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Archive for November, 2008

Transfusion-Related Risk Trials at Emory

Monday, November 24th, 2008

November 2008

A five-year, $8 million National Institutes of Health grant to Emory University School of Medicine researchers will fund a regional clinical trial examining the best ways to protect low birth weight infants from transfusion-related viral infections, and a study of new strategies for rebuilding the immune systems of bone marrow transplant recipients.

“The goal of these projects is to make transfusion and bone marrow transplant recipients safer,” says Christopher Hillyer, MD, director of the Emory Center for Transfusion and Cellular Therapies. “Although they are distinct projects, each one builds on the knowledge generated by the other.”

In a clinical trial covering the greater Atlanta area, transfusion specialists at Emory are teaming up with doctors at Northside Hospital and Children’s Healthcare of Atlanta to screen for cytomegalovirus (CMV) in blood given to low birth weight infants.

Low birth weight infants have incomplete immune systems and are vulnerable to CMV infection, which can lead to liver or lung damage, permanent disability or even death, says Hillyer, a professor of pathology and laboratory medicine at Emory.

The study will test whether a combination of screening blood by DNA and antibody methods and removing white blood cells before transfusion is enough to eliminate CMV infection.

CMV is also an example of a threat facing bone marrow transplant recipients: infections that take advantage of the patient’s weakened immune system. Doctors have to balance strengthening the patient’s new white blood cells against the cells’ ability to attack their surroundings in “graft-versus-host” disease.

Two projects funded by the grant will address bone marrow transplants. One, led by John Roback, MD, PhD, Emory associate professor of pathology and laboratory medicine and co-director of the transfusion center, tests a new vaccine against CMV in animals, with an eye towards adapting the vaccine to protect against other opportunistic infections in people.

Another, led by Edmund Waller, MD, PhD, professor of hematology/oncology and director of Emory’s Bone Marrow and Stem Cell Transplant Center, is a clinical trial where doctors will treat white blood cells with a suppressive drug before they are given to a patient post-transplant.

A fourth project, led by James Zimring, assistant professor of pathology and laboratory medicine, will advance an animal model for studying immune responses sometimes developed against red blood cells by repeat transfusion recipients.

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Severe Emphysema Treatment Study at Emory

Monday, November 24th, 2008

November 2008

Emory University researchers are participating in a nationwide study to explore an investigational treatment for advanced widespread emphysema.

The EASE (Exhale Airway Stents for Emphysema) Trial focuses on airway bypass, a minimally invasive procedure designed to reduce excessive lung inflation and shortness of breath — typical complications of emphysema – by making new pathways for trapped air to exit the lungs.

During the airway bypass procedure, new openings are created in the airway wall connecting the damaged lung tissue to the natural airway. These pathways are supported and kept open by several new drug-eluting stents.

“Emphysema permanently destroys lung function and there are currently limited treatment options for people with this devastating disease,” says Rabih Bechara, MD, assistant professor and director of interventional pulmonology, Emory University School of Medicine. “This is an exciting study that could offer substantial relief to participants, and eventually possibly to the millions who suffer from the effects of emphysema.”

Emphysema, usually caused by chronic tobacco smoking, is a persistent, progressive and irreversible lung disease characterized by shortness of breath and the destruction of lung tissue. Over time, the tiny air sacs in the lungs, or alveoli, are damaged and lose their elasticity.

This loss of the lungs’ natural elasticity and the collapse of airways in the lung combine to make exhalation ineffective, leaving emphysema sufferers with hyperinflation because they are unable to get air out of their lungs. Breathing becomes inefficient and patients have to work very hard to breathe — making normal activities, such as walking, eating or even bathing, difficult. There is no cure and few treatment options are available for most patients.

“By creating new pathways for airflow with the airway bypass procedure, we hope to reduce hyperinflation and improve lung function,” says Bechara, principal investigator of the study at Emory. “Currently, patients are often in poor physical condition, struggling with each breath so if we can help patients breathe easier it is likely to improve their quality of life.”

Physicians commonly use bronchoscopes to examine the airways within the lungs. Participants in the trial are randomized two to one to an airway bypass or a control group. If randomized to the airway bypass group, physicians will first use a Doppler probe inserted through the bronchoscope to identify a site in the airway that is away from blood vessels. A special needle is then used to make a small opening and the stent is placed in the passageway to keep it open. The procedure involves placing up to six Exhale® Drug-Eluting Stents — manufactured by Broncus Technologies, Inc.

Although this procedure is still under clinical investigation, feasibility data suggest it may hold promise for patients with emphysema. Results from the open-label Exhale Drug-Eluting Stent feasibility study were published in the October 2007 issue of the Journal of Thoracic and Cardiovascular Surgery. Positive results included a statistically significant reduction in the amount of air trapped in the lungs and an improvement in breathing for patients at six months after the airway bypass procedure.

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Brain Mapping Study of Sickle Cell Disease

Monday, November 24th, 2008

November 2008

Children’s Healthcare of Atlanta announced the launch of a unique brain mapping study of sickle cell disease.  This study consists of two parts: (1) a magnetic resonance imaging (MRI) study to obtain detail pictures of the brain-also called brain morphometrics and (2) written paper and pencil tests-also called neuropsychological tests.  These tools are new or improved and are designed to study the relationships between the brain and behavior. The purpose of this study is to better examine how sickle cell disease affects the brain, even when no serious problems, such as strokes, have occurred.

“Through this study, we are able to examine the brain’s cortical thickness and how sickle cell disease effects the development of the brain, which will ultimately lead to a better understanding of the specific areas that are particularly vulnerable to the effects of the disease, said Richard Jones, Ph.D., MRI Physicist, Children’s Healthcare of Atlanta.  “Our goal is to provide the basis for an improved understanding of how to better treat pediatric sickle cell patients.”

Children’s researchers will study the brains of children ages 12 to 21 years who (1) have sickle cell disease, but no known neurological problems and who (2) do not have sickle cell disease or a known neurological problem, but do have a sibling who has sickle cell disease. All children with sickle cell disease participating in the study are current/former patients at the Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta.  “Children’s researchers and physicians hope to prove the predictability of strokes in children with sickle cell disease through future studies like the Brain Mapping Study”

Clinical Background

Sickle cell disease (SCD) is considered one of the most prevalent diseases in the United States, afflicting roughly 1 in 400 African American children. Acute pain episodes and chronic pain are considered the most debilitating symptoms of SCA. However, as the disease progresses, various parts of the body can be compromised such as the brain. Neurologic complications secondary to cerebral infarction are an common source of disability for children with sickle cell disease (SCD). The chance of having a first overt cerebrovascular accident (CVA) by 20 years of age is estimated at 11% for patients with homozygous SS disease (Hb SS).  Previous clinical studies also show that a still larger number of children with Hb SS have cerebral infarctions that are not associated with obvious symptoms but are documented by magnetic resonance imaging (MRI). The prevalence of these “silent infarctions” is approximately 20%.

Study Elements

Brain morphometry uses detail radiology pictures of the brain collected by MRI to model the size and structure of specific areas of the brain. Currently, brain morphometry is being used in research settings to help describe the growth and function of the brain in adults and children. Neuropsychology is the study of behavior and learning. Neuropsychologists use standardized tests to measure learning skill and cognitive performance. A select set of these tests have been grouped together by Children’s neurophsycologists for this study. This group of tests should help researchers identify neurological, behavioral and psychological factors that could affect learning in children with sickle cell disease.

Process

The results of the MRI will be collected and grouped by the study subject’s sickle cell disease status. Researchers, who are unaware of clinical problems of the study participants, will identify and compare differences between the sickle cell and normal control groups. These results will then be compared with the results of the neuropsychological tests to observe ways in which the findings compare.

Objectives

The study aims to identify regions of abnormal brain development in sickle cell children who would be diagnosed as normal using conventional MRI techniques. By using a group analysis to compare the results of the brain morphometry, diffusion and MRI, the study will determine if subjects are experiencing similar patterns of abnormal development.  If so, researchers will then analyze the individual data to see if these techniques will allow an accurate assessment of the brain of individual patients. The results from the cerebral blood flow and susceptibility weighted imaging studies performed with MRI will be evaluated on a qualitative basis by one or more radiologists. The end-point for the study will occur when the indicated number of study and control subjects has been recruited.

This study is intended to learn how sickle cell disease affects the brain’s growth and development through basic interdisciplinary research.

Principal Investigator: Richard Jones, Ph.D.

Co-Investigators: Clark Brown M.D., Greg Kirk M.Sc., Susan Palasis, M.D. and Thomas Burns, Psy.D.

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Arteries from Distinct Regions Have Unique Immune Functions

Monday, November 24th, 2008

November 2008

Human arteries play distinct roles in the immune system depending on their anatomical location, researchers at Emory University School of Medicine have discovered.

Their findings explain why vascular diseases affect different parts of the arterial network and could help doctors fine-tune the treatment of such diseases as atherosclerosis and vasculitis. Atherosclerosis causes heart attacks and strokes because it occurs preferentially in arteries supplying the heart and the brain.

The results were published online by the journal Circulation.

Arteries can play an active role in sensing foreign invasion and bodily injury, because cells embedded in the arterial walls called dendritic cells act like smoke-sensing fire alarms for the immune system, says senior author Cornelia Weyand, MD. PhD, co-director of the Kathleen B. and Mason I. Lowance Center for Human Immunology at Emory University.

“All of our major arteries have this alarm system,” she says. “To our surprise, we found that the arteries of the neck, the arms, the abdomen and the legs are triggered by different infectious organisms. Thus, each artery functions in a specialized way.”

Some vascular diseases attack arteries only in the abdomen or in the neck and upper extremities, and this selectivity has puzzled doctors for years, Weyand says.

To probe the differences among arteries, Weyand and her co-workers examined the activity of genes that encode Toll-like receptors in blood vessels from human donors.

Toll-like receptors are a cornerstone of the “innate” immune system, which can be activated by common features of infection-causing invaders. The capture of bacterial or viral fragments through Toll-like receptors alerts the immune system early during an infectious attack. Toll-like receptors can respond to whip-like antennas on bacteria called flagellae, parts of bacterial cell walls, or DNA and RNA that leaks from viruses or bacteria.

Each type of artery had a different set of Toll-like receptor genes turned on, the authors found. In contrast to arteries, veins could not be stimulated through Toll-like receptors.

For example, cells in the iliac arteries, located in the vicinity of the gut, respond avidly to flagellae but cells from the subclavian arteries, which transport blood to the upper body, do not.

A possible explanation is that dendritic cells from iliac arteries are better able to sense flagellae because of the abundant bacterial flora that inhabits the gut, Weyand says.

Weyand hypothesizes that the dendritic cells in arteries are mainly performing a protective, calming function. Arteries are in constant contact with blood borne infectious agents, with potentially dangerous consequences of damaging the vessel wall.

“It’s when that protective function breaks down that we see inflammation and various vascular diseases,” she says.

She says her team is now investigating how the dendritic cells in arteries move and change as they receive various signals.

The first author of the paper is research specialist Olga Pryshchep, with contributions from postdoctoral fellow Wei Ma-Krupa, PhD, Joerg Goronzy, MD, PhD, co-director of the Lowance Center, and Brian Younge, MD, of the Mayo Clinic.

The research team used samples from 37 deceased donors with an average age of 64. Only arterial samples without atherosclerotic lesions were used.

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Medical Association of Atlanta & President Steven Walsh, M.D.

Monday, November 24th, 2008

October 2008

By Christy Simo

With rising medical costs, a looming physician shortage crisis, and skyrocketing administrative overhead due to insurance requirements, anesthesiologist Dr. Steven Walsh faces many challenges as the new president of the Medical Association of Atlanta (MAA).

dr-steven-walsh-cropped2.thumbnail.JPGBut just as he looks for new ways to help patients cope with post-operative pain, he hopes to not only grow membership, but also take MAA in a new direction to help meet those challenges.

“What we really want to do during my presidency is to reinvigorate our membership to promote the health and safety of our community through physician leadership,” says Dr. Walsh, who became the new president of the MAA in June. “We want to champion our community’s wellbeing and safety, and to advocate a healthy environment in which we practice and serve.”

The MAA is an advocate for physician issues as well as a valuable resource for education, socializing, community service, referrals and legislative support. Having been in existence for 154 years, the MAA is one of the oldest medical associations in Georgia. It was originally created in 1854 to promote the interests of Fulton County physicians and currently serves as the largest and strongest organization to speak for Atlanta-area physicians regardless of specialty, hospital affiliation or mode of practice. Today, it has nearly 1,000 members.

Still, that’s not enough for Dr. Walsh.

“There’s about 4,000 doctors in Fulton County. So although we have a thousand [members] and that’s great, we also want to increase that membership,” he says. “The larger our membership, the stronger our voice, and the greater are our resources to accomplish our mission.”

Making His Way in Medicine

Dr. Walsh completed his Anesthesiology Residency at the Medical University of South Carolina in 1985. That year, he moved to Roswell and joined a local anesthesiology practice. Two years later, he formed North Fulton Anesthesiology Associates.

“I started out with a group of two physicians, and since that time, we’ve grown to a group of 10 physicians and 12 nurse anesthetists,” Dr. Walsh says.

Although his mother was a nurse, Dr. Walsh originally had no intention of going to medical school. But after a stint as a nurse’s aid and later as an operating room technician at the now-defunct West Paces Ferry Hospital, he was inspired to attend medical school. While at the Medical College of Georgia, he was drawn to anesthesiology.

“I think you’re most influenced by some of the mentors that you have in your training. I was most influenced by Dr. Zack W. Gramling, M.D., past chair of the Department of Anesthesiology,” recalls Dr. Walsh, who noted the field focused on two of his favorite sciences in school: pharmacology and physiology. “I had a chance to work with him and see the type of care that he and his residents provided to patients. It persuaded me to pursue that specialty.”

At North Fulton Anesthesiology Associates, Dr. Walsh is using new techniques in acute pain management for patients coming out of surgery. Traditionally, post-operative pain was treated with an IV or oral narcotic medication. Now, more physicians are starting to use regional anesthesia to help patients cope with pain associated with surgery.dr-steven-walsh-group2.JPG“We’re finding very much of an advantage in reducing the patient’s narcotic medication requirements as well as the potential to provide a more effective pain management with the use of regional anesthesia, which is the injection of local anesthesia around the nerves,” he says.

For example, if somebody has shoulder or arm surgery, the injection would be placed around the nerves of the arm to provide pain control.

Imaging has come quite a long way in recent years as well, and Dr. Walsh has found that a portable imaging device helps him administer the local anesthesia.

“It has allowed us to use ultrasound imaging in the operating room area so we can identify those nerves and inject a local anesthesia around those nerves.”

Taking a New Path

As president of the MAA, Dr. Walsh hopes to lead the organization down new paths as well. The group recently elected a new executive director, David Waldrep, and met to discuss a more strategic five-year plan. As a result, the organization has several immediate initiatives as well as some long-term goals.

“One of the initiatives that we will add this year is to truly identify our physician representatives from each hospital, so that each hospital’s medical staff within the metro area can have a voice in our organization.”

The group will focus on developing and strengthening various committees to help grow membership and awareness of the group.

Membership in MAA helps the organization truly be a representative voice of Atlanta physicians and provides an avenue for grassroots legislative involvement, a starting point for leadership in organized medicine and numerous practice-building opportunities.

Dr. Walsh also hopes to open up more avenues for physicians to participate in community service.

“There’s an altruistic component to many physicians, and the community service committee will provide a means for us to reach out and help the underserved,” Walsh says.

He hopes to provide physicians and care to free clinics such as the Mercy House to not only help those less fortunate who cannot afford healthcare, but also to help physicians become involved in their communities. Such outreach efforts will also provide the public a way to better understand the charitable healthcare contributions that the medical profession makes.

Still, the medical field as a whole faces many challenges in the future.

“One of the biggest challenges facing medicine, whether it’s on a local, state or national level, is having a voice in policy,” Walsh says. “I think a lot of the policy making that’s happening in medicine is at a level of insurance companies and the big corporations. And it’s often times far removed from our bedside experience and focus that we physicians have in terms of what we feel is best for the patient.

The organization has been actively involved in promoting torte reform, and helped pass a reform bill nearly three years ago. The legislation set a $350,000 cap on non-economic damages in medical liability lawsuits. At the time the law was passed, Georgia was listed as one of 20 the American Medical Association declared to be in crisis because of rising medical liability insurance premiums.

Still, constant vigilance is needed to preserve what was accomplished in 2005. It’s no secret that Georgia is facing a physician shortage, due in large part to the state’s liability exposure. Many physicians are considering retiring early, while others are forced to discontinue high-risk procedures or leave the state.

“As malpractice premiums became more expensive, even physicians who finished their training within the state may make decisions to leave the state because of the liability exposure, and that contributes to the shortage of physicians within our state.”

And the costs to medical practices are growing.

“Administrative overhead for our practices imposed upon us by managed care requirements is an ever increasing burden,” notes Dr. Walsh, who adds that it creates a lot of uncompensated time and effort for a medical practice. “We need to create greater administrative efficiencies and use those found dollars to bring better health to healthcare.”

On a national level, Medicare reimbursement is affecting physicians everywhere.

“Medicare reimbursement, from the government perspective, is a budget neutral entity, and healthcare costs in this country continue to increase,” he says. “That puts an incredible stress on the Medicare system.”

The Sustainable Growth Rate (SGR) system requires a reduction in Medicare payment fees to physicians each year.

“Thus far, through advocacy, we’ve been able to postpone those reductions,” he says. “That’s important for patient access because as Medicare rates decrease, physicians have to make difficult decisions from a business standpoint, and that can sometimes affect patients’ access to care.”

For more information on the Medical Association of Atlanta or how you can join the organization and get involved, call 404-881-1020 or contact executive director, David Waldrep at dwaldrep@maa-assn.org.

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GSC Sponsors 7th Annual “Totes 2 Tots” Suitcase Drive for Foster Children

Thursday, November 20th, 2008

 

Georgia Cancer Specialists (GCS) – the largest private medical oncology/hematology practice in the Southeast – is pleased to announce the seventh annual “Totes 2 Tots” suitcase drive for foster children. 25 GCS offices across Georgia – including 21 in Metro Atlanta – will participate in the drive on Friday, January 16, 2009, from 10 a.m. to 2 p.m.

“Totes 2 Tots” delivers new or nearly new back packs and kid-sized suitcases to foster children in Georgia, many of whom must shuffle their belongings from home to home in garbage bags during frequent relocations. The annual volunteer event was first launched by GCS in 2003 and has collected and distributed almost 12,700 bags. The 2008 event amassed nearly 4,500 bags. Originally held on Martin Luther King Day as a way to honor Dr. King’s vision and give back to the community, Totes is now held on the Friday before MLK Day as a kickoff to a weekend of service.

To find a donation location, visit Georgia Cancer’s site.

GCS partners with the Division of Family and Children’s Services (DFCS) to distribute the bags in the counties in which they’re collected. Bobby Cagle, Family Services Director for DFCS, is thrilled to be part of such a wonderful community service project.

“One of the most difficult times that a child may experience is being placed in an environment that is unfamiliar. Unfortunately, they are often placed with very little that belongs to them, carrying these items in a paper or plastic bag,” said Cagle. “Thanks to the Totes 2 Tots program, we’ve distributed nearly 12,700 bags to children in the custody of DFCS. It is truly rewarding to see the expression on a child’s face when receiving their bag and realizing that it belongs to them! DFCS and the children and families we serve are grateful to the many volunteers who participate in this wonderful initiative.”

lenzperdue-with-bags.thumbnail.JPGLast year, Mary Perdue, Georgia’s First Lady, helped collect bags and gave a brief presentation at GCS’s Stemmer office. The First Lady and her husband, Governor Sonny Perdue, are very active in the foster community and have been foster parents themselves.

“I’m pleased with the efforts of Totes 2 Tots in finding ways to meet the needs of abused and neglected children,” said First Lady Perdue. “This endeavor enables us to help Georgia’s foster community, and I encourage all Georgians to take part in making a difference in the life of a child.”

In 2005, WSB-TV recognized the importance of the drive and agreed to support it as a part of its Family 2 Family Project.

For more information, visit www.gacancer.com, or call 1-877-716-CARE (2273).

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North Fulton Regional Celebrates 25 Years

Thursday, November 20th, 2008

North Fulton Regional Hospital (NFRH) celebrated its 25th anniversary on November 6.  Attending the event were local dignataries, including Congressman Tom Price, Roswell Mayor Jere Wood, and Alpharetta Mayor Arthur Letchas.  Congressman Price started his career in orthopaedic medicine at NFRH.

Also in attendance were NFRH Board members including NFRH Chairman of the Board and Chairman of Bank of North Georgia.

Joe Austin, President and CEO of NFRH recounted the history of North Fulton and a video featuring many of the hospital’s 25 year staff members was shared.  nfrh-group-pix.jpgAll 25 year employees and volunteers were presented with a gift and participated in an anniversary ribbon cutting.

Following are some historical facts regarding NFRH:

  • November 6, 1983:  The hospital officially opens its doors as a one-story, 108,734 square foot facility.  It provided 24-hour emergency services, obstetrical services and intensive and coronary care units.  Out patient services included ambulatory surgery, prenatal clinics and laboratory and radiology services.
  • November 6, 2008:  After a major expansion in 2006, the Emergency Department  now occupies 18,000 square feet and space for 28 patient rooms.  September 2007 brought the opening of a new patient tower taking the hospital to 202 beds.  The hospital overall is 310,000 square feet and employs approximately 1,000 people.
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Grady Receives Joint Commission Gold Seal of Approval

Thursday, November 20th, 2008

Grady Health System has received full Joint Commission accreditation for Grady Memorial Hospital, Crestview Health and Rehabilitation Center, and the health system’s behavioral health program.  The gold seal of approval was earned following an unannounced visit from a team of Joint Commission surveyors November 4, 2008.

An accreditation survey in November 2007 resulted in several “Recommendations For Improvement,” and a conditional accreditation status for the health system. Those recommendations were addressed to the complete satisfaction of the commission and full accreditation status was granted.

“The results of The Joint Commission survey are proof positive of the new Grady doing it right, doing it effectively, and doing it in the spirit of community leading to the provision of the best quality care for its patients,” said Michael A. Young, president and CEO of Grady Health System. “Full accreditation from The Joint Commission is validation for us that our on-going efforts to meet and exceed national health care and patient safety goals have been successful,” added Young.

“Grady’s transformation is on track,” says Young, evidenced by the purchase of $20 million worth of cutting edge technology digital imaging equipment.  The first major installation will be a cardiac catheterization laboratory, which will be operational in early January.

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Dr. John Frontera Joins Neurology Physician Group

Thursday, November 20th, 2008

Jonathan Kerrick, MD, and the staff of Neurology Physician Group welcome John Frontera, MD, who joined the practice in September. Dr. Frontera is a board-certified neurologist who specializes in performing and interpreting nerve conduction studies and polysomnograms.

frontera-john.jpgDr. Frontera received his undergraduate degree from State University of New York at Binghamton and his medical degree from Eastern Virginia Medical School. He completed his residency at Walter Reed Army Medical Center. Dr. Frontera went on to treat members and veterans of the U.S. military, as well as their families, while practicing at four other military medical centers. He most recently served as the director of electrophysiology and the sleep lab at Berwick Hospital Center in Pennsylvania.

Dr. Frontera is certified by the American Board of Psychiatry and Neurology. He is also a member of the American Academy of Neurology.

Neurology Physician Group offers treatment for patients with neurological conditions such as migraines, epilepsy, multiple sclerosis, stroke, dementia, Parkinson’s Disease and others.

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Fusion Sleep

Sunday, November 16th, 2008

November/December 2008 novdec2008.jpg

Fusion Sleep offers the first fully integrated sleep medicine program in the Southeast focusing on the diagnosis and long-term treatment of all sleep disorders.

To order a copy of this issue click here.

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