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2.
Drug Discov Ther ; 14(4): 153-160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32908070

RESUMO

The COVID-19 infection has been a matter of urgency to tackle around the world today, there exist 200 countries around the world and 54 countries in Africa that the COVID-19 infection cases have been confirmed. This situation prompted us to look into the challenges African laboratories are facing in the diagnosis of novel COVID-19 infection. A limited supply of essential laboratory equipment and test kits are some of the challenges faced in combatting the novel virus in Africa. Also, there is inadequate skilled personnel, which might pose a significant danger in case there is a surge in COVID-19 infection cases. The choice of diagnostic method in Africa is limited as there are only two available diagnostic methods being used out of the six methods used globally, thereby reducing the opportunity of supplementary diagnosis, which will further lead to inappropriate diagnosis and affect the accuracy of diagnostic reports. Furthermore, challenges like inadequate power supply, the method used in sample collection, storage and transportation of specimens are also significant as they also pose their respective implication. From the observations, there is an urgent need for more investment into the laboratories for proper, timely, and accurate diagnosis of COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Acesso aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Pneumonia Viral/diagnóstico , Virologia/organização & administração , Betacoronavirus/patogenicidade , Orçamentos , Técnicas de Laboratório Clínico/economia , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Custos de Cuidados de Saúde , Acesso aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Nigéria/epidemiologia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Carga Viral , Virologia/economia , Fluxo de Trabalho
4.
Healthc Q ; 23(2): 18-20, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32762815

RESUMO

A scientific paper published in the BMJ Open made international headlines by claiming that austerity policies led to 120,000 deaths in the UK (Watkins et al. 2017).


Assuntos
Betacoronavirus , Infecções por Coronavirus , Financiamento da Assistência à Saúde , Pandemias , Pneumonia Viral , Canadá , Política de Saúde/economia , Acesso aos Serviços de Saúde/economia , Humanos , Pobreza , Saúde Pública/economia
6.
PLoS One ; 15(8): e0237519, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810162

RESUMO

INTRODUCTION: Microfinance is a widely promoted developmental initiative to provide poor women with affordable financial services for poverty alleviation. One popular adaption in South Asia is the Self-Help Group (SHG) model that India adopted in 2011 as part of a federal poverty alleviation program and as a secondary approach of integrating health literacy services for rural women. However, the evidence is limited on who joins and continues in SHG programs. This paper examines the determinants of membership and staying members (outcomes) in an integrated microfinance and health literacy program from one of India's poorest and most populated states, Uttar Pradesh across a range of explanatory variables related to economic, socio-demographic and area-level characteristics. METHOD: Using secondary survey data from the Uttar Pradesh Community Mobilization project comprising of 15,300 women from SHGs and Non-SHG households in rural India, we performed multivariate logistic and hurdle negative binomial regression analyses to model SHG membership and duration. RESULTS: While in general poor women are more likely to be SHG members based on an income threshold limit (government-sponsored BPL cards), women from poorest households are more likely to become members, but less likely to stay members, when further classified using asset-based wealth quintiles. Additionally, poorer households compared to the marginally poor are less likely to become SHG members when borrowing for any reason, including health reasons. Only women from moderately poor households are more likely to continue as members if borrowing for health and non-income-generating reasons. The study found that an increasing number of previous pregnancies is associated with a higher membership likelihood in contrast to another study from India reporting a negative association. CONCLUSION: The study supports the view that microfinance programs need to examine their inclusion and retention strategies in favour of poorest household using multidimensional indicators that can capture poverty in its myriad forms.


Assuntos
Participação da Comunidade/estatística & dados numéricos , Organização do Financiamento/estatística & dados numéricos , Acesso aos Serviços de Saúde , Serviços de Saúde Materno-Infantil , Grupos de Autoajuda/organização & administração , Adolescente , Adulto , Características da Família , Feminino , Organização do Financiamento/organização & administração , Letramento em Saúde/economia , Letramento em Saúde/organização & administração , Promoção da Saúde , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Índia/epidemiologia , Recém-Nascido , Serviços de Saúde Materno-Infantil/economia , Serviços de Saúde Materno-Infantil/organização & administração , Serviços de Saúde Materno-Infantil/provisão & distribução , Pessoa de Meia-Idade , Pobreza/economia , Pobreza/estatística & dados numéricos , Gravidez , População Rural/estatística & dados numéricos , Grupos de Autoajuda/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
7.
PLoS One ; 15(8): e0236411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745100

RESUMO

BACKGROUND: Access to affordable and good quality medicines is a key to meeting Sustainable Development Goal No. 3 by the year 2030. Prices, availability and affordability of essential medicines have been studied in many developing countries, but no such information has been published about Rwanda yet. This study aimed at providing data on prices, availability and affordability of medicines in different health facilities of Rwanda. METHODS: A survey was carried out on availability, prices and affordability of 18 medicines in Kigali City and five districts of Rwanda. 44 health facilities were surveyed, including public and faith-based hospitals, public and faith-based health centers and private pharmacies. The standardized methodology developed by WHO and Health Action International (HAI) was used to collect and analyze the data. FINDINGS: Prices for generic medicines in public and faith-based health facilities were remarkably low, with median price ratios (MPRs) of 1.0 in comparison to the international procurement prices published by Management Sciences for Health. In private pharmacies, prices were twice as high (MPR = 1.99 for generics). Availability of medicines fell short of the of 80% target set by WHO, but was better than reported from many other developing countries. Availability of medicines was highest in the private sector (71.3%) and slightly lower in the faith-based (62.8%) and public (59.6%) sectors. The government procurement agency was found to work efficiently, achieving prices 30% below the international procurement price given in the International Medical Product Price Guide. Affordability of medicines was better in the public and faith-based sectors than in the private sector. CONCLUSION: In Rwanda, medicines are affordable but poorly available in both the public and the faith-based sectors. Further improvements of the availability of medicines in the public and the faith-based health facilities represent the most important key to increase accessibility and affordability of medicines in Rwanda.


Assuntos
Medicamentos Essenciais/economia , Saúde Global , Instalações de Saúde/economia , Acesso aos Serviços de Saúde/economia , Custos e Análise de Custo , Medicamentos Essenciais/uso terapêutico , Medicamentos Genéricos/economia , Humanos , Farmácias/economia , Setor Privado , Setor Público/tendências , Ruanda/epidemiologia , Inquéritos e Questionários
9.
PLoS One ; 15(7): e0235262, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716927

RESUMO

OBJECTIVE: Public insurance (Medicaid) covered 42% of all U.S. births in 2018. This paper describes and analyzes the self-reported experiences of women with Medicaid versus commercial insurance relating to autonomy, control and respectful treatment in maternity care. METHODS: The sampling frame for the Listening to Mothers in California survey was drawn from 2016 California birth certificate files. The 30-minute survey had a 55% response rate. A secondary multivariable analysis of results from the survey included 2,318 women with commercial private insurance (1,087) or public (Medi-Cal) (1,231) coverage. Results were weighted and were representative of all births in 2016 in California. The multivariable analysis of variables related to maternal agency included engagement in decision making regarding interventions such as vaginal birth after cesarean and episiotomy, feeling pressured to have interventions and sense of fair treatment. We examined their relationship to insurance status adjusted for maternal age, race/ethnicity, education, nativity and attitude toward birth as well as type of prenatal provider, type of birth attendant and pregnancy complications. RESULTS: Women with Medi-Cal had a demographic profile distinct from those with commercial insurance. In multivariable analysis, women with Medi-Cal reported less control over their maternity care experience than women with commercial insurance, including less choice of prenatal provider (AOR 1.61 95%C.I. 1.20, 2.17), or a vaginal birth after cesarean (AOR 2.93 95%C.I. 1.49, 5.73). Mothers on Medi-Cal were also less likely to be consulted before experiencing an episiotomy (AOR 0.30 95%C.I. 0.09, 0.94). They were more likely to report feeling pressure to have a primary cesarean (AOR 2.54 95%C.I. 1.55, 4.16) and less likely to be encouraged by staff to make their own decisions (AOR 0.63 95%C.I. 0.47, 0.85). CONCLUSIONS: Childbearing women with public insurance in California clearly and consistently reported less opportunity to choose their care than women with private insurance. These inequities are a call to action for increased accountability and quality improvement relating to care of the many childbearing women with Medicaid coverage.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Relações Profissional-Paciente , Respeito , Adulto , California , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Humanos , Cobertura do Seguro/economia , Idade Materna , Serviços de Saúde Materna/economia , Medicaid/economia , Medicaid/estatística & dados numéricos , Gravidez , Autorrelato/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
10.
PLoS One ; 15(7): e0234387, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32609781

RESUMO

In this article, we studied geographic variation in the use of personalized genetic testing for advanced non-small cell lung cancer (NSCLC) and we evaluated the relationship between genetic testing rates and local socioeconomic and ecological variables. We used data on all advanced NSCLC patients who had a genetic test between April 2012 and April 2013 in France in the frame of the IFCT Biomarqueurs-France study (n = 15814). We computed four established measures of geographic variation of the sex-adjusted rates of genetic testing utilization at the "départment" (the French territory is divided into 94 administrative units called 'départements') level. We also performed a spatial regression model to determine the relationship between département-level sex-adjusted rates of genetic testing utilization and economic and ecological variables. Our results are the following: (i) Overall, 46.87% lung cancer admission patients obtained genetic testing for NSCLC; département-level utilization rates varied over 3.2-fold. Measures of geographic variation indicated a relatively high degree of geographic variation. (ii) there was a statistically significant relationship between genetic testing rates and per capita supply of general practitioners, radiotherapists and surgeons (negative correlation for the latter); lower genetic testing rates were also associated with higher local poverty rates. French policymakers should pursue effort toward deprived areas to obtain equal access to personalized medicine for advanced NSCLC patients.


Assuntos
Acesso aos Serviços de Saúde/tendências , Medicina de Precisão/economia , Medicina de Precisão/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Carcinoma Pulmonar de Células não Pequenas/genética , Bases de Dados Factuais , Feminino , França , Testes Genéticos/tendências , Acesso aos Serviços de Saúde/economia , Humanos , Neoplasias Pulmonares/genética , Masculino , Pessoa de Meia-Idade
11.
PLoS One ; 15(7): e0235264, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658921

RESUMO

OBJECTIVE: To identify health systems-level barriers to treatment for women who screened positive for high-risk human papillomavirus (hrHPV) in a cervical cancer prevention program in Kenya. METHODS: In a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya in 2018-2019, women underwent hrHPV testing offered through community health campaigns, and women who tested positive were referred to government health facilities for cryotherapy. The current analysis draws on treatment data from this trial, as well as two observational studies that were conducted: 1) periodic assessments of the treatment sites to ascertain availability of resources for treatment and 2) surveys with treatment providers to elicit their views on barriers to care. Bivariate analyses were performed for the site assessment data, and the provider survey data were analyzed descriptively. RESULTS: Seventeen site assessments were performed across three treatment sites. All three sites reported instances of supply stockouts, two sites reported treatment delays due to lack of supplies, and two sites reported treatment delays due to provider factors. Of the 16 providers surveyed, ten (67%) perceived lack of knowledge of HPV and cervical cancer as the main barrier in women's decision to get treated, and seven (47%) perceived financial barriers for transportation and childcare as the main barrier to accessing treatment. Eight (50%) endorsed that providing treatment free of cost was the greatest facilitator of treatment. CONCLUSION: Patient education and financial support to reach treatment are potential areas for intervention to increase rates of hrHPV+ women presenting for treatment. It is also essential to eliminate barriers that prevent treatment of women who present, including ensuring adequate supplies and staff for treatment.


Assuntos
Crioterapia/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Infecções por Papillomavirus/terapia , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Crioterapia/economia , Detecção Precoce de Câncer/economia , Feminino , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Promoção da Saúde/economia , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/organização & administração , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Quênia/epidemiologia , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Estudos Observacionais como Assunto , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Educação de Pacientes como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , População Rural/estatística & dados numéricos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia
12.
BMJ Glob Health ; 5(6)2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-601766

RESUMO

The COVID-19 pandemic is a reminder that insufficient income security in periods of ill health leads to economic hardship for individuals and hampers disease control efforts as people struggle to stay home when sick or advised to observe quarantine. Evidence on income security during periods of ill health is growing but has not previously been reviewed as a full body of work concerning low-income and middle-income countries (LMICs). We performed a scoping review to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in gainful work. A total of 134 studies were included, providing data from 95% of LMICs. However, data across the majority of these countries were severely limited. Collectively the included studies demonstrate that coverage of contributory income-security schemes is low, especially for informal and low-income workers. Meanwhile, non-contributory schemes targeting low-income groups are often not explicitly designed to provide income support in periods of ill health, they can be difficult to access and rarely provide sufficient income support to cover the needs of eligible recipients. While identifying an urgent need for more research on illness-related income security in LMICs, this review concludes that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity. To achieve these outcomes, illness-related income protection must receive greater recognition in health policy and health financing circles, expanding our understanding of financial hardship beyond direct medical costs.


Assuntos
Acesso aos Serviços de Saúde , Renda , Pobreza , Previdência Social , Adulto , Betacoronavirus , Infecções por Coronavirus , Países em Desenvolvimento , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Pandemias , Pneumonia Viral , Licença Médica , Previdência Social/economia , Previdência Social/legislação & jurisprudência
14.
J Natl Med Assoc ; 112(3): 324-328, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563686

RESUMO

The disproportionately high burden of death and disability observed for racial and ethnic minorities under the Coronavirus pandemic necessitates sustained advocacy by the medical and public health communities around critical determinants of population health. Prompting our advocacy should be the understanding that our collective ability to rebound from such crises may ultimately hinge on protecting and equipping our most vulnerable racial-ethnic minority groups and any susceptible individuals within those populations. If proven effective, recent historic firsts by the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), the Office of Minority Health (OMH) and the Centers for Disease Control and Prevention (CDC) in response to COVID-19 should be championed for permanency within policy, practice and funding. In addition, given the complex history of Black Americans in this country and persistent and substantial Black-white disparities on health and economic measures across the board, some kind of reparations for this group may serve as a logical starting point for further advocacy. Nevertheless, we remain supportive allies of all organizations concerned with communities who suffer the weight of this pandemic and any future world health disasters. Let us as human clinicians and public health professionals capture this moment of challenge and engage in thoughtful unification of effort and commit to measurable progress for as long as the need exists and certainly for the foreseeable future.


Assuntos
Infecções por Coronavirus/etnologia , Grupos Étnicos/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Defesa do Paciente/estatística & dados numéricos , Pneumonia Viral/etnologia , Afro-Americanos/estatística & dados numéricos , Grupos de Populações Continentais/etnologia , Grupos de Populações Continentais/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Promoção da Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Incidência , Masculino , Grupos Minoritários/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Medição de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Populações Vulneráveis/estatística & dados numéricos
17.
BMJ Glob Health ; 5(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32540963

RESUMO

The COVID-19 pandemic is a reminder that insufficient income security in periods of ill health leads to economic hardship for individuals and hampers disease control efforts as people struggle to stay home when sick or advised to observe quarantine. Evidence on income security during periods of ill health is growing but has not previously been reviewed as a full body of work concerning low-income and middle-income countries (LMICs). We performed a scoping review to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in gainful work. A total of 134 studies were included, providing data from 95% of LMICs. However, data across the majority of these countries were severely limited. Collectively the included studies demonstrate that coverage of contributory income-security schemes is low, especially for informal and low-income workers. Meanwhile, non-contributory schemes targeting low-income groups are often not explicitly designed to provide income support in periods of ill health, they can be difficult to access and rarely provide sufficient income support to cover the needs of eligible recipients. While identifying an urgent need for more research on illness-related income security in LMICs, this review concludes that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity. To achieve these outcomes, illness-related income protection must receive greater recognition in health policy and health financing circles, expanding our understanding of financial hardship beyond direct medical costs.


Assuntos
Acesso aos Serviços de Saúde , Renda , Pobreza , Previdência Social , Adulto , Betacoronavirus , Infecções por Coronavirus , Países em Desenvolvimento , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Pandemias , Pneumonia Viral , Licença Médica , Previdência Social/economia , Previdência Social/legislação & jurisprudência
18.
Diabetes Metab Syndr ; 14(5): 731-732, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32473905

RESUMO

BACKGROUND AND AIMS: Diabetes mellitus (DM) is one of the most critical risk factors for complications and death in COVID-19 patients. The present study aims to highlight challenges in the management of diabetic patients during the COVID-19 outbreak in developing countries. METHODS: We reviewed the literature to obtain information about diabetic care during the Covid-19 crisis. We also seek opinions of clinicians working in undeveloped countries. RESULTS: Current challenges faced by clinicians in the management of diabetic patients in developing countries are as follows: lack of preventive measures, inadequate number of visits, loss of the traditional method of communication with the patient, shortage of medications, impaired routine diabetic care, and absence of telehealth services. CONCLUSIONS: Developing countries are faced with many challenges in diabetes management due to a lack of resources.


Assuntos
Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Pneumonia Viral/epidemiologia , Assistência Ambulatorial/economia , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Betacoronavirus/fisiologia , Infecções por Coronavirus/complicações , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Incidência , Pandemias , Pneumonia Viral/complicações , Fatores de Risco , Telemedicina/economia , Telemedicina/métodos
19.
J Am Acad Dermatol ; 83(3): 958-959, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32531304
20.
Can J Surg ; 63(3): E226-E228, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: covidwho-222031

RESUMO

Summary: The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact on waits for elective operations, with tens of thousands of scheduled surgeries being cancelled or postponed across Canada. Provincial governments will likely not only reopen elective surgical capacity when it is deemed safe, but also target new funding to address the backlog of cases. There is a dearth of research on whether the provinces' approaches to managing wait lists are equitable from a patients' needs perspective or if they are associated with patients' perception of outcomes. The surgical cost models used in the past won't be useful to governments and hospital managers. New models based on hospitals' marginal costs, associated with running on weekends or off-hours and social distancing parameters, will be needed. Surgeon input, collaboration and leadership during the strategy development, implementation and management of surgical wait lists postpandemic will be imperative, as these decisions will significantly affect the health and lives of many Canadians.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Triagem/normas , Listas de Espera , Canadá/epidemiologia , Procedimentos Cirúrgicos Eletivos/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Triagem/organização & administração
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