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January 2011


    Update Your Knowledge with MKSAP 15 Q & A

    Which of the following is the most appropriate screening test for this patient?

    A. Abdominal ultrasonography
    B. Colonoscopy
    C. Low-dose CT of the chest
    D. Office spirometry

    Click here for the answer and critique.



    ACP Leaders On The Road:
    Jacob T. Cross, Jr., MD, FACP

    Freetown, Sierra Leone

    WACP Meeting

    Left: Dr. Cross outside of the Sierra Leone Medical school with members of the Nigerian delegation.

    Sierra Leone. Many of you know this country only from the 2006 movie "Blood Diamond". That was my initial impression as well, when I was asked to attend the 34th Annual West African College of Physicians (WACP) Meeting in Freetown, Sierra Leone and represent the American College of Physicians (ACP) as its International Ambassador. I knew the movie was loosely centered on the country’s war in the late 1990s.

    I did some internet research and learned that Sierra Leone has been at relative peace since 2004. Sierra Leone is located in Sub-Saharan Africa with its Western border directly on the Atlantic Ocean. It is situated between Guinea to the North and East and Liberia to the South and is located just above the equator in the Northern Hemisphere. My task was to present a few lectures at the meeting and give a presentation about ACP.

    The first task is getting to Sierra Leone from the United States! There are no direct flights from the U.S. to Sierra Leone, so you either have to take direct flights into other African countries and then transfer on a small African-regional airline or fly into London or Brussels and then take a direct flight into Sierra Leone. I chose the London route, which requires (from my home base of Colorado) about 28 hours of travel time from start to finish each way.

    Once I arrived in Freetown I was met by one of the local physicians, Dr. James Russell (a cardiologist who had trained in South Africa). James successfully navigated us through the busy streets of Sierra Leone to our hotel, Hotel Barmoi, which was located in a beautiful coastal section of Freetown known as Aberdeen. The hotel is directly on the beach and has sweeping views of rocky beach formations and westward into the Atlantic. I quickly made it to my room and collapsed from the previous days journeys.

    One of my main hosts was Dr. Euphemia (Effie) Gooding. The next morning, I was picked up by her driver and escorted to her medical offices. After 45 minutes in the car for the 5 mile journey we arrive at Dr. Gooding’s offices. She had arranged for a medical student to escort me around town and show me the University of Sierra Leone. The centerpiece of town is the famous Cotton Tree, which is believed to be over 200 years old and has many legends surrounding it including being the resting place for the “Black Poor” who arrived in 1787 and also where former African-American slaves who had fought for Britain during the American Revolution were subsequently freed by the British and returned to Freetown in 1792. Today, it is a beautiful tree that sits in the center of the business district. It is indeed majestic and magical in the middle of an urban center and was a proud point for my tour guide to point out.

    Leaving the central business district, we then made the trek up the hillside to the University. We left the hustle and bustle of downtown and made a steep climb above Freetown. From the higher elevation it is absolutely breathtaking, with the Cotton Tree in the center and the Atlantic Ocean to the west. Here the traffic lessens and we entered the forests above the town. Along the trek we passed the U.S. Embassy. It is a beautiful building in the countryside, but as we pulled up it had stern warnings not to take any video or still pictures—much like all government buildings in the area.

    We reached the University and my guide showed me the buildings of the University. They have many different specialty areas that include an engineering school, an agriculture building, an education building, and 2 dorms (one each for men and women). They have a 7 story classroom building that was named after John F. Kennedy and built in the late 60s. Most of the classrooms have the standard wooden desks that I grew up with in Louisiana in the 1960s. Blackboards are prominent. Most of the students do not have laptops and they rely on their Professors and textbooks for much of their educational knowledge. Internet connections are not prominent but they are growing in different areas of the city.

    The 34th Annual West African College of Physicians meeting encompasses all of Sub-Saharan Africa including Nigeria, Liberia, Ghana, the Gambia, Sierra Leone, Senegal, and Cote D’ Ivoire. The organization represents most physicians from pediatricians to internists to psychiatrists and neurologists and the subspecialties of each. Most of the membership are internal medicine or family medicine physicians. Besides being the “educational” arm of their society, they also are the “certification and regulatory” agency. They oversee medical school and residency training programs and also certify physicians via oral and written exams for certification as physicians in their respective fields. Much of the meeting was centered around this aspect with many committee meetings and meetings to certify exam results and candidates for certification.

    I was present for the "educational arm" of the meeting which was officially opened by the President of the Republic of Sierra Leone, His Excellency Ernest Bai Karoma. As is custom, each visiting country and association (like my colleagues in the Royal College of Physicians from the UK, and myself from the ACP) had to give an impromptu "good wishes to the conference speech". My South African colleague from the South African delegation did not know about this custom, so when called upon he "spoke from the heart"; and I, of course, was not pre-warned either, so I joked with the audience that I was speaking from "the adrenal".

    WACP Meeting

    Opening ceremony with the President of Sierra Leone receiving Honorary Fellowship in the WACP.

    The theme of this year’s meeting was "Childhood Survival in the West African Region". I am Med-Peds, which is why I was chosen as the ACP Ambassador for the meeting, because they were having a "pediatric" bent to a generally adult internal medicine audience. Much of the educational reports were case reports with a few randomized controlled trials looking specifically at novel diarrhea therapies and HIV prevalence (Sierra Leone’s prevalence is about 1.6% compared to some areas of Sub-Saharan Africa which are at 6%). Of interest was that malaria was the number one cause of death in infants and children and diarrhea was #2. Both are treatable and preventable diseases in the U.S., but still largely untamed in this part of the world. For adults, cardiovascular disease and stroke were common causes of death, but infectious diseases were still overwhelmingly number one. Access to acute care seemed to be the biggest obstacle for most patients including adults as well as children. Many delayed seeking treatment (problem #1) and then once they went for treatment, the waits were so long (problem #2) that the acute problem either resolved or the patient succumbed. A majority of patients admitted for acute problems to the hospital died within the first 24 hours of admission; if they survived past 24 hours then generally they did well. In the pediatric wards and hospitals it was not uncommon for 4 children to be in each hospital bed.

    In talking to the few intensivists there, the issue is not so much access to medical equipment; the issue is having the knowledgeable nursing and support staff to run the equipment. Having state of the art ventilators is not helpful if you do not have anyone available who is knowledgeable to monitor them at three in the morning—a problem that seemed to recur. The equipment may be accessible but the ability to monitor and use the equipment for extended periods of time is not. To give them a global perspective, I spoke about our recent experiences with "African" diseases in the United States and their spread and epidemiology with West Nile Virus and the more recent Monkeypox outbreak in Wisconsin in 2003, being two sentinal events showing how zoonotic diseases can spread quickly in a confined area (monkeypox) and across a continent (West Nile Virus) in a relatively short period of time. I then covered some diseases that are common in the United States (e.g., Lyme disease) that are now being seen in case reports in Africa.

    My hosts, Dr. Gooding, Dr. A. Bundu Kamara, Dr. F.E.A. Lesi, and Dr. Patrick Coker (President of the WACP), were extremely gracious and I was able to experience much of the culture and beauty of the country as well as see the huge amount of work that lay before them working in such a high poverty area. The young physicians coming out of their medical schools are very bright and energetic. Most choose to find residencies in the United States or United Kingdom and unfortunately many do not return to their home countries. They talk of the "brain drain" of their brightest and I can see how these individuals are torn.



    International Meetings Update

    ACP Brazil Chapter Meeting
    October 11-13, 2010

    The Annual Meeting of the ACP Brazil Chapter was held in conjunction with the Congresso Internacional de Medicina de Urgência e Emergência da Abramurgem in Sao Paulo, Brazil from October 11-13, 2010. More than 700 participants attended the meeting. Prof. John Hansen-Flaschen, MD, FACP, was invited to speak at the meeting by Auro del Giglio, MD, FACP, Governor, ACP Brazil Chapter, under the auspices of the ACP International Ambassadors Program.

    Dr. Hansen-Flaschen spoke through a translator to an audience of about 100 physicians, residents, and medical students on the topics "Making Decisions to Limit Life Support in Emergency Departments and ICUs" and "Accute Palliative Care of Patients Who are Dying in the Hospital". Dr. Hansen-Flaschen also had the opportunity to tour a new academic research center and the main teaching hospital of the University of Sao Paulo.

    An ACP exhibit booth was on site during the meeting.

    29th Belize Medical and Dental Association International Congress
    October 21-23, 2010

    The 29th Belize Medical and Dental Association International Congress was held from October 21-23, 2010 in Belize City, Belize. The theme of the meeting was "Reaching New Heights in Emergency Medicine". The meeting was attended by approximately 200-250 physicians from all over the country, and faculty were international and local.

    Janice L. Zimmerman, MD, FACP, was invited as the ACP International Ambassador to this meeting by Jorge Hidalgo, MD, FACP, President of the Belize Medical and Dental Association. Dr. Zimmerman spoke on "Topic Management of Acute Drug Intoxication" and "Critical Care During Epidemics".

    The Canadian Society of Internal Medicine/ACP Rocky Mountain Meeting
    October 27-29, 2010

    The Annual Meeting of the Canadian Society of Internal Medicine (CSIM) was held in conjunction with the ACP Rocky Mountain Meeting from October 27-29, 2010, in Vancouver, Canada. A diverse physician audience from across Canada attended the meeting, ranging from academic leaders, practicing physicians, and resident trainees.

    Steven R. McGee, MD, FACP, was selected to speak as the ACP International Ambassador at this meeting by S. F. Paul Man, MD, FACP, Governor, ACP British Columbia Chapter and Finlay McAlister, MD, FACP, President, CSIM. Dr. McGee presented the Edwards Lecture on evidence-based physicial diagnosis. Dr. McGee had the opportunity to meet with Dr. McAlister and Dr. Hector Baillie, editor of the Canadian Journal of General Internal Medicine.

    Peruvian Society of Internal Medicine 16th Annual Congress
    October 28-31, 2010

    The 16th Annual Congress of the Peruvian Society of Internal Medicine was held in conjunction with the 32nd International Course of internal Medicine from October 28-31, 2010 in Lima, Peru. The meeting was sponsored by the Peruvian Ministry of Health, Peruvian Medical Association, and San Marcos National University.

    Cardiologist Hector Ugalde Prieto, MD, FACP, of Santiago, Chile was invited to speak at the meeting as the ACP International Ambassador by Rosa Cotrina Pereyra, MD, FACP, President, Peruvian Society of Internal Medicine. Dr. Ugalde spoke on several different topics, including "Diagnosis and Management of Acute Myocardial Infarction" and "Diagnosis and Management of Ischemic Heart Disease".

    First Annual AMM-AMS-HKAM Tripartite Congress
    November 12-14, 2010

    The First Annual Tripartite Congress of the Academies of Medicine of Hong Kong (HKAM), Malaysia (AMM), and Singapore (AMS) was held from November 12-14, 2010 in Hong Kong. Approximately 200 attendees, mainly from Hong Kong, and consisting of surgeons, obstetricians, and general and subspecialty internists, attended the meeting. The theme of the meeting was "Benefits and Risks of Recent Medical Advances".

    Virginia L. Hood, MBBS, MPH, FACP, President-elect, ACP, was invited to attend the meeting as a special guest by Prof. Raymond Liang, MBBS, FACP (Hon.), President, Hong Kong Academy of Medicine. Dr. Hood had the opportunity to meet with several leaders from the Academies including Dr. Tan Kok Chai of the AMS, Prof. Victor Ke Lim of the AMM and Prof. Liang of the HKAM.

    One particularly interesting presentation at the meeting took place at a luncheon forum about treatment of tobacco dependence and smoking as a public health issue. A leader or representative of every medical organization in Hong Kong (more than 200 brought their organization's seal, placed it on the stage and then pledged their group's commitment to making Hong Kong a tobacco free zone.


    From left: Dr. Hood with Dr. Dewhurst, President, RCP Edinburgh, and Dr. Chin Hin Chew, MD MACP, Past Master, Academy of Medicine of Singapore.


    Group photo of leaders and delegates during the congress.

    24th Annual Meeting of the Taiwan Society of Internal Medicine
    December 4-5, 2010

    The 24th Annual Meeting of the Taiwan Society of Internal Medicine was held from December 4-5, 2010 in Taipei, Taiwan. J. Fred Ralston, Jr., MD, FACP, President, ACP, was invited to participte in the meeting as the ACP International Ambassador by Prof. Ming-Fong Chen, PhD, FACP, President, Taiwan Society of Internal Medicine. Dr. Ralston spoke on "Health Reform in the United States: The Historic 2010 Law - How it Changes the US Health Care System and What Remains to be Done".



    Future World Wide Internal Medicine Meetings

    The current list of Future World Wide Internal Medicine Meetings is available here. Upcoming meetings will be taking place in Canada, Guatemala, and Panama.



    New International Fellows

    ACP is pleased to announce the following newly elected International Fellows, who were recommended by the Credentials Committee and approved for election by the Board of Regents as of November 1, 2010. They are listed by current location and may have been credentialed through a different Chapter.


    • Pablo Gonzalez Blasco, MD, PhD, FACP - Sao Paulo

    • Rafael Kaliks Guendelmann, MD, FACP - Sao Paulo


    • Narmin Kassam, MD, FACP - Alberta
    • Neil H. McAlister, MD, FACP - Toronto

    Central America

    • Daniel R. Pichel, MD, FACP - Panama
    • Sergio Solis, MD, FACP - Panama
    • Jose W. Valverde, MD, FACP - Panama


    • Natalia Londono Palacio, MD, FACP - Bogota

    • Jorge H. Lopez, MD, FACP - Bogota
    • Gustavo Adolfo Parra Zuluaga, MD, FACP - Bucaramanga
    • Juan M. Senior, MD, FACP - Medellin


    • Binda Bihari Thakur, MBBS, MD, FACP - Bihar
    • P. P. Varma, MBBS, MD, FACP - New Delhi


    • Khalid A. Jasim, MBChB, FACP - Baghdad


    • S. M. Amza Ali, MBBS, DM, FACP - Kingston


    • Konosuke Nakaji, MD, FACP - Wakayama

    • Shuichi Tsuruoka, MD, FACP - Shimotsuke Tochigi


    • Abdel Raouf AAM Al Shayeb, BM BCh, FACP - Hawalli
    • Naser H.A. Behbehani, MBBch, FACP - Safat


    • Carlos Gonzalez-Parra, MD, FACP - Puebla


    • Mohamed A. Yassin, MBBS, FACP - Qatar

    Saudi Arabia

    • Mirvat A. Alasnag, MBBCh, FACP - Jeddah
    • Zeinelabdein A. Mahgoub, MBBS, FACP - Riyadh


    • Thiravat Hemachudha, MD, FACP - Bangkok



    New International Members

    Welcome New Members!

    Welcome and congratulations to the following new ACP Members who were elected from September 1 - November 30, 2010.


    • Luis J. Murua, MD - Buenos Aires


    • Daniel J Godinez, MD - Ladyville


    • Leonardo Bath Bacelar da Silva, MD - Campos RJ
    • Vinicius Rebola Danielli, MD - Maringa PR
    • Uri Prync Flato, MD - Sao Paulo
    • Marcelo Rocha Nasser Hissa, MD - Recife PE
    • Geovani Moreno Santos, Jr., MD - Vitoria Conquista
    • Marcia Siqueira Sayeg, MD - Sao Paulo
    • Lucio Martina Vilela, Sr. MD - Ituiutaba MG


    • Bunse Leang, MD - Phnom Penh


    • Abdulla Saeed Al Ali, MBBS - Halifax
    • Khan Ali, MD - Calgary
    • Ranka Bulajic, MD - Coxheath
    • Genevieve Clermont, MD - Lac des iles
    • Dave R Cleveland, MD - Penticton
    • Jag Dhar, MD - Sarnia
    • Vera Dounaevskaia, MD, FRCPC - Toronto
    • Michael J Fisher, MD FRCPC - Calgary
    • Michael Karolak, MD FRCPC - Edmonton
    • Nadia A Khan, MD MSc FRCPC - Vancouver
    • Martial Koenig, MD - Montreal
    • Charles J Mahoney, MD - Campbell River
    • Diem-Quyen Nguyen, MD - Brossard
    • Michael Ramsden, MD - New Westminster
    • Lawrence P Schnurr, MD - Morrisburg
    • Rosemary Serwadda, MD - Swift Current
    • Callisto Tarukandirwa, MD - Red Deer
    • Julia C Trahey, MD - St John's
    • Paul John Winwood, MD - Prince George


    • 191 new Members elected. Click here for the list of names.


    • Savvas K. Savva, MD, PhD - Nicosia

    Dominican Republic

    • David De Luna, MD - Santiago


    • Takayuki Fujita, MD - Yokohama, Kanagawa
    • Tsutomu Inoue, MD - Saitama
    • Mari Ishikawa, MD - Hyuga, Miyazaki
    • Yuka Kitano, MD - Sendai, Miyagi
    • Hidetaka Kitazono, MD - Kamogawa, Chiba
    • Tetsuya Makiishi, MD - Otsu, Shiga
    • Daisuke Ogawa, MD - Nagasaki
    • Shinichiro Tanaka, MD - Inuyama, Aichi
    • Shunsei Yo, MD PhD - Yokohama, Kanagawa
    • Yukio Yokoyama, MD - Hiroshima
    • Daisuke Yoshimura, MD - Fukuoka


    • Ricardo Arturo De Leon, MD - Monterrey
    • Gabriel Frontana Vazquez, MD - Corregidora


    • Rustam Khan, MBBS - Karachi


    • Julio C Sandoval, MD - Panama City


    • Rolando Vasquez Alva, MD - Lima

    Saudi Arabia

    • Yahya M Al Hossni, MBChB - Riyadh
    • Ahmed Al Masry, MBBCh - Riyadh
    • Mosaad O Al Megren, MBBS - Riyadh
    • Ahmad M Al Qassim, MD - Riyadh
    • Iehab Alabed, MD - Riyadh
    • Awad A Alomari, MBBS - Riyadh
    • Azzam Daifullah T Alotaibi, MBBS - Riyadh
    • Amjad S Alseraya, MBBS - Riyadh
    • Mohammed A Alsheef, MBBS - Riyadh
    • Khaled Dawood Bawazir, MD - Riyadh
    • Taseer A Bhatt, MBBS - Riyadh
    • Musa A Garbati, MBBS - Riyadh
    • Aiman A Hamad, MD - Riyadh
    • Ashfaq M Hassan, MBBS - Riyadh
    • Ahmed Khalifa Ismail Hammad, MD - Riyadh
    • Abdur R Khan, MBBS - Riyadh
    • Arshad M Mian, MD - Riyadh
    • Shaeeb Mustafa, MBBS - Riyadh
    • Shahpar Nahrir, MBBS - Riyadh
    • Syed Rizvi, MBBS - Riyadh
    • Ayman G Salman, MD - Riyadh
    • Shoaib R Siddiqui, MD - Riyadh
    • Nada O Taha, MBBS - Riyadh
    • Hamid U Wani, MBBS - Riyadh
    • Badi Wehbi Almoubaid, MD - Riyadh
    • Syed Suhail Yasin, MBBS - Riyadh
    • Bouran M Zaghtiti, MD - Riyadh


    • Francis Albert T. Lo, MD - Singapore (elected in March 2010)

    Sri Lanka

    • Anoja C Rajapakse, MD - Colombo


    • Abdel Rahman A Elmagzoub, MBBS - Khartoum North


    • Yves Trisconi, MD - Lausanne VD

    Syrian Arab Republic

    • Ali Hamidouch, MD - Damascus

    Trinidad and Tobago

    • Valentine C Ogoke, MBChB - Bonaccord Tobago

    United Arab Emirates

    • Salahaldin H Arif, MBChB - Sharjah



    Highlights from ACP Internist and
    ACP Hospitalist

    ACP Internist (formerly ACP Observer) October/November 2010

    • Monitoring glucose minute by minute
      Continuous glucose monitoring presents challenges not only to patients, but to internists learning how best to teach their patients how to use it. But without enough endocrinologists to care for the 1 million patients with type 1 diabetes, internists have to pick up the slack.
    • House calls becoming a viable practice model
      Think of it as the patient-centered medical home’s ultimate evolution—care inside the patient’s own home. More doctors are making house calls, either to patients who don’t travel easily, or to improve the quality of care they could deliver in an office.
    • Expressive writing could help erase irritable bowel syndrome
      Expressive writing, used for other illnesses with a known psychological component, is now being studied to control the symptoms of irritable bowel syndrome.
    • Know the patient to achieve statin benefits
      That statins work is without question. And with costs falling due to many drugs in the class going generic, physicians are now refining when to prescribe the ubiquitous drug class based on the degree of risk.

    ACP Hospitalist November 2010



      College Corner

      ACP Announces New Chapter in Saudi Arabia

      ACP is pleased to announce the creation of a new Chapter in Saudi Arabia. In November of 2010, enough members were attained within the country to grant official chapter status. All existing Saudi Arabian members are now classed as members of the Saudi Arabia Chapter. Khalid A. Qushmaq, MD, FACP, will assume the role of Interim Governor as of December 1, 2010. His term will last for approximately six months. In the interval, ACP will start the election process and plan to identify an elected Governor by May 2011.

      Internal Medicine 2011 Promotion for New ACP Members

      New ACP Members (elected after April 1, 2010) will receive 50% off the registration fee for Internal Medicine 2011. The fee is only $284 if registered by January 31, 2011 or $319 if registered after. To receive the discount, call Customer Service at +(215) 351-2600 or fax +(215) 351-2799 to register using priority code IM1145. This discount is not available online.



      Internal Medicine 2011, San Diego, California, April 7-9, 2011, Discounted Registration Rates for International Delegations

      Receive a registration discount for groups of 10 or more. The guidelines require that one person organize the group, provide the registration forms, and submit one check for the entire group.

      Groups of 10 - 19:

      Scientific Program - $495 pp

      Pre-Session 1-day Course* - $199 pp

      Pre-Session 2-day Course* - $399 pp

      Groups of 20 or more:

      Scientific Program - $470 pp

      Pre-Session 1-day Course* - $179 pp

      Pre-Session 2-day Course* - $369 pp

      pp = per person fee.
      * Does not apply to Pre-course(s) that have a higher fee due to close faculty/student interaction or special equipment.

      Please submit completed registrations by January 28, 2011.
      Submit to:
      Pamela Carey
      Senior Associate, Customer Service
      190 N. Independence Mall West
      Philadelphia, PA 19106

      For further information contact Pamela Carey at +1-215-351-2792 or pcarey@acponline.org.



      MKSAP 15 Answer & Critique

      Answer: A, Abdominal ultrasonography.

      Educational Objective: Screen for abdominal aortic aneurysm.

      Critique: An abdominal ultrasonography is the most appropriate test for this patient. In a large randomized trial, abdominal duplex ultrasound screening in men aged 65 to 75 years who had ever smoked reduced mortality from abdominal aortic aneurysm (AAA) rupture. AAA repair prevents rupture, and the benefits of repair appear to outweigh its risks for large AAAs (>5.5 cm) in good-operative-risk patients. The U.S. Preventive Services Task Force (USPSTF) recommends a one-time screening by ultrasonography for AAA in men aged 65 to 75 years who have ever smoked, makes no recommendation for men who have never smoked, and recommends against screening in women.

      The USPSTF recommends using one of the following protocols to screen for colorectal cancer in average-risk persons: annual high-sensitivity fecal occult blood testing, sigmoidoscopy every 5 years combined with high-sensitivity fecal occult blood testing every 3 years, and screening colonoscopy at intervals of 10 years. This patient’s last colonoscopy was 8 years ago; therefore, a colonoscopy at this time is not indicated.

      Although low-dose CT is more sensitive than chest radiograph for the detection of lung cancer, there is insufficient evidence to recommend for or against this test to screen for lung cancer. In this former smoker, the fact that his risk of lung cancer is significantly less than that of a current smoker would further diminish screening test performance.

      The USPSTF recommends against using spirometry to screen for chronic obstructive pulmonary disease. This recommendation is based on the findings that harms (time and effort required by patients and the health care system, false-positive results, and adverse effects of subsequent unnecessary therapy) exceed benefits (improvement in respiratory-related health status).

      Key Point: Abdominal duplex ultrasound screening in men aged 65 to 75 years who have ever smoked reduces mortality related to abdominal aortic aneurysm rupture.


      Kim LG, P Scott RA, Ashton HA, Thompson SG; Multicentre Aneurysm Screening Study Group. A sustained mortality benefit from screening for abdominal aortic aneurysm [erratum in Ann Intern Med. 2007;147(3):216]. Ann Intern Med. 2007;146(10):699-706. [PMID:17502630] - See PubMed


Internal Medicine Meeting 2015 Digital Presentations

Internal Medicine Meeting 2015 Digital Presentations

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