California State University, Fresno



2016 Strategic Planning Retreat Notes and Action ItemsSunday, November 13th & Monday, November 14th, 2016Cambria Pines, 2905 Burton Dr., Cambria, CA 93428Sunday, November 13th, 2016, 5:30-7pmAttendance: Tammy Evans, David Luchini, Keith Winkler, Elizabeth Gazarek, Milton Teske, Van Do-Reynoso, Rebecca Nanyonjo, Kathleen Grassi, Jason Britt, Bill Mitchell, Lori Williams, Ashley Hart, Donna DeRooCounty UpdatesKingsReceived CMSP Small County Grant. They will be using it for two community health aids/bilingual community health workers/promotoras related to outreach. This funding ties in with their health education unit, where they created a unit where all of the health educators work together. Their syringe program is under public comment period at CDPH and they hope to start soon. There is a mandated period for review and they hope to start the program in February 2017. They were able to get the support of the Sherriff’s Department prior to getting approval from their board of supervisors, which was very helpful. They have a contract with SAFE Kids Worldwide and they are starting a coalition in the county and have had a very positive response. The coalition has various work groups, such as vehicle safety, burn safety/scalding, and drowning prevention. They are also planning a Children’s Safety Day event which will be at West Hills College in Lemoore. They are modeling a program from San Luis Obispo County related to climate change and how it impacts health. They are changing their logo and are using the NACCHO logo, similar to Madera and Fresno County. MaderaReceived CMSP Small County Grant. They will be starting their IGT process and they will be getting 2.1 million dollars back. They have a schematic for their new building, which is 49,000 square feet. They started their community health improvement plan and have been meeting with various groups throughout the county. They have learned that not all small communities within Madera have heard about the public health department, which has been an interesting learning experience. They are also using the turning point analysis technology, which they have a year subscription for it and they have 50 of them. They will be working on diabetes with the Oaxacan communities. They are accredited for HFA and would be able to share information with other counties. TulareThey met with the CDPH Department related to Radon as there will be a map released related to radon within Tulare County. There were surprised that most of Tulare County is at a risk of 4 or above. The reason could be related to the geography and the soil through natural causes. In 2 years related to the map, there will be mandatory testing related to titles. They are working on their CHA and will be releasing it soon and it is very thorough as it is the first one for Tulare County. They are working on their CHIP right now and have three categories. They are partnering with PHI and they conducted 21 focus groups within the county. He will be transitioning out of the role of public health director, into the HHSA Interim Director. Jason suggested that the members work on their workforce development plan for accreditation as it was the most difficult aspect related to working with other county partners, such as Human Resources. StanislausThey have a new PH Director, CD Manager, and Children’s Health Manager. They had their first annual PH Retreat which was well attended and a good transition for the staff. They last convening was 11 years ago and the employees were very excited about the event. They are recruiting for a PH Officer and Kathleen Grassi will be assisting with the panel. They have been working on accreditation as they have submitted their application and are reviewing documentation to submit. There has been a large amount of progress for most of the domains, with only a few domains remaining. They will be using GAP Analysis and are focusing on engagement throughout the entire department, brining managers and line staff together in the accreditation process. They are working on refugee health and are focusing on quality improvement, both internally and externally. They hope to reduce the number of visits for patients, by removing barriers. They have set a contract in place with Health Plan of San Joaquin for their Health Information Exchange and hope to have something in place for March 2017. They have approximately 200 staff in their public health department. The majority of the planning for the staff retreat was led by the staff as a way to engage them in the process and to have topics that were of relevance to them. There is also a staff/peer nomination and award program related to their nine values. San Joaquin They are starting their CHIP, have just submitted an RFP for developing their strategic plan, started their workforce development plan and completed the GAP Analysis two weeks ago. They hope to submit their letter of intent in December with the application in early summer 2017. They are working towards a new building and are going to the board sub-committee to expend money to create a plan. MercedTheir CHA was complete last summer and they are almost done with their CHIP and had 15 meetings throughout the county. It was helpful to be able to contact special populations and inform board members that there were meetings within their districts. Their CHIP should be completed in January with stakeholder and community partners. They are using the CHIP results to inform their strategic plan and they also have a racial equity plan which was created through their GARE participation. They hope to also have their strategic plan completed in January. They hope to submit in February/March to initiate the PHAB application. The Board of Supervisors approved their proclamation to apply for PHAB accreditation. They also have banners with the PHAB process as well as the new mission/vision and values. There is also an anonymous appreciation box for staff to submit appreciation for other staff related to the department values. Their health officer will be retiring in January and they will be recruiting very soon. Their nurse family partnership funding from the state has had difficulty retaining nurses and they have looked into the Health Families of America (HFA) Model related to case managers and paraprofessionals. Related to CCS, MediCal clients move into the county health plan. The county will continue to manage a smaller caseload of CCS-only children. They are discussing following up with all of the CCS children as a way to improve efficiency. They are working with the San Joaquin County HIE and current issues include adding seats to the governing board; however, it seems that seats would not be earmarked for specific counties. They have a PICH grant from the CDC and their staff was able to work with Merced Community College to pass a smoke-free college initiative. They were also able to work with the City of Merced to reduce tobacco sales within 1,000 feet of schools. FresnoTheir FCHIP started over a year ago and they have 4 quarterly meetings, with over 11 workgroups. They recently received funding for infrastructure from a local funder. They are moving forward on the plan from the workgroups and a few leaders are presenting successes at a national event. They have been working with unique business partners, such as agriculture, which has been a positive surprise. The directors met with new board members and both are interested in public health issues. Correctional health has been very time consuming and they are considering extending the contract with Corizon or creating an RFP. The county is determining if they will enter into an agreement with the State for the Medi-Cal Inmate Eligibility Program. They have a full-time nurse who works with the vendor to assess for gaps in service and to make sure that they meet the requirements in the Remedial Plan. They are working closely with Behavioral Health and the Sheriff’s Department to develop an improved inmate transitional program in the adult jail.They are looking at creating an additional MAPP program, which is used by the local homeless clinic, to work with the inmates to determine mental health, substance abuse, or physical health needs for released inmates in the community. They will have a public health nurse go to the jail to meet with pregnant females to establish a relationship for when they are released. The goal is to make sure the female inmate has a medical home for the pregnancy and to participate in home visitation programs. Syphilis continues to be a large problem with a reinfection rate of 28%, with most cases related to meth. They are working to bring education to younger populations. They recently hired a senior epi and field epi. They hope to bring MAPP as an additional component at the needle exchange program. Dr. Bird has an opioid committee that works toward educating providers to look at ways to treat chronic pain without the the use of long term opioids. They hope to create PSA’s with Behavioral Health soon. They hope to increase school-based health centers in Fresno Unified. Fresno County has signed off on an HIE, Central Valley HIE, and hope to get the jail medical services on board as well. They continue to work on their lab flood and have been working on reconstruction since June, with a goal of February for completion. They also have an RFP for a new lab director. Monday, November 14th, 2016, 8:30am-3:00pmAttendance: Tammy Evans, David Luchini, Keith Winkler, Elizabeth Gazarek, Milton Teske, Van Do-Reynoso, Rebecca Nanyonjo, Kathleen Grassi, Jason Britt, Bill Mitchell, Lori Williams, Ashley Hart, and Donna DeRoo2016 ReviewThe membership has been self-sustaining with all members contributing through county dues, except for Kern County, who was unable to pay due to budgetary constraints, and Calaveras County, who will be paying dues in 2016-2018, with a revised budget to be determined. There are currently two sub-committees; Data and Policy, Systems and Environmental Change (PSE). The Data Sub-Committee created a SOW/Framework and are meeting monthly, with Fresno. The Data Sub-Committee also created an asset map with their capacity and capability. The PSE Sub-Committee created a SOW/Framework and are meeting quarterly. The group discussed governance issues related to sub-committee voting through one county, one vote or consensus, as well as the need to revise the operating principles. The members explained that the sub-committees are an extension of the main SJVPHC Directors/Health Officers and that it would be best to keep them organized and aligned. The members agreed that decision making should be aligned with the sub-committees and the main SJVPHC Directors/Health Officer group. The STD group is a regional workgroup that has met 3 times and discussed the possibility of a shared project related to syphilis. The members agreed that the contact information for the sub-committee chairs should be listed on the website. Starting in January 2016, the county members decided that the regular meetings should include county public health departments only, without associate members. In February 2016, Calaveras was invited to join the Consortium. Members discussed the idea of inviting other local counties, such as Mariposa, San Benito, and Tuolumne or if the membership should be focused on current members at this time. The membership will continue to include current county members, with the option for other counties in the future. The members discussed the option of taking a membership and leadership role in statewide organizations. The group discussed creating a work group with a goal of policy to determine what the Consortium would support or not. The goal of the policy sub-committee could be related to how the work of an outcome, action, report, or activity of either the data or PSE sub-committee or the Consortium support the overall goals of the work of the Consortium and membership. The members discussed the opportunity for having a third party, either a non-profit, health plan, or the Consortium itself as a method for advocacy. There was discussion related to associate members, such as the Hospital Council, Adventist, and the universities. The current membership consisting of county members will be continued, with the option for education and information from outside partners. 2017 PlanningRegional TrainingsRecap 2016 TrainingsReturn on InvestmentIntegration of Planning Syphilis/STD- Sponsored by the StateHealth Policy Leadership ProgramGARE ConveningBrainstorm Trainings for 2017Climate Change related to Public Health Governing for Racial Equity (GARE): The original plan was related to revamping the NACCHO presentation for the valley. NACCHO has revamped their training and there is also a toolkit for health departments. Another option could be related to participating in the GARE training, at $2,000 per person. Dwayne Marsh Train the Trainer: PSE Sub-Committee: developing a valley-wide definition of PSE and training for employees and community partners, possibility of train-the-trainerTraining on how to Navigate the Conservative Environment/Working with Boards of SupervisorsMedicinal Marijuana and Recreational Marijuana Structure and Training. Possibility for a role of public health related to training and influencing elected officials and the community related to zoning and county ordinances. There are other issues related to smoke-free housing with marijuana being required to be smoked within the home. Public Health 3.0 Training. What does it mean on an operational/county level? Gun Violence and Public Health: UC Davis Center, Connections with public safety departmentsTraining from UC Davis related to Gun Violence, then the option of a policy paper related to it for the valley 2017 Regional Initiatives- Brainstorming(1) Costing/ROI for Public Health Services As a Way to Defend Public Health Programs and Funding- Conducted by UC Merced, See Below(2) Connections with Public Safety Departments/Planning DepartmentsHow to start the conversation with law enforcement and the relation with public health? Suggestion for focus on violence in general, How to frame the issue in a way to focus on overall health?Gang violence, could be a possibility of relating this to marijuana growing and other illegal activityThere are opportunities to work with law enforcement, such as jail medical, medical and recreational marijuana, opioid epidemic, syringe exchange, and gun violence. A suggestion was related to a shared agenda with law enforcement. Recreational MarijuanaDetermine how to work with other partners such as law enforcement, behavioral health in order to plan for how this new law will roll out and planning for/addressing a myriad of potential issues and consequences, ie. Medical Marijuana ID Cards, smoke-free housing, county ordinances, etc. (3) Proactive Policy Development- Proactively Addressing Policy Issues/Requests for Support and Signing DocumentsConversation about policy and the role of the group and their capacity. Proactively release policy briefs and training/education. Inform and educate through data could be easier to conduct on a regional basis as opposed to a county level. Reimbursement Rates and Provider Shortages (Primary Care, Oral Health, etc.) (4) Joint Conference: Public Health, Behavioral Health, Social ServicesThere was a suggestion related to interacting and collaborating with behavioral health directors, similar to the social services directors. Another suggestion was related to a shared conference with public health, behavioral health, and social services directors as a way to discuss shared agenda items. There was also a suggestion for a sub-committee for behavioral health, as an extension of the SJVPHC. The California Endowment wanted to support the Consortium and Van suggested that the joint conference with behavioral health and social services could be framed in a health equity/SDOH framework.(5) Climate ChangeHow to capitalize on the funding related to climate change. (6) Public Health NursingPublic Health Nursing: focus that is related to public health specifically, such as loan repayment, funding requirements (flexibility of funding streams), salary, perception of safety CA4Health- Not able to assist furtherConducted by UC MercedCosting/ROI for Public Health Services As a Way to Defend Public Health Programs and FundingAccounting for the value of what PH departments are producing, possibility of pilot project to standardizing cost accounting for public health services. Defense of Programs and Funding—Related to have a stand on policyReduced CDC FundingUC Merced is developing a Rural Health Institute and would be completing the data collection and analysisCost of Public Health Services: deeper thinking on a micro level (Tim Brown from UC Berkeley- macro, per capita vs. Cost of STD/TB/Immunizations in each county- micro), standardize how costs and expenses are calculated (UC Berkeley and Merced have Health Research Institutes, possibility of Paul Brown from UC Merced to assist with the project), cost of $25,000 for four counties with estimate of $50,000 for entire region2017 Agenda Topics Sharing of Best Practices/Successes/Challenges/Working with Other County DepartmentsExamples: Mental Health: Merced, Law enforcement- KingsSub-Committee Sharing at SJVPHC Director/Health Officer Meetings, possibility of each chair calling in for the meeting for updatesMonitor and/or Future Trainings/TopicsHealth Care AccessOral Health Services: Reinstate Childhood Dental Disease Program, with new tobacco tax passed additional funding will be allocated as well. Possibility of a combined training with shared funds of members. The main issues are related to a lack of providers. The cause is likely related to the low reimbursement rate which has decreased over time. Provider Access: availability of oral health and primary care providersPublic Health Nurse Availability and Training for PH DepartmentsAffordable Care Act Monitoring- Changes for the Future with President TrumpCommunity Health Workers as Extension of Health in the CommunityAdventist Health- Primary Care Model for Rural AreasProvider Reimbursement Rates and Addressing Provider Shortage (Primary Care and Oral Health)Adventist Health has been working on rural health and clinics, which could be a possible partnerWhole Person as a region. Required a county match and was seen as an agency project. Health Homes, funding through the health plans. Kathleen will share more information related to this issue. Future: Connecting CHIP throughout the SJ ValleyPossibility for the future in a shared convening for the regional partners working on local community health improvement partnerships who are working on the community health assessments and community health improvement plans 2017 Prioritized Regional Initiatives(1) PHAB Accreditation Coordinators Peer Group- Donna will coordinate this working group. Sub-Committee for the SJ Valley PHAB Coordinators to share best practices and resources. Suggestion to invite members to share who have become accredited; however, it can also provide an unreasonable example when counties have increased resources. Challenges could be a better topic for local counties that have become accredited. There could be an option for a rural example from another state. Another suggestion would be to have PHAB site visitors present. Madera, Tulare, and Stanislaus have a full-time PHAB Accreditation Coordinator. These are permanent positions, such as a staff analyst, health education coordinator. (2) Connections with Public Safety Departments/Planning DepartmentsConnection between public health and public safety, which is combined with other bullets around the marijuana initiative, gun violence (explore if UC Davis has a training they could provide on gun violence), gang violence, violence in general, opioid use, etc.(3) Proactive Policy Development- Proactively Addressing Policy Issues/Requests for Support and Signing DocumentsLooking at how we can be proactive about policy, and developing a framework for SJVPHC to respond to policy issues (such as being asked to sign on the policy documents from others), ie. Provider reimbursement rates were one example of a policy issue to consider for a proactive policy brief(4) Joint Conference: Public Health, Behavioral Health, Social Services(5) Climate ChangeClimate change and exploring how we might take advantage of funding for which we may be eligible(6) ROI, which is a tool, among others that have been developed within the region to develop arguments in defense of public health funding and programsConducted by UC Merced: Costing/ROI for Public Health Services As a Way to Defend Public Health Programs and Funding2017 Prioritized TrainingsClimate Change related to Public Health Governing for Racial Equity (GARE): The original plan was related to revamping the NACCHO presentation for the valley. NACCHO has revamped their training and there is also a toolkit for health departments. Another option could be related to participating in the GARE training, at $2,000 per person. Dwayne Marsh Train the Trainer: PSE Sub-Committee: developing a valley-wide definition of PSE and training for employees and community partners, possibility of train-the-trainerTraining on how to Navigate the Conservative Environment/Working with Boards of SupervisorsBrainstorm Social Services Shared Agenda TopicsShare/Work better together to overcome confidentially blocks between public health and social services, Whole Person Care and Integration, Health HomesSocial Determinants of Health: Oversee health of foster kids and older adults. How can we work together to improve the health of populations we have in common? I.e. commercially exploited children. The goal is to reduce the foster care workload, by looking upstream.GARE: Form teams that include representatives from social services, behavioral health, and social services. The Social Services staff are currently participating in the HPLP Health Equity Cohort and the staff are struggling, similarly to the public health staff. This is a tense issue for everyone. Possibility of Social Service partners to share experiences at a future meeting. Directions for Sub-CommitteesReport to the Directors related to each sub-committee and workgroup as a standing agenda item. The goal of the Data Sub-Committee is to create an interactive map for the SJ Valley, similar to the Fresno County example. There is a possibility that this could be hosted on the SJVPHC website, through Fresno State. The goal of the PSE Sub-Committee could be to create a repository of PSE materials in order to create a Train the Trainer for PSE. This could include developing a valley-wide definition of PSE and training for employees and community partners. Guidance for Budget and Funds + 2017-2018 County DuesDonna DeRoo discussed the 2016-2017 budget and balance. She also provided various options for the 2017-2018 budget and dues. Kern County has not been participating in the director’s meetings, but Dr. Jonah has been participating in the STD Workgroup and Kirt Emery has been participating in the Data Sub-Committee. The membership approved the $5,000 increase in the budget and option #2. The membership agreed that they would reach out to Kern County one more time in order to get a final “we’re not interested” before making the final call to remove them from membership. They will still be allowed to engage in sub-committee membership and workgroups at this time. Donna DeRoo will work to revise the Operating Principles related to participation, due, membership, and other issues. Collaborate with Other Consortia: Letter SigningMelissa Jones, Director of BARHII, presented by phone regarding the possibility to collaborate related to policies and the connection to health. They have one vote per county for each position statement, which are created by the health department that is most involved. The policy committee review the statement, if more than half of the counties do not want to make the statement then they will not make it or if half of the counties want to make then it is printed on letterhead and signed by the Chair and Co-Chair. They focus on issues related to highest priorities or when there is research related to health that they have already conducted, such as housing and health. Membership on BARHII is comprised of public health counties and there is a continued conversation related to outside members. Each county designates a voting representative who participates in the Executive Committee. There is also a general meeting which is open to public health staff who want to attend, with both an in-person and call-in option. The committees also have standing schedules that can be shared and participation could be open to outside members to participate if interested. Possible shared agenda items could be climate change, housing, maintenance of family units, trauma and recovery, scale and impact of incarceration, police violence, GARE (15 Bay Area members from BARHII and 8-9 from Southern CA Alliance) and recreational marijuana. They currently do not meet with the social services directors and behavioral directors as this time, but have thought about this as an option for the future. Priority Strategy: Green (assigned staff and funding), Yellow (not much staff or funding), and Red (No foreseeable staff or funding)The Southern California Public Health Alliance is currently working on the topics of food systems and water. The Consortium shared the following topics for potential collaboration, such as Return on Investment of Public Health Services. Sonoma County has been working on a project related to cost savings from different agencies. Possibility of looking at the funding stream from sugary sweetened beverages, similar to tobacco. They have not done anything related to workforce pipeline or health provider shortage. They are hosting a session on health equity considerations related to accreditation and sharing lessons from Napa County. They have found that the counties with assigned staff as accreditation coordinators have completed accreditation. Governing for Racial Equity (GARE)Dwayne Marsh presented related to the GARE 2017 Cohort. Kathleen discussed the suggestion of regional cohort as opposed to a county-specific cohort. The membership discussed who should attend the training from each county. Kathleen suggested that the two members should be representatives from public health and Merced is also looking into funding for an additional Merced County team from various departments within Merced County. Regional Group from SJVPHC: Madera: 2 participants, Tulare: 2 participants, Stanislaus: 2 participants, Kings: possibility, Fresno: need to check with Director, San Joaquin: TBD, MercedThe members decided that a collective regional approach would be the best and the funding will be reallocated towards the GARE training. Van will follow up with the funder. Governance IssuesMembership: The membership agreed that they would reach out to Kern County one more time in order to get a final “we’re not interested” before making the final call to remove them from membership. They will still be allowed to engage in sub-committee membership and workgroups at this time. If a “not interested” is decided from Kern, Kern will not going to be named as a member of the Consortium. They would only receive information related to the SJVPHC related to the STD Workgroup and the Data Sub-Committee. Their county name will be removed from the website. Revise SJVPHC Operating Principles: membership to remove Kern, add dues, decision making related to county votes (there could be specific issues that are voting matters such as policy and funding matters and those that are not). Donna will draft the revised Operating Principles. Donna will also review the SOW/Framework for the Sub-Committees. 2017 Meeting Dates and Locations: Mondays for future meetings were approved. The location will switch between Madera and Merced. Time of the train related to the time of the meeting to and from Kings County. Into Merced: 9:00 am Out of Merced: 3:35 pmMeeting Times: 9:30am to 3:00pmCalendar vs. Fiscal: Dues and Leadership coincide together as an option. 2017 Chair and Chair Elect: Fresno will continue as Chair until July 2017, with Stanislaus as the Chair Elect. Tulare County will participate as the Chair Elect in 2017-2018. Technology: Data and Information SharingAshley demonstrated the Box Cloud Sharing and will share information about how to sign up as well as tutorials. The members agreed that Box would be a useful collaborative platform and Ashley will work to implement and invite members and sub-committee members. The meeting was adjourned at 2:55pm. SJVPHC 2016 Strategic Planning RetreatDecision Points/Action ItemsSJVPHC Membership and GovernanceThe current membership consisting of county members will be continued, with the option for education and information from outside partners. The membership approved the $5,000 increase in the budget and option #2. The membership agreed that they would reach out to Kern County one more time in order to get a final “we’re not interested” before making the final call to remove them from membership. They will still be allowed to engage in sub-committee membership and workgroups at this time. The Chair will send a letter to Kern County in Spring 2017, asking them to respond in writing if they are able to pay dues. Donna DeRoo will work to revise the Operating Principles related to participation, due, membership, and other issues. Donna will also review the SOW/Framework for the Sub-Committees. Calendar vs. Fiscal: Dues and Leadership coincide together as an option. Meeting location for 2017 will be in Merced at the County Government Building2017 Chair and Chair Elect: Fresno will continue as Chair until July 2017, with Stanislaus as the Chair Elect. Tulare County will participate as the Chair Elect in 2017-2018. The members agreed that Box would be a useful collaborative platform and Ashley will work to implement and invite members and sub-committee members.Sub Committee Alignment and GoalsThe members agreed that decision making should be aligned with the sub-committees and the main SJVPHC Directors/Health Officer group. Donna will = review the SOW/Framework for the Sub-Committees. The members agreed that the contact information for the sub-committee chairs should be listed on the website. Report to the Directors related to each sub-committee and workgroup as a standing agenda item. The goal of the Data Sub-Committee is to create an interactive map for the SJ Valley, similar to the Fresno County example. There is a possibility that this could be hosted on the SJVPHC website, through Fresno State. The goal of the PSE Sub-Committee could be to create a repository of PSE materials in order to create a Train the Trainer for PSE. This could include developing a valley-wide definition of PSE and training for employees and community partners. The STD group will continue to be a regional workgroup and will meet as needed. Regional TrainingsReach out to UC Davis re: Gun Violence Training by TBDClimate Change related to Public Health Governing for Racial Equity (GARE): The original plan was related to revamping the NACCHO presentation for the valley. NACCHO has revamped their training and there is also a toolkit for health departments. Another option could be related to participating in the GARE training, at $2,000 per person. GARE: The members decided that a collective regional approach would be the best and the funding will be reallocated towards the GARE training. Van will follow up with the funder and Ashley will work with members to get sign ups. Train the Trainer: PSE Sub-Committee: developing a valley-wide definition of PSE and training for employees and community partners, possibility of train-the-trainerTraining on how to Navigate the Conservative Environment/Working with Boards of SupervisorsRegional InitiativesPHAB Accreditation Coordinators Peer Group- Donna will coordinate this working group. Connections with Public Safety Departments/Planning DepartmentsProactive Policy Development- Proactively Addressing Policy Issues/Requests for Support and Signing DocumentsJoint Conference: Public Health, Behavioral Health, Social ServicesClimate Change(By UC Merced) ROI, which is a tool, among others that have been developed within the region to develop arguments in defense of public health funding and programs2017 Agenda Topics Sharing of Best Practices/Successes/Challenges/Working with Other County Departments, Examples: Mental Health: Merced, Law enforcement- KingsSub-Committee Sharing at SJVPHC Director/Health Officer Meetings, possibility of each chair calling in for the meeting for updates ................
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