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Heslop PA, Hurst C, Sayer AA, Witham MD. Remote collection of physical performance measures for older people: a systematic review. Age Ageing 2023; 52:7008634. [PMID: 36721962 PMCID: PMC9889964 DOI: 10.1093/ageing/afac327] [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: 12/02/2021] [Revised: 10/08/2022] [Indexed: 02/02/2023] Open
Abstract
Remotely collected physical performance measures could improve inclusion of under-served groups in clinical research as well as enabling continuation of research in pandemic conditions. It is unclear whether remote collection is feasible and acceptable to older patients, or whether results are comparable to face-to-face measures. We conducted a systematic review according to a prespecified protocol. We included studies with mean participant age ≥ 60 years, with no language restriction. Studies examining the gait speed, Short Physical Performance Battery, distance walk tests, grip strength, Tinetti score, Berg balance test, sit-to-stand test and timed up and go were included. Reports of feasibility, acceptability, correlation between remote and face-to-face assessments and absolute differences between remote and face-to-face assessments were sought. Data were synthesised using Synthesis Without Meta-analysis methodology; 30 analyses from 17 publications were included. Study size ranged from 10 to 300 participants, with a mean age ranging from 61 to >80 years. Studies included a broad range of participants and conditions. Most studies had a moderate or high risk of bias. Only two studies undertook assessment of acceptability or feasibility, reporting good results. Correlation between face-to-face and remote measures was variable across studies, with no measure showing consistently good correlation. Only nine studies examined the accuracy of remote measures; in six studies, accuracy was rated as good (<5% mean difference between face-to-face and remote measures). There is a lack of robust evidence that remote collection of physical performance measures is acceptable to patients, feasible or provides comparable results to face-to-face measures.
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Affiliation(s)
- Philip A Heslop
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne Hospitals NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
| | - Christopher Hurst
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne Hospitals NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
| | - Avan A Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne Hospitals NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
| | - Miles D Witham
- Address correspondence to: Miles D. Witham, NIHR Newcastle Biomedical Research Centre, Newcastle University Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK. Tel: (+44) 191 208 1317.
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Bian C, Ye B, Mihailidis A. The Development and Concurrent Validity of a Multi-Sensor-Based Frailty Toolkit for In-Home Frailty Assessment. SENSORS 2022; 22:s22093532. [PMID: 35591222 PMCID: PMC9099547 DOI: 10.3390/s22093532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 01/06/2023]
Abstract
Early identification of frailty is crucial to prevent or reverse its progression but faces challenges due to frailty’s insidious onset. Monitoring behavioral changes in real life may offer opportunities for the early identification of frailty before clinical visits. This study presented a sensor-based system that used heterogeneous sensors and cloud technologies to monitor behavioral and physical signs of frailty from home settings. We aimed to validate the concurrent validity of the sensor measurements. The sensor system consisted of multiple types of ambient sensors, a smart speaker, and a smart weight scale. The selection of these sensors was based on behavioral and physical signs associated with frailty. Older adults’ perspectives were also included in the system design. The sensor system prototype was tested in a simulated home lab environment with nine young, healthy participants. Cohen’s Kappa and Bland−Altman Plot were used to evaluate the agreements between the sensor and ground truth measurements. Excellent concurrent validity was achieved for all sensors except for the smart weight scale. The bivariate correlation between the smart and traditional weight scales showed a strong, positive correlation between the two measurements (r = 0.942, n = 24, p < 0.001). Overall, this work showed that the Frailty Toolkit (FT) is reliable for monitoring physical and behavioral signs of frailty in home settings.
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Affiliation(s)
- Chao Bian
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 1A1, Canada;
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada;
- Correspondence:
| | - Bing Ye
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada;
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Alex Mihailidis
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 1A1, Canada;
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada;
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON M5S 1A1, Canada
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You HS, Kwon YJ, Kim S, Kim YH, Kim YS, Kim Y, Roh YK, Park B, Park YK, Park CH, Son JS, Shin J, Shin HY, Oh B, Lee JW, Shim JY, Won CW, Yoo JW, Lee SH, Kang HT, Lee DC. Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings. Korean J Fam Med 2021; 42:413-424. [PMID: 34871482 PMCID: PMC8648485 DOI: 10.4082/kjfm.21.0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/08/2021] [Indexed: 01/06/2023] Open
Abstract
Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.
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Affiliation(s)
- Hyo-Sun You
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ye-Seul Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yonghwan Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yong-Kyun Roh
- Department of Family Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Byoungjin Park
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Young Kyu Park
- Department of Family Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang-Hae Park
- Department of Family Medicine, Haengbokhankajung Clinic, Seoul, Korea
| | - Joung Sik Son
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun-Young Shin
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Bumjo Oh
- Department of Family Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jae Yong Shim
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji Won Yoo
- School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Sang-Hyun Lee
- Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Duk Chul Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Early diagnosis of frailty: Technological and non-intrusive devices for clinical detection. Ageing Res Rev 2021; 70:101399. [PMID: 34214641 DOI: 10.1016/j.arr.2021.101399] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/18/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
This work analyses different concepts for frailty diagnosis based on affordable standard technology such as smartphones or wearable devices. The goal is to provide ideas that go beyond classical diagnostic tools such as magnetic resonance imaging or tomography, thus changing the paradigm; enabling the detection of frailty without expensive facilities, in an ecological way for both patients and medical staff and even with continuous monitoring. Fried's five-point phenotype model of frailty along with a model based on trials and several classical physical tests were used for device classification. This work provides a starting point for future researchers who will have to try to bridge the gap separating elderly people from technology and medical tests in order to provide feasible, accurate and affordable tools for frailty monitoring for a wide range of users.
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Vavasour G, Giggins OM, Doyle J, Kelly D. How wearable sensors have been utilised to evaluate frailty in older adults: a systematic review. J Neuroeng Rehabil 2021; 18:112. [PMID: 34238323 PMCID: PMC8268245 DOI: 10.1186/s12984-021-00909-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/28/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Globally the population of older adults is increasing. It is estimated that by 2050 the number of adults over the age of 60 will represent over 21% of the world's population. Frailty is a clinical condition associated with ageing resulting in an increase in adverse outcomes. It is considered the greatest challenge facing an ageing population affecting an estimated 16% of community-dwelling populations worldwide. AIM The aim of this systematic review is to explore how wearable sensors have been used to assess frailty in older adults. METHOD Electronic databases Medline, Science Direct, Scopus, and CINAHL were systematically searched March 2020 and November 2020. A search constraint of articles published in English, between January 2010 and November 2020 was applied. Papers included were primary observational studies involving; older adults aged > 60 years, used a wearable sensor to provide quantitative measurements of physical activity (PA) or mobility and a measure of frailty. Studies were excluded if they used non-wearable sensors for outcome measurement or outlined an algorithm or application development exclusively. The methodological quality of the selected studies was assessed using the Appraisal Tool for Cross-sectional Studies (AXIS). RESULTS Twenty-nine studies examining the use of wearable sensors to assess and discriminate between stages of frailty in older adults were included. Thirteen different body-worn sensors were used in eight different body-locations. Participants were community-dwelling older adults. Studies were performed in home, laboratory or hospital settings. Postural transitions, number of steps, percentage of time in PA and intensity of PA together were the most frequently measured parameters followed closely by gait speed. All but one study demonstrated an association between PA and level of frailty. All reports of gait speed indicate correlation with frailty. CONCLUSIONS Wearable sensors have been successfully used to evaluate frailty in older adults. Further research is needed to identify a feasible, user-friendly device and body-location that can be used to identify signs of pre-frailty in community-dwelling older adults. This would facilitate early identification and targeted intervention to reduce the burden of frailty in an ageing population.
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Affiliation(s)
- Grainne Vavasour
- NetwellCASALA, Dundalk Institute of Technology. Co, Louth, A91 K584, Ireland.
| | - Oonagh M Giggins
- NetwellCASALA, Dundalk Institute of Technology. Co, Louth, A91 K584, Ireland
| | - Julie Doyle
- NetwellCASALA, Dundalk Institute of Technology. Co, Louth, A91 K584, Ireland
| | - Daniel Kelly
- Ulster University Faculty of Computing Engineering and The Built Environment, Derry(Londonderry), BT48 7JL, Northern Ireland
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Cruz AM, Monsalve L, Ladurner AM, Jaime LF, Wang D, Quiroga DA. Information and Communication Technologies for Managing Frailty: A Systematic Literature Review. Aging Dis 2021; 12:914-933. [PMID: 34094651 PMCID: PMC8139198 DOI: 10.14336/ad.2020.1114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022] Open
Abstract
Frailty is a prevalent condition among Canadians; over one million are diagnosed as medically frail, and in the next ten years this number will double. Information and telecommunication technologies can provide a low-cost method for managing frailty more proactively. This study aims to examine the range and extent of information and telecommunication technologies for managing frailty in older adults, their technology readiness level, the evidence, and the associated outcomes. A systematic literature review was conducted. Four databases were searched for studies: Medline, EMBASE, CINAHL, and Web of Science. In total, we included 19 studies (out of 9,930) for the data abstraction. Overall, our findings indicate that (1) the proposed frailty phenotype is the most common ground truth to be used for assessing frailty; (2) the most common uses of information and telecommunication technologies for managing frailty are detection, and monitoring and detection, while interventional studies on frailty are very rare; (3) the five main types of information and telecommunication technologies for managing frailty in older adults are information and telecommunication technology-based platforms, smartphones, telemonitoring (home monitoring), wearable sensors and devices (commercial off-the-shelf), and multimedia formats for online access; (4) the technology readiness level of information and telecommunication technologies for managing frailty in older adults is the “Technology Demonstration” level, i.e., not yet ready to be operated in an actual operating environment; and (5) the level of evidence is still low for information and telecommunication technology studies that manage frailty in older adults. In conclusion, information and telecommunication technologies for managing frailty in the older adult population are not yet ready to be full-fledged technologies for this purpose.
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Affiliation(s)
- Antonio Miguel Cruz
- 1Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,2Glenrose Rehabilitation Research, Innovation & Technology (GRRIT) Hub, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada.,3Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Laura Monsalve
- 4School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Anna-Maria Ladurner
- 1Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Luisa Fernanda Jaime
- 4School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Daniel Wang
- 1Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Digital Health Interventions among People Living with Frailty: A Scoping Review. J Am Med Dir Assoc 2021; 22:1802-1812.e21. [PMID: 34000266 DOI: 10.1016/j.jamda.2021.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Digital health interventions (DHIs) are interesting resources to improve various health conditions. However, their use in the older and frail population is still sparse. We aimed to give an overview of DHI used in the frail older population. DESIGN Scoping review with PRISMA guidelines based on Population, Concept, and Context. SETTING AND PARTICIPANTS We included original studies in English with DHI (concept) on people described as frail (population) in the clinical or community setting (context) and no limitation on date of publication. We searched 3 online databases (PubMed, Scopus, and Web of Science). MEASURES We described DHI in terms of purpose, delivering, content and assessment. We also described frailty assessment and study design. RESULTS We included 105 studies that fulfilled our eligibility criteria. The most frequently reported DHIs were with the purpose of monitoring (45; 43%), with a delivery method of sensor-based technologies (59; 56%), with a content of feedback to users (34; 32%), and for assessment of feasibility (57; 54%). Efficacy was reported in 31 (30%) studies and usability/feasibility in 57 (55%) studies. The most common study design was descriptive exploratory for new methodology or technology (24; 23%). There were 14 (13%) randomized controlled trials, with only 4 of 14 studies (29%) showing a low or moderate risk of bias. Frailty assessment using validated scales was reported in only 47 (45%) studies. CONCLUSIONS AND IMPLICATIONS There was much heterogeneity among frailty assessments, study designs, and evaluations of DHIs. There is now a strong need for more standardized approaches to assess frailty, well-structured randomized controlled trials, and proper evaluation and report. This work will contribute to the development of better DHIs in this vulnerable population.
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Cobo A, Villalba-Mora E, Pérez-Rodríguez R, Ferre X, Rodríguez-Mañas L. Unobtrusive Sensors for the Assessment of Older Adult's Frailty: A Scoping Review. SENSORS 2021; 21:s21092983. [PMID: 33922852 PMCID: PMC8123069 DOI: 10.3390/s21092983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
Ubiquity (devices becoming part of the context) and transparency (devices not interfering with daily activities) are very significant in healthcare monitoring applications for elders. The present study undertakes a scoping review to map the literature on sensor-based unobtrusive monitoring of older adults’ frailty. We aim to determine what types of devices comply with unobtrusiveness requirements, which frailty markers have been unobtrusively assessed, which unsupervised devices have been tested, the relationships between sensor outcomes and frailty markers, and which devices can assess multiple markers. SCOPUS, PUBMED, and Web of Science were used to identify papers published 2010–2020. We selected 67 documents involving non-hospitalized older adults (65+ y.o.) and assessing frailty level or some specific frailty-marker with some sensor. Among the nine types of body worn sensors, only inertial measurement units (IMUs) on the waist and wrist-worn sensors comply with ubiquity. The former can transparently assess all variables but weight loss. Wrist-worn devices have not been tested in unsupervised conditions. Unsupervised presence detectors can predict frailty, slowness, performance, and physical activity. Waist IMUs and presence detectors are the most promising candidates for unobtrusive and unsupervised monitoring of frailty. Further research is necessary to give specific predictions of frailty level with unsupervised waist IMUs.
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Affiliation(s)
- Antonio Cobo
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain;
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Correspondence: (A.C.); (E.V.-M.); Tel.: +34-910-679-275 (E.V.-M.)
| | - Elena Villalba-Mora
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain;
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Correspondence: (A.C.); (E.V.-M.); Tel.: +34-910-679-275 (E.V.-M.)
| | - Rodrigo Pérez-Rodríguez
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Hospital de Getafe, Getafe, 28905 Madrid, Spain;
| | - Xavier Ferre
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - Leocadio Rodríguez-Mañas
- Servicio de Geriatría, Hospital de Getafe, Getafe, 28095 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBER-FES), 28029 Madrid, Spain
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Lan Hing Ting K, Dessinger G, Voilmy D. Examining Usage to Ensure Utility: Co-Design of a Tool for Fall Prevention. Ing Rech Biomed 2020. [DOI: 10.1016/j.irbm.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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