Suicide Prevention Blog Series: Clinical Tip #5

by Staff and Faculty of the QPR Institute Sunday, November 24, 2013

In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Release) we bring you this five part series of clinical tips with the most up to date research and thinking on suicide prevention.  

Paul Quinnett, PhD, President and CEO, The QPR Institute, Inc, says eighteen veterans will take their own lives today.  So will someone's daughter, a brother, a co-worker, and far too many working men and grandfathers.  According to the Centers for Disease Control and Prevention, in just one day, more then 101 of our fellow Americans will die by suicide.  Perhaps this clinical tip will save just one.

Clinical tip #5 -- Communicating Suicide Risk

The nature of modern clinical care by multiple providers requires clear communication to assure consumer safety.  Not only do prescriptions need to be clearly written, but progress notes must be legible to all providers of care.  In the root cause analysis of 400 consumers in active care who attempted or died by suicide while inpatients, communication failures ranked at the top of the list of contributory causes (National Center for Patient Safety, 2006).

To improve communications between clinicians regarding suicide risk, there is little consensus about a) how to assess immediate risk or b) how to determine its severity.  Still, risk stratification decisions and clinical judgments must be made every day as these assessments necessarily guide our interventions, monitoring levels, and frequency of contact. For a variety of reasons, suicidal consumers may not be entirely helpful in disclosing their suicidal intent, desire and plans.  If, after an assessment, you are not confident of your conclusions, it may be helpful to others on your team to add a chart note to this effect.

An explanatory note of “low confidence” would be warranted when the consumer:

·      Has been uncooperative and refused to collaborate in the assessment process

·      Has or may have psychotic symptoms, especially paranoia

·      Is or has been recently intoxicated

·      Has a history of impulsivity

·      Is faced with an uncontrollable external event, such as the serving of divorce papers or an arrest warrant 

In sum, a note of low confidence in the assessment suggests higher risk and that reassessment is indicated in the near term (not more than 24 hours), as well as the need for a second opinion, greater vigilance, and more frequent observation.

The QPR Institute (www.QPRinstitute.com) provides Online Advanced Suicide Prevention Courses for a wide range of professionals including: Mental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers. For more information please visit our full library of advanced courses!

Paul Quinnett, PhD., Founder & CEO QPR Institute, www.QPRInstitute.com

 

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relationships, friendships | Self-Care | Social Work | Suicide Bereavement | Suicide Prevention | Treatment Modalities

Suicide Prevention Blog Series: Clinical Tip #4

by Staff and Faculty of the QPR Institute Wednesday, November 6, 2013

In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Release) we bring you this five part series of clinical tips with the most up to date research and thinking on suicide prevention.

Paul Quinnett, PhD, President and CEO, The QPR Institute, Inc., says 22 veterans will take their own lives today.  So will someone's daughter, a brother, a co-worker, and far too many working men and grandfathers. According to the Centers for Disease Control and Prevention, in just one day, more then 105 of our fellow Americans will die by suicide. Perhaps this clinical tip will save just one.

Clinical tip #4 -- Reassessing suicide risk

 

Suicide risk changes with time and circumstances.  A single, initial assessment of suicide risk is seldom adequate for safe practice.  Suicide risk assessments should be repeated both a fixed intervals and during times of increase stress. Based on the literature and the clinical experience of several of the QPR Institute faculty, we suggest four non-exhaustive circumstances where re-evaluating suicide risk is indicated:

 

Changes in health status, e.g., diagnosis of a life-threatening illness, exposure to HIV, continued experience of chronic pain, and when the consumer is faced with significant surgery or has suffered a significant physical injury.

Stressful life-transitions, e.g., loss of a major relationship, change in living arrangements, treatment transitions (between therapists or programs), threats to housing, income or access to care.

Response to treatment, to include side effects of psychotropic medications, non-therapeutic response to medication or other intervention failures, including impasse in therapy or conflict with therapist

Substance abuse dramatically increases suicide risk.  Relapse from recovery, binge drinking or drugging, relapse of one’s sponsor, and any significant use of intoxicants, even by non-addicted consumers.

 

A number of other circumstances suggest the need for a reassessment of suicide risk.  These include reports by third parties that suicide warning signs have been observed, any report of violent behavior, the sudden loss of a loved one through death, divorce, desertion and especially suicide.  Finally, anytime a consumer of any age is facing what may be a personal and public humiliation, suicide risk may be sharply elevated.

 

Basically, suicide risk increases dramatically with multiple successive losses, co-morbidity of illnesses, acute environmental stressors, and anytime the consumer begins to feel he or she is becoming a burden on others or care providers.  If in doubt, reassess!

 

The QPR Institute (www.QPRinstitute.com) provides Online Advanced Suicide Prevention Courses for a wide range of professionals includingMental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers. For more information please visit our full library of advanced courses!

Paul Quinnett, PhD., Founder & CEO QPR Institute, www.QPRInstitute.com

Tags:

relationships, friendships | Self-Care | Social Work | Suicide Bereavement | Suicide Prevention | Treatment Modalities

Suicide Prevention Blog Series: Clinical Tip #3

by Staff and Faculty of the QPR Institute Thursday, October 31, 2013

In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Release) we bring you this five part series of clinical tips with the most up to date research and thinking on suicide prevention.

Paul Quinnett, PhD, President and CEO, The QPR Institute, Inc., says 22 veterans will take their own lives today.  So will someone's daughter, a brother, a co-worker, and far too many working men and grandfathers. According to the Centers for Disease Control and Prevention, in just one day, more then 105 of our fellow Americans will die by suicide. Perhaps this clinical tip will save just one.

Clinical Tip #3 -- Quick and Effective Response can Save Lives ...

The vast majority of all residential and inpatient suicides occur by hanging.  From the restrictive closure of the air passage, unconsciousness occurs in 30 seconds, death in four minutes.  Saving a life from a hanging attempt requires quick and efficient action.  Emergency rescue tools have become a standard piece of equipment for responding to such events, including the now widely used "911 rescue knife." These are specially designed knives with a hooked and protected blade that allow the victim to be cut down quickly and without injury.  Because the blade is located inside the frame of the tool it cannot be utilized as a life-threatening weapon in the hands of a potentially violent person.  Fire fighters and paramedics have used them for years to cut seat belts off trapped victims.

If you work in a residential or inpatient facility, consider securing 911 rescue knives and training staff in how to access and use them quickly.  When a consumer is found hanging, every second counts.  Once a victim is discovered any time lost trying to remove a ligature by hand - and especially if unassisted - may delay rescue and lead to a preventable injury or death.  More precious time may be lost if staff cannot locate the knife or, once in hand, they are unfamiliar with how to use it.  Good safety management practices require knowledge and practice.  If fire drills save lives, so can "cut down" drills.

The QPR Institute (www.QPRinstitute.com) provides Online Advanced Suicide Prevention Courses for a wide range of professionals including: Mental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers. For more information please visit our full library of advanced courses! 
Paul Quinnett, PhD., Founder & CEO QPR Institute, www.QPRinstitute.com

Suicide Prevention Blog Series: Clinical Tip #2

by Staff and Faculty of the QPR Institute Saturday, October 26, 2013

 

In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Releasewe bring you this five part series of clinical tips with the most up to date research and thinking on suicide prevention.  

Paul Quinnett, PhD, President and CEO, The QPR Institute, Inc, says 22 veterans will take their own lives today.  So will someone's daughter, a brother, a co-worker, and far too many working men and grandfathers.  According to the Centers for Disease Control and Prevention, in just one day, more then 105 of our fellow Americans will die by suicide.  Perhaps this clinical tip will save just one.

Clinical Tip #2 -- Documenting Reasons to NOT Hospitalize

When deciding not to hospitalize a patient at risk for suicide, it is important that the clinician conduct a risk-benefit analysis.  The reasons for hospitalization may include the relative assurance of a safer, more controlled environment, a beneficial milieu, multidisciplinary staff evaluation, initiation of stabilizing medications, etc.  The reasons not to hospitalize a suicidal person might include potential loss of self-esteem, stigmatization, risk of losing a job, fostering unwanted dependency, failure to benefit from prior hospitalizations, etc.  When confronted with a possible hospitalization, the patient may also express a willingness to participate in outpatient treatment and adhere to a medication regimen. 

Whatever your reasons to not hospitalize a consumer who has expressed suicidal ideations, prior plans or suicide attempts, it is strongly recommended that the primary care provider seek consultation and/or supervision regarding the decision and to carefully document the reasons for this decision.  In a world of increasing litigation for suicide malpractice, and if a bad outcome is experienced, an uniformed jury will need to be convinced that 1) you thought the problem through, 2) you weighed the risks and benefits carefully with the patient and his or her family, and 3) you took a reasonable and prudent course of action.

The QPR Institute (www.QPRinstitute.com) provides Online Advanced Suicide Prevention Courses for a wide range of professionals including: Mental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers.

For more information please visit our full library of advanced courses!

 

Paul Quinnett, PhD., Founder & CEO QPR Institute, www.QPRinstitute.com

 


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Self-Care | Social Work | Suicide Bereavement | Suicide Prevention | Treatment Modalities

Suicide Prevention Blog Series: Clinical Tip #1

by Staff and Faculty of the QPR Institute Friday, October 4, 2013

 

In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Release) we bring you this five week series of clinical tips with the most up to date research and thinking on suicide prevention.

Clinical tip #1 -- So-called “No-Suicide Contracts”

Despite clinical lore there is no scientific evidence that so-called “no suicide” contracts actually save lives or prevent suicide attempts.  Despite their widespread use, specific training in their purpose, utility, and employment is largely unavailable.  

The use of a no-suicide contract as a defense against a complaint of suicide malpractice is at best dubious and at worst negligent.  However, experts generally agree that the refusal of a suicidal person to enter into a good-faith agreement to remain safe (which implies a willingness to participate in recommended treatment), suggests the risk for a suicide attempt may be higher than first assessed. 
 
Documentation of clinical status, including the results of a mental status examination, together with a detailed suicide risk assessment are the best evidence that due clinical diligence was undertaken. Care planning, level of monitoring, frequency of visits, and similar interventions hinge on the quality of the initial and subsequent reassessment of suicide risk. For the most recent literature review, please see Lisa McConnell Lewis, LCSW’s “No-Harm Contracts: A Review of What We Know, Suicide and Life-Threatening Behavior, vol. 7, #`, February, 2007.

The QPR Institute (www.QPRinstitute.com) provides Online Advanced Suicide Prevention Courses for a wide range of professionals including: Mental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers.

For more information please visit our full library of advanced courses!

 

  Paul Quinnett, PhD., Founder & CEO QPR Institute, www.QPRinstitute.com

 


Tags:

Self-Care | Social Work | Suicide Bereavement | Suicide Prevention

A Dream Come True

by William L. Blout LICSW Monday, September 9, 2013

We founded HelpPRO on a simple dream: “Everyone should be able to find needed mental health services quickly and easily.” We believed that a dedicated group of people and technology offered the possibility that this dream could become a reality.

In1998, a few years into the development of HelpPRO, I found out about the tragic suicide of the publisher of a local newspaper.

Suffering from severe depression, Timothy Hogan tried in vain to find a therapist who could help. He called a Massachusetts professional association referral line, his insurance company and a local hospital but instead of help, he encountered frustration.

In the end, Mr. Hogan wrote in his suicide note: “My only hope is that my death will awaken the healthcare community and lives will be saved.”

Thanks to 500 HelpPRO therapists who already joined, on September 10th, Suicide Prevention Day, we will launch the first Suicide Prevention Therapist Finder.

And the staff in 160 crisis centers nationwide will use this finder as a resource for people calling the National Suicide Prevention Lifeline.

Mr. Hogan, we heard you.  


In 1995 Bill founded HelpNet, Inc. and developed HelpPRO Therapist Finder at www.HelpPRO.com. Bill is an active advocate for mental health services in his community in Lexington, MA. Bill served as chair of the Lexington Human Services Committee and was a founding member of the Lexington Youth Services Council. Bill is a founder, past president, and clinical consultant with Lexington Youth and Family Services (LYFS), a walk-in adolescent crisis counseling service that began in 2011. From 1978-1994 Bill was the Director of RePlace, Inc., a community-based,  adolescent and family counseling center in Lexington. Bill also maintains a part-time mediation and clinical practice.

 

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Suicide Bereavement | Suicide Prevention

Heros and the Heat of the Game

by Rosemary De Faria Wednesday, July 17, 2013

There has been a lot of buzz with the play-offs lately.  One has to live under a rock to avoid being affected by it in one form or another.

Not being a sports fan I decided to take a walk on the wild side by accepting an invitation to dinner at a local bar where the final game would be played on every screen in the place.

My immersion experience began with the driver of the shuttle who took us to the bar.  He recounted the story of the previous evening’s game, sharing with emotion how he had been close to tears when it looked like his beloved team may lose.     His voice, hoarse from all the screaming, now had a lilt in it as he spoke of the team’s dramatic win.  They had managed to turn things around and to listen to him; it had been close to a spiritual experience.

In the restaurant people were already seated in the front row.   Dressed in their Heat attire, they were screaming and throwing their hands up to clap for a play which brought the team a little closer to winning.   

I began thinking of the role these sportsmen played for people, young and old from all walks of life and I found myself wondering : “Who do we make our heroes and why? “

When I think of my heroes, the people that come to mind are rarely those with celebrity.  Oh, I admit, Oprah holds a special place for me as I’m sure she does for many, but I think instead, of Sister Mendonca my fifth grade teacher who had the kindest, most loving heart.   She made some difficult times a bit easier to bear and I have never forgotten her for it.  

Now in middle age, I think of my father as another hero.  This surprises me at first, but it is a good choice nonetheless.   He was a tough, scary man, but he modeled some of the most important principles in life for which I am very grateful.  The best parts of me are all as a result of having him as my father. 

I sometimes sit across from my clients and wonder, am I a hero for them?    If so, I hope I can be like my heroes, who in very humble and unassuming ways gave me so much. 

Take the time to seek out your heroes.   They often go unnoticed, flying under the radar with little or no awareness of their own magnificence, but they are heroes nonetheless.

Let them know how they have impacted you.  Then, think about how you can be a hero for someone else and do it.  You may just change a life in unexpected ways.   Unleash the hero within you.  I promise you it’s there …ready and waiting to get into the heat of the game.

Rosemary De Faria, LCSW has a psycho-spiritual psychotherapy practice in Miami, Florida.  With over 20 years experience she uses both traditional and alternative therapies in working with her clients.  To read more about Rosemary or to read more of her articles, please visit www.distincttherapy.com. Mention this blog article for a complementary phone consultation: 954-966-3446.

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relationships, friendships | Self-Care | Social Work | Therapeutic Relationship

Will a marriage counselor tell me my partner is “right” and I’m “wrong”?

by Anita M. O'Donnell Wednesday, July 3, 2013

Couples counseling requires a balancing act in order to work well. If one person feels slighted or picked upon, the overall work is compromised. You don’t want to feel that the person who is supposed to be helping you is siding with your partner.

Typically, the subject that your partner and you disagree on feels crucial. Both people are bringing strong emotions to the discussion. For example, if you’re arguing about the frequency of sexual intimacy, one partner may feel very strongly that sex isn’t important enough to the other partner. This partner may feel rejected and undesirable as a result. The partner who looks like he/she is avoiding sex might be experiencing increased stress in daily life and may feel overwhelmed generally. The emotions this partner holds on a day-to-day basis can be debilitating. Is one person “right” and the other person “wrong”? No.

Both people are affected negatively by this disconnect in the relationship. The counselor might want them to talk to each other in the counseling session about their feelings on the topic, to explore the significance of sex, perhaps to even try some problem-solving around this subject. The counselor might help the couple build upon their knowledge of each other and their friendship. The relationship may exhibit other issues that could lead the counselor to work with the couple in building specific skills to improve the relationship. Additionally, do other factors exist that affect the sexual aspect of their relationship—medical problems, substance abuse, depression? These factors would need to be addressed as well.

In most cases, there is no “right” or “wrong” person. Counselors can look at the process of how the couple relates. Counselors can help couples focus on resolvable issues, rather than perpetual issues. Counselors can help couples learn new skills and improve upon existing skills.

Counselors that help couples transform how they relate to each other, stand a great chance of helping couples gain the knowledge to improve their relationship and love fully.


Anita M. O’Donnell, M.Ed., LPCMH, NCC provides individual and couples counseling in Wilmington, Delaware through her company SuccessWorks Unlimited, Inc. She also offers telephonic and face-to-face coaching. Ms. O’Donnell earned her M.Ed. from Temple University in Philadelphia in 1991. You can follow her at www.facebook.com/YourBestLifeToday and through her website www.successworksunltd.com.

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marriage | Therapeutic Relationship

Friendship, Love and Marriage

by Gil Shepard Thursday, April 18, 2013

 

When someone says, “She (or he) is just a friend,” this generally means the relationship is not romantic, not sexual and not too intimate. It is also understood to mean, “You need not take this too seriously.”

On the other hand we sometimes hear someone say in a reverent way about a spouse, or a partner, “He (or she) is my best friend.” This is saying, “Yes, lots of people are married, lots of people have sex and live together, but what we share is a special trust, support and a rich love.”

What does it take to have this rich enviable friendship? For a start it takes risking being open about one’s feelings, being gently honest about what one thinks and does, being able to deal with disagreements in a relatively calm manner and being able to negotiate differences.

Unfortunately these skills are rarely taught in childhood. Instead many of us learned not to trust because we found caregivers not safe, not trustworthy and it was not smart to trust. Suspicion and fear are often survival skills in childhood but as an adult they can impede love. To learn how to be a true friend and how to choose someone trustworthy may take relearning in a safe environment.

In effective relationship therapy you may learn techniques, like how to let another person know that you heard what they said by repeating what you think you heard back to them and checking to see if you are correct. You may learn certain "no-no's" like telling someone they "should" do or be a different way. That is a sure way to create distance in a relationship very quickly, almost as fast as by telling someone they are stupid. These things certainly do not gain intimacy.

But most effective may be observing the therapist's style and emotional tone. Or you may notice that the therapist may see things very differently from the way you have seen them and wonder what he sees that you don't. You may explore why your partner's comments are so upsetting to you. What does it remind you of in your history? It can be very helpful to have a wise and experienced guide to do this and feel safe.

 

 

Gil Shepard is a licensed Marriage and Family Therapist in Walnut Creek, California

 

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Social Work | Therapeutic Relationship | relationships, friendships | marriage

Make Your New Year's Resolution an Everyday Intention

by Tami Boehle Satterfield LGSW Thursday, January 3, 2013

All packed. Note bulging (ish) suitcase

I set my intention for relaxation and peace of mind. I am about to travel almost 3000 miles across the country on a connecting flight. 

Intention is the idea of something made potential through the use of language. Through language, an abstract concept can be transformed into an organized and concrete thought. It is thoughts that inform our emotions and emotions that inform our actions. If what I think informs a healthy feeling, I am more likely to act in ways that are in my best interest. 

At this moment I am feeling anxious. My husband has already been on the West coast for a week on business. I will join him and we will spend 10 days running the coast of Monterey, hiking the hills of Big Sur, and combing the beaches for sea anemones and starfish. So why do I feel anxious? 

When I back up in time, reviewing my actions and the feelings behind them, I find the space where anxiety rose. It was just after thinking that I had successfully packed the big suitcase with 10 days worth of my husband's and my casual clothes for weather ranging in temperature from 55 to 79 degrees. I was feeling very satisfied at the moment of zipping the 50 pound bag shut. And then I thought, "50 pound bag!", and I felt fear. How was I going to carry it down two flights of stairs? What if it weighs over 50 pounds and I am required to pay extra? 

Fear escalates from anxiety to panic. Should I unpack and rethink what I am bringing? Maybe I can empty the suitcase and carry the contents to the car and pack there. How can I know if it is too heavy? Why am I bringing his clothes? I should have never... And so my monkey mind runs. 

Bringing Intention In

This is the perfect place for intention. This everyday space. This moment. A moment in my life. Here and now. I can continue along with my monkey mind and setting off fireworks, dodging land mines, lamenting down memory lane, and pointing ahead to all the ways it will never work. And it is guaranteed that I will feel miserable, defeated, and unhappy as I set out for 10 days alone with the man I love in some of the most beautiful countryside in the world. This is not how I want to start my vacation. 

I center myself. Bringing my attention to my feet, noticing them flat on the floor. Hands on my thighs, I breathe in for the count of four, hold it for two, and exhale for six. I repeat it two more times. And as I bring myself more fully present in my body, I bring my awareness to the expanisve feeling I have created. 

Body relaxed, breath slowed, mind quieted. It is in this space of time that I set my intention for travel. 

What Intention is and How to Set it.

Merriam-Webster's first definition of intention reads: "a determination to act in a certain way." Thoughts inform emotions, emotions inform actions, and actions inform future possibilities. What do I want to make possible? This is important because what I want is not the same as what I don't want. Right now, what I most clearly know is what I don't want. I don't want to start my vacation miserable, defeated, and unhappy.

In setting an intention, I empower an idea that I desire to become a reality. I choose my words to attract what I desire. Watching my words carefully, as they are the directions on my map of reality and I would like to steer myself on the most direct course to the destination of relaxation and peace of mind. Attracting all possibilities for supporting and improving my opportunities to attain relaxation and peace of mind, not misery, defeat, and unhappiness. 

Notice for yourself. Place your feet flat on the floor, hands on your thighs, and practice three breaths in this way: In for four, hold for two, and exhale for six. Now say, "I don't want to be stressed out." Notice how you feel. Bring your awareness to your feet, your stomach, your chest, and your head. What do you notice? Now, do it again and say, "let me be free to experience relaxation and peace of mind." Any difference? You might notice a calmer stomach, lighter chest, and more expansive feeling in your head. You might experience more positive sensations. 

When I am present in this moment, I find myself afraid about my 50 pound suitcase. I notice that my monkey mind takes me off to the races. Here and there. Back and forth. I breathe. Feet flat on the floor, hands on my thighs, and I breathe. I see that in this moment I am reliant on my environment. There is no other way. I am dependent on the airline to transport me, their scale to weigh my bag, and my own brain and brawn to get the darn thing down the stairs. I realize that this interdependency or oneness means a relinquishing of control. I can't possibly know all the things that might happen at any moment and all the things that are interdependent of those things. To be honest, I can't know anything for certain. And if I attempt to control that which is outside my influence, I will feel more anxious. It is at this juncture, when I am willing, that I can shift my focus from control to cooperation. This is the "aha" moment. I let go and welcome the "I don't know mind." I don't know how I will get my 50 pound suitcase down the stairs, but with some curiosity and my intention set for an expansive mind, I am sure I will figure it out. And I will feel good doing it. 

This January, when you sit down to write your New Year's resolution, carefully choose words to attract what you desire and to empower you to think, feel, and act on it. And then support it with everyday intention.

***

Tami Boehle-Satterfield, LGSW, NBCCH, HTA is a licensed professional therapist, certified hypnotherapist, and practitioner of Healing Touch energy medicine. She practices therapy from a solution oriented approach called Attention to Living Therapy. She utilizes many treatment techniques that facilitate shifts to increase motivation, creativity, and self confidence. www.attentiontoliving.com

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Self-Care

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