Vaccination
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Vaccination program
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Moderna side effects, is there anything we need to be aware of other then Pfizer type effects in Australian experience so far?
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Live answered
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When patient had covid 19+ after 1 st dose of vaccine when they can have 2nd dose of vaccine ?
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Live answered
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Being answered
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if someone is concerned about a side effect from a first dose but it doesn’t meet the official criteria for exemption can we just give them an alternative vaccine for the 2nd dose or do they need to be referred to VicSIS?
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Live answered
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Being answered
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Myocarditis/pericarditis after second dose of Pfizer. Any ideas re what will be used as booster?
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Live answered
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Being answered
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Once booster doses occur, do we know if fully vaccinated includes the 3 doses rather than 2?
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Once booster doses occur, do we know if fully vaccinated includes the 3 doses rather than 2?
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Full vaccinated by definition is when a patient has had two TGA approved vaccines. The certificate will only show the last 2 vaccines they have had
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Will novavax will be used a booster dose? Also patients who do not want Pfizer for a booster or preferred AstraZeneca, where are we with this?
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At this time, only Pfizer will be used for booster doses
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Initial investigations including troponin request and ECG should be performed in the primary care setting for patients within seven days of vaccination with the mRNA vaccine (Moderna or Pfizer) who are at low cardiovascular risk
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Live answered
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Cardiac investigations are only indicated in patients with post-mRNA chest pain
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People who had 2 doses of Pfizer which vaccine given as booster?
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All boosters will be Pfizer
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Pfizer is not suitable for some patients so what am I to tell them?
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AstraZeneca or Moderna are still available
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I can give astrazenca as a booster?
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The booster approved by the TGA this week is Pfizer. Doesn't matter if you had AZ or Pfizer for the first two doses
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Any inside info on when boosters will be announced?
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It is imminent
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What is the recommendation for patients who present more than the recommended time interval for their 2nd dose AZ or Pfizer.
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If they present “late” give the vaccine; the studies had capped time frames, but being late isn’t a reason to deny the second dose
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What is the recommendation for patients who present more than the recommended time interval for their 2nd dose AZ or Pfizer?
i.e. 6 months for their 2nd dose for AZ or 3 months for Pfizer. Wil they need to redo it again for is the 2nd dose when they present enough and have a booster dose later on?
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Live answered
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Any timeline regarding rolling vaccines for 5-11yr old?
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Live answered
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People who had 2 doses of astra and have got cardiac issues which vaccine given as booster?
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Depends on what cardiac issues, if not sure then refer to cardiologists for advice
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A patient who had Fascial palsy after AZ, and has not recovered so far (a month later) worried about having the 2nd,what is the advice?
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The advice is that if there are any contraindictations to AstraZeneca, Pfizer may be used. This includes any serious or adverse events following review by experienced immunisation provider or medical specialist. If the patient safely received the first shot of AZ, it is recommended that the second shot is administered.
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See resource
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98 yo woman in aged care had primary course of AZ (2nd in June ) This was because of history of anaphylaxis (ICU x 2) to different medications and is reluctant to have Pfizer booster. What can I tell her One for Vic sis ?
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AstraZeneca is not the preferred for use as a booster dose, however it can be used in individuals who have received it for their first doses, as long as there is no contraindications or precaution for use. https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/approved-vaccines/astrazeneca
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See resource
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I have a patient who developed Guillain-Barré syndrome after flu vaccine. They are very concerned about having COVID 19 vaccine.
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Please see the clinical referral guide to the Victorian Specialist Immunisation Services (VicSIS):
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See resource
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Someone had 2 AZ vaccine, selecting 3rd dose(not the booster ) Is it between the patient and doctor if the patient doesn't want to go for Pfizer to just give Az?
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Not approved by TGA at this stage
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For people that had AZ 4- 6 weeks apart - should they be boosted earlier?
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The current advice is that booster shots should be given 6 months after the second vaccination.
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See resource
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So do I have to refer to VicSis?
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Yes, if you are not sure
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What about a person who has myocarditis or pericarditis after Dose 1 Pfizer? Do we give them AZ or wait?
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Live answered
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You discuss it with a cardiologist before proceeding
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If a person has myocarditis like sxs after 2nd Pfizer- but normal ECG/ troponin, will Pfizer be wise option for booster?
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What about fully vaccinated and within 2 weeks of second dose? Can they also have the MAB if as those risk factors?
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Yes.
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when is novovax coming to Australia?
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Many patients after recovering from COVID come for vaccine exemption, as there were told by DHS that this is the case for 6 months, but the guidelines say that they should be vaccinated after recovery, which one is right?
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The Commonwealth Government has released information regarding the timing for administration of a COVID-19 vaccine after an infection with SARS-CoV-2, If a person tests positive to COVID-19 before their first or second dose of a COVID-19 vaccine, the person should not receive a COVID-19 vaccine until they have recovered from the acute illness and been appropriately cleared from isolation. There is no need to provide a negative PCR test or serology following an acute infection, prior to vaccination.
There is no need to wait 6 months before getting vaccinated. An infection with COVID-19 will provide some natural immunity, but we recommend that vaccination should not be delayed beyond 6-months after an acute infection, due to waning immunity.
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COVID-19 vaccine – Clinical considerations | Australian Government Department of Health
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There is mention of delaying vaccination for 90days if patient received monoclonal antibody. Should the patient who received sotrovimab be delayed vaccination for 90days?
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Treatment for COVID-19 with monoclonal antibodies or convalescent plasma, would require at least a 90-day delay in the next dose of the COVID-19 vaccine. Please refer to the ATAGI clinical guidance for further details.
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See resource
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I thought should wait for 3/12 post sotrivomab for vaccination?
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Live answered
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Vaccine exemption
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Vaccine exemption certificates -shouldn’t patients only qualify for a VE certificate if they are unable to have any of the vaccines? if they have had myocarditis and are >18 can’t they just have a dose of AZ.
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The official guideline is attached. Those with more complicate medical history should be referred to VicSIS for advice. Currently wait time is more than 2 weeks.
COVID-19 mandatory vaccincation
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I had a patient brought a letter from psychiatrist-recommending COVID vaccine exemption based on severe vaccine related anxiety.
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There are options for the highly vaccine phobic: See bottom of page.
Needle phobia
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PPE |
We are struggling to source n95 masks that fit our drs and nurses - and can’t choose which masks the PHN give us. Often they are the type the don’t fit well. Any suggestions of where to source 3m/ trident masks? Half our team have been fit tested but our usual suppliers don’t seem to have the masks that fit them in stock.
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Your PHN may have a list of suppliers to source your preferred mask.
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There is difficulty in acquiring N95 masks that can comfortably be worn by GPs? Where can we source easily?
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Not sure if the experts tonight can help but the college is working hard to negotiate with the government to provide enough and appropriate PPE to GPs via PHNs
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Do we still need to wear N95/eye protection for all patient consultations when > 90% are fully vaccinated. Do we require all patients to wear face masks in consultations? The community is opening up but not general practice - because we are still worried about becoming tier 1 sites and/ or exposing patients.
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The guideline is here and every clinic and clinicians will have to gauge their own risk appetite.
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Contact management and assessment guidance and GP telephone support line
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We had reason to call the priority telephone support line for GPs today that was mentioned at the last webinar. We had a patient in our vax clinic yesterday who did not let on (despite being screened on arrival) they were waiting for a C19 test result that was reported this AM as positive. Is there some way to give feedback on using this support line? We did not find it much help at all. There is also a new GP furloughing matrix document out as of 21/10 that we found out about later in the day.
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Yes that is correct. Things change very quickly and we are working very hard to keep the updates flowing as fast as we can. Making this website a favourite, may be helpful for all of us: See resource |
See resource |
Sotrovimab and other COVID specific treatments
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Why is Mesencure not used in sick ICU patients here. It as an astounding efficacy in getting patients home |
No randomised trial evidence yet to support the efficacy |
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If a patient is asymptomatic but has co morbidities, are they eligible? If so, do we use the swab date as the date to guide treatment commencement? |
At this point it is only symptomatic patients that are eligible |
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Is there a phone number list somewhere for each of the Public Health Units that practices can access? |
1300 651 160 Press 4 for 'Medical Practitioners' when a practice become a site exposure. Telephone numbers for LPHUs regarding patients eligibility to Sotrovimab follow this link https://www.dhhs.vic.gov.au/vaccines-and-medications-patients-coronavirus-covid-19 and then click on Sotrovimab fact sheet for clinicians |
See resource |
Can you comment on timing given some patients are presenting for testing after a few days of symptoms and test results are taking several days at the moment (regional Victoria), so theoretically we may not get the result within 5 days? |
This is one of the primary issues we are encountering. We are looking at a number of way of tackling this. |
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Patients with well controlled HIV on ART, viral load undetectable, are they eligible for Sotrovimab? |
Yes. |
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Does criteria for sotrovimab in immunosuppressed patients mirror previous 3rd dose guidelines for immunosuppressed patients? Or broader than this? |
Not that specific at the moment. I.e. defined as "other" however most likely that this will be realigned with the ATAGI classification |
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Could someone cover the evidence of benefit please (e.g. numbers needed to treat to prevent 1 hospitalisation/ICU admission/intubation/death) |
Live answered |
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Sotrovimab and vaccine temporary exemption-how long should the vaccine be delayed after the infusion please? Does the delay apply for second dose too if partially vaccinated? |
Live answered |
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In my experience, it takes many days for patients to be contacted. I worry they may miss the chance for this treatment within 5 days |
Has just been answered- yes this is an issue |
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Will there be a Medicare item number to do infusion? State funding? |
Live answered |
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Also wondering if it’s more effective if given on day 1 of symptoms vs day 5? |
Studies were not powered to look at differences within specific days. Most patients treated on day 3 of symptoms. Does take time to organise treatment so the early patients consider the better. |
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Seems it will be important to do a risk assessment of all household contacts looking for any contacts who are high risk for severe disease - get them tested ASAP and get them to report any symptoms ASAP to enable them to get the treatment in time. |
Great comment |
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How long to delay vaccination for partially vaccinated and unvaccinated after sotrovimab? |
Live answered |
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Any evidence that Sotrovimab reduces risk of long covid? |
None at this stage unfortunately |
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Is there a definite time frame at which someone is no longer infectious after Covid infection? |
Live answered |
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A lot of Vaccine hesitant patients are airing that the vaccines only have “emergency approval” and that sotrovimab is “experimental”. Can I ask how do we phrase it nicely to reassure the safety of vaccines and current treatments. I’m honestly a little lost at where we are in terms of the phases of trials and so forth |
Live answered |
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Covid positive pathways
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We don’t even know they have covid for days! They are at home with their risk factors and symptoms and no contact from anyone. I fear that GP patients are cut out of this altogether.
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We are very aware of this. We continue to advocate for linking directly to GPs
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Can we talk more about the ‘covid positive pathway’? Our GPs are at sea with it, and do not feel included, and most of us don’t really know the pathway until we get a positive patient. It seems there is a high expectation that we will be doing most of the management of covid positive patients, but at this stage we don’t feel we even know who the covid positive patients are.
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We very happy to catch up with you offline and link you in with the PHN
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Who supplies at risk patients with an oximeter in Gippsland?
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will be thought the COVID positive pathways lead. Will get exact contact details and advise via RACGP
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Care of patients
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How does it work when Medicare says we can't bill for ECG interpretation?
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There are lots of care we perform we cannot individually bill. The college fought very hard in this space and will continue to advocate. Please continue to perform ECG and interpret to provide the evidence based appropriate care for our patients.
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Exactly the guidelines for post MRN chest pain that came out in the RACGP news letter.
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That is for people presenting with chest pain post mRNA vaccine who are low cardiovascular risk: See resource
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I just think how ironic when we lost billing rights for ECG interpretation.
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Agree. We are not giving up though, working in the background.
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After 2 weeks of positive COVID test , does patients need another test too after finishing isolation?
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There is no requirement unless the patient is immunosuppressed
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If patient has covid infection and at the same time if patient need examination for legal l cases such as domestic violence how we can approach this consultation. Could we do via zoom or do we need to see them in person?
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This relates to the practice of a GP- TBA
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Testing
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Repeated PCR testing of young kids is causing significant stress. As Victoria is opening up / multiple childcare/ kindergarten outbreaks and there is an increased risk of ANY respiratory viral infection - is there any way we can change the recommendation for PCR testing in this cohort. Could we use salivary testing in children?
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As at 30 October 2021 - Saliva sampling as a last resort option for symptomatic individuals.
The throat and nose swab is the gold-standard for COVID-19 testing. This is the upper respiratory specimen from which we are most confident the COVID-19 virus can be detected. However, for some people, the throat/nose swab is not acceptable or possible. This can present a barrier to participating in testing, or can result in unnecessary distress/duress to achieve a test.
Barriers may exist for people experiencing mental health issues, disabilities and/or cognitive impairment, behavioural issues, alcohol and/or substance abuse, social and/or economic exclusion, and mistrust or fear of healthcare services. In these cases, collecting saliva may be an alternative option, and an important way to enable participation in testing.
The most appropriate sampling approach should be determined by the doctor or health professional overseeing the test. Efforts should first be made to encourage the gold standard option. There are finer and more flexible swabs available, in particular for use in infants and children. Nasopharyngeal swabbing is associated with greater levels of discomfort and pain.
Saliva sampling should only be used within 7 days of symptoms onset.
The decision to use saliva sampling should be made by the treating doctor. Caution is required in relying on saliva sampling, and clinical discretion is required on any follow-up of a negative result if SARS-CoV-2 infection is suspected. If a positive result occurs from testing a saliva specimen, confirmatory testing with an oropharyngeal and deep nasal specimen is required for definitive diagnosis of a SARS-CoV-2 infection.
Saliva sampling is being well researched in Victoria. This research is guiding us about how best to use saliva in the COVID-19 response
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