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1.
Aerosp Med Hum Perform ; 92(11): 898-907, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34819216

RESUMO

BACKGROUND: While many COVID-19 studies focus on acute effects of the infection, few examine the intermediate and long-term sequelae of the illness. Studies have shown that a good portion of patients have chronic effects in several body systems for several months or longer. Such effects can potentially adversely impact pilot performance in flight. We sought to determine the long-term effects of COVID-19 infection, how such effects can affect pilot performance, and how to best evaluate pilots for aeromedical flight clearance.METHODS: We used the PubMed literature search engine to review peer-reviewed articles that focused on the intermediate and long-term effects of COVID-19 infection. Chronic signs and symptoms were subdivided based on the particular body organ system affected. Merging information obtained from case reviews, article reviews, and aeromedical standards, we created a risk stratification guide to assist with the aeromedical disposition of affected pilots.RESULTS: Long-term effects of COVID-19 infection can last for several months or longer. The most common effects are fatigue, weakness, pulmonary diffusion defects, depression, and anxiety.DISCUSSION: This review article focuses on the most common intermediate- and long-term COVID-19 conditions of aeromedical significance and the corresponding course of actions recommended for the aeromedical examiner. Aeromedical evaluation should take into consideration factors related to the pilot, aircraft type, and specific aviation environment. Such evaluation may include diagnostic testing, medical specialist consultation, preflight simulation in an altitude chamber, human centrifuge testing, and/or a flight simulator checkride.Ko SY, Nguyen NK, Lee CL, Lee LA, Nguyen KUT, Lee EC. Aeromedical implications of long-term COVID-19 sequelae. Aerosp Med Hum Perform. 2021; 92(11):898-907.


Assuntos
Medicina Aeroespacial , Resgate Aéreo , COVID-19 , Pilotos , Humanos , SARS-CoV-2
2.
Aerosp Med Hum Perform ; 92(11): 913-918, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34819218

RESUMO

BACKGROUND: The aim of this retrospective registry study was to review the medical causes of RCAF pilot permanent grounding during the period 20082017 and to compare our findings to the previous study of 19781987 to determine if disease patterns had changed.METHODS: Material was obtained from the RCAF 1 Canadian Air Division Surgeons' medical registry of military pilots. Anonymized data for permanently grounded pilots were classified by medical diagnosis, age, and training status.RESULTS: During the period 20082017, there were a total of 162 pilots permanently grounded, of which 110 were trained and 52 untrained.DISCUSSION: In comparison to the 1991 study, there has been a decrease in permanent groundings due cardiovascular disease, but an increase due to mental health conditions, musculoskeletal issues, and motion sickness.Haworth D, Gray G, Zoltenko R, Bashirzadeh AJ. Permanent medical grounding in Royal Canadian Air Force pilots (20082017). Aerosp Med Hum Perform. 2021; 92(11): 913-918.


Assuntos
Medicina Aeroespacial , Militares , Pilotos , Canadá , Humanos , Estudos Retrospectivos
3.
Aerosp Med Hum Perform ; 92(11): 857-863, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34819211

RESUMO

BACKGROUND: Sinus barotraumas are a common condition in aviation medicine, sometimes compromising flight safety and even permanently grounding aircrew. Considering this and the ever-increasing amount of commercial aviation, a thorough examination is required.METHODS: In this survey study, an anonymous, electronic questionnaire was distributed to commercial aircrew of the three major commercial airlines operating in Finland (N 3799), covering 93% of the target population (i.e., all commercial aircrew operating in Finland, N 4083). Primary outcomes were self-reported prevalence, clinical characteristics, and health and occupational effects of sinus barotraumas in flight. Secondary outcomes were adjusted odds ratios (OR) for frequency of sinus barotraumas with respect to possible risk factors.RESULTS: Response rate was 47% (N 1789/3799), with 61% (N 1088) of the respondents having experienced sinus barotraumas in flight. Of those affected, 59% had used medications, 18% had undergone surgical procedures, and 53% had been on sick leave due to sinus barotraumas (38% during the last year) in flight. Factors associated with sinus barotraumas were female sex [OR, 2.47; 95% confidence interval (CI) 1.354.50] and a high number of upper respiratory tract infections (3 vs. <3 URTIs/yr: OR, 3.61; 95% CI 2.654.93).CONCLUSION: Sinus barotraumas were reported by 61% of commercial aircrew. They caused an increased need for medications, otorhinolaryngology-related surgical procedures, and sickness absence from flight duty. The possible risk factors were female sex and a high number of URTIs/yr.Lindfors OH, Ketola KS, Klockars TK, Leino TK, Sinkkonen ST. Sinus barotraumas in commercial aircrew. Aerosp Med Hum Perform. 2021; 92(11):857-863.


Assuntos
Medicina Aeroespacial , Aviação , Barotrauma , Barotrauma/epidemiologia , Feminino , Humanos , Prevalência , Inquéritos e Questionários
4.
Aerosp Med Hum Perform ; 92(10): 806-814, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34642001

RESUMO

BACKGROUND: Fatigue is an insidious and costly occurrence in the aviation community, commonly a consequence of insufficient sleep. Some organizations use scheduling tools to generate prescriptive sleep schedules to help aircrew manage their fatigue. It is important to examine whether aircrew follow these prescriptive schedules, especially in very dynamic environments. The current study compares aircrew sleep during missions to prescriptive sleep schedules generated by a mission scheduling tool. METHODS: Participating in the study were 44 volunteers (Mage= 28.23, SDage= 4.23; Proportionmale= 77.27%) from a C-17 mobility squadron providing 25 instances of sleep and mission data (80 flights total). Aircrew wore actigraph watches to measure sleep during missions and prescriptive sleep schedules were collected. Actual and prescriptive sleep was compared with calculated performance effectiveness values per minute across mission flights. RESULTS: Prescriptive schedules generally overestimated effectiveness during missions relative to estimated actual sleep, potentially causing shifts in effectiveness to ranges of increased risk requiring elevated fatigue mitigation efforts. Actual and prescriptive effectiveness estimates tended to increasingly diverge over the course of missions, which magnifies differences on longer missions. DISCUSSION: The current study suggests that aircrew sleep during missions often does not align with prescriptive sleep schedules generated by mission planning software, resulting in effectiveness estimates that are generally lower than predicted. This might discourage aircrew from using mission effectiveness graphs as a fatigue mitigation tool. Additionally, because fatigue estimates factor into overall operational risk management processes, these schedules might underestimate risks to safety, performance, and health. Morris MB, Veksler BZ, Krusmark MA, Gaines AR, Jantscher HL, Gunzelmann G. Aircrew actual vs. prescriptive sleep schedules and resulting fatigue estimates. Aerosp Med Hum Perform. 2021; 92(10):806814.


Assuntos
Medicina Aeroespacial , Aviação , Adulto , Pré-Escolar , Fadiga , Humanos , Masculino , Sono , Privação do Sono
5.
Aerosp Med Hum Perform ; 92(10): 831-834, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34642004

RESUMO

INTRODUCTION: Military aviators are likely to be first diagnosed with inflammatory bowel diseases (IBD) during military service. Current recommendations support continuing flying with restrictions, but risks may be significant. The aim of the study was to document the long-term results of aviators newly diagnosed with IBD. METHODS: A prospective observational study over a 23-yr period included all Israeli Air Force (IAF) aviators with IBD. Primary end point was the qualification and safety to continue operational flying following IBD diagnosis. RESULTS: Subjects were 16 male aviators with an average follow-up of 130 mo. Average age was 27 (2045) and average time from symptoms onset to final diagnosis was 7.3 mo. Eight (50%) patients had Crohns disease (CD), and the other eight had ulcerative colitis (UC). Eight (50%) were high performance platform aviators. Two patients received biologic treatment, two were treated with repeated corticosteroid courses, and four with immunosuppressive therapy. Two patients underwent surgery and four needed different lengths of hospitalizations. Eight (50%) aviators (3 CD, 5 UC) were grounded for a mean of 177 d (5590). Altogether grounding for IBD aviators was 46/2087 mo (2.2%). Most grounding periods were short term and reversible. All aviators continued flying under annual monitoring or as needed and no compromise of their abilities was documented. CONCLUSIONS: All aviators were able to continue flying and no events of sudden incapacitation or severe disabling flares have been seen among patients. Our study findings support the current recommendation to continue flying when IBD is in stable remission. Tehori O, Koslowsky B, Gabbai D, Shapira S, Ben-Ari O. Military aviators with inflammatory bowel diseases continued flying. Aerosp Med Hum Perform. 2021; 92(10):831834.


Assuntos
Medicina Aeroespacial , Doenças Inflamatórias Intestinais , Militares , Pilotos , Adulto , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Masculino
6.
Aerosp Med Hum Perform ; 92(10): 845-848, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34642009

RESUMO

Kreykes AJ, Vardiman J. Aerospace medicine clinic: aseptic meningitis. Aerosp Med Hum Perform. 2021; 92(10):845848.


Assuntos
Medicina Aeroespacial , Humanos
7.
8.
Aerosp Med Hum Perform ; 92(10): 851-852, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34642011
9.
Aerosp Med Hum Perform ; 92(9): 744-750, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34645556

RESUMO

INTRODUCTION: In the mid-1970s, NASA required a robust training program for physicians responsible for the medical needs of the Shuttle astronauts. Personnel at NASA worked closely with academicians and subject matter experts at Wright State University (WSU) to develop and establish a residency program in aerospace medicine. This academic training program was initiated in 1978 and closed in 2018. The objective of this historical piece is to catalog, for posterity, the impact this training program has had on national and international human spaceflight and aviation. METHODS: A thorough review of all available historical documents and oral histories provided by contemporaries were reviewed in detail, including a search of every available residents thesis and all available historical documents and reports at WSU and NASA Headquarters. RESULTS: Over the past 40 yr, WSU has graduated 172 individuals with an M.S. degree focused on aerospace medicine, of which 84 were residents. Nearly 50 of these residents have worked closely with NASA. Many others became integrated into academia, the aviation industry, or international space programs. DISCUSSION: With the growth in interest for government and commercial spaceflight, the field of aerospace medicine is poised to grow. Although it is not well known outside of the Aerospace Medicine community, the legacy of this pioneering, 40-yr civilian-based program is of significant value. If not recorded in an easily locatable and accessible manner, many of the challenges and outcomes from this residency could be lost until future generations have to spend the money, time, and effort to relearn them. Doarn CR, Shimada K, Shepanek M. The legacy of the Wright State University Aerospace Medicine Residency program. Aerosp Med Hum Perform. 2021; 92(9):744750.


Assuntos
Medicina Aeroespacial , Internato e Residência , Voo Espacial , Medicina Aeroespacial/educação , Astronautas , Humanos , Universidades
10.
Aerosp Med Hum Perform ; 92(9): 751-753, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34645557
11.
Aerosp Med Hum Perform ; 92(9): 754-755, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34645558
12.
Aerosp Med Hum Perform ; 92(9): 702-709, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34645550

RESUMO

INTRODUCTION: Military aeromedical evaluations are common, but specialized neuropsychological norms for aviation personnel are sparse, resulting in a need to rely on norms from the general population. Little has been published regarding aviation subpopulations and how their neuropsychological profiles may differ from general population normative data. This study investigated neuropsychological test results of aeromedical service members to evaluate consistency with general population norms, and to delineate differences between aviation subpopulations.METHODS: Analyses were conducted on demographic variables and test scores of military aviators (N 26) and nonaviator crewmembers (N 36) referred for evaluation due to a clinical problem requiring a waiver for flight status. Performance differences between subsamples were investigated with general linear modeling. Base rates for low scores were described.RESULTS: Mean test scores in both subsamples were 0 to 1 standard deviation (SD) above the general populations means, with the largest discrepancies being found on measures of visuospatial ability (crewmembers) and verbal learning (aviators). Modeling revealed a significant difference between aviators and crewmembers on Trail Making Test Part B, after accounting for education. Aviators produced fewer low scores than crewmembers, even when using education adjusted normative data.DISCUSSION: Results suggest the cognitive profile of aviators is uniquely strong in specific domains, with fewer low scores. The development of aviator-specific norms may enhance sensitivity to cognitive decrements in this population. Future studies might separately assess crewmember roles to further assess cognitive performance standards across specialties.Maltez-Laurienti A, Minniear A, Moore R, McGovern T, Newman P, Brearly T. Exploring neurocognitive performance differences in military aviation personnel. Aerosp Med Hum Perform. 2021; 92(9):702709.


Assuntos
Medicina Aeroespacial , Aviação , Militares , Humanos , Testes Neuropsicológicos
13.
Aerosp Med Hum Perform ; 92(9): 710-719, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34645551

RESUMO

BACKGROUND: Fatigue of air force pilots has become an increasing concern due to changes in mission characteristics. In the current study we investigated fatigue, emotions, and cognitive performance in a simulated 11-h mission in the 39 Gripen fighter aircraft. METHODS: A total of 12 subjects were evaluated in a high-fidelity dynamic flight simulator for 12 consecutive hours. Perceived fatigue was measured by the Samn-Perelli Fatigue Index (SPFI). Emotions were assessed with the Circumplex Affect Space. Cognitive performance was assessed by five cognitive tasks. RESULTS: Significant increase in self-reported fatigue, general decrease in two positive emotional states, as well increase of one negative emotional state occurred after approximately 7 h into the mission. Self-reported fatigue negatively correlated with enthusiasm and cheerfulness (r 0.75; 0.49, respectively) and positively correlated with boredom and gloominess (r 0.61; r 0.30, respectively). Response time in the low-order task negatively correlated with enthusiasm, cheerfulness and calmness (r 0.44; r 0.41; r 0.37, respectively) and positively correlated with boredom and anxiousness (r 0.37; r 0.28, respectively). Mission duration had an adverse impact on emotions in these environmental conditions, particularly after 7 h. DISCUSSION: These results contribute to the understanding of fatigue development in general and of emotion-cognition relationships. These findings emphasize that both emotional states and the type of cognitive tasks to be performed should be considered for planning long-duration missions in single-piloted fighter aircrafts as to increase the probability of missions success. Rosa E, Gronkvist M, Kolegard R, Dahlstrom N, Knez I, Ljung R, Willander J. Fatigue, emotion, and cognitive performance in simulated long-duration, single-piloted flight missions. Aerosp Med Hum Perform. 2021; 92(9):710719.


Assuntos
Medicina Aeroespacial , Pilotos , Cognição , Emoções , Fadiga , Humanos
14.
Aerosp Med Hum Perform ; 92(9): 738-743, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34645555

RESUMO

OBJECTIVE: High altitudes imply exposure to a decreased ambient air pressure. Such a situation may also alter the performance of acoustic transducers using vibrating diaphragms due to air rarefaction. This study aimed at analyzing the performance at high altitude of hearing aids (HAs) where mechano-electric and electro-mechanic transducers are used. METHODS: A hypobaric chamber was used to perform two separated experimental sessions. In the first one two commercial models of HAs were exposed to a simulated altitude of 25,000 ft (7620 m) and to a subsequent rapid decompression profile, with a rapid climb (< 3 s) from 8000 (2438 m) to 25,000 ft. The second session separately analyzed the performance of microphone and receiver at an altitude of 9000 and 15,000 ft (2743 and 4572 m). Before and after the first session, the HAs were tested with an electronic ear while a dedicated recording system was used in the second session. RESULTS: No HA damage or dysfunction was detected during the first session. In the second one, the microphone showed a mild decrease of its output, while the receiver exhibited a much higher reduction of its output. CONCLUSION: Our findings highlight the safe use of HAs even under extreme environmental pressure changes. For altitudes exceeding 10,000 ft (3048 m), a recalibration of the HAs output via a dedicated program may be suggested. Lucertini M, Sanjust F, Manca R, Cerini L, Lucertini L, Sisto R. Hearing aids performance in hypobaric environments. Aerosp Med Hum Perform. 2021; 92(9):738743.


Assuntos
Medicina Aeroespacial , Auxiliares de Audição , Altitude , Humanos , Hipóxia , Pressão
15.
Nat Med ; 27(9): 1485, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34522036
16.
Aerosp Med Hum Perform ; 92(7): 603-605, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-34503636
17.
Aerosp Med Hum Perform ; 92(8): 633-641, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34503616

RESUMO

AbstractBACKGROUND: Members of the public will soon be taking commercial suborbital spaceflights with significant Gx (chest-to-back) acceleration potentially reaching up to 6 Gx. Pulmonary physiology is gravity-dependent and is likely to be affected, which may have clinical implications for medically susceptible individuals.METHODS: During 2-min centrifuge exposures ranging up to 6 Gx, 11 healthy subjects were studied using advanced respiratory techniques. These sustained exposures were intended to allow characterization of the underlying pulmonary response and did not replicate actual suborbital G profiles. Regional distribution of ventilation in the lungs was determined using electrical impedance tomography. Neural respiratory drive (from diaphragm electromyography) and work of breathing (from transdiaphragmatic pressures) were obtained via nasoesophageal catheters. Arterial blood gases were measured in a subset of subjects. Measurements were conducted while breathing air and breathing 15 oxygen to simulate anticipated cabin pressurization conditions.RESULTS: Acceleration caused hypoxemia that worsened with increasing magnitude and duration of Gx. Minimum arterial oxygen saturation at 6 Gx was 86 1 breathing air and 79 1 breathing 15 oxygen. With increasing Gx the alveolar-arterial (A-a) oxygen gradient widened progressively and the relative distribution of ventilation reversed from posterior to anterior lung regions with substantial gas-trapping anteriorly. Severe breathlessness accompanied large progressive increases in work of breathing and neural respiratory drive.DISCUSSION: Sustained high-G acceleration at magnitudes relevant to suborbital flight profoundly affects respiratory physiology. These effects may become clinically important in the most medically susceptible passengers, in whom the potential role of centrifuge-based preflight evaluation requires further investigation.Pollock RD, Jolley CJ, Abid N, Couper JH, Estrada-Petrocelli L, Hodkinson PD, Leonhardt S, Mago-Elliott S, Menden T, Rafferty G, Richmond G, Robbins PA, Ritchie GAD, Segal MJ, Stevenson AT, Tank HD, Smith TG. Pulmonary effects of sustained periods of high-G acceleration relevant to suborbital spaceflight. Aerosp Med Hum Perform. 2021; 92(7):633641.


Assuntos
Medicina Aeroespacial , Voo Espacial , Aceleração , Centrifugação , Gravitação , Humanos
18.
Aerosp Med Hum Perform ; 92(8): 642-649, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34503617

RESUMO

INTRODUCTION: Syncope is both incapacitating and unpredictable, presenting a significant challenge in aircrew assessment. Previous UK Civil Aviation Authority (CAA) guidance lacked transparency and relied heavily on specialist in-house cardiology and neurology opinion. A new algorithm was developed which elaborated and formalized the decision-making process. An analysis of its impact on historic cases was undertaken to ensure it aligned with previous certificatory outcomes.METHODS: The medical literature on syncope and the approaches of other national aviation authorities were reviewed to help inform the development of a new algorithm. Using syncope cases in the CAA database, regulatory outcomes generated using the new algorithm were compared with previous decisions in terms of time off from flying (TOF) and Operational Multi-Crew Limitation (OML) duration.RESULTS: There were 40 historic syncope cases (25 existing certificate holders,15 initial applicants) which were reassessed using the new algorithm. The mean TOF for existing pilots using the new algorithm was 7.1 9.8 (mean SD) vs. 4.2 3.5 mo under the old guidance with an OML duration of 21.4 34.9 vs. 24.5 25.2 mo. One less initial applicant experienced a delay to certification. Four cases with underlying pathology were detected using old and new guidance.DISCUSSION: The reassessment of cases showed no statistically significant difference in TOF and OML duration; this is a positive finding from a regulatory perspective, enabling algorithm-led decision-making with less reliance on in-house expertise. A similar approach may be useful in future updates to other areas of regulatory practice.Anderton RA, Mitchell SJ, ONunain SS. Syncope in commercial pilots and new regulatory guidance. Aerosp Med Hum Perform. 2021; 92(8):642649.


Assuntos
Medicina Aeroespacial , Aviação , Pilotos , Certificação , Humanos , Síncope/diagnóstico
19.
Aerosp Med Hum Perform ; 92(8): 650-669, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34503618

RESUMO

AbstractINTRODUCTION: For over 50 yr, investigators have studied the physiological adaptations of the human system during short- and long-duration spaceflight exposures. Much of the knowledge gained in developing health countermeasures for astronauts onboard the International Space Station demonstrate terrestrial applications. To date, a systematic process for translating these space applications to terrestrial human health has yet to be defined.METHODS: In the summer of 2017, a team of 38 international scientists launched the Bellagio ll Summit Initiative. The goals of the Summit were: 1) To identify space medicine findings and countermeasures with highest probability for future terrestrial applications; and 2) To develop a roadmap for translation of these countermeasures to future terrestrial application. The team reviewed public domain literature, NASA databases, and evidence books within the framework of the five-stage National Institutes of Health (NIH) translation science model, and the NASA two-stage translation model. Teams then analyzed and discussed interdisciplinary findings to determine the most significant evidence-based countermeasures sufficiently developed for terrestrial application.RESULTS: Teams identified published human spaceflight research and applied translational science models to define mature products for terrestrial clinical practice.CONCLUSIONS: The Bellagio ll Summit identified a snapshot of space medicine research and mature science with the highest probability of translation and developed a Roadmap of terrestrial application from space medicine-derived countermeasures. These evidence-based findings can provide guidance regarding the terrestrial applications of best practices, countermeasures, and clinical protocols currently used in spaceflight.Sides MB, Johnston SL III, Sirek A, Lee PH, Blue RS, Antonsen EL, Basner M, Douglas GL, Epstein A, Flynn-Evans EE, Gallagher MB, Hayes J, Lee SMC, Lockley SW, Monseur B, Nelson NG, Sargsyan A, Smith SM, Stenger MB, Stepanek J, Zwart SR; Bellagio II Team. Bellagio II report: terrestrial applications of space medicine research. Aerosp Med Hum Perform. 2021; 92(8):650669.


Assuntos
Medicina Aeroespacial , Voo Espacial , Astronautas , Humanos , Fatores de Tempo
20.
Aerosp Med Hum Perform ; 92(8): 670-675, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34503619

RESUMO

INTRODUCTION: Ketamine is a rapidly acting general anesthetic which is globally used in surgical analgesia, as well as in the management of pain. It is also used as a recreational drug. Because of its widespread use in surgical settings, the use of this drug presents an aeromedical problemin addition, of course, to the underlying condition for which it has been used. The literature around the mechanisms and side effects of ketamine is reasonably mature, and it is possible to make fairly dependable risk management decisions about return to flying based on the information available. Accordingly, following ketamine use it is recommended that aviators be grounded for 48 h following Aviation Medical Examiner review. If review is unavailable, the aviator should be grounded for 1 wk to allow sufficient time to identify the existence of prolonged side effects, such as psychomimetic effects or cognitive changes.Boyd NL, Navathe PD. An update to aircrew grounding periods after ketamine use. Aerosp Med Hum Perform. 2021; 92(8):670-675.


Assuntos
Medicina Aeroespacial , Aviação , Ketamina , Militares , Humanos , Ketamina/efeitos adversos
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