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Aufbau psychotherapeutischer Versorgung in der Region Dohuk, NordirakEstablishment of psychotherapeutic care in the Dohuk district of North Iraq: Gründung des Instituts für Psychotraumatologie und Psychotherapie sowie Durchführung eines Masterstudiengangs für Psychotherapie und PsychotraumatologieFoundation of the Institute of Psychotherapy and Psychotraumatology and execution of a masters degree course in psychotherapy and psychotraumatology

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Abstract

Aufgrund der Gewalttaten des „Islamischen Staats“ (IS) und der Fluchtbewegungen (Binnenflüchtlinge und Geflüchtete aus Syrien) stiegen im Irak die Prävalenzen für psychische Störungen, insbesondere affektive Störungen und Traumafolgestörungen, deutlich an. Allein in der Region Dohuk leben noch über 300.000 Binnenflüchtlinge in Lagern. Aufgrund beschränkter Ressourcen und mangelnder klinischer Expertise ist die therapeutische Versorgung von Betroffenen fast unmöglich. Im Jahr 2016 wurde an der Universität Dohuk, Nordirak, mit Unterstützung des Landes Baden-Württemberg und des Deutschen Akademischen Austauschdienstes, das Institut für Psychotherapie und Psychotraumatologie (IPP) gegründet. Das Masterprogramm Psychotherapie und Psychotraumatologie (MASPP) soll irakische Psychologen in kognitiver Verhaltenstherapie ausbilden. Aktuell ist dies der einzige Masterstudiengang für klinische Psychologie bzw. Psychotherapie im Irak. Nach einem Vorbereitungsjahr und einer Zwischenprüfung werden die Studierenden in das 2‑jährige Masterprogramm aufgenommen. Das damit 3 Jahre dauernde Programm ist an den Ausbildungsstandards in Deutschland orientiert und ähnlich aufgebaut. Die ersten 30 Studierenden wurden Anfang 2017 aufgenommen, davon bestanden 28 die Zwischenprüfung. Sie werden Ende 2019 das Studium mit einem Master of Science und einer Lizenz als Verhaltenstherapeuten abschließen.

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... For instance, difficult and precarious conditions in refugee camps and a poor infrastructure in towns and rural areas cause difficulties in providing psychiatric care. Finally, up to now the work of local psychotherapists and psychotherapists in general is not recognized as a profession [14]. ...
... In this context, up to now merely 10, 294 people out of 360, 000 IDPs were provided with MHPSS. An insufficient health care structure, a low number of professional staff, little financial resources and other causes [16] make an adequate professional and nationwide psychotherapeutic treatment system impossible [14]. ...
... Psychotherapists from abroad suffer from further disadvantages such as time contracts, minimal in-service and further training and supervision. As a rule, they are a minority profession in an NGO [14]. In addition to structural stressors such as location (camps, centres near the war zone) [22] the possible lack of specialisation of the psychotherapists, for example no additional training to become trauma therapists, plays an important part in the work in conflict areas [23]. ...
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The number of wars in the world is on the rise. A number of studies have documented the devastating impact on the public and especially public mental health. Health care systems in low- and lower-middle income countries that are frequently already challenged by the existing mental health services gap cannot provide the necessary care for those displaced by war with existing services. This is especially the case in the Kurdistan Region of Iraq (KRI) after the invasion of the terror organization ISIS in 2014. Most projects in post-conflict areas focus on short term basic psychological services and do not contribute to sustainable long-term capacity building of mental health services. An “Institute for Psychotherapy and Psychotraumatology” was therefore founded in order to train local specialists on a professional level with evidence-based methods adapted to culture and create sustainable long-term structures for psychotherapeutic treatment in the KRI. To achieve this, a number of measures were implemented, including the creation of a “Master of Advanced Studies of Psychotherapy and Psychotraumatology” in collaboration with local communities and the regional University. Two cohorts of students have successfully finished the master’s program and a third cohort are expected to graduate in 2023. Improving the capacity of local health care services to provide low-barrier, professional psychotherapeutic care in post-conflict regions supported by the innovative model presented in this article can be expected to improve the burden of psychological problems and contribute to peacebuilding.
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While university students in developing countries welcome digital learning tools, they frequently lack Information and Communication Technology (ICT) skills which enable them to successfully carry out activities linked to information and communication technologies. This, in turn, means that they struggle to meet practical academic and professional requirements. This study pursues two goals. First, it suggests how this problem can be encountered, presenting the process of pedagogically developing and implementing an interactive screencast teaching ICT skills for literature search with the PubMed database. Secondly, it evaluates the acceptance of the screencast among M.A. students in Iraq, focusing on the questions of how easily the screencast can be used (usability) and how helpful the screencast is for the students ‘ to meet academic requirements (usefulness). The evaluation design is based on the Technology Acceptance Model and LORI. An online-questionnaire using a Likert Scale was used to collect data. Data (n = 29) was analyzed through a quantitative approach and descriptive statistics. Overall, usefulness was rated higher than usability. Findings suggest that easiness of use is increased particularly through a clear overview of the topics covered in the screencast and through a targeted selection of the topics. With regards to the usefulness of the screencast, students appreciate the use of an authentic way of how skills can be acquired and practiced. Additionally, students experienced control over their learning process, refering to screencast features which allow them control over learning pace. Future studies should make use of inferential statistics and qualitative approaches to reveal details about the causality between different factors.
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Background Survivors of Islamic State of Iraq and Syria (ISIS) captivity are at high risk of developing mental disorders such as post-traumatic stress disorder (PTSD). Aims This study looks at the correlation between sexual abuse, shame, somatoform or bodily distress disorders, and dissociative seizures (psychogenic non-epileptic seizures). Method The psychological effects of traumatic events and dissociative seizure were assessed in Yazidi women who were held captive by ISIS in Northern Iraq between 2014 and 2018. These effects were examined comparing 64 women who were held captive and sexually abused by ISIS with 60 women suffering from PTSD who were not held captive and sexually abused by ISIS. Structured clinical-psychological interviews and established psychometric questionnaires were used to assess mental disorders especially dissociative seizures and somatoform disorders, and shame related to trauma. Results Women who were held captive by ISIS showed a significantly higher prevalence of dissociative seizures (43.7%; P = 0.02) and somatisation disorder (38.7%; P = 0.02), as well as depressive (75.0%; P = 0.42) and anxiety disorders (62.5%; P = 0.44), than women who were not held captive and sexually abused by ISIS. Dissociative disorders were identified in 40.6% (P = 0.36) of those female Yazidi who experienced sexual violence while being held captive. Conclusions Shame in connection with sexual violence seems to play an important role in negative self-perception after rape. Dissociation not only plays an important role in unprocessed childhood trauma with feelings of shame, but also in more recent trauma experiences with shame.
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Psychiatric care of refugees in Africa and the Middle East. Challenges and solutions Abstract Violence, flight, famine, and natural disasters first initiatives to improve psychiatric care in as well as the absence of a psychosocial refugee camps in Ethiopia, Kenya, and Sudan. healthcare system are major psychological Moreover, we provide first insights into burdens for refugees. The level of provision a project based in Northern Iraq and Germany of mental healthcare is particularly low in aimed at the treatment of people who were developing countries. Internally displaced severely traumatized by the terror regime of people and refugees place high demands on the so-called Islamic State (IS). the healthcare system because they often Keywords suffer from psychiatric disorders, such as depression, posttraumatic stress disorder, Psychosocial healthcare system · Ethiopia · and substance use disorders. We present Kenya · Sudan · Northern Iraq
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People from family-oriented societies in particular, in addition to having a post-traumatic stress disorder (PTSD) suffer from chronic pain and physical complaints. Such people have a different understanding of physical illness and pain and, compared to patients from western societies, have different ideas on healing, even when confronted with the therapist. Hitherto, these factors have not been sufficiently taken into account in modern, multi-module therapy approaches. Trauma can be perceived via pain and physical complaints, whereby the pain is not restricted to one part of the body but is seen as covering the body as a whole. Therefore, in the treatment and above all in the patient-therapist relationship, it is necessary to understand what importance is attached to the perceived pain in relation to the trauma. The afflicted body expresses the trauma in the shape of its further-reaching consequences such as the patient’s social, collective, economic and cultural sensitivity. Therefore, for the effective treatment of trauma and chronic pain, it is necessary to use a multi-modal, interdisciplinary, and culture-sensitive approach when treating patients from traditional cultural backgrounds.
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Following the severe attacks by the so-called ´Islamic State of Iraq and Syria’ (ISIS) on the Yazidi population, which started in summer 2014, the state government of Baden-Württemberg, Germany, funded a Special-Quota Project to bring 1000 very ill or left-behind women and children who were being held hostage to 22 cities and towns in Baden-Württemberg to receive integrated care. Here we report for the first time on the cases of 4 Yazidi women living in Ulm, Germany, focusing on the clinically observed and psychometrically assessed mental phenomena or disorders. Our primary aim was to explore what ICD-10 diagnoses are present in this population. Although highly traumatized, these women were suffering primarily from adjustment disorder rather than post-traumatic stress disorder (PTSD) according to official classification systems. Despite their symptoms of depression and anxiety the women’s responses to self-assessment questionnaires provided no evidence of compulsion, somatization or eating disorders. The results suggest that further investigation of the individual-level effects of rape and torture, as well the historic, systemic and collective effects, e.g., on families and societies, is required.
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In recent years, Islamic terrorism has manifested itself with an unexpectedly destructive force. Despite the fact that Islamic terrorism commences locally in most cases, it has spread its terror worldwide. In August 2014, when troops of the self-proclaimed 'Islamic State' conquered areas of northern Iraq, they turned on the long-established religious minorities in the area with tremendous brutality, especially towards the Yazidis. Vast numbers of men were executed, and women and children were abducted and willfully subjected to sexual violence. With the aim of systematic destruction of the Yazidi community, the religious minority was to be eliminated and the will of the victims broken. The medical and mental health issues arising from the combination of subjective, collective, and cultural traumatization, as well as the subsequent migrant and refugee crisis, are therefore extraordinary and require novel and wise concepts of integrated medical care.
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Background During the summer of 2014, ISIS overran Nineveh governorate in Northern Iraq. Yazidis and other religious minorities were subjected to brutal attacks and forced to seek refuge into the neighbouring Kurdistan Region, where they remain living in local communities or in camps. This survey provides a population-based assessment of the health needs and care seeking behaviours of Yazidis and other groups currently residing in camps. Methods The survey covered 13 camps managed by the Kurdish Board of Relief and Humanitarian Affairs. A systematic random sample of 1,300 households with a total of 8,360 members were interviewed between November and December 2015. Participants were asked if any household members had needed care for a health condition in the two weeks preceding the survey, and whether care was obtained from the camp primary health care centre, an outside public hospital or a private clinic. If care was received, the out-of-pocket payment was recorded; otherwise, the reason for not seeking care was queried. Results In 33.9% (CI: 31.0–37.0) of households one or more members had needed care for a health condition in the two weeks preceding the survey. The most likely to have needed care were older persons (18.5%; CI: 13.6–24.6) and infants (18.0%; CI: 11.6–26.8). The reported health conditions revealed a complex picture of communicable and non-communicable diseases as well as mental health problems and physical injuries. Care was primarily sought from private clinics (41.8%; CI: 36.4–47.4) or public hospitals (27.3%; CI: 22.6–32.7) rather than from the camp primary health care clinics (23.6%; CI: 19.5–28.2). The mean out-of-pocket payment for care received was nearly 3 times higher in public hospitals than in the camp primary health care clinics and nearly 11 times higher in private clinics. Cost was the main perceived barrier to obtaining health services. Conclusion Demand for health services was high among Yazidis and other minorities living in camps. Private services were preferred in spite of the tenuous economic circumstances of displaced households. Declines in public sector funding may further restrict access from camp clinics stressing the need for alternative access strategies.
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Für die Behandlung traumatisierter Geflüchteter sind sowohl kulturelle und sozialpolitische Aspekte, das Krankheitsverständnis und die -verarbeitung als auch die Beziehungsgestaltung zu beachten. Dazu gehört neben der Akzeptanz der körperlichen Beschwerden in der kognitiven Verhaltenstherapie auch die Beachtung von Sprachbarrieren sowie individuellen und psychosozialen Stressoren. Im vorliegenden Beitrag werden die Interaktion kultureller und psychosozialer Faktoren bei Menschen aus anderen Kulturen in der verhaltenstherapeutischen Behandlung diskutiert und daraus Empfehlungen abgeleitet. Insbesondere wird betont, dass eine kultursensibel eingesetzte Kombination aus Narrations- und Expositionstherapie die kognitive Verhaltenstherapie hilfreich ergänzen kann.
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No research, to date, has been conducted on psychological disorders among young adults in Iraq after the U.S. war. The aim of this study was to assess the prevalence of posttraumatic stress disorder (PTSD), anxiety disorder, and depression. The study also investigated the extent to which differences in the types of war trauma and social support accounted for variation in PTSD and psychiatric disorders among young adults from Iraq. The randomly selected participants (n = 224) ranged in age from 12 to 23 years. They were selected from 10 public school system in the highly war-exposed areas (Ramadi and Fallujah city). Questionnaires were administered in an interview format with participants at schools by 3 trained psychologists. Results showed that 55.8% reported symptoms consistent with a diagnosis of current PTSD related to the war, and 63.4% reported symptoms consistent with current depression. Results of multiple regression analysis indicated that perceived social support during and after the war was a significant predictor for PTSD and depression. These findings add support to the existing literature which has found that exposure to war experience tends to produce long-term substantial psychological disorders. It also underscores the importance of social support and immediate emotional response to trauma in predicting trauma-related psychopathology, and highlights the potential need for providing early care to exposed individuals exhibiting immediate and severe emotional responses. (PsycINFO Database Record
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This article reviews the strategies that have been applied across cultures in order to heal a wounded collective identity of societies upon large-scale conflicts and wars. The issues of truth, memory, and different models of justice executed within this process are discussed. Also, differences and similarities between individual and collective “healing” are explored and commented on. A general cross-cultural normative framework for conflict solving, collective “healing” and justice is neither possible, nor desirable. Models of restorative, retributive and reparative justice should be combined with reconciliation efforts. Societal problems should not be medicalized and individualized. Cultural sensitivity is crucial in designing proper strategies. The contextual model is the one that should be applied while making plans for rebuilding health and dignity after trauma on a collective level. “Healing” must be the outcome of structural and political changes and not their substitute.
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Chapter
The field of psychology began to develop in the Middle East in the early twentieth century. In this chapter, we present a broad view of the current state of clinical psychology in the Middle East. For each country we discuss the historical development of clinical psychology, academic and professional requirements and training, the number of employed psychologists, and the challenges and obstacles that hinder progress within the discipline. Given the similarities in culture and religion in most Middle Eastern countries, social and cultural factors appear to negatively affect participation in mental health care. Despite this similarity, some differences exist in clinical psychology in the countries of the Middle East. Psychology is an acceptable and common filed in some countries, as they are realizing the importance of the role of psychology in mental health and beyond. In these countries, professionals are working to develop culturally adapted concepts that are widely accepted by the public. Based on our review, we emphasize the need for increased mental health awareness, the development of culturally adapted models of clinical psychology, and the creation of specific policy recommendations to promote and advance clinical psychology in the Middle East. It is important to conduct a systematic investigation to enhance the status of clinical psychology and evaluate current and potential resources to advance clinical psychology in the Middle East.
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Violence, flight, famine, and natural disasters as well as the absence of a psychosocial healthcare system are major psychological burdens for refugees. The level of provision of mental healthcare is particularly low in developing countries. Internally displaced people and refugees place high demands on the healthcare system because they often suffer from psychiatric disorders, such as depression, posttraumatic stress disorder, and substance use disorders. We present first initiatives to improve psychiatric care in refugee camps in Ethiopia, Kenya, and Sudan. Moreover, we provide first insights into a project based in Northern Iraq and Germany aimed at the treatment of people who were severely traumatized by the terror regime of the so-called Islamic State (IS).
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Refugees are a vulnerable class of immigrants who have fled their countries, typically following war, violence, or natural disaster, and who have frequently experienced trauma. In primary care, engaging refugees to develop a positive therapeutic relationship is challenging. Relative to care of other primary care patients, there are important differences in symptom evaluation and developing treatment plans. To discuss the importance of and methods for obtaining refugee trauma histories, to recognize the psychological and physical manifestations of trauma characteristic of refugees, and to explore how cultural differences and limited English proficiency affect the refugee patient-clinician relationship and how to best use interpreters. MEDLINE and the Cochrane Library were searched from 1984 to 2012. Additional citations were obtained from lists of references from select research and review articles on this topic. Engagement with a refugee patient who has experienced trauma requires an understanding of the trauma history and the trauma-related symptoms. Mental health symptoms and chronic pain are commonly experienced by refugee patients. Successful treatment requires a multidisciplinary approach that is culturally acceptable to the refugee. Refugee patients frequently have experienced trauma requiring a directed history and physical examination, facilitated by an interpreter if necessary. Intervention should be sensitive to the refugee's cultural mores.
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1. Introduction: Voices of Victims 2. Theoretical Background Traumatic Stress: Traumatic Events, Stress and Allostatic Load, Organized Violence, The Concept of Post-Traumatic Stress Disorder (PTSD), Psychosocial Problems and Comorbid Disorders in Adults and Children, Complex PTSD PTSD and Memory: The Nature of Traumatic Memory, Sensory-Perceptual Representation, Autobiographical Contextual Memory, Neurobiological Basis of Memory and PTSD Processing of Affective Experiences: Normal Emotional Processing, Implications for Treatment, Speechlessness of Trauma: Sociopolitical Implications Narrative Exposure Therapy (NET) - The Theoretical Model: Rationale of NET, Elements of NET 3. The Therapeutic Approach of NET The Basic Procedure of Narrative Exposure Therapy (NET) The NET Process Step by Step: Organization of Sessions, First Session, Second Session, The Following Sessions, The Last Session, Post-Treatment Diagnostic Sessions, KIDNET: Narrative Exposure Therapy with Children Challenging Moments In The Therapeutic Process - NET in Depth: The Patient Attempting to Avoid, The Patient Spaces Out: Dissociation and Flashbacks, The Patient Is Withholding Information, The Patient Has Concerns or Pain, There Seems to Be No Habituation, Therapist Avoidance, Memory and Reality, The Therapist-Patient Relationship: Rules of NET and Standard Ethical Principles Limitations of NET: General Limitations, Insufficient Motivation, Medication and Drugs, Guilt Feelings 4. Appendix Appendix A: Informed Consent Appendix B: Narration of The Life Experiences of Abdul Kadir Appendix C: Who is vivo 5. References
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The association between marital dissatisfaction and 12-month prevalence rates of Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., 1987) Axis I psychiatric disorders was examined in married respondents from the National Comorbidity Survey (N = 2,538). Results indicate that marital dissatisfaction was associated with the presence of any disorder, any mood disorder, any anxiety disorder, and any substance-use disorder; dissatisfaction was also associated with 7 of 12 specific disorders for women and 3 of 13 specific disorders for men. To evaluate the unique association between marital dissatisfaction and psychiatric disorders, analyses were conducted controlling for comorbid disorders. Covariance analyses generally attenuated the bivariate associations between marital dissatisfaction and specific disorders and groupings of disorders. Results indicate that marital dissatisfaction was uniquely related to major depression and posttraumatic stress disorder for women and dysthymia for men.
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This article addresses child maltreatment intervention and prevention among American Indians and Alaska Natives. The authors argue that history and culture must be included as context and variables for developing and implementing prevention programs in Indian Country. They propose that the public health violence prevention model would benefit from incorporating tenets of the history and culture(s) of diverse groups, in this instance American Indians and Alaska Natives. The authors offer an approach that focuses on population- and individual-level risk and protective factors for child maltreatment intervention and prevention in American Indian/Alaska Native communities. They include suggestions and examples for doing the work in Indian Country.
Assessment of specialized MHPSS interventions in the context of the crises in Syria and Iraq
  • M Bajbouj
  • J Strasser
  • S Ahmad
  • S Schweininger
  • M Alasasleh
Bajbouj M, Strasser J, Ahmad S, Schweininger S, Alasasleh M (2018) Assessment of specialized MHPSS interventions in the context of the crises inSyriaandIraq. (unveröffentlichtesManuskript)
Demographic survey. Kurdistan region of Iraq
  • International Organization for Migration
International Organization for Migration (2018) Demographic survey. Kurdistan region of Iraq. http:// www.krso.net/files/articles/160918035158.pdf. Zugegriffen: 20. Nov. 2018
Kultursensitiv-narrative Traumatherapie
  • J I Kizilhan
  • JI Kizilhan
Kizilhan JI (2009) Kultursensitiv-narrative Traumatherapie. Trauma Gewalt 3:70-76
Behandlung traumatisierter Frauen in Deutschland - Transkulturelle Aspekte am Beispiel der 1000 Jesidinnen aus dem Nordirak
  • J I Kizilhan
  • JI Kizilhan
Kizilhan JI (2017a) Behandlung traumatisierter Frauen in Deutschland -Transkulturelle Aspekte am Beispiel der 1000 Jesidinnen aus dem Nordirak. Forens Psychiatr Psychol Kriminol 11:335-341
Iraq mental health survey
  • Ministry of Health in Iraq
Prevalence, severity, and unmet need for treatment of mental disorders in the world health organization world mental health surveys
  • WHO World Mental Health Survey Consortium
Prevalence and gender differences in symptomatology of posttraumatic stress disorder and depression among Iraqi Yazidis displaced into Turkey
  • A Tekin
  • H Karadag
  • M Süleymanoglu
  • M Tekin
  • Y Kayran
  • G Alpak
  • V Sar
Tekin A, Karadag H, Süleymanoglu M, Tekin M, Kayran Y, Alpak G, Sar V (2016) Prevalence and gender differences in symptomatology of posttraumatic stress disorder and depression among Iraqi Yazidis displaced into Turkey. Eur J Psychotraumatol. https://doi.org/10.3402/ejpt. v3407.28556
Lehrbuch der Transkulturellen Psychologie und Psychotherapie. Blaue Reihe. Hogrefe, Göttingen Ministry of Health in Iraq
  • U Lersner
  • J Kizilhan
Lersner U, Kizilhan J (2017) Lehrbuch der Transkulturellen Psychologie und Psychotherapie. Blaue Reihe. Hogrefe, Göttingen Ministry of Health in Iraq (2007) Iraq mental health survey 2006/7 report. http://applications. emro.who.int/dsaf/EMRPUB_2009_EN_1367. pdf. Zugegriffen: 20. Nov. 2018
The Lost Women of Iraq: Familybased violence during armed conflict
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Narrativeexposure therapy. A short-term treatment for traumatic stress disorders
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Iraq: Internally displaced people by governorate
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