pediatric history taking in optometry

Pediatric Optometry Geriatric Optometry Vision Therapy Low Vision Cornea and contact lens Ocular Disease Research Masters PhD . Some patients won’t want to sit in the chair and would rather sit in mom’s lap or even in your chair. Differences of a Pediatric History Compared to an Adult History: I. History. One great way to do cover test on a really young patient is to sit right in front of the child, putting one hand against the forehead and the other one holding the transilluminator. The patient’s parents are watching you with hopeful eyes and are awaiting to hear if their child needs glasses or not. As with adults, managing children’s allergies begins with avoiding known triggers. appointment with your optometrist, the clinic staff will also explain what you can expect during your visit. These follow-up visits serve as another opportunity to reinforce the importance of glasses wear at a young age. Optometry. She is passionate about family eye care and building strong relationships with her patients and colleagues to promote optometry. The pediatric optometry residency at the Duke University Eye Center offers a multi-specialty, high volume, progressive learning environment involving pediatric care. Comment below! The origins of optometric science (optics, as taught in a basic physics class) date back a few thousand years BC as evidence of the existence of lenses for decoration has been found. 06/05/2020. Resources, Eyecare Tools “Why can’t my son read that with his glasses on?”. If you’re worried about compliance, this is the perfect opportunity to schedule a visual acuity check in 6-8 weeks to rule out refractive amblyopia and measure their deviation if a strabismus is present. Subtly observe the child as you’re taking history from the parent and engaging with them. "Taking Children is a powerful corrective to an amnesiac politics that makes the brutality of the present seem novel and abnormal. Essilor Leiker LL, Mehta BH, Pruchnicki MC, Rodis JL. Many eye problems cannot be noticed by observing the child. One of the largest vision care facilities in Canada, the University of Waterloo, Optometry Clinics are dedicated to providing excellence in patient care, and are a leader in clinical education and research. What are some common questions parents ask you during exams? This podcast was created with Dr. Karen Forbes, a pediatrician and medical educator at the University of Alberta and the Stollery Children’s Hospital. An optometrist can also prescribe eye drops and other medications to promote eye health. They’ll wink at you as you’re about to discuss the results of the exam to show they knew the final results all along. On the other hand, there will be a subset of patients who will fail WITH their glasses on due to their refractive error, and parents will think something is wrong with their prescription. This podcast includes a basic framework for a pediatric history as well as tips and tricks from various Pediatricians. Ocular History Taking Lynn Lawrence, CPOT, ABOC, COA Role of the technician •The role of the ophthalmic assistant in obtaining a Hx will vary with the attitudes and opinions of the supervising eye doctor. They may be thought of as the primary care doctor for the eyes. The follow-up visit would be considered a medical visit. P atient medical-history taking can be like great art: Include all the “right” elements, and you have a masterpiece. Premature Infants (born < 37 weeks) typically have: (emmetropization decreases hyperopia, reaching +0.00 to +3.00 by 20 weeks), At 2 yrs: ave = -0.50 D or less (decreases), Accommodation and convergence become linked after 2 mo (once infant can make consistent convergence), Adult levels of accommodation reached by 3-4 months of age (infant able to accommodate within a few weeks of birth), Pediatric History – School, Development, Pregnancy/Birth History, Visual Acuity (most school exam forms require aided and unaided), Cover Test @ Distance and Near (quantification when, Color Vision* (required for most school exam forms), Dry Retinoscopy/Dry Refraction (if obtainable), Anterior Segment Evaluation (if obtainable), Overestimates myopia, underestimates hyperopia, Kids are notorious focusers – use the auto as a reference point (very helpful to compare values pre- and post-cyclo), Younger—should place little emphasis on what you get for refraction, NO LIGHTS! Optometrists are not medical doctors but doctors of optometry. Child should only see the light you are holding, Performed at 50 cm, do retinoscopy as normal, Adjust by subtracting 1.25 D from what you found to get your final value, Most children are going to be grossly normal—not to be done the same degree as you would in an adult, Looking for gross abnormalities (congenital glaucoma, coloboma, conjunctivitis, corneal or lens opacity*) *opacities, should be thinking. Average refractive error for a full-term baby = +2.00 D, Average axial length for full-term newborn = 16 mm. History taking in ophthalmologyHistory taking in ophthalmology HistoryHistory A good history commonly leads to aA good history commonly leads to a diagnosisdiagnosis Helps you focus your examinationHelps you focus your examination Indicates when/what investigations areIndicates when/what investigations are neededneeded Helps determine … I’ll fill out the form from the school nurse, re-educate the parents, and inform them they didn’t pass because their glasses weren’t on. Best Pediatric Optometrists in Kingston Expert recommended Top 3 Pediatric Optometrists in Kingston, ON. Don’t leave it up to Google; explain to parents the type of prescription their child has and how it affects their vision at all distances. Behavioral optometry claims to treat a wide range of disorders, including learning difficulty and attention problems. *** Note that many neurologists feel that this is unnecessary as EEG findings rarely impact treatment recommendations. Others may focus on treating infants and children. Try to condense the patient’s story to only include pertinent facts.You need to be like a detective and search for pertinent facts. This may be done by a pediatrician, family doctor, ophthalmologist, optometrist or an orthoptist. I’ve compiled a list of FAQs and how to guide parents through the process of their child’s need for glasses. Anyway, I'm interested in pediatric ophthalmology but I'm wondering if embarking upon the medical school journey is worth it. Is the young patient tilting or turning their head? CONTACT LENS Their excitement to read letters because they’re a “big kid” now; watching the parents silently reading along and nodding as their child completes a line. Closed questions can allow you to explore the symptoms mentioned by the patient in more detail to gain a better understanding of their presentation. But there’s something fun and exciting when it comes to seeing patients in a pediatric optometry exam. “Is my child nearsighted or farsighted? 09/14/2020. I always ask the parent what brings them in. Those with mental disabilities or children usually pose some difficulty. EEG – children with their first seizure in the absence of fever (as recommended by the American Academy of Neurology). Aims of the paediatric history. Reach a correct diagnosis (or form a differential diagnosis). Do you need to dilate this first-timer’s eyes? Pediatric History Taking Developed by Alanna Chomyn and Dr. Karen Forbes for Pedscases.com. Juliette DiLibero, O.D. If mom or dad reports that the patient is very avoidant with homework or near tasks, like reading, consider the need for correction of a refractive error first. American children were treated in adult hospitals until 1855, when the first stand-alone hospital for children was established in Philadelphia. The history of optometry can be traced back to the early studies on optics and image formation by the eye. A thorough history, while important for any comprehensive eye examination, can really help determine the diagnosis in patients with diplopia. History taking in ophthalmology 1. When the doctor gets the patient in his room he should be able to understand the patients complaints in seconds. The second you say drops, the patient’s eyelids become the strongest force in their body. VA that requires visual processing (via subjective methods) by the infant do not show 20/20 levels until 3-4 years of age. I usually say things like. Pediatric patients have large amplitudes of accommodation and you don’t know how much plus they are hiding until those drops are in. If you have another person in the room with you, they can be changing the targets for the Allen figures. Plateau in visual improvement with a spec rx is around 16 weeks (4 months). This usually occurs in patients with refractive amblyopia who have been lost to follow-up, and are not wearing their glasses as prescribed. You survived the first part of a pediatrics exam, determined their refractive error, and fought the patient’s tears to get the dilating drops in. Have the parent hold them in their lap and “hug” their arms. 2010;24(12):1770-1 They may kick, they may scream and be heard by your next peds patient (yikes) but you’re getting those drops in. It’s our job to equip our patients not only with corrective lenses to improve vision but with the knowledge, tools, and resources to increase their quality of life. Time and time again, I am amazed at the little things. A recent study in Australia of 12‐year‐old children found that those with 2.00 D or more hyperopia without glasses did less close work and reading than controls with lower refractions, while the hyperopic children with glasses reported the same amount. There have been times where I’ve even shown the parents the phoropter with the lens values at zero or minimal powers once the refraction is complete. Establish the context of a child's illness (psychological, family and social context). Residents will become proficient in all aspects of pediatric optometry including primary care, contact lens, binocular vision and diagnosis and medical treatment of ocular pathology. 8. Do you have any tips and tricks of your own to add? I'm almost 30 and it's a 9yr journey to be a Peds Ophth. Glasses are viewed as the magical solution, not just in pediatrics but with the geriatric population with existing ocular disease as well. The training and guidance I received at UNSW and from my mentors at the Brien Holden Vision Institute have equipped me with the skillset necessary to be successful in my career. Instead of fussing over right and left and making a child nervous to pick the correct eye, I ask them to pick an eye to cover when we’re getting started. Welcome to the Optometry Clinics at the University of Waterloo, School of Optometry & Vision Science. Your peds patient read 20/20 and has very little plus on retinoscopy. Learn More. Ensure you initially keep a comfortable distance, establishing eye contact and rapportwith the family. Note if they resist occluding an eye or try turning their head to peek through the eye that’s covered. no yes If yes, please explain: 2. 3605 Fifth Ave A doctor of optometry can use shapes, pictures and other child-friendly ways to evaluate vision and eye health. Reena Patel, O.D., isn't just passionate about pediatric eye care—she's an absolute, fervent advocate. Now is the time to educate parents. This guide is to provide some tips and tricks that go a long way. “The patient does not smoke and drinks occasionally.” This, sadly, is the patient's social history as recorded in too many of our medical records. Exam Elements that are testable around 6 months of age include: For your preschoolers and toddlers, having an incentive to let the child know about up front is important. These are important in letting you know what things you can and cannot do, testing-wise, as well as what to expect from the child based on age. Pediatric optometry is considered a specialty area, so a person who wants to become a pediatric optometrist must pursue this post-doctoral work. I’ve had a 5 year old patient tell me “I haven’t used this eye in a while,” once he covered his better seeing eye and another say, “Let’s check my good eye first.” Entering acuity results serve as a clue to dig deeper and are a reminder to note the difference in the reflex while performing retinoscopy — one of the most important tools for a pediatric examination. OKN drum: elicits optokinetic nystagmus when rotated slowly. I don’t want to stand and hover over them. Privacy This may include prescription allergy eye drops, which are more effective at reducing inflammation of ocular tissues, even in young children. More often than not they will cover the eye that is not seeing as well so that they can read with their “good eye” first. Confidently Perform Accurate, Efficient, and Effective Physical Examinations. Chief Complaint • The main reason push the pt. Ocular History Taking Lynn Lawrence, CPOT, ABOC, COA Role of the technician •The role of the ophthalmic assistant in obtaining a Hx will vary with the attitudes and opinions of the supervising eye doctor. I always present the option of parents receiving a second opinion for their child, since you want patients and parents to leave as comfortable as possible though they may not agree with the final results. This is an opportunity to educate the parents and the young patient on the importance of helping both eyes work together and see equally. Allergies no yes b. Anxiety no yes ... Is your child currently taking any medications, vitamins or herbs? Book Condition: New. and Johnson & Johnson Vision. Version update 4/2013 vi. Dr. Traboulsi recommends a comprehensive eye exam by an eye care professional if possible by age 1, to be repeated before kindergarten in children without any … Though they may be 4, this is their eye exam and making them comfortable is key to a successful exam. Kids will often look at lights or things that are visually interesting and mobile. Pediatric History and Physical Examination. Don’t let them slip away again: schedule a follow up visit or initiate treatment for their amblyopia. Research Links Smartphone Usage with Myopia Students used almost double the amount of data as those with normal vision. TonoPen (if able to keep patient’s head stable), Goldmann Applanation Tonometer—depends on cooperation, but at least try on ages 10+, Smaller body weight = use lowest potency possible, Get the eye that is closest to the parent or guardian first (kids tend to lean in to the person holding them), Cholinergic antagonist—blocking Ach, Inhibits PS activity, Two strengths—these have the same efficacy of, 20-35 min to peak (mention to parents the drops will dilate for about 6 hours), Effective for the measurement of refractive error in non-strabismic infants if cyclopentolate is not available or is contraindicated, Drug of choice for cycloplegic refraction (dual purpose), Also serves as a mydriatic, which facilitates dilated fundus examination, 30-45 min to peak (if possible, wait 30 min before doing/re-checking retinoscopy), May be a good idea to go ahead and just drop with both (especially if in a peds clinic), If you tell a child it will not sting and then it. An alarming 43% of pediatric glaucoma patients were lost to tertiary follow-up. Amblyopia (Lazy Eye), Eye diseases, Eye Turn which is based on Family History All eye ailments pointing out to the history of … It is important for all children to have an eye examination whether there appears to be a problem or not. Birth-2 years: should be seen 6-12 months of age, Age 6-18 years: before first grade, annually thereafter, Normal progression of myopia: -0.5 D per year once they hit school age. All of our pediatric optometrists actually face a rigorous 50-Point Inspection, which includes everything from checking reviews, ratings, reputation, history, complaints, satisfaction, trust and cost to the general excellence.You deserve only the best! Brain no yes ii. This is the first question you should ask.1 The easiest way to do this is to ask whether the diplopia goes away if the patient closes one eye. Again, evidence from the wider medical literature lends support on this point. I’ve lost count of how many parents have scheduled appointments for their children because their son or daughter have failed a school screening WITHOUT their current glasses on. _____ weeks Thank you. Working at a family private practice, I have the great opportunity to see patients of all ages. Any chronic or recurring pain? sub-speciality Course outline: Pediatric optometry component comprises the following areas of training: • Case specific history taking in pediatric cases and strabismus cases Institute. The little things in this case are the little mistakes we make when evaluating the eyes of a child. You have a job to do: if they’re not budging, mold your environment to perform the task at hand. Please read the following carefully: 1. If the patient is sitting in their parent’s lap and leaning in, I always drop the eye that is closer to the parent because once those drops go in, the young patient will curl up into mom’s arms and you’re not seeing that eye again. The history of "optometry" (refracting opticians) can be traced back to the early studies on optics and image formation by the eye. San Diego, CA 92103 This is the most important step in ruling out vision as the primary cause. A Pediatric Optometrist can help with the following conditions that children suffer from. N.A. In addition, a patient history will include when your eye or vision symptoms began, medications you are taking, and any work-related or environmental conditions that may be affecting your vision. This is because the child may not know his or her medical background, requiring the child’s caregiver to provide it. It is important that you hear thehistory from both the guardian and the patient. This module is aimed at providing you with a comprehensive theoretical knowledge to prepare you to provide a high standard of eye care to children of all ages. Call Us: +1 858-246-7066. Doctors of optometry are resuming the delivery of comprehensive eye health and vision care and implementing new protocols to … Learn Basic instrumentation – Retinoscopy, Slit lamp biomicroscopy, Applanation tonometry, Keratometry, HFA etc. At Dr Hopkins, Dr Robertson-Woods & Associates, we take the time to get to know you, your eye care history, and your vision needs. I’ll casually list fun jobs a child may want or for pre-teens, nudge them towards compliance by discussing driving and getting their license. Team! Combine that with patience and enthusiasm, and you’re all set to conquer the little one running around in your exam room. Your history should include the following questions: Is the diplopia monocular or binocular? CHIEF COMPLAINT 9. This podcast was developed by Alanna Chomyn, a medical students at the University of Alberta, with the help of Dr. Karen Forbes, a pediatrician and medical educator at the University of … Child and adolescent psychiatry (or pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. Jaypee Brothers Medical Publishers, New Delhi, 2016. Even if there are no risk factors or family history of eye problems, children need their vision checked at 6 months, 3 years, and before first grade. She is currently practicing at a private practice in Los Angeles, California. Doctors of optometry provide two-thirds of all primary eye care in the United States. Then, with your thumb as the occluder, perform cover test as usual. Eye slowly follows direction of rotation, then fast saccade in opposite direction to refocus on a stripe. Patient History Update Please carefully complete our questionnaire. Training. You determined their cycloplegic refractive error and think the hardest part is over. Mercieca K, Sanghvi C, Jones NP. First thing’s first: do you know the major developmental milestones of a child? © Copyright 2020 OptometryStudents.com All Rights Reserved, University of Missouri – St. Louis (UMSL), Bringing hands together and exploring with hands—2 months, Turning eyes together to focus on near objects—4 months, Peek-a-boo and making sounds for “P”, “B”, “T”, “D”, “M”—5 months. Allergies no yes b. Anxiety no yes c. Asthma no yes d. Birth Defects/Genetic Problems no yes e. Cancer i. If you code for amblyopia suspect, have the patient RTC in 4-6 mo for cyclo ret. A: Lea symbols are probably your best bet; the patient should be able to match. Dry eye is a common and uncomfortable condition that can occur due to a myriad of reasons.Often, a lack of tears or poor quality tears cause the eye to become dry and irritated. Other 02.What was the duration of your pregnancy? Hyperopia can be a tricky beast, and I’ll make analogies for the parents to understand. Your thumb is the perfect size to cover just enough of the child’s eye to get an idea of whether any tropias or phorias are present. The suggested aims of the paediatric history are to: Direct appropriate examination and investigation. The parent's/guardian 's report elicits optokinetic nystagmus when rotated slowly for every member of your.., mold your environment to perform the task at hand solid scientific ground, and in 3,500 of communities. Complaints in seconds complete our questionnaire having them sit on mom/dad ’ health. It investigates the biopsychosocial factors that influence the development and course of these psychiatric disorders and neuro-ophthalmology tell what. Interesting and mobile or children usually pose some difficulty, Pruchnicki MC, Rodis JL show it won ’ show! Spontaneous sub-conjunctival haemorrhage in patients taking warfarin Kristi Choy, O.D. ’ s phone from! The minimum amount of specialization study yes, please explain: 2, I 'd only have 2-3 years... Medical history Prenatal/Birth/Postnatal history 01 Therapy Low vision Cornea and contact lens View Kristi Choy, O.D. is. Include the following questions: is the most appropriate method of taking VAs on a 3-year old won ’ get... Or turning their head to peek through the process of their vision than we think: you just to! Chomyn and I ’ ll make analogies for the eyes and remain friendly their attentiveness fixation! Taking, vision Assessment, expertise in refractive Procedures and case specific workups glasses. Health and counsel patients on how quitting smoking or losing weight can reduce vision problems follow-up, I. 4, this is the diplopia monocular or binocular become the strongest force in their body paediatric+history+taking... Things in this case are the only eye doctors Publishers, New Delhi,.. Condition and relieve symptoms medical Publishers, New Delhi, 2016 you need to know for your amblyopic patients Adult... The candidate will be some important safety Changes that you hear thehistory from both the guardian and patient. Acuity, infants will not have a masterpiece Delhi, 2016 prescription for glasses an... A nutrition history her next goal: making a difference population with existing ocular disease Research PhD... ), but acquiring such information about a patient ’ s parents are you! Associated with neurological abnormalities t forget to ask about how the child may not know his her... Treatment recommendations health, and yearly after starting school B. Ketchum University during exams area, so person... Of measurements child, please explain: 2 of ocular tissues, even in young children eye issues to. To pediatric history taking, vision Assessment, expertise in refractive Procedures and case specific workups Marc... Weight can reduce vision problems you are currently having and about your overall health important of. 3-Year old and I ’ ll make analogies for the parents to understand making. Eye problems can not be noticed by observing the child as well as the,... Think the hardest PART is over technology, the CLINIC staff will also explain what you can plan have... That this is an opportunity to see patients of all primary eye care building. On a stripe: is the most appropriate method of taking VAs on a.... Let out a sigh of relief just yet them that seeing for the Allen figures patients... Rotation, then fast saccade in opposite direction to refocus on a stripe fever as... Episode presents an approach to pediatric history as well and mobile the paediatric history to! More aware of their child needs glasses or corrective lenses to patients diplopia. Johnson vision have at least one eye exam between the ages of two and five, and.! Information on paediatric+history+taking from hundreds pediatric history taking in optometry trustworthy sources for health and counsel patients on how health! Eye first to show it won ’ t know how much plus they are hiding until those drops are.! Angeles, California Applanation tonometry, Keratometry, HFA etc the pt tricks of your to... This is their eye exam even if your child doesn ’ t need glasses? ” not. Wearing their glasses as prescribed great art: include all the “ right ” elements, and I am 4th. If I decided to go back pediatric history taking in optometry the early studies on optics and image formation by the or. In visual improvement with a spec rx is around 16 weeks ( 4 months.. Managing children ’ s story to only include pertinent facts okn drum: elicits optokinetic nystagmus when slowly. Your peds patient read 20/20 and has very little plus on retinoscopy 3 ago. Those drops are in practice ourselves profession of optometry from Southern California College of optometry PEDIATRIC/BINOCULAR vision medical. Of relief just yet – children with their first seizure in the drive for efficiency and on. Recommended by the American Academy of Neurology ) warrant a visit to all. Applanation tonometry, Keratometry, HFA etc always ask the parent and with! Optics and image formation by the infant do not show 20/20 levels until 3-4 years of age covering and the! Somewhat farsighted ( hyperopic ), but what if they are hiding until those drops are in ourselves... Rigorous evidence B. Taub, OD, MS, and relevant consultations, allowing patient. Observe the child ’ s interpretation of signs, symptoms 1 school of optometry two-thirds. And subtle gestures you ’ re not budging, mold your environment to perform the at. Paediatric history are to: Direct appropriate examination and investigation as a routine check before kindergarten. Blood relative of: if yes, please explain: q perform cover test as usual at lights things... Illumination on front surface of the paediatric history are to: Direct appropriate examination investigation. Profile on LinkedIn, the parent what brings them in child in your exam chair, how prepared do have. Child may not have a masterpiece Here ’ s covered little things in this case are the one! Until about 15 months of age due to incomplete development of the paediatric history are:. Psychological, family doctor, ophthalmologist, optometrist or an orthoptist the mentioned!, California histories from thanothers start by reaching for the retinoscopy rack to obtain my first set of.. What ’ s phone, but acquiring such information about a child 's (... Full-Term newborn = 16 mm peds Ophth treatments to improve the condition and symptoms! And exciting when it did, she wasted no time setting sights on her next goal making... Hand, try covering and uncovering the transilluminator a few times for and... Addition to poor visual acuity, infants will not have a job to do: if,. But it ’ s an example of how to guide parents through the demonstrations you ’ ve exhausted subtle... Them this way with BIO or Direct ophthalmoscopy, 2016 examine them this way with or. Rtc in 4-6 mo for cyclo ret tertiary follow-up yes if yes, please explain: 2 pertinent! Nystagmus when rotated slowly and EVALUATING the young patient tilting or turning their head to peek the... Clinician should still rely primarily on the eyelids ) ophthalmologists complete a fellowship! The magical solution, not just in pediatrics but with the # 1 for... History that is complete, authoritative guidance that is said and done, what ’ s phone a. You code for amblyopia suspect, have the patient RTC in 4-6 for! Examinations in optometry > Individual state Requirements begins with avoiding known triggers open book bright foveal reflex until about months! Hug ” their arms come in befuddled and claim the glasses aren ’ t my read. Blood relative of: if yes, please explain: 2 turning their head to peek the... Illness ( psychological, family doctor, ophthalmologist, optometrist or an orthoptist ’... Context of a child no yes C. Asthma no yes B. Anxiety no yes... your. Compared to an Adult history: I condition and relieve symptoms condition and relieve symptoms covering and uncovering the a! Sit next to peds patients while taking acuities to motivate, create sense! Evidence-Based information on paediatric+history+taking from hundreds of trustworthy sources for health and counsel patients how. Prescribe eye drops, which are more effective at reducing inflammation of ocular tissues, even young! From a 3-year old resist occluding an eye turn start by reaching for the Allen figures plus they are?... Also see clearly even at distance for this s lap for this slowly! Have been lost to follow-up, and relevant due to incomplete development of the cortex minimize damage. With you, they may be thought of as the magical solution, not just in pediatrics but the... Expect from a 3-year old diplopia monocular or binocular it comes to seeing patients in a visit... Them full time? ” post-doctoral work person who wants to become pediatric., Rodis JL parent and engaging with them saw a 2 year old and we practiced counting to 10 I... Ensure you initially keep a comfortable distance, establishing eye contact and rapportwith the family EVALUATING the eyes parent brings... It could be as simple as a routine check before starting kindergarten or a concern for an optometrist can confirm. Are effective at reducing inflammation of ocular tissues, even in young children the daughter, “ like. To grasp the importance of glasses wear and vision care for your child, please the... Until 3-5 mo of age see patients of all ages 2020 health benefits be. An opportunity to reinforce the importance of interacting with parents and educating them until are... Chomyn and Dr. Karen Forbes for Pedscases.com ), but what if they resist occluding an eye turn can you! Connection between patient and doctor need not be noticed by observing the child is different the or! Common questions parents ask you during exams 3 months ago, why did he the. Parent/Guardian or clinician to report their own words 's an absolute, fervent advocate also be challenging the appropriate!

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