Write Business Report Outline Purpose Preparing a tentative outline and references is critical for planning your business report assignment. Successful wr

Purpose

Preparing a tentative outline and references is critical for planning your business report assignment.  Successful writers outline and receive feedback from others.

Tasks

Write the outline for this semester’s report topic, “Which strategies are most effective for increasing workplace mindfulness?”

Criteria for Success

Your assignment should be error free, include all necessary outline sections, and present three refereed sources formatted in APA Style.

Please use these three sources:

1. C. Blaszczynski, Being Intentional About Workplace Mindfulness Prog­rams, pages 48-53. Accessible from Cal State LA College of Businesnd Economics home page: Scroll down to Academics and click on Business Forum link, then click on cover of Business Forum journal (in yellow)

2. A Workplace Mindfulness Intervention May Be Associated With Improved Psychological Well-Being and Productivity. A Preliminary Field Study in a Company Setting available through Gale Academic Onefile. Also available at

http://d x.doi.org.mimas.calstatela.edu/10.3389/fpsyg.2018.00195

3.   Mäkiniemi, J-P. & Heikkilä-Tammi, K. (2018). Promoting Sustainability: The Effects of Workplace Mindfulness Training. Electronic Journal of Business Ethics and Organization Studies, 23 (1), 20-28. Retrieved from http://ejbo.jyu.fi/pdf/ejbo_vol23_no1_pages_20-28.pdf

PS: there is a sample outline

VOL. 27, ISSUE 1

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BUSINESS FORUM Vol. 27, Issue 1 | 1

Business Forum is dedicated to improving the effectiveness of business in contemporary
society. We provide a forum for fresh ideas, impactful research, and possible solutions to business
challenges. We strive to close the gap between research and practice and enable evidence-based
business management.

Our peer-reviewed articles address specialized and interdisciplinary issues of interest to
business practitioners. We accept manuscripts from all domains of business, usually themed by
a particular journal issue. We also publish reviews of books and digital materials of interest to
our audiences as well as important insights shared by business and civic leaders.

Business Forum is published semiannually as an educational service of the College of Business
and Economics at California State University, Los Angeles. As such, papers addressing
economic development in our region, or useful to its business managers or for the public good
are especially welcome.

Editor-in-Chief
Marianne James, Ph.D., CPA, CMA, Cal State LA

Editorial Board Members
Andre S. Avramchuk, Ph.D., CGEIT, Cal State LA

Vickie Coleman Gallagher, Ph.D., Cleveland State University
Tyrone Jackson, Ph.D., Cal State LA

Xiaoquan Jiang, Ph.D., Florida International University
Michael R. Manning, Ph.D., Benedictine University

Robert Marley, Ph.D., CPA, University of Tampa

Managing Editor
Xiaohan Zhang, Ph.D.

Digital Works / Book Review Editor
Shirley Stretch-Stephenson, Ph.D.

Copy Editors
Rhonda Albey and Masood Khan

Issue Editor
Andre S. Avramchuk, Ph.D.

Cover design by Pablo Martinez

ISSN: 0733-2408
Publisher: College of Business and Economics, Cal State LA

5151 State University Drive, Los Angeles, CA 90032
Phone: 1-323-343-2942

Email: BusinessForum@calstatela.edu
https://businessforum.scholasticahq.com

BUSINESS FORUM Vol 27, Issue 1 | 2

TABLE OF CONTENTS

Editorial ……………………………………………………………………………………………………………………………………………3
Andre S. Avramchuk

Adapting to an Evolving Healthcare Environment ……………………………………………………………………………..5
Cástulo de la Rocha

Cal State LA’s Mind Matters Initiative: Making a Difference ……………………………………………………………..7
Jillian Beck

ARTICLES

Pixels and Patients: Using Technological Innovations to Reduce Healthcare Costs and
Improve Health Outcomes …………………………………………………………………………………………………………………8
David R. Weinstein
Lonnie S. Barish
Micah P. Frankel

Addressing Employee Burnout Through Mitigation of Workplace Stressors ………………………………………..17
Portia Jackson Preston

Fast Food, Supermarkets, and Obesity in the Inner City: A Study of Food Access and Health in South
Los Angeles ……………………………………………………………………………………………………………………………………….24
Tom Larson
Deborah Compel Larson

Who Did the Affordable Care Act Help and Who Did It Fail? ……………………………………………………………..33
Zhen Cui
Devika Hazra

Lessons from the Healthcare Funding Challenges at Konkola Copper Mines in Zambia? …………………….39
Mwadi Kakoma Chakulya
Francis Wambalaba
Barbara W. Son

Being Intentional About Workplace Mindfulness Programs ………………………………………………………………..48
Carol Blaszczynski

BOOK REVIEW

The Gene: An Intimate History by Siddhartha Mukherjee, M.D. ………………………………………………………..54
H. Rika Houston

Call for Paper Submissions and Reviewers …………………………………………………………………………………………57

Sponsors ……………………………………………………………………………………………………………………………………………58

BUSINESS FORUM Vol. 27, Issue 1 | 3

HEALTHCARE CURRENTS: A SPECIAL ISSUE FORUM

It is an exciting time at the Business Forum, a peer-reviewed,
scholar-practitioner journal published by the College of Business and
Economics at Cal State LA. The journal provided scholarly advice and
application to business practice since the mid-1970s and is now renewed
in a modern print-online format. Our articles have always aimed to
advance business practice through application of research or theoretical
synthesis of information relevant to business. This Healthcare Currents
issue is not an exception, as we highlight an array of interesting topics
from reviewing healthcare technology advancements that contribute to
reductions in costs of care to helping managers understand wellbeing
and mindful practices at work.

We open with two vignettes setting a practical context for the articles. The President of AltaMed
Health Services Corporation shares how his company handles healthcare industry changes and
leads the way into technological and service innovation in the underinsured Southern California
communities and beyond. The “Mind Matters” initiative in the second vignette showcases one
of the wellbeing programs that engender positive change in how work-and-study community
members empower themselves with knowledge about compassionate engagement and managing
stress. Echoing previous research on compassion and change (e.g., Avramchuk, Manning, &
Carpino, 2013; Worline & Dutton, 2017), both vignettes illustrate the need for leaders to take their
organizations further on a path toward social responsibility and human thriving.

The main Articles section begins with a review of technologies for monitoring and supporting
patient care remotely. David Weinstein, Lonnie Barish, and Micah Frankel lead us on a fascinating
journey into innovative market solutions targeting improvements in preventive care and therefore
increasing its quality while reducing overall care costs. The quality-versus-costs dilemma (Bradley
& Taylor, 2015) is central in the healthcare management field, and most articles chosen for this
special issue try to tackle it in some practical way.

Addressing healthcare costs from a workplace angle, for example, Portia A. Jackson Preston
synthesizes the literature on workplace stressors and shares evidence-based recommendations for
dealing with employee burnout. Tom Larson and Deborah Compel Larson then take us outside of
the workplace and into a South Los Angeles community to demonstrate through their research how
the food deserts in urbanized environments coexist with the obesity epidemic and other healthcare
cost drivers among our local population, including its working-age segment.

Among the key currents in our healthcare field is the set of monumental changes due to the
enactment and ongoing implementation challenges of the Patient Protection and Affordable Care
Act of 2010 (ACA). Zhen Cui and Devika Hazra have examined the associated positive and

EDITORIAL

BUSINESS FORUM Vol 27, Issue 1 | 4

negative impacts on healthcare cost coverage and provide interesting, original statistics on who the ACA
helped and who it failed in this regard. Their research gives insight into the issue of health insurance
for the self-employed and suggests policymaking implications for healthcare coverage of part-time
employees in the United States.

Mwadi Kakoma Chakulya, Francis Wambalaba, and Barbara W. Son bring into the spotlight an
increasingly important, global view on employee healthcare financing through a unique case of Zambian
copper miners. The authors’ survey research illuminates the nuances in employee attitudes toward
paying for healthcare costs, producing potentially useful lessons for the unionized miner workforces in
particular and labor-management partnerships in general.

We then close with the article by Carol Blaszczynski that harnesses and showcases the power of workplace
mindfulness through a synthesis of literature and current organizational practices. The author presents a
compelling business case for mindfulness programs in different work settings and across employee and
management job levels. The article furthers the encouragement from several authors of this special issue
to build organizational communities for a sustainable workplace and a healthy society.

Finally, H. Rika Houston reviews The Gene: An Intimate History, a book by Siddhartha Mukherjee, that
helps us to “challenge and reimagine preconceived notions of health and wellness” (Houston, 2018, p.
54). As we struggle to reconcile business imperatives with societal priorities (Rosenthal, 2018), there are
paradigm shifts emerging to affect the core of what we know about our struggles, passions, and nature.
The Business Forum journal aspires to bring our audiences fresh perspectives on how to work effectively
and organize efficiently yet continue to live with wonder about a better world filled with creativity,
innovation, and purpose. The Healthcare Currents issue attempts to deliver on this hefty promise.

Andre S. Avramchuk
Issue Editor

References

Avramchuk, A. S., Manning, M. R., & Carpino, R. A. (2013). Compassion for a change: A review
of research and theory. In A. B. (Rami) Shani, W. A. Pasmore, R. W. Woodman, & D. A. Noumair (Eds.),
Research in Organizational Change and Development, Vol. 21, pp. 201-232. Bingley, U.K.: Emerald.
Bradley, E. H., & Taylor, L. A. (2015). The American health care paradox: Why spending more
is getting us less. New York, NY: PublicAffairs.
Houston, H. R. (2018). The gene: An intimate history by Siddhartha Mukherjee, M.D., Business
Forum, 27(1), pp. 54-55.
Rosenthal, E. (2018). An American sickness: How healthcare became big business and how you
can take it back. New York, NY: Penguin.
Worline, M. C., & Dutton, J. E. (2017). Awakening compassion at work: The quiet power that
elevates people and organizations. Oakland, CA: Berrett-Koehler.

BUSINESS FORUM Vol. 27, Issue 1 | 5

If you’ve been
paying attention to
what’s happening in
Washington, D.C., you
know that change is,
ironically, a constant in
health care. This includes
new policies from our
nation’s capital as well
as the medical needs of
our communities. Over
the last several years,
AltaMed Health Services
has adapted to these
changes and has forged

itself as a leader in ensuring access to health care and
preventive services. Whatever happens in Washington,
we are dedicated to continuing our nonprofit mission of
providing quality health care without exception to each
and every person we serve.

In more than four decades of operation, our key to success
remains our focus on serving our local communities,
particularly the underinsured. This has helped AltaMed
grow from one storefront neighborhood clinic, staffed by
volunteer physicians who treated 11,000 patients a year
on a five-figure budget, into a $600 million health care
provider with nearly 2,700 employees, delivering more
than one million patient visits annually.

One of the hurdles we faced in achieving this growth was
adapting to a state health care market that moved from a
fee-for-service model to a managed care system. To remain
competitive, we had to shift from operating as a grant-
driven organization to a market-driven one with the ability
to provide contracted Medi-Cal, Medicare and commercial
health care services to every HMO in the region.

The Affordable Care Act (ACA) proved to be both a
challenge and a growth opportunity. When the ACA was
enacted, it was a victory for health care advocates across

the nation. It also became a game changer for community
clinics. It enabled us to receive reimbursement for much
more of the care we provided, because more patients now
had private insurance or began to qualify for Medicaid
because of its expansion. Community clinics like ours
were able to use federal grants to expand facilities and
add services, such as dentistry, urgent care or mental
health care. Many clinics that once spent years in the
red, barely able to keep their doors open, are now finally
breaking even because of the ACA.

Patients who became insured as a result of the new
legislation were now able to visit the doctor without
the fear of unexpected medical costs. They have the
security of a known co-pay and deductible, and can plan
accordingly. In the case of Medicaid patients, they have
the security of knowing that lack of income will not get in
the way of their need for medical care.

At AltaMed, we have traditionally treated and prepared
ourselves to act as safety net to a largely low-income
demographic that would otherwise have very limited
options for receiving medical care. Close to 185,000 of
our patients – approximately 70 percent – currently rely
on Medicaid for coverage across Los Angeles and Orange
counties. Our ratio of Medicaid patients is significantly
higher than the Medicaid coverage rate across California,
as approximately one-third of California residents under
65 are on Medi-Cal.

We also have more than 50,000 patients who do not
qualify for traditional coverage. These are patients who
rely on our sliding fee scale and the fee-for-service
model.

The implementation of the ACA forced us to increase the
number of facilities we offer, to expand our capacity to
serve more patients, improve and manage our operational
costs, and ensure that we consistently deliver the best
possible outcomes for our patients. Adjusting to the
law was a difficult, two-year effort, but it helped move

Adapting to an Evolving Healthcare Environment
By Cástulo de la Rocha

Cástulo de la Rocha is President and Chief Executive Officer of AltaMed Health Services Corporation, the largest nonprofit Federally Qualified
Health Center in California in the nation. A social architect, Mr. de la Rocha has changed the faces of the communities AltaMed serves by
expanding a sustainable and innovative model of health care delivery to provide access to quality care for millions of underserved patients.
Accredited by the Joint Commission as a Patient Centered Medical Home, AltaMed is home to nearly 2,700 employees, provides care to
approximately 300,000 patients, and delivers more than one million patient visits annually across nearly 50 medical, dental, HIV and PACE sites in
Los Angeles and Orange counties.

BUSINESS FORUM Vol 27, Issue 1 | 6

AltaMed from the bottom quartile in performance to
being ranked among Kaiser Permanente, CareMore and
others as a top health care provider.

If Congress repeals the ACA, California could lose
$20 billion annually in federal funding for Medicaid
expansion and insurance subsidies, leaving 7.5 million
Californians without access to affordable insurance
coverage. It will be a dark, dark day in this country’s
history if we suddenly terminate coverage for the 22
million Americans who now receive some kind of benefit
through the ACA.

Although plans for a replacement continue to be
discussed in Congress, they just aren’t good enough.
Many of the previously proposed plans have included
potential cuts to Medicaid, which would largely affect the
working poor and elderly. Getting rid of the individual
mandate that all legal residents must be insured would
likely mean that young, healthy people would stop
buying plans, and insurers would once again be footing
the greater part of the bill to cover people with higher
medical expenses. That would lead to increased premiums
and out-of-pocket costs for those who do continue to
purchase insurance. By one estimate, 10 percent of those
living in Los Angeles, Fresno, Kern, San Bernardino,
San Joaquin and Tulare counties have received benefits
under ACA. Some of these regions are represented by
Republicans and have large numbers of Republican voters
who’ve taken advantage of the ACA’s benefits. This is
also true of many of the key states Republicans carried in
the November election.

In 2015, U.S. health care costs reached an all-time high
of $3.2 trillion, partly due to millions of Americans
gaining coverage through the ACA. Employers, small
businesses and chambers of commerce have to take a
more active role in the debate over affordable health care.
In particular, we have a significant stake in serving the
Latino market where there are significant numbers of
unemployed and working poor. Washington has floated
many proposals, including health care spending accounts
and tax credits. We have to become actively engaged to
ensure that whatever policy Republicans and Democrats
pass will continue to provide access to affordable health
care for the maximum possible number of people. The
consequences of not instituting a policy solution that
keeps health care affordable would create an undue
burden for working-class Americans.

And though we have seen ideas floated around, like
expansion of tax-free health savings accounts or selling
insurance plans across state lines, the best way to increase
access to health care is yet to be determined. That said,

AltaMed will continue working closely with Covered
California to identify the greatest need for coverage that
remains in our state, and we will continue to offer one-on-
one assistance at our health centers to ensure that no one
who qualifies in our community is left without coverage.
We will continue to operate until changes are solidified,
and we will do our best to continue advocating for those
who are still seeking coverage assistance.

The effect that the ACA has had on operating budgets,
revenue and margins has forced some providers, like
Aetna and United Healthcare, to leave the program. On
a local level, we’ve seen Anthem Blue Cross exit the
Covered California market. However, since the ACA
became law, health care cost increases have been in the
single-digit range, compared to previous increases of 12
to 20 percent. To contain future health care costs, doctors,
hospitals, clinics and pharmacies will need to move away
from a fee-based system, reliant on volume, to a value-
based system with a capped monthly rate for services.

Across the spectrum, we all share responsibility for
managing health care costs. As employers, we need to
monitor and continually evaluate the care our employees
receive and work with insurers to better manage those
costs through wellness and other programs. Both
employers and individuals have a role to play in choosing
providers that deliver the best performance. Lastly,
employees need to become more informed consumers
and demand the information that will help them make
decisions about their health care.

Health care will soon resemble the consumer market
in that breakthrough innovations are being driven by
data and technology. Providers that leverage data and
technology to engage their patients will be the winners.
For AltaMed, it means we have to use more strategic
technology to deliver cost-effective, high-quality medical
care. We’re already using electronic medical records in
our back offices, and electronic prescription management
and telemedicine in the clinical setting. Where technology
will be especially helpful is connecting bilingual
psychologists, cardiologists, dermatologists and other
specialists with our patients. That’s a major challenge for
providers, but advances like smartphone apps and remote
medicine will help us meet patients’ needs anywhere and
anytime. In order to stay relevant, we have to keep up
with the times and continue to listen and meet the ever-
changing needs of the communities we serve.

BUSINESS FORUM Vol. 27, Issue 1 | 7

Cal State LA’s Mind Matters Initiative:
Making a Difference
By Jillian Beck | Cal State LA News Service

The goal of the Mind Matters initiative at
California State University, Los Angeles
is to integrate inner well-being into the
framework of University life as a means
of supporting student success.

Cal State LA President William A.
Covino and First Lady Dr. Debbie
Covino created the Mind Matters
initiative in 2013 to provide resources and
programs to help students navigate the
demands of academic excellence, family
responsibilities and jobs. The President
and First Lady realize that without inner
well-being, there is no academic success.

The Mind Matters initiative comes at a
time when college students nationwide are
experiencing high levels of stress, including
problems caused by sleep deprivation and
anxiety about adjusting to university life.

“Now, perhaps more than ever, we need
to ensure that our students understand
the importance of caring for their inner
selves,” President Covino said. “And we
are providing them with ways to do so.”

To help ensure student success, additional
counselors have been hired for the Student
Health Center, doubling the number
available to assist students. Space was
renovated in the center to accommodate
the additional counseling and workshops
and activities were added to promote
physical and mental well-being.

The number of peer health educators on
the Student Health Advisory Committee
(SHAC) has also expanded to more than
50 students. These volunteers help educate
students about health and wellness issues.

Mind Matters programs include Well-
Being Wednesdays, which promote
inner well-being by encouraging a
campus culture based on compassionate

engagement and mutual support. Mind
Matters and SHAC volunteers, Well-
Being Ambassadors and the new Mind
Matters eagle mascot, Welly, promote
inner well-being on the Main Walkway on
Wednesdays with materials that reinforce
the values of care and compassion.

More than 440 faculty, students and
staff, including the President’s Leader-
ship Team, have been trained in Mental
Health First Aid, an eight-hour course
that teaches participants how to identify,
understand and respond to signs of mental
illnesses and substance use disorders. The
training provides skills needed to reach
out and provide initial help and support
to someone who may be developing a
mental health or substance use problem
or experiencing a crisis. On Well-Being
Wednesdays, those trained in Mental
Health First Aid wear green “We Care, I
Care” buttons.

The Mind Matters initiative also features a
speaker series, providing students, faculty
and staff with insights on compassion,
inner well-being and time management.

The engaging speakers have included Los
Angeles Times columnist Steve Lopez
and Rev. Gregory J. Boyle, S.J., founder
of Homeboy Industries.

The Mind Matters Town Halls have been
of great value to the campus commu-
nity, complementing the civic-learning
research Cal State LA students carry out
in their classes. During the gatherings,
students have created action plans for the
health and well-being of the University
community. Town halls are a proven
practice that can contribute to student
success and degree completion. More than
2,000 students have participated in Mind
Matters Town Halls, and another 2,500
are expected to participate in the 2017-18
academic year.

BUSINESS FORUM Vol 27, Issue 1 | 8

A R T I C L E S
_________________________________________________________

PIXELS AND PATIENTS: USING TECHNOLOGICAL
INNOVATIONS TO REDUCE HEALTHCARE COSTS AND

IMPROVE HEALTH OUTCOMES

David R. Weinstein
Extropy Health Solutions

Lonnie S. Barish

WellSpring Pharma Services

Micah P. Frankel
California State University, East Bay

SUMMARY: Advancements in remote monitoring technologies provide new opportunities to
mitigate the growth of healthcare costs while improving patient health outcomes. These
technologies have the promise to positively impact a patient’s health by producing and
contributing additional, valuable and timely “health information pixels” to the picture of a
patient’s clinical profile. In this article, we review how the use of remote monitoring and support
technologies to gather data, digitally connect patient data to healthcare teams, and generate
actionable messages may further contribute to addressing the key dilemma of improving
healthcare quality while reducing healthcare costs.

Introduction

The United States continues to grapple with significant challenges posed by the magnitude
of healthcare costs and their year-over-year rate of growth. For example, family deductibles under
the Affordable Care Act averaged over $12,000 for 2017 bronze plans, while average premiums
rose over 20% from the prior year (Mangan, 2016). Average healthcare spending in 2016 was over
$10,000 per capita in the United States. These numbers are projected to rise by another 50%
between now and 2025, so even just a 1% reduction in actual healthcare spending growth rates
will have a significant impact on absolute costs (Kamal & Sawyer, 2017). Advancements in remote
monitoring technologies provide new opportunities to mitigate the growth in healthcare costs while
improving patient health outcomes. These technologies have the promise to positively impact a
patient’s health by producing and contributing additional, valuable and timely “health information
pixels” to the picture of a patient’s clinical profile. In this article, we review how the use of remote
monitoring and support technologies to gather data, digitally connect patient data to healthcare

BUSINESS FORUM Vol. 27, Issue 1 | 9

teams, and generate actionable messages may further contribute to addressing the key dilemma of
improving healthcare quality while reducing healthcare costs.

Medication Adherence

One area targeted by these new technologies is poor medication adherence. The World

Health Organization defines medication adherence as “the degree to which the person’s behavior
corresponds with the agreed recommendations from a healthcare provider” (Jose & Beena, 2011,
p. 155). Poor medication adherence is a growing concern for clinicians, healthcare systems, and
other stakeholders (e.g., payers) because of mounting evidence that it is prevalent and associated
with adverse outcomes and higher costs of care (Ho, 2009).

The statistics are staggering. Poor medication adherence costs the healthcare system nearly
$300 billion per year in additional doctor visits, emergency department visits, and hospitalizations
(Bresnick, 2015). Chronic diseases such as diabetes, hypertension, and hyperlipidemia (i.e., high
cholesterol) affect one out of every 10 American adults (Chronic Disease Overview, 2017) and
account for 86% of healthcare costs (At A Glance 2015, 2015). Poor medication adherence may
affect 50% of all patients and increases the likelihood of a hospitalization by up to 134% for
chronic diseases such as high blood pressure, diabetes, and high cholesterol (Chronic Disease
Overview, 2017). In 2003, the World Health Organization identified medication non-adherence as
a leading cause of preventable morbidity, mortality, and healthcare costs (World Health
Organization, 2003).

Data Pixelation

Past efforts at improving medication adherence have suffered from “data pixelation,” the
concept from computer graphics used to describe blurry digital images caused by a dearth of
pixels—the information elements of these images. Data on daily medication dosing is rare.
Physicians typically rely upon monthly prescription insurance claims created when patients pick
up their medications at the pharmacy (Lam, 2015). Monthly data provide a fairly coarse view of
the patient’s adherence behavior and are usually actionable only weeks or months after the fact.
The metaphor of a low-resolution digital photo is striking; with their relatively few data points,
monthly prescription insurance-claims data present a pixelated, under-informed view of the
patient’s true medication adherence.

Consequently, physicians often make assumptions about medication dosing behavior
which may not comport with the facts (Goldberga, Cohena, & Rubinb, 1998; Hulka et al., 1976;
Rand & Wise, 1994). Generally, physicians tend to overestimate the level of their patients’
adherence to therapy (Philips, 1996). “Non-adherence to medications reduces treatment benefits
and can confound the clinician’s assessment of therapeutic effectiveness, and is thought to account
for 30% to 50% of cases where drugs fall short of their therapeutic goals” (Wroth & Pathman,
2006, p. 478).

Let us consider a hypertensive patient who forgets to take prescribed blood pressure
medication every other day. This poor adherence behavior produces two health risks. First, by not
taking medication as prescribed, the patient’s blood pressure may remain above the clinical goal,
impacting long-term health through increased risk of cardiovascular events (Green, Kwok, &
Durrington, 2002). Second, in response to the patient’s continued high blood pressure, the
physician may raise the daily dose of blood pressure medication. Consequently, if the patient

BUSINESS FORUM Vol 27, Is

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