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Patient self-reported follow-up for radiation oncology patients during COVID-19: feasibility and patient-clinician agreement COVID-19期间放射肿瘤患者自我报告随访:可行性和患者-临床共识
Pub Date : 2023-02-07 DOI: 10.5166/jroi.12.2.1
T. Sandell, Andre Miller, H. Schütze, R. Ivers, Vivega Vijayakumar, Lincoln Dinh
Introduction COVID-19 required health services to be innovative and quickly adapt their health service delivery, including adopting health technology in cancer clinical practice. COVID-19 restrictions forced us to introduce follow-up consultations for many patients via telehealth. At the same time, we adapted an existing Patient Reported Outcome messaging service that linked to the patient’s medical record to allow patients to self-report their health and disease status before their telehealth follow-up consultation. This study aimed to evaluate the feasibility of self-reporting for cancer follow-up care, and determine the patient-clinician level of agreement. Methods Cross-sectional clinical practice study. Patients on radiation oncology follow-up care were sent a text message with a weblink to a survey to self-report their health before their radiation oncologist appointment. Radiation oncologists completed the same set of questions during or within a day of the telehealth follow-up consultation. Descriptive statistics were analysed to evaluate the uptake of self-reporting. Percent agreement and Cohen’s Kappa were used to determine patient-clinician agreement. Results A moderate response rate of 62% was achieved from the 145 patients. There was no difference in the age of patients that were able to complete the assessment. Percent agreement between the patient-reported and the clinician-reported for weight change, appetite, physical performance, side effects was acceptable (>75%). However, percent agreement was moderate for pain and sleep. For most items, Cohen’s Kappa indicated moderate agreement, with pain, side effects, and recurrence being fair. Patients were more likely to report themselves worse than the clinician for all items, except for side effects. Conclusion Patient self-reported health can provide useful information for clinicians to remotely follow-up their patients. This holds promise for future models of follow-up care, particularly for rural and remote patients, and during pandemics and other disasters where clinic attendance is not possible.
2019冠状病毒病要求卫生服务机构创新,并迅速调整其卫生服务提供方式,包括在癌症临床实践中采用卫生技术。COVID-19限制措施迫使我们通过远程医疗为许多患者提供后续会诊。同时,我们调整了与患者医疗记录相关联的现有患者报告结果消息传递服务,允许患者在进行远程医疗后续咨询之前自我报告其健康和疾病状态。本研究旨在评估自我报告用于癌症随访护理的可行性,并确定患者与临床医生的一致程度。方法横断面临床实践研究。接受放射肿瘤学后续治疗的患者在预约放射肿瘤学家之前,会收到一条带有网页链接的短信,让他们自我报告自己的健康状况。放射肿瘤学家在远程医疗随访咨询期间或一天内完成了相同的一组问题。对描述性统计数据进行分析,以评估自我报告的接受程度。百分比同意和科恩Kappa用于确定患者-临床同意。结果145例患者的缓解率为62%。能够完成评估的患者的年龄没有差异。患者报告和临床报告在体重变化、食欲、身体表现、副作用方面的一致性百分比是可以接受的(>75%)。然而,在疼痛和睡眠方面,同意的百分比是中等的。对于大多数项目,Cohen的Kappa显示中度一致,疼痛,副作用和复发是公平的。除了副作用外,患者更有可能报告自己在所有项目上都比临床医生差。结论患者自述健康状况可为临床医生远程随访患者提供有用信息。这为未来的后续护理模式带来了希望,特别是对农村和偏远地区的患者,以及在大流行病和其他无法就诊的灾害期间。
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引用次数: 0
Multilayer Perceptron Analysis of Radiomics to Predict Local Recurrence of Lung Cancer After Radiotherapy 放射组学预测肺癌放疗后局部复发的多层感知机分析
Pub Date : 2022-12-24 DOI: 10.5166/jroi.12.1.1
Alli Jan, Andrew Miller, Peter Wright, Dale Glennan
Purpose: to assess the likelihood of local recurrence of lung malignancies following stereotactic ablative radiotherapy (SABR) by evaluating clinical and radiomic features with machine learning and novel use of deep learning methods. Methods: pre-treatment CT images were attained from seventy patients with primary lung malignancies. The malignancy was segmented by the treating radiation oncologist and 107 radiomic features were extracted from the image. The data underwent feature reduction via Spearman’s correlation and selection with adapted LASSO regression analysis. A random forest model and a multilayer perceptron (MLP) with cost-sensitive classifier were independently used to assess for local recurrence of malignancy. The recurrence likelihood predictions from each of these were used to stratify patients into groups with high and low risk of recurrence. These were assessed for time-to-event predictions using Kaplan-Meier analyses and Gray’s test to evaluate the separation between the high and low-risk groups. The prognostic capacity of the models was evaluated with a concordance index, 95% confidence intervals and bootstrapping (10,000 iterations). Results: the MLP was able to predict the recurrence of malignancy with 100% sensitivity and 91% specificity (AUC 0.95). The MLP predictions showed statistically significant separation of high and low-risk patients, and robust model fit (p=0.04, c=0.79), which out-performed random forest model predictions (p=0.15, c=0.41) that did not reach statistical significance. Conclusions: radiomic data analysis with an MLP showed improved prediction potential within this dataset compared to random forest models for predicting local recurrence of lung cancer.
目的:通过机器学习和新颖的深度学习方法评估临床和放射学特征,评估立体定向消融放疗(SABR)后肺部恶性肿瘤局部复发的可能性。方法:对70例原发性肺恶性肿瘤患者的治疗前CT图像进行分析。由治疗放射肿瘤学家对肿瘤进行分割,并从图像中提取107个放射学特征。数据通过Spearman相关进行特征还原,并采用LASSO回归分析进行选择。随机森林模型和多层感知器(MLP)与代价敏感分类器分别用于恶性肿瘤局部复发评估。这些预测的复发可能性被用于将患者分为复发风险高和低的组。使用Kaplan-Meier分析和Gray测试来评估高风险组和低风险组之间的分离,对这些进行了事件时间预测。通过一致性指数、95%置信区间和自举(10,000次迭代)评估模型的预测能力。结果:MLP预测恶性肿瘤复发的敏感性为100%,特异性为91% (AUC 0.95)。MLP预测显示高、低危患者分离有统计学意义,模型拟合稳健(p=0.04, c=0.79),优于随机森林模型预测(p=0.15, c=0.41),但未达到统计学意义。结论:与随机森林模型相比,使用MLP的放射学数据分析在预测肺癌局部复发方面显示出更好的预测潜力。
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引用次数: 0
Data-driven shared decision-making: a paradigm shift 数据驱动的共同决策:一种范式转变
Pub Date : 2021-11-09 DOI: 10.5166/JROI.11.2.1
R. Fijten, L. Wee, A. Dekker, C. Roumen
At first sight, shared decision-making and data science seem like two vastly different fields. Yet, despite their differences, both fields could, if combined, reinforce clinical utility for both. Here we describe a new paradigm called data-driven shared decision-making (dSDM), an extension of the existing shared decision-making paradigm. In dSDM, data’s role and its interaction with the patient and doctor are made explicit. Furthermore, we describe the opportunities and challenges of combining data science and shared decision-making into this new paradigm. We believe that dSDM will bridge the gap between the need for patient empowerment and the need for more personalized medicine.
乍一看,共享决策和数据科学似乎是两个截然不同的领域。然而,尽管它们存在差异,如果结合起来,这两个领域可以增强两者的临床效用。在这里,我们描述了一种称为数据驱动的共享决策(dSDM)的新范式,它是现有共享决策范式的扩展。在dSDM中,数据的角色及其与患者和医生的互动是明确的。此外,我们描述了将数据科学和共享决策结合到这个新范式中的机遇和挑战。我们相信,dSDM将弥合患者赋权需求与更个性化医疗需求之间的差距。
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引用次数: 0
How to PROceed? Reviewing obstacles and perspectives in patient-centered digital care in radiation oncology 如何继续?回顾以患者为中心的放射肿瘤学数字化护理的障碍和前景
Pub Date : 2021-08-18 DOI: 10.5166/jroi.11.1.1
A. Böhner, L. C. Schmeel, F. Andreas, Scafa Davide, Sarria Gustavo R., Adriana Torres Crigna, D. Koch, S. Garbe, Barbara Link, Dilini Brüser, F. Giordano
As the general public is increasing their online presence and is becoming confident with the digital infrastructure, an opportunity for patient-centered digital care has arisen. Electronic patient-reported outcomes, (e)PRO in short, may facilitate enhanced clinical management of radiation oncology patients. This might enable the physicians to take the initiative and counteract symptoms or undesired side effects before they aggravate and thus, reducing treatment-associated costs. In this article, we review the impetus for and modalities of (e)PRO-based data acquisition and handling in research and routine. We conclude that prospective and technical studies are needed to prove the clinical significance of (e)PROs to pave the way to monetary compensation and widespread application.
随着公众越来越多地上网,对数字基础设施越来越有信心,以患者为中心的数字护理的机会出现了。电子患者报告结果(e)PRO,简称PRO,可能有助于加强放射肿瘤学患者的临床管理。这可能使医生能够采取主动,在症状或不良副作用加重之前消除它们,从而降低与治疗相关的费用。在本文中,我们回顾了在研究和日常中基于(e) pro的数据采集和处理的动力和模式。我们的结论是,需要前瞻性和技术研究来证明(e)PROs的临床意义,为货币补偿和广泛应用铺平道路。
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引用次数: 1
Procedural Creation of Medical Reports with Hierarchical Information Processing in Radiation Oncology 基于分层信息处理的放射肿瘤学医学报告程序创建
Pub Date : 2019-03-18 DOI: 10.5166/jroi-10-1-2
Martin Vogel, H. Fahrner, M. Gainey, M. Schmucker, S. Kirrmann, F. Heinemann
Background: For many years, the oncological doctor's letter has been the pivotal means of information transfer to general practitioners, medical specialists or medical consultants. Yet, both creator and recipient require a high level of abstraction, retentiveness and analysis due to the large number of diagnoses and therapies. In contrast to the commonly used structure of doctor's letters, where all diagnoses and therapies are listed in sequential order with all diagnoses first, it is by no means trivial to establish the important chronological and hierarchical context in the description of oncological cases. Additional aspects of importance are the integration of these letters into existing clinical and departmental information systems (for example via HL7 interface), various export formats (for example PDF, HTML), fax and encrypted email. Moreover these letters need a modern layout that, among others, meets the requirements of corporate design. Methods: The requirements for a doctor's letter system are manifold and can only be represented rudimentarily via a normal word processing system. Due to this deficiency we developed a system that covers all special features and requirements for clinical use. The system is based on a scalable and extensible client-server architecture. We use the programming languages Harbour, C++, PHP and JavaScript, Microsoft SQL database for data storage and the HL7 standard as the interface to other information systems such as hospital information system (HIS). Export formats are PDF, HTML/XML. Layouts are generated with TeX, LaTeX and MikTeX. Results: The aforementioned requirements were resolved with the doctor's letter and finding system IntDok. The hierarchical presentation of diagnoses, histologies and therapies provides the recipient with a first outline of the course of the disease. A strict procedure controls the whole process of document compilation and assists the user with many highly regarded tools such as text blocks, import and export (PDF and HTML/XML including barcodes) functions or HL7 interface to other information systems. The software also provides a sophisticated mail merging. All content from previous letters can easily be inserted into the current document. A TeX-server automatically provides document layout including supreme hyphenation so that uniform and perfect appearance (corporate design) is guaranteed. The documents are saved in a MS-SQL database (almost 230,000 documents since 1991), independent of any proprietary formats such as MS-Word. Conclusion: Creation of documents is fast, simple and well-structured. Sophisticated tools guarantee the optimal use of human resources and time. The system is an important module in our overall digital work environment.
背景:多年来,肿瘤医生的信件一直是信息传递给全科医生,医学专家或医学顾问的关键手段。然而,由于大量的诊断和治疗,创造者和接受者都需要高度的抽象、保留和分析能力。与通常使用的医生信函结构相反,所有的诊断和治疗都是按顺序列出的,所有的诊断都在前面,在肿瘤病例的描述中建立重要的时间顺序和层次背景绝不是微不足道的。其他重要的方面是将这些信件集成到现有的临床和部门信息系统(例如通过HL7接口)、各种导出格式(例如PDF、HTML)、传真和加密电子邮件中。此外,这些信件需要一个现代的布局,其中,符合企业设计的要求。方法:对医生信系统的要求是多方面的,只能通过正常的文字处理系统来基本表示。由于这一不足,我们开发了一个系统,涵盖了所有的特殊功能和临床使用的要求。该系统基于可伸缩和可扩展的客户机-服务器体系结构。我们使用编程语言Harbour、c++、PHP和JavaScript,使用Microsoft SQL数据库进行数据存储,并使用HL7标准作为与医院信息系统(HIS)等其他信息系统的接口。导出格式为PDF、HTML/XML。布局是用TeX, LaTeX和MikTeX生成的。结果:通过indok医生信访系统解决了上述要求。诊断、组织学和治疗的分层呈现为接受者提供了疾病病程的第一个大纲。一个严格的程序控制文档编制的整个过程,并协助用户使用许多高度重视的工具,如文本块,导入和导出(PDF和HTML/XML包括条形码)功能或HL7接口到其他信息系统。该软件还提供了一个复杂的邮件合并。以前字母中的所有内容都可以很容易地插入到当前文档中。文本服务器自动提供文档布局,包括最高的连字符,以保证统一和完美的外观(公司设计)。这些文档保存在MS-SQL数据库中(自1991年以来有近23万份文档),独立于MS-Word等任何专有格式。结论:文档的创建快速、简单且结构良好。先进的工具保证了人力资源和时间的最佳利用。该系统是我们整个数字化工作环境中的一个重要模块。
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引用次数: 0
Multimodal Document Management in Radiotherapy, an Update 放射治疗中的多模式文件管理
Pub Date : 2019-02-11 DOI: 10.5166/JROI-10-1-1
H. Fahrner, S. Kirrmann, M. Gainey, M. Schmucker, Martin Vogel, F. Heinemann
Background: In 2013, we presented a study entitled “Multimodal document management in radiotherapy”, demonstrating the excellent routine performance of the system about four years after its initiation by evaluating a sample of n=500 documents. During this time the system saw additional developments and significant improvements: the most important innovative step being the automatic document processing. This has been completely reworked, to minimize staff-machine interaction, to increase processing speed and to further simplify the overall document handling. This improved system has been running practically without any problems for several months. Methods: While reworking the automatic document processing, we have developed algorithms that allow us to transfer documents with varying type, within a single scanning procedure, into our departmental system. The system identifies and corrects for any arbitrary order or rotation of scanned pages. Finally, after the transfer into the departmental system, all documents are in the correct order and they are automatically linked to the respective patient record.  Results: According to our surveys, the error rate of the system, as in the previous version, is 0%. Compared to manual scanning and mapping of documents, we can quantify a 30-fold increase in the processing speed. In spite of these additional and elaborate processes, code optimizations yielded a processing speed increase of 20%. Pre-sorting of the documents (e.g., medical reports, or documents of informed consents) can be completely dispensed with the automated correction for jumbled documents or document rotations. In this manner 25,000 documents are automatically processed each year in the Department of Radiation Oncology at the University of Freiburg. Conclusion: With the methods presented in this study, and some additional bug fixes, and small improvements, automatic document processing of our departmental system was significantly improved without compromising the error rate. Keywords: Clinic management, documents, workflow, optimisation, efficiency, automation, Mosaiq, oncology informatics  
背景:2013年,我们发表了一项名为“放射治疗中的多模式文件管理”的研究,通过评估n=500份文件的样本,证明了该系统在启动约四年后的优异常规性能。在此期间,系统有了进一步的发展和重大改进:最重要的创新步骤是自动文档处理。这已完全重新设计,以尽量减少工作人员与机器的相互作用,提高处理速度,并进一步简化整个文件处理。这个改进后的系统实际上已经运行了几个月没有任何问题。方法:在重新设计自动文件处理系统的同时,我们开发了一种算法,使我们能够在一次扫描程序内将不同类型的文件传送到我们的部门系统。系统识别并纠正扫描页面的任意顺序或旋转。最后,在转移到部门系统后,所有文件都按照正确的顺序排列,并自动链接到各自的患者记录。结果:根据我们的调查,系统的错误率与上一个版本一样为0%。与手动扫描和映射文档相比,我们可以将处理速度提高30倍。尽管有这些额外和复杂的过程,代码优化使处理速度提高了20%。文件(例如,医疗报告或知情同意文件)的预先排序可以完全免除,因为可以自动更正混乱的文件或文件旋转。通过这种方式,弗莱堡大学放射肿瘤科每年自动处理25000份文件。结论:通过本研究提出的方法,以及一些额外的错误修复和小的改进,在不影响错误率的情况下,我们部门系统的自动文档处理得到了显著改善。关键词:临床管理,文件,工作流程,优化,效率,自动化,Mosaiq,肿瘤信息学
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引用次数: 1
A Step Forward in Cancer Informatics—It Is Mandatory to Make Guidelines Machine Readable 癌症信息学的进步——必须使指南机器可读
Pub Date : 2018-12-15 DOI: 10.5166/jroi-9-1-1
N. Cihoric, I. Igrutinovic, A. Tsikkinis, E. Vlaskou Badra, P. Mackeprang
Clinical guidelines are general recommendations for practicing clinicians regarding prevention, diagnosis and treatment of a given disease. One of the most comprehensive and used guidelines are developed and regularly updated by the National Comprehensive Cancer Network (NCCN). Guidelines are readily available for download in portable document format (PDF). A machine-readable representation of NCCN guidelines is currently not available. In this writing, we argue on the necessity that clinical guidelines should be published in a machine-readable format. After review of the available literature, we describe the most important achievements in the field. Publication of guidelines in a machine-readable form may also be beneficial for other scientific and technical disciplines.
临床指南是针对某一疾病的预防、诊断和治疗的一般建议。国家综合癌症网络(NCCN)制定并定期更新了最全面和最常用的指南之一。指引以可携式文件格式(PDF)可供下载。目前还没有机器可读的NCCN指南表示。在这篇文章中,我们认为临床指南应该以机器可读的格式出版的必要性。在回顾现有文献后,我们描述了该领域最重要的成就。以机器可读的形式出版指南也可能对其他科学和技术学科有益。
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引用次数: 1
A Rational Informatics-enabled approach to Standardised Nomenclature of Contours and Volumes in Radiation Oncology Planning 放射肿瘤学规划中轮廓和体积标准化命名的理性信息学支持方法
Pub Date : 2017-10-02 DOI: 10.5166/JROI-6-1-22
Andrew Miller
The standardising of nomenclature in the radiotherapy planning process has deep implications for the abilityof the profession to examine the adequacy of construction of radiotherapy plans in outcomes research, particularly in relation to disease control and toxicity generation. This paper proposes an interim standardisednomenclature which can be used by any institution as a template for a mappable local standard.The nomenclature is systematically constructed using the Foundational Model of Anatomy, ICRU Report 50 and ICRU report 62. The system foreshadows a XML metadata structure to detail the method of constructionof volumes. Treatment Planning System vendors should build their software with the ability to use this systematic construction technique so that contours and volumes in a radiotherapy plan can be annotated. Thismetadata will allow the investigation of how a radiation plan's construction can affect the therapy outcome.
放射治疗计划过程中术语的标准化对专业人员在结果研究中检查放射治疗计划构建的充分性的能力具有深远的影响,特别是在疾病控制和毒性产生方面。本文提出了一种临时标准命名法,可以被任何机构用作可映射的地方标准的模板。命名法系统地使用解剖学基础模型,ICRU报告50和ICRU报告62。该系统预示了一个XML元数据结构,以详细说明卷的构造方法。治疗计划系统供应商应该构建他们的软件,能够使用这种系统的构建技术,以便放射治疗计划中的轮廓和体积可以被注释。这些元数据将允许研究放射计划的构建如何影响治疗结果。
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引用次数: 4
Developing a tool for crowd-sourcing to Verify a Radiation Oncology Ontology: a Summer Project 开发一种大众外包工具来验证放射肿瘤学本体:暑期项目
Pub Date : 2017-10-02 DOI: 10.5166/JROI-6-1-23
Joshua Pratt, V. Pandian, Evan D. Morrison, Andrew Miller
We have been unable to find a verified, published Radiation Oncology Ontology. We undertook the process of verifying a Radiation Oncology Ontology with a mixture of crowd-sourcing and expert-based approaches to verify relationships in the ontology. We used a natural language based approach to portray concepts and relationships, surveying users to assess the relationships between concepts in the Radiation Oncology ontology. The work used a description of a patient's history expressed in XML. The natural language statements relating concepts are available on a website for verification, and readers are invited to complete the survey at http://coi-hs-survey.appspot.com/ to contribute.
我们一直无法找到一个经过验证的,出版的放射肿瘤学本体。我们进行了验证放射肿瘤学本体的过程,混合了众包和基于专家的方法来验证本体中的关系。我们使用基于自然语言的方法来描绘概念和关系,调查用户以评估放射肿瘤学本体中概念之间的关系。这项工作使用了用XML表示的对病人病史的描述。有关概念的自然语言陈述可在网站上进行验证,并邀请读者在http://coi-hs-survey.appspot.com/上完成调查以提供意见。
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引用次数: 1
Regmentation: A New View of Image Segmentation and Registration 图像分割与配准的新视角
Pub Date : 2017-10-02 DOI: 10.5166/JROI-4-1-19
Marius Erdt, S. Steger, G. Sakas
Image segmentation and registration have been the two major areas of research in the medical imaging community for decades and still are. In the context of radiation oncology, segmentation and registration methods are widely used for target structure definition such as prostate or head and neck lymph node areas. In the past two years, 45% of all articles published in the most important medical imaging journals and conferences have presented either segmentation or registration methods. In the literature, both categories are treated rather separately even though they have much in common. Registration techniques are used to solve segmentation tasks (e.g. atlas based methods) and vice versa (e.g. segmentation of structures used in a landmark based registration). This article reviews the literature on image segmentation methods by introducing a novel taxonomy based on the amount of shape knowledge being incorporated in the segmentation process. Based on that, we argue that all global shape prior segmentation methods are identical to image registration methods and that such methods thus cannot be characterized as either image segmentation or registration methods. Therefore we propose a new class of methods that are able solve both segmentation and registration tasks. We call it regmentation. Quantified on a survey of the current state of the art medical imaging literature, it turns out that 25% of the methods are pure registration methods, 46% are pure segmentation methods and 29% are regmentation methods. The new view on image segmentation and registration provides a consistent taxonomy in this context and emphasizes the importance of regmentation in current medical image processing research and radiation oncology image-guided applications.
几十年来,图像分割和配准一直是医学影像界的两个主要研究领域。在放射肿瘤学的背景下,广泛使用分割和配准方法来定义靶结构,如前列腺或头颈部淋巴结区域。在过去两年中,在最重要的医学成像期刊和会议上发表的所有文章中,有45%的文章采用了分割或配准方法。在文献中,这两个类别被分开对待,尽管它们有很多共同之处。注册技术用于解决分割任务(例如,基于地图集的方法),反之亦然(例如,基于地标的注册中使用的结构分割)。本文回顾了图像分割方法的文献,介绍了一种新的基于形状知识量的分类方法。基于此,我们认为所有全局形状先验分割方法都与图像配准方法相同,因此这些方法不能被描述为图像分割方法或配准方法。因此,我们提出了一种能够同时解决分割和配准任务的新方法。我们称之为调控。通过对目前医学影像学文献的调查,量化发现,25%的方法是纯配准方法,46%是纯分割方法,29%是重构方法。图像分割和配准的新观点在此背景下提供了一致的分类,并强调了分割在当前医学图像处理研究和放射肿瘤学图像引导应用中的重要性。
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引用次数: 53
期刊
Journal of Radiation Oncology Informatics
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