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Heart health is predominantly a matter of how we live our lives, as opposed to being determined by the miracles of Medicine, spectacular though they are. The central message from the biofeedback perspective is to make people aware of how much control they can in fact exercise over their own heart function. It is not just a matter of diet, exercise, weight loss, and if necessary, medical management of cholesterol and of high blood pressure, with perhaps a baby aspirin thrown in for good measure.
We can also influence our heart function immediately and directly, both through our control of the breath and through the management of our emotional state. Simply by attending to our own breath, by moving it toward calmer and slower rhythms and by shifting toward abdominal breathing, we can alter the state of our physiology profoundly in the moment. Extended practice, conducted at moments of opportunity, can promote healthier habits over the long term. Similarly, attending to the extremes of our emotions can also be very helpful. The stealth killer in heart disease is uncontrolled anger. But unrelieved grief can also lead quite literally to a "broken heart."
The most straight-forward intervention is training toward healthy heart dynamics, a technique now known as Heart Rate Variability (HRV) training. Ideally the heart exhibits healthy variation from moment to moment in its function, as it responds to the external and internal environment. When it ceases to be able to do that, cardiologists look upon this as the best predictor of cardiac mortality. It was shown in Russian research that this measure is directly trainable, and it appears that people are better off for having made the effort. No long-term outcome data are available yet, as this technique is relatively new in the United States.
With general Neurofeedback / EEG Biofeedback training, the whole enterprise of improved regulation can be significantly helped. The body will gravitate toward calmer and more stable regulation, and the person may no longer be in the grip of extreme emotions. Neurofeedback does not erase either anger or grief, but it can help to tame the experience and moderate the physiological excursions.
Neurofeedback can also help by allowing people to function with lower levels of those medications that may influence the heart unintentionally. This includes some of the medications for the ADHD spectrum, such as the stimulants and Clonidine. People at risk of cardiac events should consider a combination of HRV and Neurofeedback training to gain a higher level of mastery over their condition.
Heart emergencies may be attributed to arterial occlusion, but such occlusion most likely did not have sudden onset. The immediate emergency was likely caused by the disregulation of heart rhythms. The deliberate training of heart rhythms makes sense as a contributory preventive measure.
IQ Change
CP Bachers
Associates List 5/18/4
I have a clinical report in the most recent issue of the Neurofeedback Journal on a young man I worked with over a long period of time with birth trauma CP. Results - IQ pre/post 48/71. He also went from being raised in isolation due to hours of decorticate-seeming moaning and spasticity when exposed to any sudden auditory stimulus - laughter, applause, commercials, restaurant noises, etc. to attending a rock concert given for him to raise money for a wheel chair lift for their car. It is a long haul, should entail home training, and ultimately very satisfying for all.
Case Report:
A clinician reports:
I worked for a long time with a boy with CP due to a stroke in utero. He was hemiplegic on the left side. He was having seizures, hearing voices, could not read or do math, and the classroom was too stimulating for him.
About two years into his recovery work with Neurofeedback / EEG Biofeedback his mom took him to Canada for hyperbaric dives at more affordable rates than were available locally. He came back after a summer able to use his left hand and move his left ankle. He worked a couple of years more with Neurofeedback and earlier this year he graduated from high school - a class of one student!
He is now going to Community College and is an instructor at the local equestrian center teaching developmentally disabled children how to ride. His parents say that he never could have achieved all that if it had not been for Neurofeedback. About two years ago he was awarded his Eagle Scout award. The Court of Honor was held on the flight deck of the USS Abraham Lincoln, docked in the Everett Home Port. The Governor of Washington at the time, Gary Locke, pinned on his award. Governor Locke had been an Eagle Scout too. It was a tremendous day.
The following report is from a Neurofeedback clinician:
The following case dates back to 1997, when we employed much more limited techniques than we do now. But it shows that we have been working successfully with cerebral palsy for more than ten years (It has actually been nearly twenty).
The report: In 1997 I trained a 7-year-old girl who was diagnosed with cerebral palsy. This young girl was barely able to walk and was being raised by her grandparents because her parents couldn't manage caring for her when her younger sister was born. Fortunately her wise grandfather had exercised with her daily to keep her muscles somewhat supple. By the end of her training (60 sessions) she was walking much better and in fact was able to run up the stairs after her sister. Her teachers reported that her attention and concentration levels at school had skyrocketed and her grades went from D's and F's to A's and B's. Her anxiety decreased and she was a much more functional child.
Chemo Brain is a colloquial term for the cognitive fog and mental confusion that often accompanies chemotherapy treatment. This has been an "inconvenient truth" around chemotherapy for a long time, one that was too readily dismissed by oncologists. A recent study at UCLA found that the effects might linger for up to ten years.
There are two issues here: The first relates to how the person feels while undergoing chemotherapy. The second relates to lingering functional deficits after the treatment program has been completed. Neurofeedback can be helpful in both domains.
Neurofeedback / EEG Biofeedback is a form of brain training where we use a computer program to assist the client in shifting brain states. A session feels like playing a computer game but you're playing it with your brain. When your brain generates optimal brainwave activity,the spaceship on the screen flies more rapidly and you hear the appropriate sound effects. In fact, the sounds reflect brainwave activity. When you space out or tense up, the spaceship slows down and the sounds diminish. During a session, the client may shift brain states in a subtle way thousands of times. This process of shifting states is the exercise and over time, creates a more stable and resilient brain.
During chemotherapy, we often find the following symptoms: fatigue, irritability, anxiety and depression, mood swings, insomnia, and pain syndromes. With Neurofeedback, we are able to address these issues.
We challenge the brain to function better in the moment, and track symptoms along the way to monitor progress. Much Neurofeedback / EEG Biofeedback training addresses organic brain deficits, so we have an advantage here in that the person was likely quite functional before the chemotherapy. It is a matter of accessing or restoring function, not of training it in the first place.
With Neurofeedback / EEG Biofeedback training we expect benefits not only in terms of general regulation (quality of sleep, maintenance of vigilance, pain and suffering) but also with respect to emotional regulation and specific cognitive function (executive function, working memory). The person is likely to experience a kind of "toughening up" that can be helpful in enduring the procedures. Since the chemotherapy "insult" is ongoing, the Neurofeedback training may also have to be repeated numerous times during the therapy.
In Neurofeedback application to functional recovery after the active chemotherapy treatment has been completed, we see the problem generally by analogy to chemical injury, to multiple chemical sensitivity, and to minor traumatic brain injury. There is a great deal of commonality in symptom presentation among these conditions, and patterns of recovery are similar as well.
The problem of "chemo fog" may be particularly severe in the case of breast cancer, apparently due to possible influences on hormonal regulation. For these cases, we can draw on analogies from our work with PMS and menopausal symptoms. Finally, there is the observation that cognitive processing in affected individuals is accompanied by higher metabolism than in unaffected individuals. These brains are functioning, but they are working harder to accomplish the same task. It should not come as a surprise that explicit training might help in such situations. The frequent report of trainees is that things just get easier in their lives.
One of the recent studies on chemo fog found certain brain regions involved in cognitive and attentional processing to actually shrink in size somewhat over the course of treatment. Three years later, however, the original size had been recovered. The structural recovery is reassuring, but it is by itself no guarantee that functional recovery occurs as well. The neurological integrity of neuronal resources is a separate issue from their proper functionalintegration. On the other hand, the observation of regrowth supports the supposition that functional recovery should be possible.
Home training options are beginning to make their appearance, so that in future trainees may be able to combine in-office training sessions with home-based complementary training. This should make the training much more economical overall, as well as allowing the affected person to train more frequently in order to maintain peak functional status.
The reader is invited to start this section by reading the entry for "Brain Injury" above before proceeding with the following. Chemical injury refers to such events as exposure to carbon monoxide, cyanide, hydrofluoric acid, chlorine or bromine gas, or high concentrations of CO2. The consequences typically consist of diffuse injury to the brain. Such injury can have large functional implications, but these are typically remediable with Neurofeedback. That is to say, the chemical injury is often well short of precipitating cell death, but the insult is such that the brain may lose function. Such brains have considerable recovery potential, and such potential can be drawn upon with our training techniques.
One consequence of chemical injury may be the development of Multiple Chemical Sensitivity (see below). The life-threatening trauma that the chemical exposure represented for the person served to sensitize the nervous system not only to the agent involved but to anything that may be correlated with it. The CNS may become hyper-sensitive to a broad range of chemical agents and even to common solvents kept under every kitchen sink. Neurofeedback / EEG Biofeedback can be profoundly helpful in gradually moving the nervous system to a calmer and more controlled state. Standard biofeedback methods can usefully be brought to bear as well.
Calming the chemically injured and traumatized brain is the first order of business for the clinician. That opens the door to everything else that needs to be done. The hyper-excitability and hyper-sensitivity that the chemical exposure triggered is not helpful to the person over the long haul. It is actually counter-productive over time. But the nervous system cannot climb down from such a state by itself, typically. It needs a guiding hand.
Once the nervous system is sufficiently calmed, additional functions may be specifically targeted. Autonomic (involuntary) nervous system functioning is a particular case in point. Finally, the psychological trauma associated with the event can be addressed with Neurofeedback as well.
- Childhood Bipolar Disorder
Pediatric and Early Adolescent Bipolar Disorder (PEA-BD) is just in the process of coming into focus. The diagnosis of childhood bipolar disorder used to be so extremely rare that it was not even listed in the Diagnostic Statistical Manual of psychiatry. Its increasing prevalence parallels that of autism, asthma, the ADHD spectrum, and childhood depression to indicate that mental health indices are declining for a significant fraction of our youngsters.
The prominent clinical features of pediatric bipolar are rapid mood swings, labile mood, high irritability, rage behavior that is difficult to abort, episodic euphoria, and grandiosity. The presentation may be very different from the classic manic-depressive pattern of adulthood.
All these refined clinical distinctions don't matter so much when it comes to Neurofeedback. The clinical features point to a pervasive pattern of disregulation in which the brain is unable to maintain state. From our perspective the remedy is straight-forward. It is to train the brain toward greater stability. So the various symptoms may not even require targeted approaches. It may be largely sufficient to target the underlying instability. Whatever remains in terms of symptoms can then be more specifically targeted.
The concern about diagnostic distinctions is indeed important in the psychiatric realm because pediatric bipolar disorder is often swept up in the more common ADHD diagnosis. The problem is that the typical medical remedies for ADHD may be entirely inappropriate for childhood bipolar disorder and may even make things worse. None of this presents a comparable challenge to Neurofeedback. If the child presents with symptoms of nervous system instability of any kind, then the appropriate training approach is adopted.
We have in fact been very pleased with our results with childhood bipolar disorder. Many of these children present a considerable challenge to their families. Parents may even be fearful of what they children may do, or how they will grow up. With Neurofeedback, the trajectory of these children can typically be turned around quickly. Longer-term training is often needed, but once the child is better regulated the parents can continue the training at home under clinical supervision.
There is no known remedy for Chronic Fatigue Syndrome, and Neurofeedback does not constitute a remedy either. However, it can be helpful as part of an overall treatment program. In the early days of our work, we would feel gratified if we could boost the energy level of the chronic fatigue sufferer. However, these benefits often proved merely transitory. Sometimes the person would feel so energized that he or she would immediately plunge back into the maelstrom and then relapse soon after. So a more gradual building of support for a higher level of function is more appropriate. The symptoms of Chronic Fatigue Syndrome overlap considerably with those of Fibromyalgia (see below), where we can be helpful as well.
One of the prominent applications of biofeedback has been to the area of chronic pain. Most recently, it has been found that EEG biofeedback can be particularly helpful here as well. Startling results are coming out in which profound symptom relief can be obtained within a single session, although these gains are usually transient. Over time, clients can be trained to the point where these gains can be held onto permanently.
Chronic pain patients exhibit a variety of disregulations, not only pain. But when pain is present, it rises to the top of our hierarchy of needs. And in chronic pain the pain level is so severe that the sufferer may well not wish to continue with this life at all. Among chronic pain patients there is a very high incidence of early childhood trauma. The correlation is so high that is seems as if the trauma sets people up for chronic pain. For this reason it is never sufficient simply to address the pain, even if we did know how to do that systematically. One needs to also address the trauma. That rarely happens in a medical setting where the attention is focused on medical remedies such as implants and blocks.
The importance of trauma in the history of chronic pain patients highlights for us the importance of the psychological realm. Chronic pain is subject to regulation by the central nervous system, which we have access to through Neurofeedback. With our intervention we improve the entire regulatory environment of the chronic pain sufferer, and with that the level of perceived pain improves as well. Then a second kind of Neurofeedback addresses the residual consequences of early trauma, and that may have the effect of changing the person's relationship to his pain. Mastery over the trauma may also carry over into mastery over the pain. The point may be reached at which the person may no longer be bothered by the pain even though, if asked, the pain may indeed still be present at some level.
It is the central fact of chronic pain that it has a significant component involving central regulation, and this fact frustrates all of the medical approaches to pain that attempt to address the source of the pain. The late Professor Liebeskind at UCLA, who specialized in pain, liked to recite a case in which a chronic pain patient was subjected to one procedure after another. As a tenth and final attempt to resolve the pain, a kind of frontal lobotomy was performed on the woman. Her pronouncement afterwards: I still feel the pain, but now I no longer care. Although this history is fortunately not being repeated anymore these days, the story does resonate with modern thinking. We may not be able to extinguish chronic pain, but we may be able to move the person to where he or she is the master, not the victim of the pain experience. That sense of mastery may be the key to what is doable at the present time.
Case Vignette:
Chronic pain cases are almost always complex, involving a variety of medical and psychological issues. The following case vignette illustrates this:
The case relates to a middle-aged woman who has suffered from fibromyalgia and migraines for the last four years following a relatively minor accident. The accident appears to have either triggered or intensified an autoimmune condition. As this condition progressively worsened, not only did she struggle with fibromyalgia and migraines but also with rheumatoid arthritis in her hips and lower back. Chronically high levels of inflammatory factors were observed in blood tests. Over the last year her life was further complicated by chronic severe gastroparesis. After many hospital tests and trial medications the only remaining medical option recommended to her by her doctors was an experimental gastric pacemaker implant to support an under-active vagus nerve.
Alongside the more immediate medical issues, this person was also having difficulty with depression and anxiety, for which antidepressants had not been found helpful. She came for neurofeedback to help with the anxiety and depression. She had not known about neurofeedback previously.
By the time of this writing, fifteen sessions of neurofeedback have been done. For the past five weeks she has had no migraines, only one episode of a fibromyalgia flare-up that lasted just one day, and no attacks of gastroparesis. Additionally she is sleeping through the night, which was not the case before. Most remarkably, a blood test revealed that her inflammatory factors had returned to within normal range.
A medical practitioner reading this might well opine that the relief from gastroparesis should be understood within the medical model. However, it is also possible that vagal nerve activation renormalized with the neurofeedback training. After all, vagal nerve stimulators are sometimes used for the control of seizures, for which neurofeedback efficacy has long been established. A similar mechanism could be at work in both situations.
Remarkably, it is possible to use Neurofeedback techniques to help people come out of the coma state and to help those labeled as being in "persistent vegetative state." We have made a dreadful error in concluding that if a person had no motor output function then he was ipso facto also unable to process sensory inputs. Again, the new imaging techniques have shown us the error of our ways. It is actually quite remarkable that this has taken so long, but in September 2006 we now have the first evidence from imaging of a coma patient responding in brain activity to the command to "imagine yourself playing tennis."
Of course not all people in vegetative states exhibit such an ability, but the point is that some do, and that has implications for recovery. Neurofeedback takes the empirical approach, since functional imagery is not usually available. The person is reinforced in certain kinds of brain activity, and if there is a response, then indeed the brain must have been attentive to the information.
For what has gradually come to be hundreds of people in coma, a one or two-day trial of Neurofeedback has been sufficient to bring people to consciousness. Percentage of success is not an issue here. The fact that this happens at all is remarkable all by itself. This work has literally been going on for decades. Medical observers of these recoveries would always treat them as isolated events or as spontaneous recoveries, but when viewed collectively they must be seen as indicating a substantial recovery capacity that can be systematically appealed to.
The coma recovery process also tells us something about Neurofeedback, which is that consciousness is not necessary to achieve the result. Our conversation is really with the brain, and the person at issue just has to bring his eyeballs and ears and make the brain available to train. So, we now know to a certainty that even the brain in coma may be able to appraise and react to the environment, and may be in a position to process information provided through Neurofeedback. Remarkable.
Also known as Temporal Lobe Epilepsy, we are dealing here with a common seizure pattern that is often resistant to medical interventions, sometimes even leading to the recommendation of surgical resection of the anterior temporal lobe. This part of the bran is quite vulnerable because of where it juts out of the brain, and because of its proximity to its bony enclosure. Head injury that causes our spongy brain to slosh about within the cranial cavity affects no cortical structure as much as the temporal and the frontal lobes.
Fortunately, Neurofeedback can be very helpful here in the event that medication does not lead to the full subsidence of seizure incidence. We may not succeed completely either, but Neurofeedback should be at least comparable to what one expects for an anti-convulsant.
Neurofeedback should be considered particularly by candidates for surgery. It is a much cheaper option, obviously, and one does not lose part of one's brain. A series of twenty training sessions should give a good indication of what is possible here. As a practical matter, few people who have chosen to do Neurofeedback have ever gone on to undertake brain surgery. The numbers are small, but sufficient to say that the vast majority gain sufficiently from Neurofeedback that surgery is put on the back burner.
Even more significant, perhaps, in the overall scheme of things is the population where subtle temporal lobe injury is present, but it does not rise to the level of causing overt seizures. In this realm, a sub-clinical presumptive seizure focus can influence other behaviors of the child or adult. There are reasons to think that this is one of the chief mechanisms for a lot of episodic violence and other criminality. Everyone in our prison system should be getting Neurofeedback training before they are allowed back on the street.
- Complex Regional Pain Syndrome
Significant progress has been made over the last several years in combining Neurofeedback with the best medical treatment for this condition. In such a combination, the benefit derived from Neurofeedback still stands out. It should therefore be considered as part of any treatment program for CRPS, which is also called Reflex Sympathetic Dystrophy. As in all other cases of chronic pain, one must then go on to treat the trauma dimension of this condition, which can also be done with Neurofeedback.
The research on Neurofeedback for this condition is wending its way currently through the publication pipeline. But clinical methods are changing underfoot even as this is being written. No chronic pain patient should have to suffer without the chance of trying Neurofeedback.
Compulsive behavior, in association with obsessional thoughts, takes many forms in different people. But individualized and highly routinized patterns of behavior do emerge, so we must be seeing a combination of a general brain proclivity and of a specific set of learned behaviors. With Neurofeedback, we might expect to deal with the brain proclivity, but not necessarily with the learned behavior. As it turns out, that is generally sufficient. If we back the brain away from its "self-trapping into compulsivity," the behavior tends to fall away.
Often the compulsions are around issues such as grooming behavior, food, or other very basic biological functions that we either cannot give up, or have no intention of doing so. Abstention is either not an option or it is not in prospect. Normalization of function is therefore only viable objective, as is the case for so many other issues under discussion in this compilation.
Calming the brain, which is an overall objective in much of Neurofeedback, generally also has the benefit of reducing compulsive behavior. But protocols have been developed that help specifically with this condition. These focus on pre-frontal function and on left-hemisphere function. In the language of neurochemistry, we are no doubt influencing primarily the frontal dopamine circuits. These are crucially involved not only in executive function and motor planning, but also in our experience of reward. That said, it is one of the advantages of Neurofeedback that it does not target one neuromodulators system or another, but rather the orchestration of the whole. We could just as well conjecture that we are influencing the serotonin system, which promotes a sense of well-being that can overcome the feeling of incompleteness that drives compulsions.
It turns out that all compulsions, regardless of their specific object of focus, respond to the same kind of Neurofeedback training. That tends to persuade us that we are addressing a neurophysiological mechanism that is common to them all. And when compulsions are an aspect of another condition, such as Tourette Syndrome or an eating disorder, we at least know how to target that aspect of the condition.
Conduct Disorder is commonly seen in conjunction with ADHD. This is a label that has been traditionally given to children that might now be diagnosed as attachment disordered. One of the down-sides of a single-minded focus on the medication remedy for ADHD is that the medications do not resolve or even address Conduct Disorder (or even Oppositional-Defiant Disorder). Both Conduct Disorder and Reactive Attachment Disorder find their origins in early childhood emotional trauma or neglect, and this simply cannot be resolved by drugs. The child has to learn emotional regulation, but at this later stage of life the conduct-disordered child is no longer available for the normal pathways of learning emotional control.
The only viable alternative is to train the brain through techniques such as Neurofeedback, and to do so without raising objections from the trainee. Fortunately, there is nothing in the Neurofeedback itself that can cue the child as to the actual objective of the training. We target better brain function, to which little objection can be raised, and we get better emotional regulation and brain stability. Soon enough, the child will see the world differently and respond to it differently. The difference, however, may be much more apparent to those who interact with the child than to the child himself. The change feels so natural that it may be difficult to identify as a change.
A widely prescribed drug for severe constipation, Zelnorm, has recently been taken off the market because of side effects of heart attacks and stroke (March 2007). This leaves few medical options for those who suffer from a particular kind of irritable bowel. This involves mainly women, and the cohort at risk could be as high as 12 million Americans.
It is therefore timely to observe that we have been helping many people with constipation over the years, and in particular those afflicted with irritable bowel. The fact that this should be the case only illustrates the complexity of our own regulatory function, namely that the brain does, among other things, also influence gut function. Good gut function could there depend on good brain regulation. It is doubtful that such a connection is getting serious attention in research because it is so difficult to organize and conduct studies of an inter-disciplinary character.
But for the moment we can simply enjoy the fruits of these observations. Constipation is also a severe issue in many autistic children, and here again we observe that brain training alone can bring relief. In fact, we judge the quality of our brain training in autism on the basis of whether the child's constipation resolves or not.
Almost no one seeks out Neurofeedback because he or she has a problem of constipation. So it is rarely the primary target of our work. But Neurofeedback intrinsically moves the brain toward a better state of regulation broadly, and so we look to a variety of indices to show that improvements are being achieved. Constipation, when it is present, is an important such marker.
It is also not necessary to count on Neurofeedback to bear the sole burden of recovery here. Anyone suffering from irritable bowel or constipation should be under the care of a health professional who is knowledgeable on the issues of gut flora, gut permeability, celiac disease, yeast overgrowth, etc. But often the Neurofeedback will turn out to be the fast-acting remedy. Hence it might well be undertaken first even if it is known that gut dysbiosis is an issue.
One obvious connection between the central nervous system and gut function is that a person may be resident in such a highly over-aroused state that the body neglects its vegetative functions. This may be the case for highly anxious people, and it is particularly the case for the autism spectrum. In the latter case, we are very likely to have the unfortunate combination of extreme over-arousal with gut dysbiosis. All relevant remedies should be brought to bear, and that includes in particular Neurofeedback.
This is a symptom seen in connection with Tourette Syndrome. As with other symptoms of Tourette's, it is a symptom that can be transiently but not permanently suppressed. Hence it is actually a lot more common that our experience would indicate. Neurofeedback can be helpful here to the same degree that we can be helpful generally with Tourette Syndrome. Over the years, Neurofeedback has been refined to the point of even being able to address the more exotic and severe manifestations of Tourette's.
This is one of a number of autoimmune diseases for which no good medical remedy has been found. Neurofeedback is not a remedy either, but clinical experience with this condition does indicate that Neurofeedback / EEG Biofeedback may be helpful in effecting a reduction in the incidence of flare-ups and of their severity. Presumably this occurs through influence on immune system excitability. Neurofeedback may serve also as a tangible demonstration that a degree of influence is available to be exercised by the patient. The patient who has lived with an intractable case of Crohn's might well consider making Neurofeedback a part of a more inclusive program of remediation.
Neurofeedback / EEG Biofeedback seems to be the treatment of choice for the whole Bipolar Disorder spectrum, and that includes cyclothymia. In a dramatic early application of the method to a person who cycled faithfully on a 24-hour clock, the pattern was broken with a mere 23 sessions of training, and cycling behavior was never seen again in that individual. On the other hand, a few of those 23 sessions were filled with great drama. Neurofeedback has been refined over the years to the point where a client can be held reasonably stable even over the early phases of the training. The early problem was paradoxically one of our methods being too strong.
Think of the problem of balancing an old scale when you only have large weights to work with. We could swing the balance either way at will, but it was difficult to find the point of balance. We needed milder and more controllable methods, not stronger ones. The analogy of bipolar swings to an old apothecary balance is actually not bad, because one has the sense of these nervous systems being balanced on a knife edge, with a tendency to teeter either one way or the other. The point of balance is not easily maintained under the vicissitudes of life. In cyclothymia, the swings are simply periodic.
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