Research Development

Staff Publications

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Find out what your colleagues have been writing. This section features articles published by staff working for St Helens and Knowsley Teaching Hospitals and Halton, Knowsley and St Helens community staff.

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All publications by 'Tridente A'



Mersey and West Lancashire Teaching Hospitals NHS Trust – St Helens & Knowsley Staff

A second update on mapping the human genetic architecture of COVID-19

Extract Investigating the role of host genetic factors in COVID-19 severity and susceptibility can inform our understanding of the underlying biological mechanisms that influence adverse outcomes and drug development1,2. Here we present a second updated genome-wide association study (GWAS) on COVID-19 severity and infection susceptibility to SARS-CoV-2 from the COVID-19..

Published: 07/09/2023
Authors: Shuker K, Tridente A

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CXR-Net: A Multitask Deep Learning Network for Explainable and Accurate Diagnosis of COVID-19 Pneumonia from Chest X-ray Images

Abstract Accurate and rapid detection of COVID-19 pneumonia is crucial for optimal patient treatment. Chest X-Ray (CXR) is the first-line imaging technique for COVID-19 pneumonia diagnosis as it is fast, cheap and easily accessible. Currently, many deep learning (DL) models have been proposed to detect COVID-19 pneumonia from CXR images...

Published: 09/11/2022
Authors: Lechareas S, Tridente A

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Differential attainment and recruitment to Intensive Care Medicine Training in the UK, 2018–2020

Background Differences exist among doctors in examination performance, clinical and academic career progression, and prevalence of performance assessment by professional regulatory bodies. Some of these differences have been reported in relation to individual characteristics. The purpose of this study is to establish whether any specific individual characteristics are associated with..

Published: 12/09/2022
Authors: Tridente A

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Review of Burn Resuscitation: is Plasmalyte® A Comparable Alternative to Ringer’s Lactate?

Abstract Ringer’s lactate has been the most widely used fluid for burn resuscitation for decades. Plasmalyte®, a newer balanced crystalloid, is gaining popularity for use in the critically ill, including patients with burns. This popularity is partly due to the fact that Plasmalyte® theoretically offers a favourable metabolic profile,..

Published: 02/08/2022
Authors: Cappuyns L, Tridente A, Stubbington Y, Shokrollahi K

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Epidemiology of Neonatal Acute Respiratory Distress Syndrome: Prospective, Multicenter, International Cohort Study

Objectives Age-specific definitions for acute respiratory distress syndrome (ARDS) are available, including a specific definition for neonates (the “Montreux definition”). The epidemiology of neonatal ARDS is unknown. The objective of this study was to describe the epidemiology, clinical course, treatment, and outcomes of neonatal ARDS. Design Prospective, international, observational, cohort..

Published: 10/05/2022
Authors: Tridente A

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Burn fluid resuscitation using plasmalyte®: Is it a safe replacement for ringers lactate and what is the potential cost saving?

Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf Introduction Fluid resuscitation remains the basis of early burn management. Both the type and volume of fluids can impact the outcome of burn patients. Appropriate fluid resuscitation..

Published: 04/05/2022
Authors: Cappuyns L, Tridente A, Stubbington Y, Shokrollahi K

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Electroanalytical point-of-care detection of gold standard and emerging cardiac biomarkers for stratification and monitoring in intensive care medicine - a review

Abstract Determination of specific cardiac biomarkers (CBs) during the diagnosis and management of adverse cardiovascular events such as acute myocardial infarction (AMI) has become commonplace in emergency department (ED), cardiology and many other ward settings. Cardiac troponins (cTnT and cTnI) and natriuretic peptides (BNP and NT-pro-BNP) are the preferred biomarkers..

Published: 15/03/2022
Authors: Tridente A

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Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity

Abstract The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate..

Published: 18/01/2022
Authors: Tridente A, Shuker K

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Perspectives From a Regional Plastic Surgery Centre on Evidence for the Purported Link Between SGLT2 Inhibitors and Fournier's Gangrene

Introduction The recent report issued by the MHRA indicating an association of Sodium glucose linked transporter type 2 (SGLT2) Inhibitors with the contraction of Fournier's Gangrene (FG), has been drawn with insufficient supporting evidence and without an adequately powered study to make any meaningful assertions or recommendations. We aimed to look..

Published: 10/12/2021
Authors: Asmar O, Mandal A, Tridente A, Hardy KJ, Shokrollahi K

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Mapping the human genetic architecture of COVID-19.

Abstract: The genetic make-up of an individual contributes to the susceptibility and response to viral infection. Although environmental, clinical and social factors have a role in the chance of exposure to SARS-CoV-2 and the severity of COVID-191,2, host genetics may also be important. Identifying host-specific genetic factors may reveal biological..

Published: 08/07/2021
Authors: Tridente A

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Validation of the factors influencing family consent for organ donation in the UK

Summary Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the..

Published: 16/04/2021
Authors: Tridente A

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Toward the Rapid Diagnosis of Sepsis

Abstract This paper reports the detection of the inflammatory and sepsis-related biomarker, interleukin-6 (IL-6), in human blood plasma using functionalized screen-printed electrodes (SPEs) in conjunction with a thermal detection methodology, termed heat-transfer method (HTM). SPEs are functionalized with antibodies specific for IL-6 through electrodeposition of a diazonium linking group and..

Published: 01/04/2021
Authors: Tridente A

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Genetic mechanisms of critical illness in COVID-19

Abstract Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244..

Published: 03/03/2021
Authors: Tridente A, Shuker K

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Evaluating the Possibility of Translating Technological Advances

Abstract Lactate is widely measured in critically ill patients as a robust indicator of patient deterioration and response to treatment. Plasma concentrations represent a balance between lactate production and clearance. Analysis has typically been performed with the aim of detecting tissue hypoxia. However, there is a diverse range of processes..

Published: 28/01/2021
Authors: Tridente A

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Introducing video content into Scars, Burns & Healing

Tridente, A. (2020). Introducing video content into Scars, Burns & Healing. Scars, Burn and Healing. 6  

Published: 24/11/2020
Authors: Tridente A

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Comfort care for burns patients

Zack-Williams, SDL; Gurusinghe, D; Tridente, A; Shokrollahi, K. (2020). Comfort care for burns patients: The gold standard for assessment and delivery of care remains in a burn center. Burns. epub 24 Oct    

Published: 24/10/2020
Authors: Zack-Williams SDL, Gurusinghe D, Tridente A, Shokrollahi K

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Immature platelet indices alongside procalcitonin for sensitive and specific identification

Abstract Hematological markers that can be rapidly analyzed and regularly monitored during a patient’s stay on ICU, and that can identify bacterial causes of sepsis are being extensively sought. The significance of platelets in early immunological responses provides justification for assessing their usefulness in the identification of bacteremia amongst..

Published: 08/09/2020
Authors: Tridente A

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EP282 Revising the RCA; Streamlining Root- Cause Analyses for bacteraemias on ITU

Abstract Sepsis is a leading cause of mortality within the Intensive care environment.1 Over the last 3 decades, the recognition of sepsis has greatly improved and blood cultures form an integral part of both diagnosis and management. At the authors’ institution, any detected bacteraemia is examined through a process of Root..

Published: 13/08/2019
Authors: Saunders R, Clark S, Stubbington Y, Tridente A

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EP265 De- Bugging ITU; What to do with a positive blood culture. Journal of the Intensive Care Society

Abstract Positive blood cultures form a cornerstone in the diagnosis and treatment of sepsis. Falsely positive blood cultures due to contamination pose a significant clinical conundrum for the treating clinician. We aimed to develop a tool to aid decision making in the process of distinguishing the postive from the false..

Published: 13/08/2019
Authors: Saunders R, Clark S, Tridente A, Stubbington Y

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EP229 Initial Measurement of Ideal Body Weight in Ventilated Patients to Guide Tidal Volumes

Introduction Lung hyperinflation is a known contributing factor to ventilator-induced lung injury. Tidal volume (Vt) strategies utilising 6 ml/kg targets have shown decreased mortality and fewer days of ventilation when compared to more traditional Vt approaches1,2. Early measurement of Ideal Body Weight (IBW) on admission to critical care is essential..

Published: 13/08/2019
Authors: Edwards M, Tridente A

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Impact of frailty on critical care and hospital mortality in critically-ill patients with decompensated alcoholic liver disease

Introduction We aimed to assess the effect of frailty as assessed by Clinical Frailty Scale (CFS) and Karnofsky performance score (KPS) on critical care (CC) and hospital mortality in this group at a non-specialist tertiary critical care unit. Methods Patients admitted to critical care were identified from our electronic database..

Published: 26/06/2019
Authors: Tridente A

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Methodological challenges in European ethics approvals for a genetic epidemiology study in critically ill patients

Background During the set-up phase of an international study of genetic influences on outcomes from sepsis, we aimed to characterise potential differences in ethics approval processes and outcomes in participating European countries. Methods Between 2005 and 2007 of the FP6-funded international Genetics Of Sepsis and Septic Shock (GenOSept) project, we asked..

Published: 14/05/2019
Authors: Tridente A

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Porcine vs bovine surfactant therapy for preterm neonates with RDS

Background Bovine surfactants are known to be clinically equivalent but it is unclear if porcine or bovine surfactants at their licensed dose should be preferred to treat respiratory distress syndrome in preterm neonates. Methods We performed a comprehensive review of biochemical and pharmacological features of surfactants to understand the biological..

Published: 22/02/2019
Authors: Tridente A

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Sepsis 3 and the burns patient: do we need Sepsis 3.1?

Sepsis definitions and their relevance to the burns patient Sepsis has been described as ‘one of the oldest and most elusive syndromes in medicine’. Since ancient times, the human mind has been able to conceptualise infection and the possibility of its spread from a localised area to the rest of..

Published: 29/08/2018
Authors: Tridente A

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Derivation and validation of a prognostic model for postoperative risk stratification of critically ill patients with faecal peritonitis

​Background: Prognostic scores and models of illness severity are useful both clinically and for research. The aim of this study was to develop two prognostic models for the prediction of long-term (6 months) and 28-day mortality of postoperative critically ill patients with faecal peritonitis (FP). Methods: Patients admitted to intensive care..

Published: 04/01/2018
Authors: Tridente A

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0951: Frailty and functional status as decision factors regarding admission to critical care

INTRODUCTION Pressure on Critical Care (CC) services is significant, with a progressively more complex patient population with increasing comorbidities. Admission may be inappropriate if the patient is unlikely to benefit from it. Guidance published in the past may no longer reflect current practice [1–2]. Clinical frailty is associated with worse outcomes..

Published: 03/01/2018
Authors: Andrews FJ, Feeney J, Tridente A

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0820: A prognostic model for post-operative risk stratification of critically ill patients with faecal peritonitis

INTRODUCTION Prognostic models of illness severity are useful both clinically and for research purposes. A specific tool for prognostication in critically ill patients with faecal peritonitis is not available. OBJECTIVES We aimed to develop two prognostic models, for the prediction of 6 months and 28 day mortality of post-operative critically ill patients..

Published: 03/01/2018
Authors: Tridente A

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Relationship between transcutaneous bilirubin

​ Background Transcutaneous bilirubin (TcB) consists of the skin-deposited bilirubin. Free bilirubin represents the protein-unbound bilirubin (UB) that is able to pass into the tissues. We aimed to describe the relationship UB-TcB and study the passage of UB into the skin. Methods We prospectively enrolled 194 neonates and we measured TcB, UB,..

Published: 23/02/2017
Authors: Tridente A

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The importance of frailty

​Introduction Demand for Critical Care (CC) is increasing but admission may be inappropriate if the patient is unlikely to survive. Consequently, published guidance may no longer reflect current practice [1-2]. Clinical frailty evaluation scores have recently been shown to be associated with increased mortality in patients already admitted to CC [3]...

Published: 10/10/2016
Authors: Tridente A

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Admission to critical care

Introduction Critical Care (CC) services are in increasing demand but published guidance for triaging admissions may no longer reflect current practice [1-2]. Exercise tolerance and clinical frailty assessment may have a role in assessing patients (pts) referred to CC [3]. We aimed to establish the impact of frailty and other factors..

Published: 16/08/2016
Authors: Bolton N, , England L, Feeney J, Tridente A, Wilkinson K

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Platelet function analysis utilising the PFA-100

​ Introduction Sepsis is known to be associated with impaired platelet function (1). The PFA-100 (Siemens Healthcare, Dade International, Miami, Fla., USA) is a device in which a citrated whole blood sample is aspirated through an aperture coated with agonists inducing platelet activation. Platelet aggregation leads to occlusion of the aperture and..

Published: 16/08/2016
Authors: Bolton N, , Bonney S, Tridente A, Nee PA

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The impact of Karnofsky performance scale

​ Introductions Karnofsky performance scale (KPS) [1] is being widely to describe patients’ functional status. Correlation between poor functional levels and adverse outcomes has been found. KPS is used in decision making surrounding starting aggressive therapy. We evaluated the impact of KPS on long term renal & patient survival in AKI patients, receiving ..

Published: 10/08/2016
Authors: Tridente A

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Outcomes of patients

​ Introduction Palliative oncology patients are admitted to critical care not uncommonly, outcomes are variable and often difficult to predict. We sought to observe Intensive care unit (ICU) and hospital outcomes of palliative oncology patients, in relation to demographic, disease and organ failure criteria. Methods Retrospective review of the electronic database..

Published: 09/08/2016
Authors: Tridente A

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Tolvaptan for Heart Failure

​ Abstract The vasopressin type 2 receptor antagonist tolvaptan (TLV) is available to treat congestion in patients with heart failure (HF). However, there is paucity of evidence guiding its use, and lack of evidence of its long term efficacy. Our objectives are to perform a systematic review of studies examining tolvaptan's effects..

Published: 19/07/2016
Authors: Tridente A

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Long term outcomes in acute kidney injury patients

​ Introduction and Aims Acute kidney injury (AKI) affects 40% of critically ill patients with UK data reporting 5% needing renal r​eplacement therapy (RRT). Hospital mortality is reported as being up to 60%. We sought to evaluate renal and long term patient survival outcomes in AKI patients receiving RRT on our ICU.    Methods..

Published: 19/07/2016
Authors: Tridente A

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The implementation of a blood conservation strategy

​ I​ntroduction Patients admitted to intensive care units (ICUs) are commonly affected by anaemia, which is contributed to by iatrogenic blood loss from diagnostic testing, with potential risks of increasing transfusion requirements and negative effect on outcomes. Recently published guidelines make several recommendations for the management of anaemia and red..

Published: 19/07/2016
Authors: Tridente A, Bonney S, Nee PA

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The FICE course and qualification - experience from the Cheshire and Merseyside group

​ Introduction The utility of echocardiography for assessing the critically ill patient has long been recognised. The Focused Intensive Care Echocardiography (FICE) training pathway is endorsed by the Intensive Care Society of the UK. Candidates attend a full day course consisting of lectures and practical sessions. Subsequently, every candidate is required..

Published: 19/07/2016
Authors: Bolton N, Rogers G, Booker K, Mohammed A, Mahendran V, Tridente A

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Trends in clinical variables and outcome

​ Introduction  Patients admitted to intensive care following surgery for faecal peritonitis present particular challenges in terms of clinical management and risk assessment. Collaborating surgical and intensive care teams need shared perspectives on prognosis. We aimed to determine the relationship between dynamic assessment of trends in selected variables and outcomes. Methods ..

Published: 19/07/2016
Authors: Tridente A

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Phenotypic factors associated with outcome

​ Introduction Patients admitted to intensive care following surgery for faecal peritonitis present particular challenges in terms of clinical management and risk assessment that require close collaboration between surgical and intensive care teams [1]. We aimed at establishing whether dynamic assessment of trends in selected variables may be associated with outcomes, and..

Published: 19/07/2016
Authors: Tridente A

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Successful implementation of a medical emergency team

​ Introduction A medical emergency team (MET) was introduced in our institution in January 2012 to provide timely response to the needs of acutely ill inpatients and cardiac arrest calls. The MET assesses the patient and prescribes a management plan for the responsible team to follow; promptly stabilising and transferring patients to..

Published: 19/07/2016
Authors: Elmore J, Mahambrey T, Tridente A, Varia R

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Critically ill patients with faecal peritonitis

​ Introduction Faecal peritonitis (FP) is a common cause of sepsis and admission to the ICU [1]. We report a review of all patients admitted to our ICU over 5 years with FP. The aim was to define the clinical characteristics, outcomes and risk factors for mortality in ICU patients with FP. Methods..

Published: 19/07/2016
Authors: Tridente A

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Long-term renal and survival outcomes

​ Introduction Acute kidney injury (AKI) affects 40% of critically ill patients, with UK data reporting 5% needing renal replacement therapy (RRT). Hospital mortality is reported as being up to 60%. We sought to evaluate renal and long-term patient survival outcomes in AKI patients receiving RRT on our ICU. Methods Data were collected from..

Published: 19/07/2016
Authors: Tridente A

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Patients with haematological malignancies

​ Introduction  Critical care (CC) admission has traditionally been viewed as likely to result in a poor outcome for immune-compromised haemato-oncological (HO) patients [1,2]. Recent studies have challenged such views [3,4]. We recently reported results from a cohort of HO patients admitted to CC, showing the pAO2/FiO2 (P/F) ratio to be..

Published: 19/07/2016
Authors: Tridente A

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Organisational changes in service provision

​ Introduction  Demand for critical care (CC) resources is constantly increasing in the face of limited availability. Guidance for triage exists but may no longer reflect current practice [1,2]. We previously identified nonmedical and medical factors (comorbidities, physiological derangement and functional status) as predicting likelihood of admission of referred patients to CC [3..

Published: 19/07/2016
Authors: Tridente A

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Berlin definition for acute respiratory distress syndrome during

​ Purpose A new acute respiratory distress syndrome (ARDS) definition has been recently issued: the so-called Berlin definition (BD) has some characteristics that could make it suitable for pediatrics. The European Society for Pediatric Neonatal Intensive Care (ESPNIC) Respiratory Section started a project to evaluate BD validity in early childhood. A..

Published: 19/07/2016
Authors: Tridente A

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An epidemiological survey of the GenOSept cohort

​ Introduction Faecal peritonitis (FP) is a common cause of sepsis and admission to the intensive care unit (ICU). The Genetics of Sepsis and Septic Shock in Europe (GenOSept) project is investigating the influence of genetic variation on the host response and outcomes in a large cohort of patients with sepsis..

Published: 19/07/2016
Authors: Tridente A

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St Helens Community Staff

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Knowsley Community Staff

GWAS and meta-analysis identifies 49 genetic variants underlying critical COVID-19

Abstract Critical illness in COVID-19 is an extreme and clinically homogeneous disease phenotype that we have previously shown1 to be highly efficient for discovery of genetic associations2. Despite the advanced stage of illness at presentation, we have shown that host genetics in patients who are critically ill with COVID-19 can..

Published: 17/05/2023
Authors: Shuker K, Tridente A

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Halton Community Staff

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North West Boroughs Community Health Staff

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