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Viaud-Murat EM, Bahra L, Redmann AJ, Buck LS, Carratola M. Ethics in Practice: Laryngotracheoplasty Versus Tracheostomy in a Patient With Severe Hydranencephaly. Otolaryngol Head Neck Surg 2024; 170:1474-1477. [PMID: 38353287 DOI: 10.1002/ohn.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 04/30/2024]
Affiliation(s)
| | - Luka Bahra
- Department of Otolaryngology, University of Colorado Anschutz Medical Campuus, Parker, Colorado, USA
| | - Andrew J Redmann
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lauren S Buck
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University Health Sciences Center, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana, USA
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Shikani AH, Rohayem Z, D'Adamo CR, Miller AC. Linear versus Turbulent Airflow Tracheostomy Heat and Moisture Exchangers: A Crossover Study. Laryngoscope 2023; 133:3422-3428. [PMID: 37289035 DOI: 10.1002/lary.30795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the impact of two tracheostomy heat and moisture exchangers (HMEs), namely the Shikani Oxygen HME™ (S-O2 HME, ball type, turbulent airflow) and Mallinckrodt Tracheolife II DAR HME (M-O2 HME; flapper type, linear airflow) on tracheobronchial mucosal health, oxygenation, humidification, and patient preference. METHODS A randomized cross-over study was conducted with HME-naïve long-term tracheostomy subjects at two academic medical centers. Bronchoscopy assessments of mucosal health were performed at baseline and day 5 of HME application, along with oxygen saturation (SpO2 ) and breathed air humidity at four oxygen flow rates (1, 2, 3, and 5 lpm). Patient preference was assessed on study conclusion. RESULTS Both HMEs were associated with improved mucosal inflammation and decreased mucus production (p < 0.0002), with greater improvements in the S-O2 HME group (p < 0.007). Both HMEs improved humidity concentration at each oxygen flow rate (p < 0.0001), without significant differences between groups. SpO2 was greater for the S-O2 HME versus the M-O2 HME across all measured oxygen flow rates (p = 0.003). At low oxygen flow rates (1 or 2 lpm), the SpO2 in the S-O2 HME group was similar to that of the M-O2 HME at higher oxygen flow rates (3 or 5 lpm; p = 0.6). Ninety percent of subjects preferred the S-O2 HME. CONCLUSION Tracheostomy HME uses correlated with improved indicators of tracheobronchial mucosal health, humidity, and oxygenation. The S-O2 HME outperformed the M-O2 HME with respect to tracheobronchial inflammation, SpO2 , and patient preference. Regular HME use by tracheostomy patients is recommended to optimize pulmonary health. Newer ball-type speaking valve technology additionally allows concomitant HME and speaking valve application. LEVEL OF EVIDENCE 2 Laryngoscope, 133:3422-3428, 2023.
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Affiliation(s)
- Alan H Shikani
- Division of Otolaryngology-Head and Neck Surgery, LifeBridge Sinai Hospital, Baltimore, Maryland, USA
- Division of Otolaryngology-Head and Neck Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Ziad Rohayem
- Division of Otolaryngology-Head and Neck Surgery, LifeBridge Sinai Hospital, Baltimore, Maryland, USA
- Division of Otolaryngology-Head and Neck Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Christopher R D'Adamo
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew C Miller
- Department of Emergency Medicine, Memorial Hospital of Belleville, Belleville, Illinois, USA
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Sison SM, Sivakumar GK, Caufield-Noll C, Greenough WB, Oh ES, Galiatsatos P. Mortality outcomes of patients on chronic mechanical ventilation in different care settings: A systematic review. Heliyon 2021; 7:e06230. [PMID: 33615014 PMCID: PMC7880845 DOI: 10.1016/j.heliyon.2021.e06230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/24/2021] [Accepted: 02/04/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives To determine the outcomes of chronically ventilated patients outside the setting of intensive care units. Design Systematic review. Setting and participants Studies evaluating patients on chronic invasive mechanical ventilation in different care settings. Methods A systematic literature search of the PubMed, Embase, Cochrane Library, CINAHL (EBSCOhost), LILACS and Scopus databases from inception to March 27, 2020. Studies reporting mortality outcomes of patients ≥18 years of age on chronic invasive mechanical ventilation in intensive care units and other care settings were eligible for inclusion. Results Sixty studies were included in the systematic review. Mortality rates ranged from 13.7% to 77.8% in ICUs (n = 17 studies), 7.8%-51.0% in non-ICUs including step-down units and inpatient wards (n = 26 studies), and 12.0%-91.8% in home or nursing home settings (n = 19 studies). Age was associated with mortality in all care settings. Weaning rates ranged from 10.0% to 78.2% across non-ICU studies. Studies reporting weaning as their primary outcome demonstrated higher success rates in weaning. Home care studies reported low incidences of ventilator failure. None of the studies reported ventilator malfunction as the primary cause of death. Conclusions and implications Mortality outcomes across various settings were disparate due to methodological and clinical heterogeneity among studies. However, there is evidence to suggest non-ICU venues of care as a comparable alternative to ICUs for stable, chronically ventilated patients, with the additional benefit of providing specialized weaning programs. By synthesizing the global data on managing chronically ventilated patients in various care settings, this study provides health care systems and providers alternative venue options for the delivery of prolonged ventilatory care in the context of limited ICU resources.
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Affiliation(s)
- Stephanie M Sison
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Gayathri K Sivakumar
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - William B Greenough
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Frostell C, Björling G, Strömberg E, Karlsson S, Aune RE. Tracheal implants revisited. Lancet 2017; 389:1191. [PMID: 28353438 DOI: 10.1016/s0140-6736(17)30777-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 12/23/2016] [Accepted: 01/25/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Claes Frostell
- Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden.
| | - Gunilla Björling
- Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden; The Swedish Red Cross University College, Huddinge, Sweden
| | - Emma Strömberg
- School of Chemical Science and Engineering, Fibre and Polymer Technology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sigbritt Karlsson
- School of Chemical Science and Engineering, Fibre and Polymer Technology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ragnhild E Aune
- Department of Materials Science and Engineering, Norwegian University of Science and Technology, Trondheim, Norway
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Laakso K, Markström A, Idvall M, Havstam C, Hartelius L. Communication experience of individuals treated with home mechanical ventilation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2011; 46:686-699. [PMID: 22026570 DOI: 10.1111/j.1460-6984.2011.00040.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Mechanical ventilatory support seriously affects speaking and communication, and earlier studies show that many ventilator-supported patients experience difficulties and frustration with their speech and voice production. Since there is a growing number of individuals who require mechanical ventilatory support and there is a paucity of studies that examine ventilator-supported communication, this research area needs to be developed to ensure adequate health services for this population. The present study focused on ventilator-supported communication from the point of view of individuals receiving home mechanical ventilation (HMV). AIMS The specific aim was to examine the communication experience of individuals receiving HMV. METHODS & PROCEDURES A qualitative approach was adopted for this study, and data were collected by means of semi-structured interviews. Qualitative content analysis was used to structure, condense and interpret the data. The participants were recruited from the National Respiratory Centre (NRC) in Sweden, and included 19 individuals receiving HMV. OUTCOMES & RESULTS The main theme A long and lonely struggle to find a voice and six subthemes detailing different facets of it emerged from data analysis: Managing changed speech conditions, Prioritising voice, A third party supporting communication, Using communication to get things done, Depending on technology, and Facing ignorance. Important aspects influencing the ventilator-supported individuals' communicative performance (speech, support from others and technological solutions) are discussed. CONCLUSIONS & IMPLICATIONS The study revealed that healthcare practitioners involved in the care of individuals receiving HMV need to improve their understanding and knowledge of issues related to ventilator-supported communication. Individuals receiving HMV encounter a needlessly long and lonely struggle to achieve effective communication. They face numerous challenges regarding their communication, and they need to be heard in both literal and figurative senses. To overcome these challenges they need support from competent healthcare practitioners and personal assistants, and continuous follow-up by speech and language therapists tailoring communicative solutions to fit individual needs.
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Affiliation(s)
- Katja Laakso
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, SwedenLund University, The Swedish Institute for Health Sciences (Vårdal Institute), Lund, Sweden
| | - Agneta Markström
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, SwedenLund University, The Swedish Institute for Health Sciences (Vårdal Institute), Lund, Sweden
| | - Markus Idvall
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, SwedenLund University, The Swedish Institute for Health Sciences (Vårdal Institute), Lund, Sweden
| | - Christina Havstam
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, SwedenLund University, The Swedish Institute for Health Sciences (Vårdal Institute), Lund, Sweden
| | - Lena Hartelius
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, SwedenLund University, The Swedish Institute for Health Sciences (Vårdal Institute), Lund, Sweden
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Laakso K, Markström A, Hartelius L. Communication and quality of life in individuals receiving home mechanical ventilation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.12.45421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katja Laakso
- Institute of Neuroscience and Physiology, Division of Speech and Language Pathology, University of Gothenburg, Gothenburg, and The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, Lund, Sweden
| | - Agneta Markström
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, Sweden
| | - Lena Hartelius
- Institute of Neuroscience and Physiology, Division of Speech and Language Pathology, University of Gothenburg, Gothenburg, Sweden
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Browaldh N, Markström A, Friberg D. Elective tracheostomy is an alternative treatment in patients with severe obstructive sleep apnoea syndrome and CPAP failure. Acta Otolaryngol 2009; 129:1121-6. [PMID: 19065292 DOI: 10.1080/00016480802572509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSIONS Elective tracheostomy with custom-made tubes was tolerated in a majority of patients with severe obstructive sleep apnoea syndrome (OSAS), as it reduced daytime symptoms and served as a link to other treatments. OBJECTIVES To evaluate the tolerability of elective tracheostomy and changes in excessive daytime sleepiness and nocturnal oxygen desaturations (ODI) in patients with severe OSAS and obesity. PATIENTS AND METHODS The medical records of 10 patients, median age 53.5 years (range 31-77), BMI 36 kg/m(2) (31-50), ODI 81 (55-126) during a 5-year period were reviewed. Inclusion criteria were failure of continuous positive airway pressure (CPAP), acceptance of tracheostomy, excessive daytime sleepiness and ODI > 50. All patients received a custom-made tube. Sleep apnoea recordings and questionnaires with Epworth sleepiness scale (ESS) were performed before and after tracheostomy. RESULTS Eight of 10 patients tolerated the tube for more than 6 months. The ESS score was reduced from median 18 (range 8-23) to 5 (0-7) and the ODI values from 81 (55-126) to 13 (1-87). Two patients insisted on decannulation because they had nocturnal breathing problems, two underwent palatal surgery and were decannulated, and five still have their tubes. Severe cough, sputum infections and stoma granuloma were seen in all patients.
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Backman S, Björling G, Johansson UB, Lysdahl M, Markström A, Schedin U, Aune RE, Frostell C, Karlsson S. Material wear of polymeric tracheostomy tubes: a six-month study. Laryngoscope 2009; 119:657-64. [PMID: 19205021 DOI: 10.1002/lary.20048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objectives were to study long-term material wear of tracheostomy tubes made of silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU) after 3 and 6 months of clinical use. STUDY DESIGN The study has a prospective and comparative design. METHODS Nineteen patients with long-term tracheostomy, attending the National Respiratory Center in Sweden, were included, n = 6 with Si tubes, n = 8 with PVC tubes, and n = 5 with PU tubes. The tubes were exposed to the local environment in the trachea for 3 and 6 months and analyzed by scanning electron microscopy, attenuated total reflectance Fourier transform infrared spectroscopy, and differential scanning calorimetry. RESULTS All tubes revealed severe surface changes. No significant differences were established after 3 or 6 months of exposure between the various materials. The changes had progressed significantly after this period, compared to previously reported changes after 30 days of exposure. The results from all analyzing techniques correlated well. CONCLUSIONS All tubes, exposed in the trachea for 3-6 months, revealed major degradation and changes in the surface of the material. Polymeric tracheostomy tubes should be changed before the end of 3 months of clinical use.
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Affiliation(s)
- Sara Backman
- School of Chemical Science and Engineering, Fiber, and Polymer Technology, Royal Institute of Technology (KTH), Stockholm, Sweden
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Affiliation(s)
- P Pratt
- Critical Care and Chronic Ventilation Service, University Hospitals of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
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Björling G, Axelsson S, Johansson UB, Lysdahl M, Markström A, Schedin U, Aune RE, Frostell C, Karlsson S. Clinical use and material wear of polymeric tracheostomy tubes. Laryngoscope 2007; 117:1552-9. [PMID: 17632426 DOI: 10.1097/mlg.0b013e31806911e3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives were to compare the duration of use of polymeric tracheostomy tubes, i.e., silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU), and to determine whether surface changes in the materials could be observed after 30 days of patient use. METHODS Data were collected from patient and technical records for all tracheostomized patients attending the National Respiratory Center in Sweden. In the surface study, 19 patients with long-term tracheostomy were included: six with Bivona TTS Si tubes, eight with Shiley PVC tubes, and five with Trachoe Twist PU tubes. All tubes were exposed in the trachea for 30 days before being analyzed by scanning electron microscopy (SEM) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR). New tubes and tubes exposed in phosphate-buffered saline were used as reference. RESULTS Si tubes are used for longer periods of time than those made of PVC (P<.0001) and PU (P=.021). In general, all polymeric tubes were used longer than the recommended 30-day period. Eighteen of the 19 tubes exposed in patients demonstrated, in one or more areas of the tube, evident surface changes. The morphologic changes identified by SEM correlate well with the results obtained by ATR-FTIR. CONCLUSIONS Si tracheostomy tubes are in general used longer than those made of PVC and PU. Most of the tubes exposed in the trachea for 30 days suffered evident surface changes, with degradation of the polymeric chains as a result.
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Affiliation(s)
- Gunilla Björling
- Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, National Respiratory Centre, and the Sophiahemmet University College, Stockholm, Sweden.
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Björling G, Belin AL, Hellström C, Schedin U, Ransjö U, Ålenius M, Johansson UB. Tracheostomy inner cannula care: a randomized crossover study of two decontamination procedures. Am J Infect Control 2007; 35:600-5. [PMID: 17980239 DOI: 10.1016/j.ajic.2006.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 11/17/2006] [Accepted: 11/27/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Today several methods for decontaminating inner cannulae exist. These methods are not based on scientific data, but often on local clinical tradition. This study compares two different decontamination methods. The aim was to find a practical and safe decontamination method. It is a randomized, single-blinded, comparative crossover study. METHODS Fifty outpatients with long-term tracheostomy with an inner cannula were consecutively included and randomly allocated to begin with one of two different treatment sequences: detergent and chlorhexidine-alcohol (A) or detergent (B). Samples for bacterial culture were taken before and after decontamination, and the number of bacteria colonies was counted. RESULTS Before decontamination, the inner cannulae grew high numbers of bacteria, which were parts of the normal flora of the upper respiratory tract and did not differ significantly between the two sequences (AB; BA). The primary variable was the culture count value after chlorhexidine-alcohol/detergent (A) and detergent (B). The effects of both methods were larger than expected, and the results showed a nearly total elimination of organisms. The equivalence criterion, ratio of mean colony counts (A/B) >0.8, was met at a significance level of P<0.001. CONCLUSIONS Cleaning the tracheostomy inner cannula with detergent and water is sufficient to achieve decontamination.
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Nishiyama K, Komori M, Narushima M, Yoshizawa H, Kawamata M, Ozaki M. A woman who required long-term mechanical ventilation to treat limbic encephalitis during pregnancy. Acta Anaesthesiol Scand 2007; 51:252-4. [PMID: 17073854 DOI: 10.1111/j.1399-6576.2006.01178.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We describe our experience with a woman who had severe non-herpetic acute limbic encephalitis at 20 weeks' gestation. Despite receiving mechanical ventilation for about 3 months because of impaired consciousness and frequent convulsions, she had a normal delivery and an uneventful recovery with no sequelae. The patient did not respond to treatment with antiviral agents. Anticonvulsant agents were given while monitoring plasma drug concentrations. Early treatment and the prevention of complications apparently contributed to good outcomes in the mother and child.
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Affiliation(s)
- K Nishiyama
- Department of Anesthesiology, Medical Center East, Tokyo Women's Medical University, Tokyo, Japan
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