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Johansson, Lars
Publications (10 of 13) Show all publications
Öhman, L., Johansson, M., Jansson, J.-H., Lind, M. & Johansson, L. (2018). Positive predictive value and misclassification of diagnosis of pulmonary embolism and deep vein thrombosis in Swedish patient registries. Clinical Epidemiology, 10, 1215-1221
Open this publication in new window or tab >>Positive predictive value and misclassification of diagnosis of pulmonary embolism and deep vein thrombosis in Swedish patient registries
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2018 (English)In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, p. 1215-1221Article in journal (Refereed) Published
Abstract [en]

Purpose: To validate diagnoses of pulmonary embolism (PE) and deep vein thrombosis (DVT) in administrative registries. We also estimated the frequency of misclassified PE and DVT events.

Patients and methods: A registry search for ICD codes representing PE and DVT was performed between 1985 and 2014 in a large population-based cohort in northern Sweden. An additional search using an extended set of ICD codes was performed to identify misclassified events. Diagnoses were validated manually by reviewing medical records and radiology reports.

Results: Searching ICD codes in the National Patient Registry and Cause of Death Registry identified 2,450 participants with a first-time diagnosis of PE or DVT. The positive predictive value (PPV) for a diagnosis of PE or DVT was 80.7% and 59.2%, respectively. For the period of 2009 to 2014, the PPV was higher for PE (85.8%) but lower for DVT (54.1%). Misclassification occurred in 16.4% of DVT events and 1.1% of PE events.

Conclusion: Registry-based data on PE, especially in recent years, are of acceptable quality and can be considered for use in registry-based studies. For DVT, we found that data were of low quality in regards to both PPV and misclassification and should not be used without validation.

Place, publisher, year, edition, pages
Dove Medical Press, 2018
Keywords
pulmonary embolism, deep vein thrombosis, positive predictive value, International Classification of diseases, validation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-152428 (URN)10.2147/CLEP.S177058 (DOI)000445048000002 ()30271217 (PubMedID)
Funder
Västerbotten County Council
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2019-08-20Bibliographically approved
Johansson, C., Dahlqvist, E., Andersson, J., Jansson, J.-H. & Johansson, L. (2017). Incidence, type of atrial fibrillation and risk factors for stroke: a population-based cohort study. Clinical Epidemiology, 9, 53-62
Open this publication in new window or tab >>Incidence, type of atrial fibrillation and risk factors for stroke: a population-based cohort study
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2017 (English)In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 9, p. 53-62Article in journal (Refereed) Published
Abstract [en]

Purpose: The aims of this study were to estimate the incidence of atrial fibrillation and atrial flutter (AF), to assess the presence of provoking factors and risk factors for stroke and systemic embolism, and to determine the type of AF in patients with first-diagnosed AF. Patients and methods: This cohort study was performed in northern Sweden between January 1, 2011 and December 31, 2012. Diagnosis registries were searched for the International Classification of Diseases-10 code for AF (I48) to identify cases of incident AF. All AF diagnoses were electrocardiogram-verified. Data pertaining to provoking factors, type of AF and presence of risk factors for stroke and systemic embolism according to the CHA(2)DS(2)-VASc score were obtained from medical records. Results: The incidence of AF in the entire population was 4.0 per 1,000 person-years. The incidence was 27.5 per 1,000 person-years in patients aged >= 80 years. A total of 21% of all patients had a provoking factor in association with the first-diagnosed episode of AF. The CHA(2)DS(2)-VASc score was 2 or higher in 81% of the patients. Permanent AF was the most common type of AF (29%). Conclusion: There was a considerable increase in the incidence of AF with age, and a provoking factor was found in one-fifth. The most common type of AF was permanent AF. Four in five patients had a CHA(2)DS(2)-VASc score of 2 or more.

Keywords
atrial fibrillation, atrial flutter, incidence, risk factors for stroke
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-131648 (URN)10.2147/CLEP.S122916 (DOI)000392661300001 ()28182159 (PubMedID)2-s2.0-85011003129 (Scopus ID)
Available from: 2017-02-28 Created: 2017-02-28 Last updated: 2019-12-02Bibliographically approved
Lind, M., Johansson, L., Nilsson, T., Jansson, J.-H. & Hollestelle, M. J. (2015). von Willebrand activation factor as a marker of mortality, cardiovascular events, and bleeding complications in patients treated with oral anticoagulants. Thrombosis Research, 136(5), 878-882
Open this publication in new window or tab >>von Willebrand activation factor as a marker of mortality, cardiovascular events, and bleeding complications in patients treated with oral anticoagulants
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2015 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 136, no 5, p. 878-882Article in journal (Refereed) Published
Abstract [en]

Background: Serious bleeding is a frequent and feared treatment complication in patients treated with oral anticoagulants (OACs). Levels of von Willebrand factor (VWF) antigen have been linked to the risk of bleeding complications, mortality, and cardiovascular events. Objectives: In this longitudinal cohort study of evaluating patients treated with OACs, we aimed to evaluate the relationship between VWF displaying a glycoprotein Ib binding conformation (VWF activation factor) and the risk of cardiovascular events, bleeding complications, or all-cause mortality. Materials and methods: Blood samples were collected at baseline in 356 patients on OACs. Patients were followed for an average of 48 months and bleeding complications leading to admission to hospital or death, cardiovascular events (myocardial infarction, ischemic stroke, and peripheral arterial emboli), and all-cause mortality were recorded and classified. Results: During the study period, 47 bleeding complications, 84 cardiovascular events, and 97 deaths occurred. In multivariate Cox regression analyses, VWF activation factor was significantly associated with all-cause mortality (HR 1.62; 95% CI: 1.25-2.08) and cardiovascular events (HR 1.28; 95% CI: 1.01-1.63). There was no association observed between VWF activation factor and bleeding complications. Conclusions: Patients with high levels of VWF activation factor had an increased risk of cardiovascular events and all cause mortality during OAC treatment. The selectivity for thrombotic complications adds to the potential value of VWF activation factor as a biomarker or pharmacological target. (C) 2015 Elsevier Ltd. All rights reserved.

Keywords
Anticoagulants, Hemorrhage, Biological marker, Mortality, VWF
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-114033 (URN)10.1016/j.thromres.2015.08.016 (DOI)000366712000009 ()26364970 (PubMedID)
Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2019-08-20Bibliographically approved
Lind, M., Boman, K., Johansson, L., Nilsson, T., Slunga-Järvholm, L. & Jansson, J.-H. (2014). D-dimer predicts major bleeding, cardiovascular events and all-cause mortality during warfarin treatment. Clinical Biochemistry, 47(7-8), 570-573
Open this publication in new window or tab >>D-dimer predicts major bleeding, cardiovascular events and all-cause mortality during warfarin treatment
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2014 (English)In: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, Vol. 47, no 7-8, p. 570-573Article in journal (Refereed) Published
Abstract [en]

Objectives: Previous studies have shown that biomarkers in blood plasma can predict bleeding complications during anticoagulant treatment as well as thromboembolic events and may improve existing risk stratification schemes in patients on or considered for oral anticoagulant treatment. The aim of this study was to investigate if levels of D-dimer, tissue plasminogen activator (tPA) and its complex with plasminogen inhibitor type 1 (tPA/PAI-1 complex) can predict major bleedings, cardiovascular events and all-cause mortality in patients with warfarin treatment.

Design and methods: In a longitudinal cohort study, 719 patients on oral anticoagulant treatment were followed for a total of 3001 treatment years. Major bleeding, stroke, arterial emboli, myocardial infarction and death were recorded and classified. Blood samples collected at baseline were analyzed for D-dimer, tPA, and tPA/PAI-1 complex.

Results: In multivariate Cox regression analysis, high levels of D-dimer were associated with major bleeding (HR 1.27 per SD; 95% CI: 1.01-1.60), cardiovascular events (HR 1.23 per SD; 95% CI: 1.05-1.45) and all-cause mortality (HR 1.25 per SD; 95% CI: 1.06-1.47). Neither tPA nor the tPA/PAI-1 complex was associated with major bleeding, cardiovascular events or all-cause mortality.

Conclusion: We conclude that high levels of D-dimer predict major bleeding, cardiovascular events and all-cause mortality during warfarin treatment. (C) 2014 The Canadian Society of Clinical Chemists. 

Keywords
D-dimer, Bleeding, Warfarin, Mortality, PAI-1, Cardiovascular events
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-90777 (URN)10.1016/j.clinbiochem.2014.03.003 (DOI)000335905200012 ()24636802 (PubMedID)
Available from: 2014-10-10 Created: 2014-07-01 Last updated: 2019-08-20Bibliographically approved
Hagg, L., Johansson, C., Jansson, J.-H. & Johansson, L. (2014). External Validity of the ARISTOTLE Trial in Real-Life Atrial Fibrillation Patients. Cardiovascular Therapeutics, 32(5), 214-218
Open this publication in new window or tab >>External Validity of the ARISTOTLE Trial in Real-Life Atrial Fibrillation Patients
2014 (English)In: Cardiovascular Therapeutics, ISSN 1755-5914, Vol. 32, no 5, p. 214-218Article in journal (Refereed) Published
Abstract [en]

Objective

Our primary objective was to determine the proportion of patients with atrial fibrillation (AF) eligible for enrollment in a randomized controlled trial for a novel oral anticoagulant, the ARISTOTLE trial. A secondary objective was to describe the reasons for trial ineligibility.

Methods

We performed a cross-sectional study of an unselected population including 2274 patients in Skelleftea, Sweden with at least one verified episode of AF on or before December 31, 2010. Patients were classified as suitable or unsuitable for anticoagulant treatment according to current guidelines. The enrollment criteria from the ARISTOTLE trial were extracted from the original publication and applied to the population.

Results

Among all patients with AF, 1579 were classified as suitable for anticoagulant treatment. Of these, only 658 patients (42%) were eligible for participation in the ARISTOTLE trial. Among the 921 patients ineligible for participation, 498 did not meet the ECG criteria, 272 had psychosocial problems, and in addition, 78 patients were excluded due to both of these criteria.

Conclusion

Our study shows that a majority of the patients in an unselected population with AF suitable for anticoagulant treatment were ineligible for participation in the ARISTOTLE trial. The applicability of the ARISTOTLE trial is therefore unknown for a considerable proportion of patients with AF in real life.

Keywords
Apixaban, ARISTOTLE, Arrhythmias, Atrial fibrillation, Coagulation, Thrombosis, External validity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-96617 (URN)10.1111/1755-5922.12087 (DOI)000342852700005 ()24975869 (PubMedID)
Available from: 2014-11-28 Created: 2014-11-24 Last updated: 2018-06-07Bibliographically approved
Isaksson, M., Johansson, L., Olofssson, I. & Eurenius, E. (2013). Shoulder pain and concomitant hand oedema among strokepatients with pronounced arm paresis. European journal of physiotherapy, 15(4), 208-214
Open this publication in new window or tab >>Shoulder pain and concomitant hand oedema among strokepatients with pronounced arm paresis
2013 (English)In: European journal of physiotherapy, ISSN ISSN 2167-9169, EISSN 2167-9177, Vol. 15, no 4, p. 208-214Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this prospective study was to identify clinical factors associated with the development of shoulder pain in stroke patients with pronounced arm paresis. Methods: At stroke onset, 485 patients were initially assessed in 2007 – 2009. Sixty-three patients with pronounced arm paresis completed the study, and 21 of these developed shoulder pain. Clinical findings were recorded fortnightly by the attending physiotherapist during hospital stay. Results: Hand oedemaon the paretic side was more common in patients developing shoulder pain compared with those who did not develop shoulder pain. The onset of shoulder pain was associated with concomitant hand oedema. High NIHSS score was associated with developing shoulder pain. Patients with a history of shoulder pain developed pain earlier than those without previous shoulder pain. Patients with haemorrhagic stroke were significantly more prone to developing shoulder pain. Conclusions: One-third of the stroke patients with pronounced arm paresis developed shoulder pain. Concomitant hand oedema seems to be an additional symptom of shoulder injury. Patients with low general status are more vulnerable to develop post-stroke shoulder pain.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
arm injuries, cerebrovascular disorders, hemiplegia, prospective studies, rehabilitation
National Category
Health Sciences
Identifiers
urn:nbn:se:umu:diva-84906 (URN)10.3109/21679169.2013.843202 (DOI)
Available from: 2014-01-22 Created: 2014-01-22 Last updated: 2018-06-08Bibliographically approved
Johansson, L., Stenlund, H., Bylund, P.-O. & Eriksson, A. (2012). ER visits predict premature death among teenagers. Accident Analysis and Prevention, 48(S1), 397-400
Open this publication in new window or tab >>ER visits predict premature death among teenagers
2012 (English)In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 48, no S1, p. 397-400Article in journal (Refereed) Published
Abstract [en]

Background: The purpose of this study was to investigate if teenagers visiting an emergency room because of injury have an increased risk of premature death ahead and, if so, identify possible risk factors and suggest preventive measures. Methods: In January 2010, the personal identity numbers of 12,812 teenagers who had visited the emergency room at the University Hospital in Umea. Sweden, during 1993 through 2006 because of injury were checked against the National Cause of Death Register in Sweden. Standardised mortality ratio and confidence intervals were calculated. For the unnatural deaths that took place in Sweden, the police report, autopsy protocol, and hospital records, if present, were studied. Results: Thirty-eight fatalities were included giving a standardised mortality ratio of 1.44 (95% CI: 1.02-1.98). A majority of the decedents were males (n = 32, 84%) and the median age at the time of death was 21 years. Twenty-three deaths were caused by unintentional injuries and ten by intentional injuries (all suicides), while five deaths were categorised as undetermined whether intentional or not. Seventy-four percent tested positive for either alcohol or drugs or a combination at the post mortem examination. Nine males and one female committed suicide, five tested positive for alcohol (one also for drugs), while four tested negative at the post mortem examination. One died abroad and in this case we lack information on alcohol and drugs. Conclusion: Teenagers visiting an emergency room due to injury experience an increased risk of premature death by unnatural cause and those at risk are especially males. The use of alcohol and drugs often seems to contribute to their untimely deaths. Identifying those at risk when they visit the emergency room for an injury and to take preventive actions at this stage could be a way to reduce the number of fatalities. (C) 2012 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Oxford: Elsevier, 2012
Keywords
ER, Premature death, Alcohol/drugs
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-60058 (URN)10.1016/j.aap.2012.02.012 (DOI)000307140500045 ()
Available from: 2012-10-09 Created: 2012-10-01 Last updated: 2018-06-08Bibliographically approved
Johansson, L. (2010). Teenager fatalities: epidemiology and implications for prevention. (Doctoral dissertation). Umeå: Umeå Universitet
Open this publication in new window or tab >>Teenager fatalities: epidemiology and implications for prevention
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A significant number of teenagers are killed each year by unintentional or intentional injuries. A teenager is in a vulnerable phase of her/his life, going from being a child to adult. This transition often includes testing the limits of their capabilities, which can include, e.g., high speed driving, testing alcohol and other drugs, including drinking and driving. The development from child to adult includes different psychological stress factors, such as, e.g., school problems, broken love affairs and bullying. The demands – perceived or real – also increases over time and vulnerable individuals can turn to self-harm and in the most extreme case suicide.

The aim of this thesis was to investigate teenager fatalities in the northern half of Sweden and to suggest preventive measures.

A survey of teenager fatalities during a twenty-year period revealed that the incidence of unintentional (n=248) deaths decreased, while intentional (n=102) deaths were unaffected over time. Most unintentional deaths were transportation related (n=204) while most of the intentional deaths were suicides (n=88). Twenty-eight percent of the decedents were test-positive for alcohol at autopsy.

In a series of three studies, teenager suicides were investigated in depth, firstly through an interview study with the investigating police officer in charge of the investigation of a teenager suicide. Most of the suicides occurred in rural and depopulated areas despite the fact that most teenagers live in the larger cities along the coastline. A majority of the suicides appeared to be planned. Females, contrary to males, often had a psychiatric history. One of the conclusions was that police officers provide essential information concerning the circumstances around a teenager suicide.

Parents who had lost a child through suicide, and in some cases siblings, were interviewed 15-25 months after the suicide. It was striking how the life of the surviving family members were still affected by the devastating trauma of the suicide; most parents testified that they were still struggling with the question “why?” and that they were thinking of their lost child every day. Post suicide support was often badly timed and insufficient, especially for the younger siblings. The family doctor has an important role as a co-ordinator of a long-term individually formulated support scheme for the bereaved.

Evidence of suicide contagion and suicide cluster formation, i.e., one teenager suicide led to another suicide, was found in these studies, and two suicide clusters were identified, with links between the victims in each cluster. Both clusters occurred within a geographical and timely proximity. Everyone involved in the well-being of the young should be aware of the risk of contagion and suicide cluster formation.

The fifth study concerned 12,812 teenagers who visited the Emergency Room at Umeå University Hospital due to an injury during 1993 through 2006. Sixty-one of these were found dead through 2007, 49 by unnatural (of which 38 were included) and 12 by natural causes. The standard mortality rate for unnatural death was calculated to 1.44 (1.02-1.98), confirming an increased risk of premature death. In many of these deaths, alcohol and drugs may have contributed. By increasing the awareness among health professionals that injury can predict a premature death - primarily among those who develop substance abuse - some premature deaths may be prevented by early intervention.

This thesis confirms that most teenagers die from unnatural causes, mostly in transportation-related events and by suicide. By studying these deaths, preventive measures that could save lives have been suggested.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2010. p. 56
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1371
Keywords
Teenager, fatalities, injury, suicide, alcohol, drugs, intoxication, trends
National Category
Forensic Science
Research subject
Forensic Medicine
Identifiers
urn:nbn:se:umu:diva-36682 (URN)978-91-7459-063-0 (ISBN)
Public defence
2010-10-29, Betula, by 6M, Umeå, 15:05 (Swedish)
Opponent
Supervisors
Available from: 2010-10-11 Created: 2010-10-07 Last updated: 2018-06-08Bibliographically approved
Lindqvist, P., Johansson, L. & Karlsson, U. (2008). In the aftermath of teenage suicide: a qualitative study of the psychosocial consequences for the surviving family members. BMC Psychiatry, 8(1), 26
Open this publication in new window or tab >>In the aftermath of teenage suicide: a qualitative study of the psychosocial consequences for the surviving family members
2008 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 8, no 1, p. 26-Article in journal (Refereed) Published
Abstract [en]

Background Studies of family reactions following teenage suicide are hampered by the psychological difficulties of approaching families and recruiting an unbiased sample of study subjects. By using a small but consecutive series of cases, we examined the qualitative aspects of loosing a teenage family member due to suicide. Such an understanding is important for future organisation of proper programs that provide professional support in the grief process.

Methods From a large project on teenage unnatural death in northern Sweden 1981-2000 (n=88), 13 cases from 1995 through 1998 were retrospectively identified and consecutively analysed. Ten families agreed to participate. The open interviews took place 15 to 25 months after the suicide. The information gathered was manually analysed according to a grounded theory model, resulting in allocation of data into one of three domains: post-suicidal reactions, impact on daily living, and families´need for support.

Results. Teenager suicide is a devastating trauma for the surviving family and the lacko of sustainable explanations for the suicide is a predominant issue in the grief process. The prolonged social and psychological isolation of the families in grief should be challenged. At the time of the interview, the families were still struggling with explaining why the suicide occurred, especially since most suicides had occurred without overt premonitory signs. The bereaved family members were still profoundly affected by the loss, but all had returned to an ostensibly normal life. Post-suicide support was often badly timed and insufficient, especially for younger siblings.

Conclusions Family doctors can organise a long-term, individually formulated support scheme for the bereaved, including laymen who can play a most significant role in the grief process. There is also a need for better understanding of the families who have lost a teenager whom committed suicide and for the development and testing of treatment schemes for the bereaved family.

Keywords
teenage suicide, surviving family members
National Category
Forensic Science
Identifiers
urn:nbn:se:umu:diva-9559 (URN)10.1186/1471-244X-8-26 (DOI)18426560 (PubMedID)
Available from: 2008-04-25 Created: 2008-04-25 Last updated: 2018-06-09Bibliographically approved
Ekblom, K., Hultdin, J., Stegmayr, B., Johansson, I., Van Guelpen, B., Hallmans, G., . . . Marklund, S. L. (2007). Iron stores and HFE genotypes are not related to increased risk of ischemic stroke.: a prospective nested case-referent study. Cerebrovascular Diseases, 24(5), 405-411
Open this publication in new window or tab >>Iron stores and HFE genotypes are not related to increased risk of ischemic stroke.: a prospective nested case-referent study
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2007 (English)In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 24, no 5, p. 405-411Article in journal (Refereed) Published
Abstract [en]

Background: High iron levels can increase the formation of noxious oxygen radicals, which are thought to contribute to cerebrovascular disease. The aim of this prospective study was to determine if iron status and HFE genotypes constitute risk factors for stroke.

Methods: First-ever stroke cases (231 ischemic and 42 hemorrhagic) and matched double referents from the population-based Northern Sweden cohorts were studied in a nested case-referent setting.

Results: For total iron binding capacity, an increased risk of ischemic stroke was seen in the highest quartile (OR 1.80; 95% CI 1.14-2.83; p for trend 0.012). The highest quartile of transferrin iron saturation showed a decreased risk of ischemic stroke in men (OR 0.44; 95% CI 0.22-0.87; p for trend 0.028), but not in women. There was an increased risk of hemorrhagic stroke in the second (OR 4.07; 95% CI 1.09-15.20) and third quartile (OR 4.22; 95% CI 1.08-16.42) of ferritin. Neither quartiles of plasma iron concentrations nor the HFE C282Y and H63D genotypes were associated with ischemic or hemorrhagic stroke.

Conclusions: Iron stores were not positively related to increased risk of ischemic stroke. Furthermore, HFE genotypes did not influence the risk of ischemic or hemorrhagic stroke. Copyright (c) 2007 S. Karger AG, Basel.

Keywords
Adult, Aged, Anthropometry, Cardiovascular Diseases/*etiology/genetics, Europe, Female, Humans, Life Style, Male, Middle Aged, Nutritional Status, Prospective Studies, Questionnaires
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Clinical Chemistry
Identifiers
urn:nbn:se:umu:diva-16977 (URN)10.1159/000108429 (DOI)17878720 (PubMedID)
Available from: 2008-01-11 Created: 2008-01-11 Last updated: 2018-06-09Bibliographically approved
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