Ph.D., University of Michigan, School of Public Health (1989)
Enhancing our understanding of psychosocial factors at work (occupational stress, social support at work, organizational justice, organizational empowerment) that are associated with health and disease.
Developing effective strategies for enhancing employee resiliency and reducing exposure to psychological and behavioral risk factors at work.
The quality of one's overall diet has proven to be of great importance to health and well-being. Unfortunately, diet quality is time-consuming to assess. The Stanford Wellness Living Laboratory (WELL) administered an online survey that included the WELL Diet Score (a novel diet quality assessment calculated from 12 diet-related items). Subsequently, WELL participants were asked to complete the 127-item Block Food Frequency Questionnaire (FFQ) online. The present study's primary objective was to compare the WELL Diet Score with the established FFQ-based Alternative Healthy Eating Index-2010 (AHEI-2010), in a subset of WELL participants (n = 248) who completed both dietary measures through WELL's online platform. The two scores were significantly correlated (r = .69; p < .0001). Regression analyses demonstrated that the WELL Diet Score was positively significantly associated with sociodemographic determinants of diet quality and protective health factors, including older age, higher education, lower BMI, and higher physical activity. In summary, the WELL Diet Score, derived from 12 small diet-related items that can be completed in 5 min, was significantly positively correlated with the AHEI-2010 derived from the lengthy 127-item FFQ, suggesting the potential utility of the WELL Diet Score in future large-scale studies, including future WELL studies.
View details for DOI 10.1002/fsn3.1558
View details for PubMedID 32566188
View details for PubMedCentralID PMC7300046
Our aim was to explore the concepts of health and well-being from the point of view of the people experiencing them. Most of the efforts to understand these concepts have focused on disease prevention and treatment. Less is known about how individuals achieve health and well-being, and their roles in the pursuit of a good life. We hoped to identify important components of these concepts that may provide new targets and messages to strengthen existing public health programs. An improved understanding of health and well-being - or what it means to be well - can guide interventions that help people lead healthier, more fulfilling lives.Using a grounded qualitative approach drawing from narrative inquiry, we interviewed 24 Taiwanese adults. Thematic inductive coding was employed to explore the nature of health and well-being.Eight constituent domains emerged regarding well-being and health. While the same domains were found for both constructs, important frequency differences were found when participants discussed health versus well-being. Physical health and lifestyle behaviors emerged as key domains for health. Disease-related comments were the most frequently mentioned sub-category within the physical health domain, along with health care use and aging-related changes. For well-being, family and finances emerged as key domains. Family appears to be a cornerstone element of well-being in this sample, with participants often describing their personal well-being as closely tied to - and often indistinguishable from - their family. Other domains included work-life, sense of self, resilience, and religion/spirituality.Health and well-being are complex and multifaceted constructs, with participants discussing their constituent domains in a very interconnected manner. Programs and policies intended to promote health and well-being may benefit from considering these domains as culturally-appropriate leverage points to bring about change. Additionally, while the domains identified in this study are person-centered (i.e., reflecting the personal experiences of participants), the stories that participants offered provided insights into how well-being and health are influenced by structural, societal and cultural factors. Our findings also offer an opportunity for future refinement and rethinking of existing measurement tools surrounding these constructs.
View details for DOI 10.1186/s12889-020-8201-3
View details for PubMedID 32013898
View details for Web of Science ID 000473349401341
View details for Web of Science ID 000473349400250
View details for Web of Science ID 000446532700259
Evidence of whether behavioral weight-loss interventions reduce depressive symptoms among Latino immigrants is limited. The effect of a behavioral weight-loss intervention on depressive symptoms was assessed using data from a clinical trial among Latino immigrants. Participants were randomized to a usual care (UC) control (n = 41), case management (CM) alone (n = 84), or CM with community health worker support (CM+CHW) (n = 82). Generalized estimating equation models were used to compare the impact of each intervention with UC. Effect modification by poverty level was further investigated. Overall, treatment groups were not significantly associated with 24-month changes in CES-D scores. Among participants below the 100% federal poverty level (FPL), those randomized to CM+CHW had 24-month CES-D scores significantly lower (Β coefficient = 0.72; 95% CI 0.55-0.93) than those in UC (p = 0.01). A behavioral weight-loss intervention providing case management and support from a CHW reduced depressive symptoms among Latino immigrants below the 100% FPL.
View details for PubMedID 29038966
View details for Web of Science ID 000446516100584
OBJECTIVES: Migration is an increasingly prevalent worldwide phenomenon. In recent years, Maasai men and women have migrated from their traditional rural villages to cities in Tanzania in growing numbers. This study explores the experience of rural-to-urban migration among female Maasai migrants and how this experience affects ethnic identity, resilience, and well-being.METHODS: Thirty-one female Maasai migrants were interviewed in Swahili, Maa, or English. Researchers used a rigorous multi-pass, qualitative coding process to analyze interview transcripts.RESULTS: Migration-driving factors, specifically a desire for education (leading to permanent migrants) and a need to support one's family (resulting in circular migrants), influence how Maasai women adapt and respond to challenges in the city. Circular migrants hold closely to their traditional ethnic identity and remain isolated from city life, while permanent migrants modulate their ethnic identity and integrate into urban society.CONCLUSIONS: Increasing connections among female Maasai migrants might create a more resilient community leading to improved health. Pilot workshops with this aim are being implemented.
View details for PubMedID 29868928
View details for Web of Science ID 000431185201082
View details for Web of Science ID 000431185201479
View details for Web of Science ID 000431185201076
Skill utilization, defined as having the opportunity to do one's best at work, has been examined as a contributor to productivity, organizational efficiency, job satisfaction, and mental health. Drawing from self-determination theory, we postulate that high levels of skill utilization are positively associated with physical health and that some of the effect is mediated by health behavior.Using the 2014 Gallup Daily Tracking Survey data (n = 87,316), a nationally representative sample of working adults in the United States, we examine the associations between perceived skill utilization and five health outcomes (self-rated health, hypertension, high cholesterol, cancer, asthma) with healthy behavior (regular exercising, fruits and vegetable consumption) as a mediator of the associations.The regression results showed that a one-point increase in skill utilization (on a three-point scale) was associated with 20% lower odds of reporting poor or fair health, 3% and 8% lower odds of reporting hypertension and high cholesterol, but had no significant association with cancer or asthma. Health behavior mediated 10% of the association between skill utilization and self-rated health, 46% for hypertension, and 18% for high cholesterol.The findings suggest that providing employees the opportunities to use their skills well at work improves health in general, and the effect is partly through enhancing the likelihood of engaging in healthy behaviors. Implications for organizational practice as well as future research directions are discussed.
View details for DOI 10.1016/j.socscimed.2016.12.048
View details for PubMedID 28111118
High-income country (HIC) trainees are undertaking global health experiences in low- and middle-income country (LMIC) host communities in increasing numbers. Although the benefits for HIC trainees are well described, the benefits and drawbacks for LMIC host communities are not well captured.This study evaluated the perspectives of supervising physicians and local programme coordinators from LMIC host communities who engaged with HIC trainees in the context of the latter's short-term experiences in global health.Thirty-five semi-structured interviews were conducted with LMIC host community collaborators with a US-based, non-profit global health education organisation. Interviews took place in La Paz, Bolivia and New Delhi, India. Interview transcripts were assessed for recurrent themes using thematic analysis.Benefits for hosts included improvements in job satisfaction, local prestige, global connectedness, local networks, leadership skills, resources and sense of efficacy within their communities. Host collaborators called for improvements in HIC trainee attitudes and behaviours, and asked that trainees not make promises they would not fulfil. Findings also provided evidence of a desire for parity between the opportunities afforded to US-based staff and those available to LMIC-based partners.This study provides important insights into the perspectives of LMIC host community members in the context of short-term experiences in global health for HIC trainees. We hope to inform the behaviour of HIC trainees and institutions with regard to international partnerships and global health activities.
View details for DOI 10.1111/medu.13106
View details for PubMedID 27762010
Despite their rapid increase in number, workers in personal care and service occupations are underrepresented in research on psychosocial work characteristics and occupational health. Some of the research challenges stem from the high proportion of immigrants in these occupations. Language barriers, low literacy, and cultural differences as well as their nontraditional work setting (i.e., providing service for one person in his/her home) make generic questionnaire measures inadequate for capturing salient aspects of personal care and service work. This study presents strategies for (1) identifying psychosocial work characteristics of home care workers that may affect their occupational safety and health and (2) creating survey measures that overcome barriers posed by language, low literacy, and cultural differences.We pursued these aims in four phases: (Phase 1) Six focus groups to identify the psychosocial work characteristics affecting the home care workers' occupational safety and health; (Phase 2) Selection of questionnaire items (i.e., questions or statements to assess the target construct) and first round of cognitive interviews (n = 30) to refine the items in an iterative process; (Phase 3) Item revision and second round of cognitive interviews (n = 11); (Phase 4) Quantitative pilot test to ensure the scales' reliability and validity across three language groups (English, Spanish, and Chinese; total n = 404). Analysis of the data from each phase informed the nature of subsequent phases. This iterative process ensured that survey measures not only met the reliability and validity criteria across groups, but were also meaningful to home care workers.This complex process is necessary when conducting research with nontraditional and multilingual worker populations.
View details for DOI 10.1080/13557858.2014.925095
View details for Web of Science ID 000357321600003
View details for PubMedID 24990579
This pilot study explored students' responses to feedback about their own and their peers' depression symptoms. The study also examined how experiences with the normative feedback might vary according to academic exposure to depression-related topics.For 9 weeks, female undergraduates (N=73) completed a weekly web-based version of the 8-item Patient Health Questionnaire, which gauges depression symptom levels. Next, they participated in semi-structured face-to-face interviews where they responded to the personalized normative feedback. The interviews were transcribed, coded, and analyzed.Students responded favorably to the feedback and without notable distress. The feedback increased students' awareness of their own depression symptoms and those of their peers. Those with higher academic exposure to depression-related topics were more likely to have accurate perceptions of their peers' depression symptoms and were less likely to be surprised by information in the feedback than students with less exposure.Personalized normative feedback for depression symptoms has potential as an effective tool for promoting more accurate views of personal and peer depression symptoms and reducing barriers to help-seeking. Students with less academic exposure to depression-related topics may benefit from increased knowledge of how to gauge their own depression symptoms and increased awareness of their peers' symptoms. Further research is needed to more fully evaluate the effects of this feedback and to directly assess the effects of this feedback on help-seeking behaviors.
View details for DOI 10.1007/s40596-014-0076-0
View details for PubMedID 24664603
This pilot study explored students' responses to feedback about their own and their peers' depression symptoms. The study also examined how experiences with the normative feedback might vary according to academic exposure to depression-related topics.For 9 weeks, female undergraduates (N = 73) completed a weekly web-based version of the 8-item Patient Health Questionnaire, which gauges depression symptom levels. Next, they participated in semi-structured face-to-face interviews where they responded to the personalized normative feedback. The interviews were transcribed, coded, and analyzed.Students responded favorably to the feedback and without notable distress. The feedback increased students' awareness of their own depression symptoms and those of their peers. Those with higher academic exposure to depression-related topics were more likely to have accurate perceptions of their peers' depression symptoms and were less likely to be surprised by information in the feedback than students with less exposure.Personalized normative feedback for depression symptoms has potential as an effective tool for promoting more accurate views of personal and peer depression symptoms and reducing barriers to help-seeking. Students with less academic exposure to depression-related topics may benefit from increased knowledge of how to gauge their own depression symptoms and increased awareness of their peers' symptoms. Further research is needed to more fully evaluate the effects of this feedback and to directly assess the effects of this feedback on help-seeking behaviors.
View details for DOI 10.1007/s40596-014-0076-0
View details for PubMedID 24664603
The operation of all-terrain vehicles (ATVs) by youth has contributed to the incidence of serious and fatal injuries among children. This study explored factors related to the frequency with which youth wore a helmet and refrained from engaging in three risky driving behaviors (driving at risky speeds, on paved roads and on unfamiliar terrain) while operating an ATV. Youth (n = 248) aged 9-14 from central Ohio and one of their parents completed self-report measures of ATV safety behaviors, youth general propensity for risk taking, protection motivation and parental behaviors to facilitate youth safety. Data from two focus groups provided insight on quantitative results. Analyses revealed considerable variation in the frequency with which youth performed the safety behaviors, with 13- and 14-year-olds reporting less frequent safe behavior than 9- to 12-year-olds. Multiple regression analyses suggested that parental behaviors, such as providing reminders to wear a helmet, were associated with more frequent helmet use but were not associated with risky driving behaviors. Youth's general propensity toward risk taking was not associated with helmet use and only associated with riskydriving behaviors among the 13- and 14-year-olds. Self-efficacy was an important predictor across both age groups and behaviors. Implications for injury prevention are discussed.
View details for DOI 10.1093/her/cyu016
View details for PubMedID 24740837
Biomechanical, psychosocial and individual risk factors for low back disorder have been studied extensively however few researchers have examined all three risk factors. The objective of this was to develop a low back disorder risk model in furniture distribution workers using biomechanical, psychosocial and individual risk factors.This was a prospective study with a six month follow-up time. There were 454 subjects at 9 furniture distribution facilities enrolled in the study. Biomechanical exposure was evaluated using the American Conference of Governmental Industrial Hygienists (2001) lifting threshold limit values for low back injury risk. Psychosocial and individual risk factors were evaluated via questionnaires. Low back health functional status was measured using the lumbar motion monitor. Low back disorder cases were defined as a loss of low back functional performance of -0.14 or more.There were 92 cases of meaningful loss in low back functional performance and 185 non cases. A multivariate logistic regression model included baseline functional performance probability, facility, perceived workload, intermediated reach distance number of exertions above threshold limit values, job tenure manual material handling, and age combined to provide a model sensitivity of 68.5% and specificity of 71.9%.The results of this study indicate which biomechanical, individual and psychosocial risk factors are important as well as how much of each risk factor is too much resulting in increased risk of low back disorder among furniture distribution workers.
View details for DOI 10.1016/j.clinbiomech.2011.09.002
View details for Web of Science ID 000300810600003
View details for PubMedID 21955915
The North American Guidelines for Children's Agricultural Tasks (NAGCAT) were developed to reduce the risk of childhood agricultural injury. The purpose of this study was to evaluate compliance with NAGCAT-recommended work practices (WPs) when youth work with large animals. On a daily basis, over a period of 10 weeks, youth self-reported the number of minutes they worked with a large animal and whether they followed the associated NAGCAT WP guidelines. Statistical analyses were conducted to compare boys to girls and to consider the effect of factors such as youth age, farm residence status, and selected parental characteristics. A high proportion of youth exhibited relatively low compliance for most of the five WPs evaluated. Respirators were rarely worn, but checking for people and obstacles in the area while working with large animals was commonly reported. In general, boys, especially the older boys, exhibited higher compliance than did girls. The results of our study demonstrate, in general, that youth are not following recommended NAGCAT WPs when working with large animals, identifying an area in agricultural safety and health requiring focused attention.
View details for DOI 10.1080/1059924X.2011.584044
View details for Web of Science ID 000300238300003
View details for PubMedID 21728869
Social forces and cultural factors may contribute to Latino and White workers experiencing similar jobs differently. This study examines the psychosocial stressors and resources experienced by Latino and White workers in manual material handling jobs in the US and the effects of these stressors and resources on worker well-being.Fifty-nine Latino warehouse workers were matched with White workers by job title, job tenure, and warehouse facility. Matched sample t tests and linear regression analyses models were conducted.Results reveal similar psychosocial stressors and resources for both groups. However, Latino workers reported better well-being. For Latino workers, social resources at work such as management fairness and supervisor support have a stronger relationship with well-being. For White workers wage fairness is the most significant predictor for well-being.These differential results challenge us to consider how cultural factors, expectations and the prior work history of Latino workers may influence their experience of work and the effect of work on health.
View details for DOI 10.1002/ajim.20752
View details for Web of Science ID 000275084500004
View details for PubMedID 19774551
To examine the role of physical activity (PA) companions in supporting PA participation among African American women.Data were collected through in-depth interviews and focus groups. Fifteen physically active African American women participated in the study. Grounded theory data analysis techniques were used to develop a taxonomy depicting roles of PA companions for African American women.PA companions functioned in 4 different roles: motivational, social, facilitative, and instructional. Supportive behaviors associated with each role were also elucidated.These findings provide an understanding for the function of companions in sustaining active lifestyle that can be used to inform intervention development.
View details for Web of Science ID 000271597500005
View details for PubMedID 19320616
A small but growing literature has documented an association between justice at work and employee health. However, the pathways and mechanisms underlying this association are not well understood. This article proposes a conceptual framework that bridges the organizational justice, occupational stress, and occupational epidemiology literatures. Justice appraisals are proposed to be both important mediators and moderators in the causal flow from exposure to the organizational environment to employee health. The potential role of justice in enhancing employee health is compared to that of the well-established concepts of social support and job control. Directions for future research are suggested, along with strategies for overcoming challenges inherent in this multidisciplinary area of research. Implications for work-site health interventions are discussed.
View details for DOI 10.1177/1090198107306435
View details for Web of Science ID 000266397000007
View details for PubMedID 18006665
Diabetes-related disparities are well documented among racial minority groups in the United States. Online programs hold great potential for reducing these disparities. However, little is known about how people of different races utilize and communicate in such groups. This type of research is necessary to ensure that online programs respond to the needs of diverse populations.This exploratory study investigated message frequency and content on bulletin boards by race in the Internet Diabetes Self-Management Program (IDSMP). Two questions were asked: (1) Do participants of different races utilize bulletin boards with different frequency? (2) Do message, content, and communication style differ by race? If so, how?Subjects were drawn by purposeful sampling from participants in an ongoing study of the effectiveness of the IDSMP. All subjects had completed a 6-week intervention that included the opportunity to use four diabetes-specific bulletin boards. The sample (N = 45) consisted of three groups of 15 participants, each who self-identified as American Indian or Alaskan Native (AI/AN), African American (AA), or Caucasian, and was stratified by gender, age, and education. Utilization was assessed by counting the number of messages per participant and the range of days of participation. Messages were coded blindly for message type, content, and communication style. Data were analyzed using descriptive and nonparametric statistics.In assessing board utilization, AAs wrote fewer overall messages (P = .02) and AIs/ANs wrote fewer action planning posts (P = .05) compared with Caucasians. AIs/ANs logged in to the program for a shorter time period than Caucasians (P = .04). For message content, there were no statistical (P
View details for DOI 10.2196/jmir.1153
View details for Web of Science ID 000274632700006
View details for PubMedID 19632975
View details for PubMedCentralID PMC2762800
View details for DOI 10.2196/jmir.1153
View details for Web of Science ID 000274632700006
View details for PubMedID 19632975
View details for PubMedCentralID PMC2762800
Regular physical activity is linked to a reduced risk of obesity and chronic disease. African American women bear a disproportionate burden from these conditions and many do not get the recommended amount of physical activity. Long-term success of interventions to initiate and maintain a physically active lifestyle among African American women has not been realized. By clearly elucidating the process of physical activity adoption and maintenance, effective programming could be implemented to reduce African American women's burden from chronic conditions. In-depth interviews were conducted with physically active African American women. Grounded theory, a rigorous qualitative research method used to develop theoretical explanation of human behavior grounded in data collected from those exhibiting that behavior, was used to guide the data collection and analysis process. Data derived inductively from the interviews and focus groups guided the development of a behavioral framework explaining the process of physical activity evolution.
View details for DOI 10.1177/1090198107306434
View details for Web of Science ID 000262950200008
View details for PubMedID 18006664
We examined the influence of social and cultural contexts on participation in recommended levels of physical activity (PA) among African American women using a grounded theory approach. Data were collected through in-depth interviews and focus groups with 15 physically active African American women. Participants described social and cultural factors that served as challenges for participation in PA. Of particular importance, participants discussed their strategies for overcoming these challenges to initiate and maintain an active lifestyle. Strategies emerged to address three main areas: lack of PA exposure, PA norms and beliefs, and hair maintenance. Understanding contextually appropriate strategies to assist African American women in long-term PA maintenance will help inform effective health promotion efforts to reduce the burden of sedentary lifestyle and chronic disease in this community of women.
View details for DOI 10.1080/03630240802690861
View details for Web of Science ID 000264823600006
View details for PubMedID 19485236
This study explores the extent to which the constructs of social support and social connectedness differ in terms of their associations with the structural characteristics of social networks and the health status of older adults.Trained interviewers conducted 126 face-to-face interviews with community-dwelling older adults aged 65 to 85 years.Having frequent contact with network members was positively associated with social support. Network density and having network members living in close proximity were positively associated with perceived social connectedness. Furthermore, perceived social connectedness had a significant positive association with health status, whereas social support did not.Perceived social connectedness may be relatively more important to the health and well-being of older adults than the perceived availability of social support. Efforts to enhance older adults' social relationships can be focused on developing friends and companions, allowing them to feel socially engaged in society.
View details for DOI 10.1177/0898264308324626
View details for Web of Science ID 000259737000007
View details for PubMedID 18815414
The Intervention Evaluation Competition at the Work, Stress, and Health conference in Miami (March 2006) highlighted the importance of intervention evaluation studies that promote safety and health at work. A retitled, "Best Practices Evaluation Competition," has been included in the March, 2008, Work, Stress, and Health conference, in Washington, DC. This brief note describes the development of the criteria used to evaluate the manuscripts. The criteria are discussed with respect to (a) improving the science of evaluation methodology, (b) promoting the highest ethical standards in intervention evaluation, and (c) using the current criteria as a starting point for continuing to raise the bar for evaluation methodology. The policy implications of the evaluation criteria are discussed as well.
View details for DOI 10.1037/1076-89188.8.131.52
View details for Web of Science ID 000252615700001
View details for PubMedID 18211164
To model the effects of computer use on reported visual and physical symptoms and to measure the effects upon quality of life measures.A survey of 1000 university employees (70.5% adjusted response rate) assessed visual and physical symptoms, job, physical and mental demands, ability to control/influence work, amount of work at a computer, computer work environment, relations with others at work, life and job satisfaction, and quality of life. Data were analyzed to determine whether self-reported eye symptoms are associated with perceived quality of life. The study also explored the factors that are associated with eye symptoms. Structural equation modeling and multiple regression analyses were used to assess the hypotheses.Seventy percent of the employees used some form of vision correction during computer use, 2.9% used glasses specifically prescribed for computer use, and 8% had had refractive surgery. Employees spent an average of 6 h per day at the computer. In a multiple regression framework, the latent variable eye symptoms was significantly associated with a composite quality of life variable (p = 0.02) after adjusting for job quality, job satisfaction, supervisor relations, co-worker relations, mental and physical load of the job, and job demand. Age and gender were not significantly associated with symptoms. After adjusting for age, gender, ergonomics, hours at the computer, and exercise, eye symptoms were significantly associated with physical symptoms (p < 0.001) accounting for 48% of the variance.Environmental variability at work was associated with eye symptoms and eye symptoms demonstrated a significant impact on quality of life and physical symptoms.
View details for Web of Science ID 000249000200012
View details for PubMedID 17700327
Tractor-related injuries among youth are an important public health problem. The major objectives of this study were to (1) provide a rigorous estimate of the number of youth operating tractors in Ohio and (2) assess the extent to which these youth are participating in federally mandated tractor safety training. A self-administered questionnaire was completed by approximately 4,000 students ages 14 or 15 years who were enrolled in a stratified cluster sample of 99 Ohio schools. Almost one-third of the youth (30%) reported having operated tractors, with 19% having operated a tractor on a farm not owned by a parent or guardian. More than half of the youth (52%) reported having operated a tractor and/or other hazardous machinery, with 25% having operated the machinery on a farm not owned or operated by a parent or guardian. Extrapolating from 4-H records and Ohio census data, fewer than 1% of the youth who are operating tractors or other hazardous machinery have participated in tractor certification training. Increasing participation in mandated training may be an important step in protecting the health of our nation's young agricultural workers.
View details for PubMedID 16981442
The high incidence of musculoskeletal disorders (MSDs) among healthcare workers suggests that the introduction of ergonomic interventions could be beneficial. While laboratory studies have clearly documented the efficacy of ergonomic devices, few studies have examined their effectiveness in the healthcare workplace.This study evaluated a statewide program that provided ergonomic consultation and financial support for purchasing ergonomic devices, which aid in patient handling and lifting. Changes in MSD rates between baseline (1 year pre-intervention) and post-intervention (up to 2 years) periods were examined in 100 work units in 86 healthcare facilities.The median MSD rate decreased from 12.32 to 6.64 per 200,000 employee-hours, a decrease greater than the secular trend for the study period (1999-2003).This study suggests that ergonomic consultation and financial support for purchasing ergonomic equipment can be an effective intervention to reduce MSDs among healthcare workers.
View details for DOI 10.1002/ajim.20225
View details for Web of Science ID 000233125200003
View details for PubMedID 16254947
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