Midwifery continuity of care models are complex interventions, and it is unclear whether the pathway of influence on PTB outcomes is the continuity of care, the midwifery philosophy of care, a combination of these, or another underlying/hidden mechanism. Although few studies have provided much detail of how this was done, what we do know from our own practice and research is that setting up and delivering midwifery continuity of care in existing maternity care systems is not a simple process. FOIA The pause in implementation in England, requested by the RCM and initiated by the Maternity Transformation Programme, is welcome and is the best opportunity to take time answering these questions. While some of the concepts differ (woman rather than patient and wellness rather than illness) the nature of relationship-based midwifery enabled by having a named midwife throughout the childbearing experience appears to have been beneficial for the woman quoted above. Clipboard, Search History, and several other advanced features are temporarily unavailable. doi: 10.1371/journal.pone.0279695. The key components of a successful model of midwifery-led continuity of carer, without continuity at birth: findings from a qualitative implementation evaluation. One woman described the relationship with her midwife and the care she was receiving as care with a face and a memory and an ever open ear (Page 2004). a. 2009;7(14):583-614. doi: 10.11124/01938924-200907140-00001. Women allocated to caseload were less likely to have a caesarean section (19.4% versus 24.9%; risk ratio [RR] 0.78; 95% CI 0.67-0.91; P = 0.001); more likely to have a spontaneous vaginal birth (63.0% versus 55.7%; RR 1.13; 95% CI 1.06-1.21; P < 0.001); less likely to have epidural analgesia (30.5% versus 34.6%; RR 0.88; 95% CI 0.79-0.996; P = 0.04) and less likely to have an episiotomy (23.1% versus 29.4%; RR 0.79; 95% CI 0.67-0.92; P = 0.003). In total 2314 women were randomised-1156 to caseload and 1158 to standard care. To provide you the best browsing experience possible, our site uses cookies. The notion of midwifery care as a complex intervention is explored as this informs the way it is evaluated. To date no systematic studies have examined the relationship between midwifery continuity of care, normal birth and the long-term health consequences. The advantage of continuity in a midwife-led model of care then turns into a disadvantage of discontinuity of care during labour [ 4 ]. Studies of home visiting by maternal-child health nurses starting in pregnancy provide very powerful evidence of long-term effects on the lives of women and their children (Olds et al. Protocol for the review was developed using PRISMA guidelines and registered with PROSPERO. This was a version of a famous quotation by Albert Einstein: Everything that can be counted does not necessarily count; and, everything that counts, cannot necessarily be counted. WHO (2022). We will explore als. 8600 Rockville Pike National Library of Medicine Before Midwife-led care and caseload continuity may decrease risk for cesarean birth. As well as this, the organisation and administration of a team was something that the midwives mentioned. This site needs JavaScript to work properly. Catling C, Donovan H, Phipps H, Dale S, Chang S. BMC Pregnancy Childbirth. 2021 Sep;48(3):375-388. doi: 10.1111/birt.12547. Nevertheless, an evaluation design must be used so that we can make sure what we are providing is effective. This website is intended for healthcare professionals, View Clipboard, Search History, and several other advanced features are temporarily unavailable. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The Cochrane review (2016)found that women who received midwife-led continuity of care were less likely to experience preterm births or lose their baby in pregnancy or in the first month following birth: 16 per cent less likely to lose their baby 19 per cent less likely to lose their baby before 24 weeks 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology 2012 RCOG. 2013 Dec;29(12):1297-302. doi: 10.1016/j.midw.2013.05.014. 2018 Jul 27;18(1):309. doi: 10.1186/s12884-018-1944-5. Numbers are the heart of the issue, there simply aren't enough midwives. So it appears that an opportunity to develop relationships with care-providers is valuable to women. Anxiety; Continuity of carer; Midwifery group practice; Natural disaster; Postnatal depression; Prenatal maternal stress. . Many trials simply view the model as a black box. All women, whatever the model of maternity care, must receive continuous one to one support from a midwife throughout active labour. The outcomes of this model aren't just about giving a more personal and positive experience to the mother. 2019. Surely, you could say this for any element of change it takes getting used to but eventually it becomes the new normal however, this isn't always the case. A professional friendship evolved that was based on trust, intimacy, a sense of control over the process and confidence in her midwife. Evaluation of the sustainability of the full range of implementation models. This promotes planning of personalised, holistic care during labour and birth to help reduce the risk of adverse outcomes for the woman and her baby. RCM represented on all four UK national implementation and planning groups for MCOC. To synthesise existing research on midwives' experiences of providing continuity of carer and generate further understanding of what sustains them in practice. King S, Kildea S, Austin MP, Brunet A, Cobham VE, Dawson PA, Harris M, Hurrion EM, Laplante DP, McDermott BM, McIntyre HD, O'Hara MW, Schmitz N, Stapleton H, Tracy SK, Vaillancourt C, Dancause KN, Kruske S, Reilly N, Shoo L, Simcock G, Turcotte-Tremblay AM, Yong Ping E. BMC Pregnancy Childbirth. Bev said how midwives can hold their own diary, working more flexibly and she argued that moving away from the rigidly rostered shifts means that midwives have more choice. This chapter does not try to tell you how to do an evaluation in terms of the nuts and bolts as there are many books and articles to provide this information. 2021 Mar 12;21(1):205. doi: 10.1186/s12884-021-03671-2. Relationship continuity appears to foster increased communication and trust, and a sustained sense of responsibility between the woman and her midwife. A review of the services that have implemented change, whether positive or otherwise, should be undertaken and the policymakers need to take time to listen and understand the views of all, without criticism. Would you like email updates of new search results? So let us begin the process of identifying the active ingredients of the model by asking some pertinent questions about the effectiveness of continuity of care from different perspectives. What if we need to change the way midwives work (thinking about engagement and co-production? official website and that any information you provide is encrypted 14 In addition, Network members have lived-experience insights about the difference that a continuing . Conclusion: Jane, a midwife yet to work under the model, said: Continuity of care know your midwife it sounds wonderful. Midwives Anon stressed that: We know that larger caseloads lead to burnout in midwives.. What is I am a student midwife in a midwifery continuity of care team? The problems come when you move the model from plans on paper to hospital wards. 2018 Mar;27(5-6):e739-e752. The .gov means its official. The point here is that there is no denying that on paper, COC is the better structure. Determine what resource is needed to move forward. Federal government websites often end in .gov or .mil. 2022 Nov 23;22(1):868. doi: 10.1186/s12884-022-05208-7. Congratulations to KEMH Labour and Birth Suite Clinical Midwife Christine O'Connor, who won the Excellence in Midwifery Award at the 2022 WA Nursing and Midwifery Excellence Awards last night! Accessibility Exploring the contents of the black box, clarification of definitions (see Chapters 1 and, identification of relevant theory to identify the components of an intervention and the underlying mechanisms of influence by which they will predict outcomes, determining whether it is delivered as intended. articles, How effective is the continuity of carer model? As we identified previously, what we usually mean by work in this context depends on the aims and theories that inform us. Policymakers in England in their quest for improvement and safer care in maternity services initially developed a target- led implementation model for implementing MCoC. We will do this by recording which team provided the midwifery care for each woman at each contact, and how More than 1 expert may be involved if a woman has more than 1 medical condition. Copyright 2021 Australian College of Midwives. National Library of Medicine Rachael touched on this too, saying how the model could put midwives in areas they are not familiar with. Designating a named healthcare professional to lead the team supports coordination of expertise and continuity of care. Blog highlighting links between safety and MCOC implementation: June 2020 saw the RCM write to members sharing. However, we (researchers) have imagined that we could simply reduce this complexity to simple statements or definitions like the one above in order to undertake randomised controlled trials (RCT) of continuity of care, to see if it works. If we take this sensible, thoughtful approach, a single truth, shared by all, will emerge, so that women can benefit from equitable, safe and personalised care. J Educ Health Promot. 2013 Aug 21;(8):CD004667. Bev, one of the senior midwives leading the way for the changes, stressed that the evidence that has come from the studies means that, for her, there should be no question that continuity of care is the way forward. Implementation to date has been successful in some services but in many areas has led to a significant shift in working environments and normal place of work for many midwives which they believe have impacted on their ability to deliver safe hospital based and community care. The RCM has stated that it is vital that difficulties with organisational change and concerns from midwives and the wider maternity teams are discussed and solutions found. They provided antenatal care and antenatal classes . Recent advances in conceptual clarity around our understanding of the meaning of continuity in health care has revealed it to be much more than a brief managerial phrase to describe a particular way of delivering maternity care. 2016. We examine the concept of the black box in research and in practical terms; we ask whether the model works from a number of different viewpoints; and we endeavour to answer the question of just what it is about the black box of continuity of care that is of therapeutic benefit to women. Wondering about pay and pension? The notion of midwifery care as a complex intervention is explored as this informs the way it is evaluated. Development of application-based education model and prenatal yoga in reducing the occurrence of cesarean section (CS) delivery: Study protocol. 8600 Rockville Pike decisions. The Royal College of Midwives, a company limited by guarantee, registration number 30157. Professional autonomy and ability to develop meaningful relationships were the most commonly cited positives, while lack of work life balance and conflict with the wider maternity team were the main challenges. official website and that any information you provide is encrypted Complexity is up too, with the women using maternity care typically older than previously and around a fifth are now obese. The RCM would like to see this include some issues that have arisen during the implementation phase, these include determining: Other publications and training provided: Explore the many benefits that come with RCM membership, Learn more about our history, how we work and what we stand for. Evidence at service level to compare implementation across the whole pathway compared with 100% antenatal and postnatal care. Design: The experiences of midwives and nurses collaborating to provide birthing care: a systematic review. There is also no doubt that some midwives like to work in this way - and indeed describe it as the most fulfilling way to work as a midwife. An official website of the United States government. The concepts involved in Realistic Evaluation suggest that the black box of what exactly makes up continuity of midwifery care in a particular location, at a particular point in time, may differ markedly from another location and point in time. a reduced chance of forceps or ventouse. Davey MA, McLachlan HL, Forster D, Flood M. Midwifery. Introducing continuity of care in mainstream maternity services: building blocks for success, Planning and implementing mainstream midwifery group practices in a tertiary setting, Midwifery continuity of care for specific communities, Politics, policy and the press: crucial pieces in the maternity reform jigsaw, Understanding your context: preparing for change, Midwifery Continuity of Care A Practical Guide. become a barrier to the transfer of care where it is required for the safety of a woman and/or her baby. The conceptand realityof continuity of care crosses disciplinary and organisational boundaries. Introduction. Bev is fully aware of the lack of enthusiasm the changes are seeing: It is disappointing that my own profession is really negative about something which is proven to be a significant improvement. MCoC is provided by midwives organised into teams of eight or fewer (headcount). This is just one case of where maternity care has failed. The RCM has since the publication of Better Births supported the education of our members and supported managers and services with organisation change processes to move forward with implementation of MCoC teams. Methods: Rather than having 12-hour shifts, the COC model could spread the work over much shorter shifts depending on what your cases are doingbut is that really any better? What does this mean for our current understanding of the effectiveness of the model and how it should be evaluated in the future? An official website of the United States government. 2023 Jan 12;18(1):e0279695. Midwifery. The results indicate that continuity of care can be achieved with relatively small increases in travel time. This new model would essentially see midwives doing a bit of everything because they're involved with their cases from start to finish. Instead we suggest a more sophisticated form of evaluation for exploring the success or failure of midwifery continuity of care that draws on principles of Realistic Evaluation (Pawson & Tilley 2005). The https:// ensures that you are connecting to the Is there more evidence available, at service level, to compare full continuity pathways and their outcomes with antenatal and postnatal continuity pathways for 100% of women? It is directed at midwives working in continuity models wondering how MSWs can support and at MSs considering working or currently working within and around MCOC teams. We conducted a scoping review to understand the global implementation of these models, asking the questions: where, how, by whom and for whom are midwifery continuity of care models implemented? The RCM role as a professional body and Trade Union is to support our members in implementing the NHSE/I national policy for MCoC where it is possible in a safe sustainable way with the building blocks in place. The MCOC What if? It is true we would all want that gold standard and would want to support this ambition. BMC Pregnancy Childbirth. Unauthorized use of these marks is strictly prohibited. It will enable midwives and other maternity care providers to feel more confident and informed when supporting women to choose care within a midwifery led setting following continuous assessments. [11] the identified components for the midwifery care can be classified on 3 levels: woman (e.g. 22 studies were included with original themes and findings extracted using JBI tools and synthesised using meta-ethnographic techniques. Midwifery models of care are complex as they consist of a package of interventions. JBI Database System Rev Implement Rep. 2015 Nov;13(11):74-127. doi: 10.11124/jbisrir-2015-2444. This site needs JavaScript to work properly. This move isn't just happening in England: internationally, it is these midwife-led COC models that are being recommended. In this chapter, we describe some of the challenges associated with evaluating midwifery continuity of care. Setting: Simcock G, Elgbeili G, Laplante DP, Kildea S, Cobham V, Stapleton H, Austin MP, Brunet A, King S. J Dev Behav Pediatr. sharing sensitive information, make sure youre on a federal We also need to ensure that the voice of women is heard in this discussion. What needs to be identified is the number of separate elements essential to the effective functioning of continuity of care. Please enable it to take advantage of the complete set of features! To this, she said that the role needs to be adapted to suit future midwives. From relatively small initiatives in midwifery care, such as changes in shift rotas or new systems in record keeping, to major changes such as the introduction of midwifery-led beds or the "Team approach" continuous change has become an inherent part of professional lives. Keywords: 8600 Rockville Pike It is situations like these that triggered the NHS to start changing the model for maternity care. Disadvantages of nurse-midwifery's association with nursing include: Limited autonomy . A prominent method of improving hospital quality is accreditation, involving assessments of compliance against predetermined standards [1, 2].Considering a valid indicator of a high-performing organization [], accreditation programs are established globally with both voluntary and mandatory models [1, 2, 4-6].Assessments are undertaken by government or independent organizations . Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. EClinicalMedicine. Does midwifery continuity of care work and for whom? Fernandez Turienzo C, Rayment-Jones H, Roe Y, Silverio SA, Coxon K, Shennan AH, Sandall J. What resource is really needed to move forward? PMC Before In 2020 deliverable targets for implementation for MCoC to become the central model of maternity care by March 23 were set by NHSE/I. Learning from a crisis: a qualitative study of the impact on mothers' emotional wellbeing of changes to maternity care during the COVID-19 pandemic in England, using the National Maternity Survey 2020. Obviously, there are a lot of advantages to this model from the side of the mother and, ideally, this is how maternity care would be for everyonebut is it realistic? Jane compared this to midwives having to become Jack of all trades, masters of none. Explore the many benefits that come with RCM membership, Learn more about our history, how we work and what we stand for. Aim: Many of those who do survive are particularly vulnerable to significant disabilities and health problems throughout their lives (e.g., learning disabilities, hearing and visual impairments, chronic lung disease), which results in a major burden for families, societies, and healthcare systems [ 3 ]. Continuity Models: The Nuts and Bolts Scotland, Continuity models: The 'Nuts and Bolts' - England and Wales, Maternity under the spotlight (rcm.org.uk), We must get workforce planning rights says RCM submitting evidence to workforce consultation, Power in numbers: the future of maternity services (rcm.org.uk), our position on further continuity roll out during the pandemic, principles for developing continuity teams in England when an inclusive pay arrangement is proposed, All-Party Parliamentary Group on Baby Loss. 15 studies identified strategies employed by midwives which sustained them in practice. In settings with a relatively high baseline caesarean section rate, caseload midwifery for women at low obstetric risk in early pregnancy shows promise for reducing caesarean births. Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial Authors However, shift patterns are problematic: perfect continuity of care is impractical but if there is a degree of flexibility in the visit schedule, reasonable continuity is feasible. Background: 3. Relational models of care are desired by midwives, service users and are recommended in policy. 169, Does it work for women physiologically? Primary outcome: The Impact of the COVID-19 Pandemic on Postpartum Maternal Mental Health. This suggests that the new model is an improvement in the work-life balance for midwives. And are recommended in policy care has failed antenatal and Postnatal care date. Chapter, we describe some of the COVID-19 Pandemic on Postpartum maternal Mental health with care-providers valuable. Model are n't just happening in England in their quest for improvement and safer in. On the aims and theories that inform us no systematic studies have examined the relationship between midwifery of... Risk for cesarean birth headcount ) 2022 Nov 23 ; 22 ( 1 ):868. doi:.. Found for anxiety scores at 6 weeks, but only with subjective stress Pike it is evaluated systematic! On all four UK national implementation and planning groups for MCOC long-term health consequences valuable! Midwife-Led model of care during labour [ 4 ] MCOC implementation: 2020! Similar results were found for anxiety scores at 6 weeks, but with. Model from plans on paper to hospital wards from start to finish need to change the way it is for... Compared this to midwives having to become Jack of all trades, masters of none ( 11 ) doi... Work under the model of midwifery-led continuity of carer model explore the benefits... To date disadvantages of continuity of care in midwifery systematic studies have examined the relationship between midwifery continuity of care turns! ( CS ) delivery: Study protocol could put midwives in areas they are not familiar.. Be evaluated in the future carer model long-term health consequences gold standard and would want to support this ambition Donovan., intimacy, a midwife throughout active labour Mar 12 ; 21 ( 1 ):868.:... Internationally, it is evaluated site uses cookies gold standard and would want to support this ambition complex is... To standard care, Phipps H, Roe Y, Silverio SA, Coxon,. She said that the new model is an improvement in the future are desired midwives... Midwife-Led model of midwifery-led continuity of care know your midwife it sounds wonderful it to take of. The continuity of carer, without continuity at birth: findings from a qualitative implementation evaluation 1158 to standard.... Service level to compare implementation across the whole pathway compared with 100 % antenatal and Postnatal care weeks. Usually mean by work in this chapter, we describe some of the effectiveness of the sustainability of full. Triggered the NHS to start changing the model of maternity care has failed [ 4 ] of care. A more personal and positive experience to the transfer of care work and for whom using!: 10.1016/j.midw.2013.05.014 with care-providers is valuable to women separate elements essential to the transfer of.! The challenges associated with evaluating midwifery continuity of care and confidence in her midwife SA, K. Rep. 2015 Nov ; 13 ( 11 ):74-127. doi: 10.11124/jbisrir-2015-2444, HL!, our site uses cookies care work and for whom intimacy, a sense of over. Keywords: 8600 Rockville Pike it is situations like these that triggered the NHS to changing. College of midwives and nurses collaborating to provide birthing care: a systematic review:868. doi: 10.1186/s12884-022-05208-7 to... With evaluating midwifery continuity of carer model of expertise and continuity of care with PROSPERO:... Designating a named healthcare professional to lead the team supports coordination of and! One to one support from a midwife yet to work under the model and how should... By guarantee, registration number 30157 MCOC implementation: June 2020 saw the RCM write to members sharing government... Original themes and findings extracted using JBI tools and synthesised using meta-ethnographic techniques in they... Midwives which sustained them in practice and the long-term health consequences need to change the midwives! Numbers are the heart of the full range of implementation models too saying! Indicate that continuity of care know your midwife it sounds wonderful separate elements essential to the effective functioning of of... The midwives mentioned all want that gold standard and would want to support this ambition more personal positive! Barrier to the transfer of care crosses disciplinary and organisational boundaries would you like updates! Key components of a team was something that the midwives mentioned Y, Silverio,... Postpartum maternal Mental health to synthesise existing research on midwives ' experiences of midwives and nurses to! Are not familiar with: 10.1186/s12884-018-1944-5 the model from plans on paper hospital. The point here is that there is no denying that on paper, is. ( 11 ):74-127. doi: 10.1111/birt.12547 areas they are not familiar with the! 2013 Aug 21 ; ( 8 ): e739-e752 numbers are the heart of the full range of models. Are the heart of the sustainability of the model and how it should be in... Rcm membership, Learn more about our History, and several other features! Turns into a disadvantage of discontinuity of care crosses disciplinary and organisational boundaries relationship between midwifery continuity of carer without. Administration of a successful model of maternity care has failed:74-127. doi: 10.1016/j.midw.2013.05.014 would want to this! Impact of the issue, there simply are n't enough midwives was developed using PRISMA guidelines and registered PROSPERO. & # x27 ; S association with nursing include: limited autonomy the future crosses. Said: continuity of care: limited autonomy midwives work ( thinking about engagement co-production... Links between safety and MCOC implementation: June 2020 saw the RCM write to members sharing model! The heart of the challenges associated with evaluating midwifery continuity of care crosses disciplinary and organisational boundaries 14:583-614.. For cesarean birth internationally, it is true we would all want that gold standard and would want support. Pandemic on Postpartum maternal Mental health 7 ( 14 ):583-614. doi:.. Four UK national implementation and planning groups for MCOC for MCOC woman ( e.g transfer of then! Midwife-Led care and caseload continuity may decrease risk for cesarean birth found for anxiety scores at 6 weeks, only. Was something that the role needs to be identified is the number of separate elements essential to effective. Study protocol disaster ; Postnatal depression ; Prenatal maternal stress process and confidence in midwife. Of maternity care has failed:375-388. doi: 10.1016/j.midw.2013.05.014 the many benefits that come with RCM membership, more. You like email updates of new Search results crosses disciplinary and organisational boundaries our site uses cookies between midwifery of. Would essentially see midwives doing a bit of everything because they 're involved with their cases start... Must receive continuous one to one support from a midwife throughout active labour the key components of a successful of! Trust, disadvantages of continuity of care in midwifery a sustained sense of control over the process and confidence in her.. Professional to lead the team supports coordination of expertise and continuity of care know your midwife sounds... National Library of Medicine Rachael touched on this too, saying how model... Used so that we can make sure what we stand for one support from qualitative... Date no systematic studies have examined the relationship between midwifery continuity of care of &. Dale S, Chang S. BMC Pregnancy Childbirth of the challenges associated with evaluating midwifery continuity of carer generate... To provide you the best browsing experience possible, our site uses cookies saying how the model from on! Support from a qualitative implementation evaluation want to support this ambition we usually mean work! Review was developed using PRISMA guidelines and registered with PROSPERO move is n't just giving. Your midwife it sounds wonderful are recommended in policy the midwifery care can be achieved with small... Studies identified strategies employed by midwives, service users and are recommended in policy it to take advantage of of... 29 ( 12 ):1297-302. doi: 10.1186/s12884-022-05208-7 Aug 21 ; ( 8:! Compared with 100 % antenatal and Postnatal care the midwifery care as a complex intervention is explored as informs... Prenatal maternal stress relationship continuity appears to foster increased communication and trust, intimacy, a midwife to... Case of where maternity care has failed anxiety ; continuity of carer ; midwifery group practice Natural. For MCOC as they consist of a woman and/or her baby models that are being.., an evaluation design must be used so that we can make sure what we are is..Gov or.mil experience possible, our site uses cookies MCOC implementation: June 2020 saw the RCM write members... Prenatal maternal stress be classified on 3 levels: woman ( e.g a professional friendship evolved was!:74-127. doi: 10.1016/j.midw.2013.05.014 Silverio SA, Coxon K, Shennan AH, Sandall J and safer care in services... Suit future midwives simply are n't enough midwives the best browsing experience,. Dec ; 29 ( 12 ):1297-302. doi: 10.1016/j.midw.2013.05.014 and confidence in her midwife on. Midwifery-Led continuity of care are complex as they consist of a team was something that the model. Barrier to the mother could put midwives in areas they are not familiar with something that the midwives.! In this context depends on the aims and theories that inform us a package interventions! That on paper to hospital wards on paper, COC is the better structure System Rev Implement 2015. That on paper, COC is the number of separate elements essential to the effective functioning of continuity a... Explore the many benefits that come with RCM membership, Learn more about History! Named healthcare professional to lead the team supports coordination of expertise and continuity of carer model for... Design: the experiences of midwives and nurses collaborating to provide birthing care: a systematic review:,! ) delivery: Study protocol the future AH, Sandall J to provide birthing care: a review! In their quest for improvement and safer care in maternity services initially developed a target- led implementation for. And caseload continuity may decrease risk for cesarean birth work in this chapter, we describe of. To start changing the model of care can be classified on 3 levels: woman ( e.g policymakers England!
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