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Serruya S, Costa ML, De Mucio B, Duran P, Sosa C, Colomar M, Leon RGPD, Souza RT, Luz AG, Cecatti JG. Bridging the Gap between Surveillance and Interventions in Latin America Addressing Maternal and Perinatal Morbidity and Mortality. Rev Bras Ginecol Obstet 2023; 45:e555-e556. [PMID: 37944920 PMCID: PMC10635784 DOI: 10.1055/s-0043-1776732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Suzanne Serruya
- Latin American Center for Perinatology, Women's and Reproductive Health of the Pan American Health Organization (PAHO), Montevideo, Uruguay
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Bremen De Mucio
- Latin American Center for Perinatology, Women's and Reproductive Health of the Pan American Health Organization (PAHO), Montevideo, Uruguay
| | - Pablo Duran
- Latin American Center for Perinatology, Women's and Reproductive Health of the Pan American Health Organization (PAHO), Montevideo, Uruguay
| | - Claudio Sosa
- Latin American Center for Perinatology, Women's and Reproductive Health of the Pan American Health Organization (PAHO), Montevideo, Uruguay
| | - Mercedes Colomar
- Latin American Center for Perinatology, Women's and Reproductive Health of the Pan American Health Organization (PAHO), Montevideo, Uruguay
| | - Rodolfo Gomez Ponce de Leon
- Latin American Center for Perinatology, Women's and Reproductive Health of the Pan American Health Organization (PAHO), Montevideo, Uruguay
| | - Renato Teixeira Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Adriana Gomes Luz
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Jose Guilherme Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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Braga A, Sun SY, Zaconeta ACM, Junior AT, Luz AG, Osanan G, Duarte G, Ramos JGL, Wender MCO, Nomura RMY, Francisco RPV, Borges VTM, Mattar R. Increase in cesarean sections in Brazil - a call to reflection. Rev Bras Ginecol Obstet 2023; 45:109-112. [PMID: 37105193 PMCID: PMC10166644 DOI: 10.1055/s-0043-1768454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Antonio Braga
- Department of Obstetrics and Gynecology, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
- Department of Maternal Child, Fluminense Federal University, Niterói, RJ, Brazil
- Vassouras University, Vassouras, RJ, Brazil
| | - Sue Yazaki Sun
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Alberto Trapani Junior
- Departamento de Ginecologia e Obstetrícia, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Adriana Gomes Luz
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Gabriel Osanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - José Geraldo Lopes Ramos
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Celeste Osório Wender
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roseli Mieko Yamamoto Nomura
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Rosiane Mattar
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Mattar R, Neto ARB, Luz AG, Hatanaka A, Zaconeta A, Guazzelli CAF, Traina E, Baptista FS, Osanan G, Duarte G, Ramos JGL, Oppermann ML, Francisco RPV, Cardoso SMLDQ, Quintana SM, Sun SY, Borges VTM. Expert Recommendations on Monkeypox (MPX) in Pregnancy, Postpartum and Lactating Women. Rev Bras Ginecol Obstet 2022; 44:1122-1125. [PMID: 36580939 PMCID: PMC9800143 DOI: 10.1055/s-0042-1759635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Rosiane Mattar
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Antonio Rodrigues Braga Neto
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Universidade Federal Fluminense, Niterói, RJ, Brazil
| | | | - Alan Hatanaka
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Evelyn Traina
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Gabriel Osanan
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Geraldo Duarte
- Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | | | | | - Sue Yazaki Sun
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Paz LDC, Banegas RC, Luz AG, Costa ML. Robson's Ten Group Classification System to Evaluate Cesarean Section Rates in Honduras: The Relevance of Labor Induction. Rev Bras Ginecol Obstet 2022; 44:830-837. [PMID: 36216268 PMCID: PMC9948060 DOI: 10.1055/s-0042-1753547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To use the Robson Ten Group Classification (RTGC) to analyze cesarean section (CS) rates in a Honduran maternity hospital, with focus in groups that consider induction of labor. METHODS Cross-sectional study. Women admitted for childbirth (August 2017 to October 2018) were classified according to the RTGC. The CS rate for each group and the contribution to the overall CS rate was calculated, with further analyses of the induction of labor among term primiparous (group 2a), term multiparous (group 4a), and cases with one previous CS (group 5.1). RESULTS A total of 4,356 women were considered, with an overall CS rate of 26.1%. Group 3 was the largest group, with 38.6% (1,682/4,356) of the cases, followed by Group 1, with 30.8% (1,342/4,356), and Group 5, with 10.3% (450/4,356). Considering the contribution to overall CS rates per group, Group 5 contributed with 30.4% (345/1,136) of the CSs and within this group, 286/345 (82.9%) had 1 previous CS, with a CS rate > 70%. Groups 1 and 3, with 26.6% (291/1,136) and 13.5% (153/1,136), respectively, were the second and third larger contributors to the CS rate. Groups 2a and 4a had high induction success, with low CS rates (18.4 and 16.9%, respectively). CONCLUSION The RTGC is a useful tool to assess CS rates in different healthcare facilities. Groups 5, 1, and 3 were the main contributors to the CS rate, and groups 2 and 4 showed the impact and importance of induction of labor. These findings may support future interventions to reduce unnecessary CS, especially among primiparous and in women with previous CS.
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Affiliation(s)
| | | | - Adriana Gomes Luz
- Department of Obstetrics, University of Campinas, Campinas, SP, Brazil
| | - Maria Laura Costa
- Department of Obstetrics, University of Campinas, Campinas, SP, Brazil
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Albuquerque RCD, Pereira GMV, Luz AG, Nóbrega MA, Lajos GJ, Brito LGO. Risk factors for mediolateral episiotomy at a tertiary hospital: a cross-sectional study. Rev Assoc Med Bras (1992) 2022; 68:463-469. [DOI: 10.1590/1806-9282.20211251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022] Open
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Nóbrega MA, Pereira GMV, Brito LGO, Luz AG, Lajos GJ. Severe Perineal Trauma in a Brazilian Southeastern Tertiary Hospital: A Retrospective Cohort Study. Female Pelvic Med Reconstr Surg 2021; 27:e301-e305. [PMID: 32576733 DOI: 10.1097/spv.0000000000000910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the prevalence of severe perineal trauma (obstetric and anal sphincter injury [OASIS]) in a tertiary high-risk pregnancy facility and the associated factors. METHODS A retrospective electronic chart review on perineal lacerations was performed from the period of April 2017 to February 2019. Obstetric and anal sphincter injury was diagnosed by a rectal examination. Primary outcome was the prevalence of OASIS (third- and fourth-degree perineal tear). Independent variables were maternal, intrapartum, and neonatal characteristics. Univariate and multivariate analyses with logistic regression models were performed. A P value lower than 0.05 was considered significant. RESULTS The prevalence of OASIS (third/fourth-degree laceration) was 1.51% (43/2846) in our population. Our population was mostly white (66.3%) and mostly primiparous (52.1%). By comparison, the prevalence of first/second-degree laceration was 43% (1223/2846). Selective episiotomy occurred in 18.73% (517/2761) of patients, and it was not associated with OASIS (P = 0.211). Advanced maternal age (P = 0.196), higher number of vaginal examinations (P = 0.169), fetal presentation (P = 0.533), and duration of second stage (P = 0.757) were not associated with OASIS. Univariate analysis has found that forceps delivery (odds ratio [OR], 3.68 [1.74-7.79]; P = 0.001), neonatal macrossomy (OR, 3.42 [1.02-11.43]; P = 0.045), and larger head circumference (OR, 1.15 [1.02-1.32]; P = 0.026) were risk factors for OASIS, whereas higher gravidity reduced the risk (OR, 0.61 [0.42-0.91] for OASIS. However, after multivariate analysis, only head circumference (OR, 1.86 [1.10-3.14]; P = 0.020) remained as a risk factor. CONCLUSIONS Larger neonatal head circumference increased in 86% the risk for severe perineal trauma in this cohort of women.
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Affiliation(s)
- Marina Augusto Nóbrega
- From the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Surita FGDC, Luz AG, Hsu LDPR, Carvalho FHC, Brock MF, Nakamura MU. Outpatient care for pregnant and puerperal women during the COVID-19 pandemic. Rev Bras Ginecol Obstet 2020; 42:588-592. [PMID: 32992361 PMCID: PMC10309212 DOI: 10.1055/s-0040-1718473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
| | - Adriana Gomes Luz
- Departamento de Tocoginecologia, Faculdade de Ciêcias Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Rocha SR, Romão GS, Setúbal MSV, Lajos GJ, Luz AG, Collares CF, Amaral E. Cross-Cultural Adaptation of the Communication Assessment Tool for Use in a Simulated Clinical Setting. Teach Learn Med 2020; 32:308-318. [PMID: 32090632 DOI: 10.1080/10401334.2020.1717958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Construct: The Communication Assessment Tool (CAT) is a 14-item instrument developed in English to assess medical trainees' interpersonal communication skills from the patient's perspective in clinical settings. Background: Using validated instruments and simulated patients constitutes good practice in assessing doctor-patient communication. The CAT was designed for use in real practice, but has not yet been applied to assessing OB-GYN residents' delivery of bad news in Objective Structured Clinical Examination (OSCE) stations. This study aims to provide validity evidence for using the CAT to assess residents' interpersonal communication skills under difficult circumstances in a simulated clinical setting in Brazil. Approach: Cross-cultural adaptation comprised translation into Portuguese, synthesis of translations, and back-translation. Next, a committee of 10 external and independent experts rated the items for linguistic equivalence and relevance to the overall scale. Researchers used the expert ratings to produce a preliminary Brazilian-Portuguese version. This version was applied by four simulated patients to assess 28 OB-GYN residents completing two, 10-minute OSCE stations focused on delivering bad news. Item and scale content validity indices and internal-consistency reliability were calculated. Simulated patients were interviewed to clarify any doubt regarding the content and usability of the tool and their response process. Findings: Thirteen of the 14 items in the Brazilian-Portuguese version were considered "equivalent" by at least 70% of the experts. All items were considered relevant by 100% of the experts. The Item Content Validity Index ranged from .9 to 1, and the Scale Content Validity Index was .99. The instrument showed good reliability for both scenarios (Cronbach's alpha > .90). Simulated patients considered the CAT easy to understand and complete. Conclusions: This study provides validity evidence for using the Brazilian-Portuguese CAT in a simulated clinical environment to assess OB-GYN residents' delivery of bad news. Based on this study's findings, the OB-GYN Department organized an annual formative assessment for residents to improve their interpersonal communication skills. This version of the CAT may also be applicable to other specialties.
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Affiliation(s)
| | | | | | - Giuliane Jesus Lajos
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Adriana Gomes Luz
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Carlos Fernando Collares
- Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands
| | - Eliana Amaral
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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Luz AG, Osis MJMD, Ribeiro M, Cecatti JG, Amaral E. Perspectives of professionals participating in the Brazilian Network for the Surveillance of Severe Maternal Morbidity regarding the implementation of routine surveillance: a qualitative study. Reprod Health 2014; 11:29. [PMID: 24708862 PMCID: PMC4274739 DOI: 10.1186/1742-4755-11-29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 03/09/2014] [Indexed: 11/17/2022] Open
Abstract
Background The Brazilian Network for the Surveillance of Severe Maternal Morbidity was developed in Brazil with the participation of 27 centers in different regions of the country. The objective of the network project was to evaluate the frequency of severe maternal morbidity (near-miss and potentially life-threatening conditions) and the factors involved with these clinical conditions. Over the data collection period, this project implemented a surveillance system to identify these cases in the participating institutions. The objective of the present study was to evaluate the perspective of the professionals who participated in this network regarding the surveillance of cases of severe maternal morbidity, the facilities and difficulties encountered in involving colleagues in the process, and participants’ proposals to give continuity to this practice of qualifying maternal healthcare. Methods A descriptive study with a qualitative approach was conducted in which coordinators, investigators and managers at all the 27 obstetric units participating in the network were interviewed. Data were collected at 6 and 12 months after implementation of the network during semi-structured telephone interviews that were recorded following verbal informed consent. Thematic content analysis was performed of the responses to the open questions in the interviews. Results In the opinion of 60% of the participants, involving their colleagues in the surveillance process proved difficult, principally because these professionals were not very interested in the research project, but also because they found it difficult to review concepts and professional practices, because they had an excessive workload or due to operational and technical difficulties. The great majority considered that support from government agencies providing financial resources would be crucial to enable surveillance to be maintained or expanded and also to train a larger number of professionals and improve work conditions. The majority of participants found it difficult to define the ideal time interval at which surveillance should be conducted. Conclusion The investigators, coordinators and managers involved in the Brazilian network project mentioned several problems that had to be confronted during this process; however, in their opinion the project should be maintained and even expanded in view of its potential to contribute towards improving obstetric care.
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Affiliation(s)
- Adriana Gomes Luz
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
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Luz AG, Osis MJD, Ribeiro M, Cecatti JG, Amaral E. Impact of a nationwide study for surveillance of maternal near-miss on the quality of care provided by participating centers: a quantitative and qualitative approach. BMC Pregnancy Childbirth 2014; 14:122. [PMID: 24690270 PMCID: PMC4234017 DOI: 10.1186/1471-2393-14-122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 03/24/2014] [Indexed: 11/28/2022] Open
Abstract
Background The Brazilian Network for Surveillance of Severe Maternal Morbidity was established in 27 centers in different regions of Brazil to investigate the frequency of severe maternal morbidity (near-miss and potentially life-threatening conditions) and associated factors, and to create a collaborative network for studies on perinatal health. It also allowed interventions aimed at improving the quality of care in the participating institutions. The objective of this study was to evaluate the perception of the professionals involved regarding the effect of participating in such network on the quality of care provided to women. Methods A mixed quantitative and qualitative study interviewed coordinators, investigators and managers from all the 27 obstetric units that had participated in the network. Following verbal informed consent, data were collected six and twelve months after the surveillance period using structured and semi-structured interviews that were conducted by telephone and recorded. A descriptive analysis for the quantitative and categorical data, and a thematic content analysis for the answers to the open questions were performed. Results The vast majority (93%) of interviewees considered it was important to have participated in the network and 95% that their ability to identify cases of severe maternal morbidity had improved. They also considered that the study had a positive effect, leading to changes in how cases were identified, better organization/standardization of team activities, changes in routines/protocols, implementation of auditing for severe cases, dissemination of knowledge at local/regional level and a contribution to local and/or national identification of maternal morbidity. After 12 months, interviewees mentioned the need to improve prenatal care and the scientific importance of the results. Some believed that there had been little or no impact due to the poor dissemination of information and the resistance of professionals to change practice. In this second interview, a lack of systematic surveillance after the end of the study, difficulty in referring cases and changes in the leadership of the unit were mentioned. Conclusion In the opinion of these professionals, participating in a network for the surveillance of severe maternal morbidity represented a good strategy for improving services, even in reference centers.
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Luz AG, Tiago DB, Silva JCGD, Amaral E. [Severe maternal morbidity at a local reference university hospital in Campinas, São Paulo, Brazil]. Rev Bras Ginecol Obstet 2009; 30:281-6. [PMID: 19142505 DOI: 10.1590/s0100-72032008000600003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 06/03/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE to assess the prevalence and risk factors associated with near miss and other severe maternal morbidity at a reference tertiary maternity. METHODS this is a cross-sectional study on severe maternal morbidity at the Hospital e Maternidade Celso Pierro, Campinas, São Paulo, between October 2005 and July 2006, identified from infirmary, admission and delivery unit logbooks. Pregnant and post-partum women with severe maternal morbidity were identified according to clinical criteria proposed by Waterstone. Later, cases with more severe morbidity, called extremely severe maternal morbidity, were reclassified using Mantel criteria, based on organic dysfunction and clinical management. RESULTS there were 114 severe maternal morbidity cases among 2,207 birth deliveries, with a ratio of other severe morbidity and extremely severe morbidity near miss of 44.9 and 6.8 cases/1,000 live births, respectively. Mean gestational age at delivery was 35 weeks, and 87% came from the reference area for the maternity service. Hypertension (severe pre-eclampsia) represented 96% of other severe morbidity, while hemorrhage represented 60% of all extremely severe cases, followed by hypertension. The prevalence of extremely severe morbidity among the severe morbidity cases was not associated with marital status, schooling, maternal age, type of delivery, parity, gestational age at birth and home place. CONCLUSIONS the other morbidities were 6.6 times more frequent than near miss, and it was not possible to differentiate both groups by epidemiological risk factors.
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Affiliation(s)
- Adriana Gomes Luz
- Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil.
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