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Undesirable effects that resulted from Ke0pra intravenous use are similar to those associated with Kfppra oral use. The most frequently reported adverse reactions were dizziness, somnolence, headache and postural dizziness. Since there was limited exposure for Kpepra intravenous use and since oral and intravenous formulations are bioequivalent, the safety information of Kwppra intravenous will rely on Kepppra oral use. In monotherapy 49.8 % of the subjects experienced at least one drug related undesirable effect. The most frequently reported undesirable effects were fatigue and somnolence. Pooled safety data from clinical studies conducted with Keppra oral formulations in adult patients with partial onset seizures showed that 46.4 % of the patients in the Keppra group and 42.2 % of the patients in the placebo group experienced undesirable effects. Serious undesirable effects were experienced in 2.4% of the patients in the Keppra and 2.0% of the patients in the placebo groups. The most commonly reported undesirable effects were somnolence, asthenia and dizziness. In the pooled safety analysis, there was no clear dose-response relationship but incidence and severity of the central nervous system related undesirable effects decreased over time. A study conducted in paediatric patients 4 to 16 years ; with partial onset seizures showed that 55.4 % of the patients in the Keppra group and 40.2 % of the patients in the placebo group experienced undesirable effects. Serious undesirable effects were experienced in 0.0 % of the patients in the Keppra group and 1.0 % of the patients in the placebo group. The most commonly reported undesirable effects were somnolence, hostility, nervousness, emotional lability, agitation, anorexia, asthenia and headache in the paediatric population. Safety results in paediatric patients were consistent with the safety profile of levetiracetam in adults except for behavioural and psychiatric adverse events which were more common in children than in adults 38.6% versus 18.6% ; . However, the relative risk was similar in children as compared to adults. A study conducted in adults and adolescents with myoclonic seizures 12 to 65 years ; showed that 33.3% of the patients in the Keppra group and 30.0% of the patients in the placebo group experienced undesirable effects that were judged to be related to treatment. The most commonly reported undesirable effects were headache and somnolence. The incidence of undesirable effects in patients with myoclonic seizures was lower than that in adult patients with partial onset seizures 33.3% versus 46.4% ; . A study conducted in adults and children 4 to 65 years ; with idiopathic generalised epilepsy with primary generalised tonic-clonic seizures showed that 39.2 % of the patients in the Keppra group and 29.8 % of the patients in the placebo group experienced undesirable effects that were judged to be related to treatment. The most commonly reported undesirable effect was fatigue. Undesirable effects reported in clinical studies adults and children ; or from post-marketing experience are listed in the following table per System Organ Class and per frequency. For clinical trials, the frequency is defined as follows: very common 1 10 common 1 100, 1 uncommon: 1 000, 1 100 rare 1 10, 000, 1 000 very rare 1 10, 000 ; , including isolated reports. Data from post-marketing experience are insufficient to support an estimate of their incidence in the population to be treated. General disorders and administration site conditions Very common: asthenia fatigue. Nervous system disorders Very common: somnolence. Common: amnesia, ataxia, convulsion, dizziness, headache, hyperkinesia, tremor, balance disorder, disturbance in attention, memory impairment Post-marketing experience: paraesthesia.
One Irish Setter named Darrowby has given hope to many who cannot afford one type of epilepsy medication. One Dalmation named Emma has given life to Darrowby enjoyed a a web site and a support group for "powerful life force." owners of pets affected by epilepsy. And one Maltese named Stormy has given additional insights into a neurological disease that affects small breed dogs. Neurological disorders annually affect a significant number of dogs in the U.S.; diseases such as epilepsy, encephalitis, and spinal disorders can be long-lasting and devastating, not only physically but emotionally and economically. Mel Krauss, owner of an Irish Setter named Darrowby, knows the challenges of having a dog with neurological disease. "Darrowby, " says Krauss, "was an incredible dog in every way." The Irish Setter began suffering from seizures at age six. Initially managed by standard anticonvulsants, the seizures increased in frequency and intensity; at age nine, Darrowby began receiving Keppra levetiracetam ; , one of the newer epileptic drugs used to treat humans. "Keppra did such a tremendous job controlling his seizures that I believe we added at least two more years to his life, " says Krauss. "Veterinarians who worked with Darrowby said that they had never seen a dog go through so much yet have such a powerful life force. Darrowby had such a spirit that even with his spinal problems, he was able to run when he wanted to." Due to the increasing spinal deterioration, Darrowby was euthanized on March 1, 2007. In honor of his pet, Krauss established the "Darrowby Fund" to help other owners pay for Keppra, which can cost hundreds of dollars a month. The owner must meet certain criteria, part of which includes being a Veterinary Teaching Hospital client under the direction of neurologist Dr. Karen Munana.
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CUTTING EDGE apoptosis to occur 6, 26 ; . As shown in Fig. 3C, there was a relatively low frequency of apoptotic cells associated with the first three rounds of division irrespective of the time after SEB injection. In contrast, there was a striking increase in the number of apoptotic cells in CFSE peaks corresponding to CD4 V 8 cells that had divided four or five times. Importantly, the association of apoptosis with division peaks 4 and 5 was observed independently of the time after SEB injection, demonstrating that the number of cell divisions rather than kinetic parameters ; was responsible for this phenomenon. It should be noted that the actual number of cell divisions correlating with the induction of apoptosis was constant within a given experiment but varied slightly usually by no more than one cycle ; from one experiment to another. In conclusion, our data suggest that upon activation by superantigens, T cells are programmed to undergo a fixed number of cell divisions before undergoing apoptosis. The molecular mechanism underlying such a delayed death program in activated T cells remains to be established. One possibility would be that some longlived inhibitor of apoptosis is induced early after activation and gradually diluted out during subsequent cell divisions, leading eventually to apoptosis. Alternatively, a critical death effector molecule may be induced or up-regulated ; specifically after a fixed number of cell divisions. Finally, it is possible that apoptosis in this model is not causally linked to cell division but rather to some other parameter such as activation state ; that correlates with division status. Whatever the mechanism, it is tempting to speculate that apoptosis is regulated in this way so as to allow T cells to expand and perform their effector functions, while at the same time ensuring homeostasis.
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Levetiracetam is a white to off-white crystalline powder with a faint odor and a bitter taste. It is very soluble in water 104.0 g 100 ml ; . It is freely soluble in chloroform 65.3 g 100 ml ; and in methanol 53.6 g 100 ml ; , soluble in ethanol 16.5 g 100 ml ; , sparingly soluble in acetonitrile 5.7 g 100 ml ; and practically insoluble in n-hexane. Solubility limits are expressed as g 100 ml solvent. ; KEPPRA tablets contain the labeled amount of levetiracetam. Inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, polyethylene glycol 3350, polyethylene glycol 6000, polyvinyl alcohol, talc, titanium dioxide, and additional agents listed below: 250 mg tablets: FD&C Blue #2 indigo carmine aluminum lake 500 mg tablets: iron oxide yellow 750 mg tablets: FD&C yellow #6 sunset yellow FCF aluminum lake, iron oxide red KEPPRA oral solution contains 100 mg of levetiracetam per ml. Inactive ingredients: ammonium glycyrrhizinate, citric acid monohydrate, glycerin, maltitol solution, methylparaben, potassium acesulfame, propylparaben, purified water, sodium citrate dihydrate and natural and artificial flavor. CLINICAL PHARMACOLOGY Mechanism Of Action The precise mechanism s ; by which levetiracetam exerts its antiepileptic effect is unknown. The antiepileptic activity of levetiracetam was assessed in a number of animal models of epileptic Page 1 of 33.
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Potential pharmacokinetic interactions were assessed in clinical pharmacokinetic studies phenytoin, warfarin, digoxin, oral contraceptive ; and through pharmacokinetic screening in the placebo-controlled clinical studies in epilepsy patients. Drug-Drug Interactions Between Keppra And Other Antiepileptic Drugs AEDs ; Potential drug interactions between Keppra and other AEDs phenytoin, carbamazepine, valproic acid, phenobarbital, lamotrigine, gabapentin and primidone ; were assessed by evaluating the serum concentrations of levetiracetam and these AEDs during placebo-controlled clinical studies. These data indicate that levetiracetam does not influence the plasma concentration of other AEDs and that these AEDs do not influence the pharmacokinetics of levetiracetam. Other Drug Interactions Oral Contraceptives Keppra 500 mg twice daily ; did not influence the pharmacokinetics of an oral contraceptive containing 0.03 mg ethinyl estradiol and 0.15 mg levonorgestrel, or of the luteinizing hormone and progesterone levels, indicating that impairment of contraceptive efficacy is unlikely. Coadministration of this oral contraceptive did not influence the pharmacokinetics of levetiracetam. Digoxin Keppra 1000 mg twice daily ; did not influence the pharmacokinetics and pharmacodynamics ECG ; of digoxin given as a 0.25 mg dose every day. Coadministration of digoxin did not influence the pharmacokinetics of levetiracetam. Warfarin Keppra 1000 mg twice daily ; did not influence the pharmacokinetics of R and S warfarin. Prothrombin time was not affected by levetiracetam. Coadministration of warfarin did not affect the pharmacokinetics of levetiracetam. Probenecid Probenecid, a renal tubular secretion blocking agent, administered at a dose of 500 mg four times a day, did not change the pharmacokinetics of levetiracetam 1000 mg twice daily. Cssmax of the metabolite, ucb L057, was approximately doubled in the presence of probenecid while the fraction of drug excreted unchanged in the urine remained the same. Renal clearance of ucb L057 in the presence of probenecid decreased 60%, probably related to competitive inhibition of tubular secretion of ucb L057. The effect of Keppra on probenecid was not studied. Carcinogenesis, Mutagenesis, Impairment Of Fertility Carcinogenesis Rats were dosed with levetiracetam in the diet for 104 weeks at doses of 50, 300 and 1800 mg kg day. The highest dose corresponds to 6 times the maximum recommended daily human dose MRHD ; of 3000 mg on a mg m2 basis and it also provided systemic exposure AUC ; approximately 6 times that achieved in humans receiving the MRHD. There was no evidence of carcinogenicity. A study was conducted in which mice received levetiracetam in the diet for 80 Page 11 of 18 and elavil.
Hycamtin is a second line treatment for ovarian, cervical and small cell lung cancer. Bexxar is a treatment for patients with CD20 follicular, non-Hodgkin's lymphoma with and without transformation whose disease is refractory to rituximab and who have relapsed following chemotherapy. Arranon nelarabine ; a treatment for patients with T-cell acute lymphoblastic leukaemia and T-cell lymphoblastic lymphoma, received US approval in 2005 and was submitted for European approval in 2006.
Fig. 8. Putative mechanisms of the eosinophil-dominated inflammatory reaction. For details see text. B-lym: B-lymphocytes; EPO: eosinophil peroxidase; GM-CSF: granulocyte-macrophage colony-stimulating factor; IFN-: interferon-; IgE: immunoglobulin E; IL: interleukin; MBP: major basic protein; PAF: platelet-activating factor; TNF: tumour necrosis factor; TGF: tumour-growth factor; Tlym: T-lymphocytes; PDGF: platelet-derived growth factor and endep.
Periods, were randomized to receive either KEPPRA or placebo. The enrolled population included 198 patients KEPPRA N 101, placebo N 97 ; with refractory partial onset seizures, whether or not secondarily generalized. The study consisted of an 8-week baseline period and 4week titration period followed by a 10-week evaluation period. Dosing was initiated at a dose of 20 mg kg day in two divided doses. During the treatment period, KEPPRA doses were adjusted in 20 mg kg day increments, at 2-week intervals to the target dose of 60 mg kg day. The primary measure of effectiveness was a between group comparison of the percent reduction in weekly partial seizure frequency relative to placebo over the entire 14-week randomized treatment period titration + evaluation period ; . Secondary outcome variables included the responder rate incidence of patients with 50% reduction from baseline in partial onset seizure frequency per week ; . Table 4 displays the results of this study. Table 4: Reduction In Mean Over Placebo In Weekly Frequency Of Partial Onset Seizures Placebo N 97 ; KEPPRA N 101 ; 26.8.
Ottariano, Steven G. 1999. Medicinal Herbal Therapy: A Pharmacist's Viewpoint. Nicolin Fields Publishing. Portsmouth, New Hampshire. Simon, James E., Alen F. Chadwick, and Lyle E. Craker. 1984. Herbs: An Indexed Bibliography, 1971-1980: The Scientific Literature on Selected Herbs, and Aromatic and Medicinal Plants of the Temperate Zone. Archon Books. Hamden, Connecticut. Thomas, Margaret G. and David R. Schumann. 1993. Income Opportunities in Special Forest Products: Self-Help Suggestions for Rural Entrepreneurs. Agriculture Information Bulletin AIB-666. U.S. Department of Agriculture. Washington, D.C. Weiss, Gaea and Shandor Weiss. 1985. Growing and Using Healing Herbs. Rodale Press. Emmaus, Pennsylvania and citalopram.
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Dear Healthcare Professional: On January 31, 2008, the FDA issued an Alert to healthcare providers regarding antiepileptic drugs. The FDA reported an increased risk of suicidal thoughts and behaviors suicidality ; in patients who take antiepileptic drugs generally.1 Please refer to the following FDA link for further information about this for healthcare providers and patients: : fda.gov cder drug InfoSheets HCP antiepilepticsHCP Keppra levetiracetam ; is a broad-spectrum antiepileptic drug manufactured and sold by UCB. Keppra has been used in clinical practice to treat over 1 million patients with epilepsy since its FDA approval in 1999. The safety of patients has always been of primary importance for UCB, Inc. This is why we wanted to be certain that this important information about FDA's Alert was brought to the attention of prescribers of Keppra and the other antiepileptic drugs. Patients who are currently taking Keppra should be informed not to make any changes in their medications without first consulting their healthcare provider. They should also be closely monitored for notable changes in behavior that could be indicative of suicidal thoughts or behavior. Patients, their families and caregivers should also be informed to immediately report any thoughts of or behaviors relating to suicide to their healthcare provider. The FDA Press Release states that the agency will be working with manufacturers of antiepileptic drugs to include this new information in the future labeling for these products. Further, the agency has reported it anticipates that labeling changes will be applied broadly to the entire class of drugs and that the FDA plans to review the data at an upcoming advisory committee meeting. The labeling for Keppra has long included reference to suicide and UCB will promptly incorporate any class labeling changes recommended by the FDA. It is important to highlight the FDA's recommendations to healthcare professionals who prescribe antiepileptic drugs, as set forth in the Alert of 01 31 2008 Information for Healthcare Professional Suicidality and Antiepileptic Drugs1. Specifically the FDA recommended the following. Healthcare professionals who prescribe antiepileptic drugs should: Balance the risk for suicidality with the clinical need for the drug Be aware of the possibility of the emergence or worsening of depression, suicidality, or any unusual changes in behavior; Inform patients, their families, and caregivers of the potential for an increase in the risk of suicidality so they are aware and able to notify their healthcare provider of any unusual behavioral changes and haldol.
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There was no significant association between the FES and age, body mass index, number of vertebral fratures and a history of 2 or more falls in the previous year. Conclusions The FES, which is a practical and easy to administer tool assessing fear of falling in older people, is significantly associated with instruments measuring activities of daily living, mood and quality of life. Further work is required to clarify whether fear of falling causes or simply reflects functional decline and to define its role in clinical practice.
Patients were administered five times the prescribed dose. Labelling on the vials is being changed to make it more obvious that each vial of Keppra concentrate for infusion contains 500mg of levetiracetam. UCB Pharma is advising pharmacists to keep this in mind when dispensing prescriptions for Keppra and to pass on this information to relevant staff. Pharmacists who have observed cases of misinterpretation of the labelling attached to the vials should report any adverse events to UCB Pharma on 01753 534655. Further information is also available on this number and fluoxetine.
There has been much talk in the media recently about the great savings to be made by the Department of Health and Children DOHC ; if it would use generic drugs instead of branded medicines. The Health Supplement of The Irish Times recently had a front page headline which read "Generic drugs could save State `millions'". This trend seems to have started with the famous infamous? ; Brennan Report into the Health services which put a lot of store by the savings which could be made from generic substitution. What does all of this mean to the average man, woman or child in the street with epilepsy? This article will attempt to find out. Firstly, it is important to understand what a generic drug is. Most drugs or medications are developed by pharmacological companies usually known as Pharmas or drug companies ; who spend huge amounts of money on laboratory testing and clinical trials before bringing the drug to market. When they are given a licence by the regulatory authorities to sell the drug, they usually get a fixed number of years during which only they can market the drug. They will then sell that drug on the market using their brand name. A recent example of an AED developed in this way would be the AED branded as Keppra which has been developed and marketed by UCB Pharma. All of these drugs also have a name under which they are developed in the lab and this is known as the generic name. The generic name for Keppra is Levetiracetam. When the licence runs out, any other Pharma can apply to produce that generic drug under its own brand name. Obviously, the companies who do this have spent nothing on research and development and can then sell their drugs much more cheaply. What is being proposed for the DOHC is that all branded drugs prescribed under its General Medical Services and Long Term Illness Schemes be changed to generics by means of financial incentives to General Practitioners. Unfortunately, for people with epilepsy it is not that simple because research has found that AEDs cannot be changed in this manner without putting the person receiving them at great risk. The reason for this is that for AEDs, licensing authorities allow a plus or minus 20% difference in bioavailability between a generic and an original product. While this is of little consequence for most products, it may have serious consequences in epilepsy. Small changes in bioavailability can result in breakthrough seizures with serious implications for the quality of life for people with epilepsy. Breakthrough seizures, increases in seizures, or worsening of side-effects are unacceptable to anybody with epilepsy. Even one single seizure can have a major impact on an individual's life. It means the automatic loss of a driving licence for a year, which in turn can lead to the loss of a job and can cause further problems if the individual is the family's only driver or lives in a rural area. Seizures obviously bring with them the risk of injury from jerking or falling. Some people experience a loss of confidence, particularly if the seizure takes place at work or in a public place. Ultimately, there is the risk of epilepsy-related death about 65-70 people die every year in Ireland of epilepsy related causes. Research in the UK has shown that at least 40% of these deaths are potentially avoidable if the best treatment had been available to the persons. Side-effects from AEDs are a major issue for many people with epilepsy, and can affect employment, education, and social life. Some claim that they would rather have occasional seizures than live with daily side-effects, and the right balance between seizure control and side-effects can be difficult to achieve. Side-effects include cognitive impairment, weight gain or loss, loss of hair or growth of body hair, bone damage, psychiatric disorders, potentially life-threatening rashes, etc. Of course, people with epilepsy can be prescribed generic AEDs right from the start of their treatment and this is not a problem and is something Brainwave supports provided the same generic is delivered with every prescription for the person. In other countries, it is been known for Pharmacists to mix up different batches of different makes of a generic AED with disastrous effects so the same source generic AED must be used to fill a person's prescription every time. Evidence from the USA now indicates that the savings made by Health Departments through generic substitution of AEDs turn into massive cost increases as a result of the increased use of medical services, especially the specialist services as a result of the impact of these seizures and.
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In order to obtain maximum benefits for hospital or medical services, any person who enrolls in any of the PPO Plans will need to use one of the participating providers in the Administrator's PPO network. PPO providers are conveniently located throughout Illinois. Participants in any of the PPO Plans will receive a CHIP-PPO identification card that contains a Blue Cross Blue Shield logo. This will identify them as a member of the Administrator's PPO program, and allow them to receive in-network benefits while traveling anywhere in the United States subject to a 45 day per calendar year limit on services provided by out-of-state hospitals in most cases. Call 1-800-810-2583 or visit the Plan Administrator's website at bcbsil to verify which providers are participating in its PPO network. The Medicare Plan is not a PPO Plan, since Medicare is always primary. PRESCRIPTION DRUG CARD BENEFITS Coverage for prescription drugs obtained through a retail or mail-order pharmacy is provided through a drug card program for persons enrolled in the Traditional Plans, the HIPAA Plans, and the HIPAA-HCTC Plans. The ID card that is issued to participants eligible for this prescription drug card program provides information to the pharmacy for submitting claims at the time the prescription is obtained. Call or visit the Prescription Drug Administrator website at mywhi to find a participating pharmacy. There are no prescription drug card benefits available under the Medicare Plan. ANNUAL ELECTION PERIOD If you are enrolled in any of the PPO Plans, you have the right to change to or from an HDHP plan annually, as of January 1st of any calendar year, provided you remain eligible for and enrolled in any of these PPO Plans. You can change your CHIP coverage from an HDHP to a non-HDHP or from a non-HDHP to an HDHP option. You must do so during the annual election period, which occurs at the end of every calendar year. The change will become effective on January 1 of the next calendar year after we have received and approved your properly completed election form. If an election form is not received by December 31st, it will not be accepted.
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INDEX OF DRUGS INVANZ . 9 INVEGA . 18 INVIRASE . 20 IPOL INACTIVATED IPV . 34 ipratropium bromide for inhalation . 39 ipratropium bromide nasal solution . 39 IRESSA . 16 irinotecan. 16 ISENTRESS tab . 36 ISOLYTE-H DEXTROSE 5% . 40 ISOLYTE-P DEXTROSE 5% . 40 ISOLYTE-S . 40 ISOLYTE-S PH 7.4 . 40 ISOLYTE-S DEXTROSE 5% . 40 isoniazid . 14 ISORDIL TITRADOSE 40mg . 24 isosorbide dinitrate . 24 isosorbide dinitrate er . 24 isosorbide mononitrate . 24 isosorbide mononitrate er . 24 itraconazole . 13 jantoven . 23 JANUMET . 21 JANUVIA . 21 JE-VAX. 34 jolivette . 31 junel. 32 KADIAN . 6 KALETRA . 20 kaon-cl-10 . 40 kariva. 32 kcl d5w lr . 40 kcl d5w nacl . 40 KEMADRIN . 18 KENALOG INJECTION . 13 KENALOG TOPICAL SPRAY . 28 KEPPRA . 10 ketoconazole . 13 ketorolac tablet . 14 KINERET . 34 KIONEX . 12 klor-con . 40 klor-con m . 40 klotrix . 40 KYTRIL . 12 labetalol . 24 laclotion. 28 LACRISERT . 37 lacticare-hc . 28 lactulose . 30 LAMICTAL . 10 lamotrigine chewable disp . 10 LANOXICAPS . 24 LANOXIN . 24 leflunomide . 35 lessina. 32 LETAIRIS . 39 leucovorin calcium . 16 LEUKERAN . 16 leuprolide acetate . 33 LEVEMIR . 21 LEVEMIR FLEXPEN . 21 LEVO DROMORAN INJECTION . 6 levobunolol hcl. 37 LEVOCARNITINE . 40 levora. 32 levothroid . 33 levothyroxine sodium. 33 LEVOXYL . 33 LEVULAN KERASTICK . 28 LEXIVA . 20 lidocaine injection . 7 lidocaine prilocaine . 7 LIDODERM . 7 lidomar viscous . 7 lindane . 17 LIPOSYN III. 40 LIPRAM . 29 LIPRAM-PN . 29 LIPRAM-UL . 29 lisinopril . 25 lisinopril hydrochlorothiazide . 25 lithium carbonate . 20, 21 lithium carbonate er . 21 lithium citrate . 21 lofene. 30 lonox . 30 loperamide. 30 loratadine. 39 LOTRONEX . 30 lovastatin . 25 LOVAZA . 25 Page | 49.
Neurons are often considered to be the computational engines of the brain, with synapses acting solely as conveyers of information. But the diverse types of synaptic plasticity and the range of timescales over which they operate suggest that synapses have a more active role in information processing. Long-term changes in the transmission properties of synapses provide a physiological substrate for learning and memory, whereas short-term changes support a variety of computations. By expressing several forms of synaptic plasticity, a single neuron can convey an array of different signals to the neural circuit in which it operates.
What is the patient's understanding of his or her problem? What does the patient understand about the disease of addiction? What Stage of Change is the patient in now: Precontemplation, Contemplation, Preparation, Action, Maintenance, Relapse? See appendix G. ; What stages has he or she passed through in the past? How responsive.
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