p<0·001 for both). CONCLUSIONS AND RELEVANCE Primary-level outreach screening improves access for the poorly-educated and elderly, and removes gender inequity in access to DR care in this setting, while also identifying more severely-affected patients than case finding in hospital.
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Affiliation(s)
- Baixiang Xiao
- Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | - Gareth D. Mercer
- Department of Ophthalmology and Visual Sciences, McGill University, Montréal, Canada
| | - Ling Jin
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Han Lin Lee
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Tingting Chen
- The Ophthalmology Department of the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanfang Wang
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Yuanping Liu
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | | | - Catherine A. Egan
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Jia Li
- Orbis International, New York, NY, United States of America
| | - Qing Lu
- Orbis International, New York, NY, United States of America
| | - Ping Xu
- Orbis International, New York, NY, United States of America
| | - Nathan Congdon
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Orbis International, New York, NY, United States of America
- * E-mail:
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Olawoye O, Azuara-Blanco A, Chan VF, Piyasena P, Crealey GE, O'Neill C, Congdon N. A Review to Populate A Proposed Cost-Effectiveness Analysis of Glaucoma Screening in Sub-Saharan Africa. Ophthalmic Epidemiol 2021; 29:328-338. [PMID: 34372742 DOI: 10.1080/09286586.2021.1939887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To populate a proposed cost-effectiveness analysis of glaucoma screening in Sub-Saharan Africa (SSA).A complete search was conducted on PubMed, Medline and African Journals Online (AJOL) to obtain relevant published articles, which were included in this review. All relevant articles on prevalence of glaucoma in SSA and among other African-derived populations, severity of glaucoma, cost of diagnosis and management, clinical effectiveness of glaucoma screening and treatment and the different glaucoma screening strategies in SSA were reviewed.Population screening interventions for glaucoma may be considered as follows: standalone screening for glaucoma, screening for glaucoma during cataract outreach, and screening incorporated with diabetic retinopathy image review using tele-ophthalmology. Our review suggests that cost of glaucoma treatment is relatively low with cost of medical treatment ranging from USD 273 to USD 480 per year/patient and surgical treatment cost of USD 283 per patient as with other developing countries. Compliance with medication is moderate to good in about 50% of glaucoma patients. Prevalence of glaucoma is much higher in SSA and almost 50% of glaucoma patients are blind in at least one eye at presentation in clinics (without outreach screening). Our review suggests a moderate sensitivity and specificity in identifying glaucoma with basic equipment (direct ophthalmoscope, contact tonometer and frequency doubling technology) during outreach screening although about a third or fewer take up glaucoma services in clinics.Our review provides the necessary information to conduct a cost-effective analysis of glaucoma screening in SSA using the decision Markov model.
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Affiliation(s)
- Olusola Olawoye
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,School of Optometry, College of Health Sciences, University of Kwa-Zulu Natal (Ving Fai Chan)
| | - Augusto Azuara-Blanco
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Ving Fai Chan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,College of Health Sciences, University of Kwa-Zulu Natal, South Africa
| | - Prabhath Piyasena
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Grainne E Crealey
- J.E. Cairns School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Nathan Congdon
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Xiao X, Xue L, Ye L, Li H, He Y. Health care cost and benefits of artificial intelligence-assisted population-based glaucoma screening for the elderly in remote areas of China: a cost-offset analysis. BMC Public Health 2021; 21:1065. [PMID: 34088286 PMCID: PMC8178835 DOI: 10.1186/s12889-021-11097-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/17/2021] [Indexed: 12/04/2022] Open
Abstract
Background Population-based screening was essential for glaucoma management. Although various studies have investigated the cost-effectiveness of glaucoma screening, policymakers facing with uncontrollably growing total health expenses were deeply concerned about the potential financial consequences of glaucoma screening. This present study was aimed to explore the impact of glaucoma screening with artificial intelligence (AI) automated diagnosis from a budgetary standpoint in Changjiang county, China. Methods A Markov model based on health care system’s perspective was adapted from previously published studies to predict disease progression and healthcare costs. A cohort of 19,395 individuals aged 65 and above were simulated over a 15-year timeframe. Fur illustrative purpose, we only considered primary angle-closure glaucoma (PACG) in this study. Prevalence, disease progression risks between stages, compliance rates were obtained from publish studies. We did a meta-analysis to estimate diagnostic performance of AI automated diagnosis system from fundus image. Screening costs were provided by the Changjiang screening programme, whereas treatment costs were derived from electronic medical records from two county hospitals. Main outcomes included the number of PACG patients and health care costs. Cost-offset analysis was employed to compare projected health outcomes and medical care costs under the screening with what they would have been without screening. One-way sensitivity analysis was conducted to quantify uncertainties around model results. Results Among people aged 65 and above in Changjiang county, it was predicted that there were 1940 PACG patients under the AI-assisted screening scenario, compared with 2104 patients without screening in 15 years’ time. Specifically, the screening would reduce patients with primary angle closure suspect by 7.7%, primary angle closure by 8.8%, PACG by 16.7%, and visual blindness by 33.3%. Due to early diagnosis and treatment under the screening, healthcare costs surged dramatically to $107,761.4 dollar in the first year and then were constantly declining over time, while without screening costs grew from $14,759.8 in the second year until peaking at $17,900.9 in the 9th year. However, cost-offset analysis revealed that additional healthcare costs resulted from the screening could not be offset by decreased disease progression. The 5-, 10-, and 15-year accumulated incremental costs of screening versus no screening were estimated to be $396,362.8, $424,907.9, and $434,903.2, respectively. As a result, the incremental cost per PACG of any stages prevented was $1464.3. Conclusions This study represented the first attempt to address decision-maker’s budgetary concerns when adopting glaucoma screening by developing a Markov prediction model to project health outcomes and costs. Population screening combined with AI automated diagnosis for PACG in China were able to reduce disease progression risks. However, the excess costs of screening could never be offset by reduction in disease progression. Further studies examining the cost-effectiveness or cost-utility of AI-assisted glaucoma screening were needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11097-w.
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Affiliation(s)
- Xuan Xiao
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Long Xue
- School of Public Health, Fudan University, Shanghai, 200433, China
| | - Lin Ye
- Department of Eye Plastic and Lacrimal Disease, Shenzhen Eye Hospital of Jinan University, Shenzhen, 518040, China
| | - Hongzheng Li
- School of Public Health, Fudan University, Shanghai, 200433, China
| | - Yunzhen He
- School of Public Health, Fudan University, Shanghai, 200433, China.
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Gertig D, Smith JR. Screening and avoidance of blindness: One cannot exist without the other. Clin Exp Ophthalmol 2020; 48:1133-1135. [PMID: 33191539 DOI: 10.1111/ceo.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Demi Gertig
- Flinders University, Adelaide, South Australia, Australia
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