Archive | RGPAS

What matters in remote & rural practice? Your input requested…

RuralGP.com has just received this request from Elizabeth, who is seeking contributions to research that she is carrying out into the needs of remote & rural practice in Scotland.  If you are able to assist, please contact Elizabeth directly…

My name is Elizabeth Lemmon, I am a PhD student based at the University of Stirling and currently undertaking an internship at the Scottish Government within the Health and Social Care Analysis Team. The aim of the internship is to carry out some research into remote and rural general practice in Scotland in an attempt to better characterise them in terms of their activities and the challenges they face. I’m currently pulling together data which are publicly available on general practices to improve the evidence base and identify where further data analysis are needed.

I am contacting you to ask if anyone would be interested in sharing their experiences within remote and rural general practice and highlight any areas which you feel are priorities or which need further research?

I understand that there is currently work taking place within the Scottish Government on the Primary Care Evidence Collaborative which is developing a 10-year evaluation framework for primary care transformation. The work I will be doing during my internship on remote and rural practices will help to identify priorities for data, research and analysis and ensure that rural issues are included.

Any feedback is much appreciated!

Elizabeth Lemmon
Scottish Graduate School of Social Science Intern
Health and Social Care Analysis
Scottish Government
Email: Elizabeth.Lemmon@gov.scot
T: 0131 244 3469

 

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What are green lights all about?

Flashing green lights are rarely seen in cities, but they are part of an important emergency response to rural areas.  In this article we highlight the use of green lights in the provision of prehospital and other health care in Scotland.

Please help us by sharing this article with others who may be visiting rural Scotland this summer.

You’re enjoying the amazing scenery to be found on the North Coast 500 route around northern Scotland.  Behind you, you notice a car with a flashing green light.  What does this mean?…

  1. it’s a funeral director attending a sudden death
  2. it’s a vet attending an emergency
  3. it’s a doctor attending a medical emergency
  4. it’s a fashion statement

The answer is 3.

We’ve written this article as a number of our members have highlighted increasing difficulties getting to emergency calls as other road users can seem unaware of the meaning of green lights.  As we head into another busy summer to welcome tourists and visitors to Scotland’s rural countryside and islands, we thought we might provide some information about the meaning of green lights.

The NC500 (North Coast 500) seems to have particular issues – perhaps as it has experienced a significant increase in the number of people travelling along its roads, who aren’t used to driving in rural/remote Scotland.  Here’s what one of our members recently described…

The NC500 is becoming a significant concern, in particular with groups of cars travelling nose to tail in convoy and not appreciating that they will not all fit into one passing place. This as I’m sure you can imagine causes complete gridlock. Thankfully we have very few emergency calls ourselves but both of us have experienced difficulty getting past slow traffic in recent weeks despite using green lights.

My particular one was a very urgent call to **** (young man, cardiac arrest, we were told, so you can imagine how keen I was to get there safely but as soon as possible). I found myself behind a group of 3 open top sports cars. On open road they were going fast enough for me not to need past but I could see that as soon as we reached a narrow section there would be a problem. Indeed at the first passing place they couldn’t all get in, and ended up with a prolonged negotiation with a large campervan not wanting to reverse.

I had green dashboard lights on and also tooted and flashed my lights, hoping they would stay where they were and let me pass once the campervan was away, but all I got was rude gestures in the air, and they moved off very slowly, continuing in very close convoy. I assume (hope?) that they did not notice the green lights or did not know what they meant but there are other similar tales which I’m afraid make me wonder.

Spot the Sandpiper responder? They work with all other emergency personnel, including ambulance, fire, police, lifeboat and mountain rescue teams. (Staged simulation – pic by Chris Hogge).

Across Scotland’s rural landscape, the Scottish Ambulance Service rely on over 500 volunteers (probably a lot more) to augment its emergency service.  As well as First Responders (local community members trained up to use a defib, oxygen, administer CPR and deliver vital emergency care to heart attack and other seriously ill patients), there are Sandpiper BASICS doctors, nurses and paramedics who make themselves available – including in their own time – to attend road accidents, cardiac arrests, seizures and lots of other medical emergencies.  Sometimes they will be requested to attend by the ambulance service directly, or they decide to attend a patient after a phone assessment or having been informed by another community member.  We work closely with our local ambulance crews, and national services such as Helimed, the Emergency Medical Retrieval Service and Coastguard helicopters.

Green flashing lights are permitted in law – The Road Vehicles Lighting Regulations 1989 s 11 (2)(m) – to be used as “a warning beacon fitted to a vehicle used by a medical practitioner registered by the General Medical Council (whether with full, provisional or limited registration)”.  They do not permit drivers to be exempt from any road traffic laws, but serve as an important means of making other drivers aware that a doctor is on their way to an emergency call.  In rural areas – where traffic lights, 30mph speed limits and other restrictions are less frequent – it can make a significant difference if a clear passage can be enabled for doctors to attend emergencies as soon as possible.

Lights are usually only used in life-or-limb threatening situations – when time is of the essence.  Rural areas normally experience longer ambulance response times.  This is partly due to longer distances being travelled due to geography.  However many islands in Scotland have only one or two ambulances (which are normally also used for patient transport too) – so if they are unavailable, or if there are multiple casualties at an incident, a local GP, nurse or off-duty paramedic is often asked to assist.

So what should I do?

As with assisting any emergency vehicle with their progress, there is no need for erratic action.  However, it makes a significant difference to pull over safely, and allow a car behind you to get through.  If you see a doctor’s car approaching, plan ahead where possible to ‘create space’ in the road for them to pass other users, and use passing places on single track roads.  Please don’t stop on corners however, as this is a dangerous place to overtake, unless there is a clear view of the road ahead.

If it’s not safe to allow the car to pass, then don’t worry – just wait until the next suitable opportunity to pull over and let the vehicle past.

What about other responders?

The law allows only registered medical practitioners (doctors) to use green lights.  However rural areas rely on lots of voluntary responders – including lifeboat crews, mountain rescue teams and coastguard teams.  Team vehicles are often permitted to use blue lights and sirens.  Some volunteers will make themselves more visible by wearing emergency clothing en route, or by using sun-visor signs that should be visible in your rear-view mirror.

Often, they will be the first responder on scene for some time, particularly if the nearby ambulance is already busy.  Please do what you can to allow these essential services to make good progress through traffic – it could be you or your family who need their assistance the next time!

Where can I learn more?

To learn more about the role of Sandpiper BASICS responders, and of Community First Responders, watch the videos below.  Here are some links to the organisations mentioned above:

Finally, here’s two stories about where a fast local voluntary response made a significant difference…

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Podcast from @fakethom and @RuralGPScot highlights #ruralLGBTQ work in #ruralGP

Back in March, the Rural GP Association of Scotland (RGPAS) launched a range of guidance designed to make rural practice in Scotland more accessible to lesbian, gay, bisexual, transgender (LGBTQ+) patients.

At the annual RGPAS Conference last year, held in Inverness, we were delighted to welcome Dr Thom O’Neill to talk about LGBTQ+ inequalities in rural areas, and some of the practical ways that as GPs we can reduce barriers to healthcare.

Thom’s presentation stimulated a lot of discussion, and led to a project whereby he worked with RGPAS to develop factsheets, posters and other materials to help rural GP practices ensure that their services are welcoming to LGBTQ+ patients – especially younger patients.

You can find out more about these resources at: www.ruralgp.scot/lgbtq-plus.

We are aware that since then a number of GP practices have had discussions in their teams about how to make their health services more LGBTQ+ accessible.  We’ve also had a number of international enquiries about this work – including from Canada, New Zealand and Australia – who have been keen to use this work to increase awareness.

Thom has also been asked to adapt the factsheets for secondary care use in some parts of Scotland too.  So, as expected, the theme seems to have resonated with a wide number of clinicians and service managers.

Thom and David recently caught up to discuss how these guidelines came about, and to explore some of the themes of why LGBTQ+ patients seem to face specific inequalities of access to health care – and how rural practice has some unique opportunities to improve this.  We hope to have Thom back to this year’s RGPAS Conference (2-4 November, once again in Inverness – details soon) for an update on what how this work has been developing.

You can listen to the podcast here:

In the podcast above, we make reference to the work of Alex Bertie about recording his experience of seeking help and assistance with gender dysphoria.  Alex’s videos make for some insightful and compelling viewing, but this one is specifically about his thoughts about the GP consultation – and the difference that a more supportive and informed consultation can make particularly at a challenging and difficult time.

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Report from Islay: GURRMS Medical Student Conference

Student led conference in Islay provides novel long-term solution to rural GP recruitment

By Keenan Smith, Gregor Stark and Alistair Carr

Six months ago, we were sitting in the Glasgow University Union listening to Alistair explain his plan. He’d just returned from a five week GP placement on Islay where his eyes had been opened to the challenges and excitement that lay in rural general practice.  Despite the recruitment crisis facing general practice everywhere, and rural general practice in particular, he was convinced that if other students could experience what he had, it would inspire them too.

That evening, the five of us formed the Glasgow University Remote and Rural Medicine Society (GURRMS).  Our founding goal was to host a conference with a real and lasting impact.  With a message that no delegate could ignore: rural GP provides an exciting and dynamic career that should not be written off as a sleepy backwater of a career.

We wanted to create something that would change not just how 60 medical students thought, but that would become a staple of the undergraduate social and educational calendar – changing perceptions for years to come.

If we were going to make that much of a difference, we were going to have to think big.  We knew this had to show off everything that rural practice had to offer and that this meant going to Islay.

The Gaelic College in Bowmore was the conference venue

To say we didn’t have doubts would be a lie, we had thousands, but the largest was the central premise of the entire project: if we offered this to students, would they even want to come? A close second to this was: how would we find the funding for a conference involving the immense logistical challenges of providing transport, accommodation, and catering in an island with a permanent population of 3,500.

Despite our reservations our 60 delegate tickets sold out within four and a half hours – clearly demonstrating the demand among medical students for more exposure to rural practice. Following this, we were successful in securing sponsorship from organisations that were able to appreciate the vision and scope of what we were trying to achieve.

Dr Angus MacTaggart explaining the joys of being a rural GP

When Friday 10th of March came around, every seat in the Gaelic College was filled with eager students. Most were from Scotland but some had come from as far away as Plymouth, Oxford and Hull.

A spectacular view across Loch Indaal was the backdrop to the inaugural National Undergraduate Remote and Rural Medicine Conference. The morning session started with a talk by Dr Angus McTaggart defining what rural medicine is and the rewards it can offer. This was followed by the EMRS team talking about their role and how they interact with rural GPs.

EMRS doctors Michael Carachi and Kevin Thomson

Following a short break Dr Kate Pickering talked about the importance of medical leadership, after which a workshop took place. This gave the opportunity for two of Islay’s retired GPs, Drs Chris Abell and Sandy Taylor, to engage the students in a discussion about the benefits and challenges of working in a rural environment. Simultaneously to this another workshop took place, led by the Rural GP Fellows Drs Jess Cooper and Durga Sivasathiaseelan, leading a discussion about how to act in a rural emergency and also providing information about the Rural GP Fellowship programme.

During lunch the students chatted with patients who had volunteered to come in to speak about their experiences of rural healthcare and also to give a flavour of island life. Following lunch, Mr Stuart Fergusson kicked off with a talk about rural surgery in Scotland, after which Professor John Kinsella, Chair of SIGN Guidelines, gave a talk about the limitations of guidelines in a rural setting where he made the interesting comparison of rural medicine to the ICU environment.

Obligatory visit to sample local produce!

After another break, with more excellent catering by the Gaelic College team, the EMRS guys provided a brief overview of the realities of pre-hospital care which was then followed by five student presentations. These provided a showcase of the projects that students have undertaken whilst on rural placements or undertaken during intercalated degrees. The educational content of the day finished with a panel discussion about what Realistic Medicine is and how that applies in the rural context.

The Saturday was used to explore rural life and further experience the community we were being invited to be a part of. Some of the students explored the beautiful scenery by going for a hill walk and some participated in a joint RNLI and coastguard training exercise which involved three of the students being winched out of the sea. For the students that had caught wind of Islay’s whisky reputation, a tour of the Bruichladdich distillery was arranged where they were treated to some proper Islay hospitality.

Students participating in the Saturday hill walk

The informal feedback we have got thus far has been overwhelmingly positive: certainly more than one rural elective is being sought after last weekend. A recurring theme has been how impressed students were by the strength of the island’s community and the generosity of the locals.  Formal feedback is in the process of being collected and will be made available in due course.

The 2017-18 GURRMS committee has now been elected and have exciting plans for the future. Watch this space!

GURRMS 2017-18 committee – what does the future hold?

Cool shades featured throughout the conference!

GURRMS would like to thank all our speakers: Dr Angus MacTaggart; Dr Michael Carachi and Dr Kevin Thomson; Mr Stuart Ferguson; Dr Kate Pickering; Dr Jess Cooper and Dr Durga Sivasathiaseelan; Dr Chris Abell and Dr Sandy Taylor; Professor John Kinsella; Cameron Kay; Beth Dorrans; Josie Bellhouse; James McHugh; Eloise Miller and Hannah Greenlees.

Also our sponsors: the Royal College of Physicians and Surgeons of Glasgow; the Rural General Practitioner Association of Scotland; the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh; the University of Glasgow; NHS Highland and Bruichladdich distillery.  And finally a huge thanks to all of the medical team of Islay for your support and for believing in us.

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@RuralGPScot launches #ruralLGBTQ resources for #ruralGP

Last week, the Rural GP Association of Scotland (RGPAS) launched a range of guidance designed to make rural practice in Scotland more accessible to lesbian, gay, bisexual, transgender (LGBTQ+) patients.

At the annual RGPAS Conference last year, held in Inverness, we were delighted to welcome Dr Thom O’Neill to talk about LGBTQ+ inequalities in rural areas, and some of the practical ways that as GPs we can reduce barriers to healthcare.  Here he is talking about what doctors can do to better support LGBTQ+ patients.

Thom’s presentation stimulated a lot of discussion, and led to a project whereby he worked with RGPAS to develop factsheets, posters and other materials to help rural GP practices ensure that their services are welcoming to LGBTQ+ patients – especially younger patients.

You can find out more about these resources at: www.ruralgp.scot/lgbtq-plus.

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RGPAS Scholarships – for students and GPs

2015logopngApplications are invited for a number of scholarships made available by The Rural GP Association of Scotland (RGPAS).  Funded by the RGPAS Educational Trust (which also receives any monies raised through RuralGP.com advertising) the scholarship scheme aims to:

  1. Encourage and enable Scottish students to experience a Rural GP elective in Scotland, and
  2. Support members of RGPAS (GPs and ST Trainees) to attend international conferences, in a bid to promote international collaboration, awareness of Scottish innovations in rural general practice, and to experience the benefits of seeing innovation from across the world.

Undergraduate Elective Scholarships

In 2017 there will be five student elective scholarships available, each to a value of £200.

  • This can be used to fund accommodation, travel or other associated costs. Receipts may be requested at the committee’s discretion.
  • The student must be doing their elective at a Scottish rural practice where at least one GP is a member of RGPAS. The student must be at least 20 miles away from their home address.
  • Electives may take place at any time of the year, and be for a minimum of 4 weeks.
  • The student must be an undergraduate medical student from a Scottish university.
  • The student should submit either a 500 word report or a video (of 3 minutes or more) about their experience within 2 months of the end of the elective. They may be asked to present at the next RGPAS conference too, if they are able.
  • Details of successfully awarded scholarships will be made available to RGPAS members, and also via the RuralGP.scot and RuralGP.com websites.

GP Travel Scholarships

In 2017 there will be four travel scholarships available. Nominally each of these will be worth £500, however some flexibility may be applied by the Committee to support applications which require more or less than this amount.

  • The applicant will be a member of RGPAS for at least 3 months prior to application. They will be a GP or a GP Trainee (at any stage of ST training) currently practising in Scotland.
  • RGPAS Committee members are eligible to apply.
  • The recipient should attend a conference in a country other than the UK. There will be a preference for activities that foster new relations with other country/world organisations such as WONCA or rural GP associations.
  • The money may be used for travel, accommodation or locum costs associated with attending a conference, event or experience in rural practice
  • The recipient should submit either a 500 word report or video (of 3 minutes or more) about their experience within 2 months of the end of the travel period. They may be asked to present at the next RGPAS conference too, if they are able.
  • Details of successfully awarded scholarships will be made available to RGPAS members, and also via the RuralGP.scot and RuralGP.com websites.

How to Apply

  • Please read the application pack – available from the link button below – and submit it as instructed.
  • Closing date: 6pm Friday 27th January 2017
  • The RGPAS committee will meet virtually, to discuss and judge the applications. Their decision will be final. They may decide not to award all available scholarships.

RGPAS is keen to ensure that this investment in future GPs as well as the development of its existing members, will help to generate innovation, collaboration and inspiration across Scottish rural general practice.  We look forward to receiving applications!

Download application form
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#RGPAS16 a major success

Last week, over eighty students, trainees, new and more experienced GPs from across Scotland and beyond, met at the annual conference of RGPAS.  An action-packed programme provided a wide variety of clinical and non-clinical topics, and there were plenty of opportunities to meet and discuss rural practice.  Rural GP-ing in Scotland is a simulating place to be!

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Scroll to the bottom of the page for more conference photos…

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But we had some GPs from further afield too!

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Rural GPs from across Scotland came for the conference…

Kicking off the programme, we heard from Dr Helen Brandstorp of the National Centre for Rural Medicine in Tromso, Norway.  Helen provided a good backdrop to the fact that “we’re all in this together” – the challenges and delights of rural practice are prevalent in Norway in similar levels to Scotland.  The ground is fertile for further collaboration with international confreres and we hope to see ongoing links with our Norwegian counterparts in rural medicine.

The rest of the conference featured a rich variety of clinical and non-clinical topics of relevance to rural practice.  We were lucky to have an excellent range of engaging and entertaining speakers.  From updates in emergency medicine, to humanitarian and MSF work, to developing rural LGBT-friendly health services, to IT Reprovisioning, to research tips, to rural surgery, to featured student presentations… there was plenty going on, and the conference dinner provided plenty of opportunity to make further connections and allow the conversations to flow, along with a bit of traditional music too.

We were delighted to host a good number of students, trainees and new doctors… in particular there were nineteen heavily-subsidised student places – and they didn’t disappoint in their contributions of innovative ideas throughout the conference.

Instead of listing all the speakers here, the programme remains available – and we were delighted that over 200 #rgpas16 tweets were exchanged in the course of the conference.  We’ve collated these with Storify, and you can view the Storify timeline here.

Here’s a few of the twitter highlights:

The conference rounded off on the Saturday with a visit to the Bristow Coastguard helicopter base at Inverness Airport, where Winchman Paramedic Duncan Tripp and his colleagues treated student and experienced GPs to a tour round the facilities, including one of their £26 million Sikorsky search and rescue helicopters.

Thanks to all those who presented, and to all others who contributed to the conference planning.  The event proved to be fun, engaging and relevant to rural practice.  We hope to do the same next year – provisionally booked at the Craigmonie Hotel again on 2nd-4th November 2017.  Meantime, at RGPAS we are keen to stimulate and encourage further work in Scottish rural practice.  A new committee was formed, and I am delighted to take the helm of an able and enthusiastic team.  It’s going to be an exciting year!

Here’s some photos of the event…

 

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Who’s speaking at #RGPAS16?

We have a wide range of presentations at the Annual Conference of the Rural GP Association of Scotland, which starts this afternoon.

You can follow the conference on twitter using #rgpas16, and view the programme here.

Here’s some introductions to just a few of those who are speaking over the next two days…

Helen Brandstorp, lege, UNN, Tromsø

Helen Brandstorp was trained and worked as a GP (1998-2006), in the northenmost county of Norway. She has a special interest in collaboration in prehospital emergency medicine and organisation of healthcare, and hopes to defend her ph.D thesis in a few months. Since 2013 she has been the director of the National Centre of Rural Medicine, located in Tromsø, at UiT The Arctic University of Norway. 

 

 

 

 

 

dawsonKate Dawson is a GP partner at Benbecula Medical Practice and Clinical Lead of the community hospital.  She has recently completed a Scottish Patient Safety Fellowship.  She has interests in dermatology, acute rural medicine, and is a jeweller, leprologist, gardener, tweeter, mother, wife, felt-maker – no end to the roles you can rock as a rural GP!

 

 

 

 

maclean

Sarah Maclean is a Senior Clinical Fellow in Aeromedical Retrieval with the Emergency Medical Retrieval Service and a Specialty Registrar in Anaesthesia & Intensive Care Medicine in Tayside. She is interested in teaching and contributes regularly to undergraduate teaching at the Universities of Dundee and Aberdeen. Her other interests include altitude physiology and rural critical care. In her spare time she enjoys mountain biking, hillwalking, ski touring, playing music, baking, and visiting Scottish islands.

 

 

 

 

james

James McHugh is a 4th year student at the University of Glasgow. At the University he is the secretary for the General Practice society, where they hope to engage new and current students in the excitement and challenges of general practice. James has a passion for GP and a new found interest in rural medicine after undertaking an elective on Arran (where he spent an evening with the lifeboat crew – see picture!).

 

 

 

 

 

wilsonPhil Wilson worked as a partner in a small practice in Glasgow for 23 years while building a wide-ranging list of research publications as a part-time researcher at the University of Glasgow.  His practice was one of the first research practices in Scotland and Phil was awarded a primary care career scientist award in 2003. His research interests lie in the development and evaluation of complex interventions to improve health.  Since 2012 Phil has worked as professor of primary care and rural health at the University of Aberdeen, based in Inverness, and he holds visiting professorships at Gothenburg, Copenhagen and Glasgow Universities.  He continues to work in Inverness as a GP one day each week.  He has published over 110 peer reviewed papers: details at http://www.abdn.ac.uk/staffnet/profiles/p.wilson/

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#RGPAS16 brimming with student ideas for #ruralGP

newlogosquaretextToday over 80 students, trainees and rural GPs will meet up in Inverness, for the annual conference of the Rural GP Association of Scotland.

This year’s event has attracted record numbers of attendees, and a stimulating programme of events is in store, along with lots of opportunities to chat, network and seek new ideas for rural practice.

As part of the RGPAS student scholarship programme, we have encouraged student delegates to submit video or audio clips of around 60 seconds, outlining their visions of the future of rural practice.

Not all clips are available as yet, and we will develop this page over the next week to include more clips, as well as add the photos of RGPAS students on this page too.  In the meantime, take a listen to the diverse and innovative ideas being put forward by the students below, all of whom will be joining us in Inverness.  Great to hear such an inspired group of students!

The conference will run from 2pm today – Thursday 3rd November – to Friday 4th November.  You can follow events on twitter using the hashtag #RGPAS16 – we hope to share reports and presentations from the conference on RuralGP.com soon after the conference too.

 

Innovation ideas

Sally Andrews (Aberdeen University): On the role of telemedicine to improve patient care and good housing availability to improve recruitment to rural areas…


Joe Daley (Glasgow University): Improving the interface between rural primary care and secondary care input…


Rhys Hall (Glasgow University):  The use of drones to overcome geographical barriers of rural practice…


Catherine Lawrence (Hull & York Medical School): Reflects on her experience of a Scottish rural GP elective…


Scott MacDonald (Glasgow University): Using technology to allow patients to take more responsibility for monitoring their health…


Lean-Lik Ng (Dundee University): How to engage with medical students of today to pave the way for future rural general practice…


Iona Robertson (Dundee University): Describes the increasing role of telemedicine in reducing the need to travel longer distances to secondary care…


Keenan Smith (Glasgow University): Reflecting on infrastructural revolution to provide better access to rural healthcare…


Blair Wallace (Dundee University): On the role of point-of-care investigations in improving efficiencies and quality of care offered to rural patients…

 

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