South Australians urged to get tested after coronavirus-positive patient breaks quarantine



A large number of South Australians are being urged to get a coronavirus test — even if they do not have symptoms — in the wake of an infected man leaving quarantine and visiting several shops and businesses in Adelaide last Sunday.

The man, aged in his 30s, is believed to have caught the virus as a casual contact at the Intensive English Language Institute at Flinders University.

SA Health said people who on Sunday, November 22, were at Big W Brickworks between 12:15pm and 12:50pm, Foodland at Norwood between 1:20pm and 2:00pm, and Kmart at Kurralta Park between 2:45pm and 3:00pm should urgently get a COVID-19 test.

People who were at the Flinders University Sturt Campus between November 13 and 28 are also urged to get tested.

“Those four locations we are considering at high risk — and we want anyone who’s been there at those times and dates to get tested,” Chief Public Health Officer Professor Nicola Spurrier said.

“We had enjoyed more or less eliminating this virus for several months.”

Professor Spurrier said there was a lower risk for people who visited On the Run at Hilton, Anaconda at Mile End, Guzman y Gomez at Glandore and Boost Juice at Glenelg, but they still should monitor for symptoms and get tested if they develop.

She pointed people to SA Health’s website for the complete list of locations, dates and times of concern.

Pop-up testing clinics will open this afternoon at Big W Brickworks and Kmart Kurralta Park.

In the past 24 hours, there have been no further cases linked to the Parafield cluster.

More to come.



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SA coronavirus lockdown forces cancer patient to cut short bucket list holiday in tropical Queensland


A South Australian woman and her terminally ill mother have been forced to abandon their bucket list holiday in Far North Queensland after the latest coronavirus outbreak in Adelaide.

Bo Duncan and her mother Deb Duncan, who was diagnosed with cancer in 2018, arrived in Cairns on Sunday with the aim of going snorkelling on the Great Barrier Reef.

But by Monday morning, South Australian health authorities had confirmed significant community transmission of COVID-19.

South Australia will go into a strict lockdown from Thursday that will see all schools, pubs, cafes and takeaway food outlets close for six days.

On Monday night — only a day after arriving in Cairns — the Duncans received a text from Queensland Health instructing them to get a COVID-19 test and to quarantine for 14 days.

“Straight away we were in the mode of trying to get home, but how are you supposed to get home if you’re supposed to be in quarantine for two weeks?” Ms Duncan said.

Deb Duncan was desperate to get home before Monday, when she is due to receive the next dose of a drug as part of a clinical trial to treat her cancer.

Bo Duncan said she spent hours on the phone, trying to reach Queensland Health for advice on what to do.

“Mum got a note from her oncologist saying that she had to be returned [home] immediately but we couldn’t get hold of anyone to find out what was going on,” Bo Duncan said.

Both women were tested for coronavirus on Tuesday and returned negative results, but the clinician who took the test told them to return to their hotel and quarantine.

Great Barrier Reef trip will have to wait

The Duncans were in the midst of booking their long-awaited bucket list trip to the Great Barrier Reef when the news about SA started flooding in and their uncertain situation began to unfold.

“Dad and my sister Storm were supposed to come to Cairns [on Wednesday] while mum and me just had a bit of girl time before,” Deb Duncan said.

“The Great Barrier Reef didn’t get to happen this time but hopefully we’ll get back — we’ll just have to see how it goes with mum’s clinical trial and that sort of thing.

“She did The Ghan earlier this year, we’ve been to Europe, we went to Western Australia last year, so she’s slowly getting through it, so it’s a bit sad that this one didn’t get to be achieved.”

Bo and Deb Duncan smile as they take a selfie on the beach at Palm Cove near Cairns in Far North Queensland.
The Duncans have paid $4,000 for their flights home — an unexpected cost at the end of a disappointing holiday.(Supplied: Bo Duncan)

Cancer drug trial awaits

Deb Duncan received the first dose of the cancer drug last week, and her oncologist told her she was able to travel.

“She had a week off between doses so they said she was welcome to come [to Cairns],” Bo Duncan said.

However, this week her doctor told her that it would be detrimental to her health if she did not return home in time for her second dose of the experimental drug.

By Wednesday, the Duncans had given up getting in touch with Queensland Health and they booked a flight to Adelaide, connecting through Brisbane.

When asked for the correct protocol for interstate travellers from hotspots, Queensland Health directed the ABC to its website.

It states any South Australians who entered Queensland from a hotspot before 11:59pm AEST on November 16 must be tested and quarantine for 14 days from the date of leaving the hotspot.

However, the website later states people from designated hotspots are allowed to leave Queensland before their quarantine period has finished.

“If you have come from an interstate hotspot and you decide you no longer want to remain in Queensland after you have started quarantine, you can leave before your 14 days are finished,” the website said.

“You should leave Queensland by the most direct route possible and without stopping or coming into contact with the community.”

The Duncans have paid $4,000 for their flights home — an unexpected cost at the end of a disappointing holiday.

“We had to — if it was any other circumstance we would have stayed here, but mum needs her medication, she needs her treatment,” Bo Duncan said.

She said she was frustrated by the lack of information about their specific circumstances.

A spokesperson for Queensland Health said it was a “rapidly evolving situation” and advice would change as necessary.

“The situation in Adelaide is concerning and the decision to close the border is an appropriate response given the significant health risk to Queenslanders,” the spokesperson said.

“We understand that this has thrown travel plans into chaos for many.

“We worked to get advice to the public as quickly as possible with the aim of keeping Queenslanders safe.”

The spokesperson said up-to-date information was available on the Queensland Health website.



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Royal Hobart Hospital sued by patient left with colostomy bag after appendectomy


A 31-year-old Tasmanian man is suing the Royal Hobart Hospital, claiming a delay in performing emergency surgery and failure to closely monitor him afterwards has left him with various internal injuries and the need for a colostomy bag.

Documents filed in the Supreme Court of Tasmania show when the man visited his GP in May 2016 he had a high temperature and had been struggling with abdominal pain for four days.

His GP diagnosed him with acute appendicitis and referred him to the RHH’s emergency department (ED) for an “urgent surgical review”, informing the RHH of his symptoms in writing.

The man presented at the ED about 6:25pm that evening and was reviewed by a registrar who noted he was “flushed and lethargic looking”.

The registrar said it was his impression that the man was suffering from appendicitis.

The plaintiff’s lawyer claims the hospital should have recognised he was likely suffering from an obstructive type of appendicitis, and was at risk of rapid deterioration and further complications.

He argued the man should have immediately undergone emergency surgery.

The man was examined two more times during the night and was found to be febrile with ongoing abdominal pain.

It was not until about 9:30am, close to 15 hours after he had first presented to ED, that the man underwent laparoscopic appendectomy surgery.

During that surgery court documents allege doctors found the man had a gangrenous and perforated appendix, which was removed in a “piecemeal manner”.

The man’s lawyer claimed the hospital should have known he had suffered a ruptured appendix, generalised peritonitis and was at risk of developing or suffering ongoing appendicitis, infection, sepsis and adhesions (bands of scar-like tissue that cause tissues and organs to stick together).

Man discharged despite ongoing symptoms

Over the next few days during his stay at the hospital, staff reviewing the then 27-year-old noted he was still suffering from high temperatures and complaining of abdominal pain, nausea and feeling faint.

In the document, the man’s lawyer wrote that the hospital should have known the patient’s signs and symptoms indicated his condition was deteriorating and he may have been developing underlying conditions, chronic illness and more.

He argued that the hospital should have performed further investigations beyond blood and biochemistry tests to determine whether or not he was deteriorating.

He says he should have been kept in hospital during those investigations, but was instead discharged about five days after surgery.

The man’s GP sent him to the emergency department.(ABC News)

Following his discharge, the man’s symptoms persisted and a month later he returned to his GP complaining of abdominal pain, night sweats and a persistent cough.

After a number of tests, his doctor referred him back to the RHH where he underwent a second surgery.

The man is claiming his injuries during the entire ordeal — including a ruptured appendix, a pelvic abscess, extensive adhesions, tears to the bladder and bowel, and need for a colostomy bag — are a result of the hospital’s negligence.

Hospital denies negligence

The RHH, however, is denying it was negligent in its duty of care.

In documents filed with the court the state’s Solicitor-General Michael O’Farrell wrote: “If it were negligent, which it specifically denies, then the plaintiff’s loss and damage was caused or contributed to by his own negligence.”

He claimed the man failed to seek medical attention within a reasonable period of time that would ensure an optimal outcome.

The case has yet to be resolved.



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Terminally-ill bowel cancer patient sues over delayed diagnosis, missed opportunities for treatment


A 58-year-old man is taking his former GP and hospital to court claiming they failed to detect a cancerous tumour in time to stop it becoming terminal.

Jeff Whitehead was rushed to hospital for urgent surgery in June 2018 after a CT scan revealed a tumour the size of a cricket ball in the junction between his large and small intestines.

“The tumour had broken out of my bowel and [the doctor] said it was like an octopus trying to latch onto the inside of my stomach,” he said.

“It ended up going to my liver and lungs.”

Mr Whitehead was living alone in Maryborough, north-west of Melbourne, at the time, and had been suffering worsening symptoms including abdominal pain, constipation, and weight loss for months.

He said, at multiple points, his symptoms were not properly investigated and he now has fewer than 12 months to live.

“The cost is my life, that’s what it is, and I can’t get that back,” he said.

Jeff Whitehead is now fighting multiple cancers after his colorectal tumour became malignant and spread.(ABC Ballarat: Charlotte King)

‘Multiple missed opportunities’

A statement of claim on behalf of Mr Whitehead has been lodged, alleging his treatment from both the Maryborough District Health Service and his former GP were negligent.

The document, lodged with the court in October, argues the alleged negligence had resulted in “injury, loss and damage”, including the “progression of caecal adenocarcinoma, metastatic spread of adenocarcinoma, and reduced life expectancy”.

“There is a difference between unlucky, and perhaps negligent, circumstances,” Mr Whitehead’s lawyer, Alice Robinson, said.

“Between his GP and the hospital, there were multiple missed opportunities for treatment which would have made a big difference to Jeff’s health now,” Ms Robinson said. 

Mr Whitehead first went to see his doctor complaining of abdominal symptoms in May 2017.

By August of that year, his doctor had organised a colonoscopy, a procedure that looks for abnormalities in the bowel.

The result came back normal, but Mr Whitehead said his symptoms began to get worse and he was inexplicably losing weight.

Mr Whitehead’s lawyer argued that “reasonable medical practice” on the part of the hospital would have identified his tumour, and had it been identified his chances of survival would have improved.

Ms Robinson also claimed that Mr Whitehead’s GP failed in his duty of care to properly investigate his patient’s symptoms when the colonoscopy failed to provide a diagnosis.

In separate defences lodged with the court, both the hospital and Mr Whitehead’s GP have denied their actions were negligent.

Patient told ‘you don’t have cancer’

Part of the claim centres around the GP’s response to a positive result that Mr Whitehead received from the national bowel screening test in February 2018. 

Mr Whitehead said he took the test after it came in the post and then made an appointment with his GP when it came back positive.

“He looked at me before I sat down and said ‘what’d you to do that for?’

“And I said ‘because it came in the mail and it’s a positive’.

“And he said ‘how many times I’ve got to tell you, you don’t have cancer’.”

Medical records viewed by the ABC reveal the doctor did not recommend further investigation of the result at the time.

Bowel cancer screening kit
Part of the claim centres around the GP’s response to a positive result Mr Whitehead received from the national bowel screening test in February 2018. (bowelcanceraustralia.org)

It was only by chance that another doctor picked up there was a serious problem after routine blood tests were taken in the lead-up to a knee operation the same month.

The results found several red flags including iron deficiency and the presence of a protein that can be linked to cancer.

Mr Whitehead’s GP became aware of the February blood test results in March. It was another three months before he ordered the CT scan which revealed the large tumour in his patient’s bowel.

By that stage, the cancer had spread to other parts of his body.

In a defence filed to the Supreme Court, lawyers for the doctor have admitted he did not suggest further investigation of the positive bowel screening test, stating that “the colonoscopy and subsequent histopathology was reported as revealing no abnormality”.

Clinical guidelines for general practitioners from the time state, once a decision is made to investigate, “if investigations are incomplete, an alternative investigation is necessary”.

Mr Whitehead’s lawyers have argued the GP had a responsibility to further investigate the man’s symptoms after his colonoscopy and immediately after his positive bowel screening test result.

The ABC contacted Mr Whitehead’s former GP but he was unavailable for an interview.

Tumour not ‘readily apparent’

Mr Whitehead also complained to the Australian Health Practitioner Regulation Agency (AHPRA) about his GP’s approach to his treatment.

The authority investigated the matter based on clinical notes and the guidelines from the time.

In its response to Mr Whitehead, the authority noted the GP’s observations that the case was “complex” and that the tumour was not “readily apparent” until the CT scan was performed in June 2018.

“He maintains that until that time, he was reassured by various sources nothing more sinister was responsible for the patient’s presentation,” the AHPRA response stated. 

AHPRA closed the complaint, ruling the case was up to standard.

But Ms Robinson said that did not diminish Mr Whitehead’s argument for compensation.

“We are looking at a very different standard, we are looking at what’s known as a civil standard of care,” she said.

“We measure the GP’s behaviour by what other GPs say would be reasonable, based on their expertise and experience.

More focus on regional areas

A dramatic sunset in Australian bushland
Regional Victoria’s cancer survival rates are consistently worse than in metropolitan areas.(Supplied)

Data released this month from the Victorian Cancer Registry reveals that survival rates for regional Victorians are consistently worse than in metropolitan areas.

Residents in metropolitan Melbourne have a 71 per cent chance of survival compared to regional Victoria’s rate of 67 per cent.

According to the most recent breakdown of smaller geographic areas from the Australian Institute of Health and Welfare, Maryborough had the worst cancer mortality rate in the state.

Cancer Council Victoria’s chief executive Todd Harper said there could be a number of reasons for that including poverty, smoking, and obesity rates, which are all higher in Maryborough. 

“But it also might be related to the stage at which cancer is diagnosed. So, obviously, if the cancer is detected at an earlier stage there are much better prospects for a healthy recovery,” he said.

“It’s really important that we focus our prevention efforts, our treatment and supportive care efforts, in those areas to make sure that people in those areas have access to the best treatment that we know is available now.”



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Podcast: Therapist or Patient: Who’s in Charge?


Join us for a great discussion that sheds new light on how we should be treating mental health issues.

 

Guest information for ‘Barry L. Duncan- Therapist or Patient’ Podcast Episode

Barry L. Duncan, Psy.D. . is CEO of Better Outcomes Now and a psychologist, trainer, and researcher with over 17,000 hours of face-to-face experience with clients. Dr. Duncan is the developer of the clinical process of the evidence based practice, the Partners for Change Outcome Management System (PCOMS), a process that ensures that clients are privileged and therapy is accountable.  Barry has over one hundred publications, including 18 books addressing client feedback, consumer rights, and the power of relationship in any change endeavor. Because of his self-help books (the latest is What’s Right With You), he has appeared on Oprah, The View, and several other national TV programs.

 About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Barry L. Duncan- Therapist or Patient’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of The Psych Central Podcast, I’m your host Gabe Howard and calling into the show today, we have Dr. Barry L. Duncan. Dr. Duncan is the CEO of Better Outcomes Now and a psychologist, trainer and researcher. His self-help books, the latest is What’s Right With You, have led to appearances on Oprah, The View and several other national TV programs. Dr. Duncan. Welcome to the show.

Barry L. Duncan, Psy.D.: It’s great to be here again. Thanks for having me.

Gabe Howard: Today we’re going to discuss holding therapists accountable and their need to evolve. Now, as a person living with bipolar disorder, I can tell you that patients are always encouraged to change our way of thinking and to evolve. But in some ways, therapy hasn’t really changed all that much in the 20 years that I’ve been involved. Now, I’ve been involved as a patient. But Dr. Duncan, what are your overall thoughts on that?

Barry L. Duncan, Psy.D.: Well, I think you’re right on the money with that, I mean, as a profession, we really haven’t changed a heck of a lot in the last hundred years in a lot of ways. I mean, there’s a lot of these models and techniques. In fact, there’s over four hundred models and techniques now. But a lot of things about psychotherapy have not changed, like, for example, who’s in charge and how the hierarchy works and who calls the shots and how collaborative it is. And all of those things are pretty much the same as it’s always been. And that’s why we do need for therapists and the field itself to evolve to be a bit more accountable than it’s been in its last hundred years.

Gabe Howard: It’s interesting to me that you say it really hasn’t evolved in the last hundred years because everything’s evolved in 100 years. I can’t hang on to a cell phone for more than six months before it’s considered outdated old technology. So for something to last a hundred years, was it just perfect or are we really using this antiquated method that isn’t giving us our best results?

Barry L. Duncan, Psy.D.: There had been an evolution of different models and techniques and ways of understanding people’s problems and way of treating people’s problems. The only problem with that is that no one approach now developed is any more effective than the approaches developed 50 years ago.

Gabe Howard: Gotcha.

Barry L. Duncan, Psy.D.: All approaches work about equally well. That means, then, that psychotherapy as a treatment endeavor has not improved. It was as effective 50 years ago as it is right now. That’s the disconcerting part, and that is because we have not been results oriented. We haven’t been accountable to the client, the consumer or the patient, whatever you want to call that person sitting in the room with you, we haven’t been accountable to what they think would be a successful conclusion to the therapy.

Gabe Howard: And is that who you think that therapist should be accountable to?

Barry L. Duncan, Psy.D.: Yes, it would be totally accountable to their perception of their own benefit, their perception of their experience of the therapy itself, rather than feeding the therapist, the provider, the psychiatrist, a psychologist, whoever they’re seeing, instead of fitting their viewpoint of how the therapy should go, how the patients should wind up, it should be taken from the construction, the perception of the person receiving the treatment.

Gabe Howard: Do you get a lot of pushback when you say that, because I know people living with mental illness or even people with mental health concerns, we often feel like whenever things go well, it’s because we have a great therapist. And whenever things go poorly, it’s because we’re not listening to our great therapist. That’s our world. But you’re over on the other side. Do your colleagues like you saying this publicly?

Barry L. Duncan, Psy.D.: Actually, a lot of them do, but there’s a portion that don’t like that arrangement where they blame the client when there’s no change and take credit when there is, I would like for that to be spun around completely, 180 there. And when there is change that the client take credit for making the changes because they’re the ones doing it. And when there’s no change, it’s about the treatment model and how the treatment model interacted. Is the right fit for the person receiving it rather than putting the blame on the client’s shoulders, which is what psychotherapy has done since the beginning. Right. When there’s no change, it’s because of the client’s psychopathology. Think about how we organize our profession. If you change, it’s because I’m so super brilliant and I’m a great practitioner, if you don’t change well, you are quite sick. This is going to take more time, more effort, more drugs, more therapy. That’s been the kind of mentality. I think that kind of story is reaching its end at this point. And people are starting to realize that they’re far more fruitful ways of going about this.

Gabe Howard: A lot of my listeners don’t know this, but whenever we set up a guest on the show, we always ask the guests to submit some questions because they know the questions that they get asked most of all. And I can’t know everything as much as I tell my wife that I do. And one of the questions that you submitted, I think it might be my favorite question ever. The question is, what does the death of George Washington have to do with our topic today, Dr. Duncan?

Barry L. Duncan, Psy.D.: Actually, it is the perfect story for our situation today, because here’s what happened to little George after he retired from the presidency, right? Right. His Mount Vernon estate every morning. And on a cold, blustery December day in 1799, he got back from his ride and he got a sore throat and a cough. And so, they put him to bed and they summoned the area physicians. The first physician got there and administered the standard of care of the day, and Washington’s condition grew worse. The second physician got there, re-administered the standard of care of the day and Washington lost consciousness. And then finally, the third physician arrived later that night, re-administered the standard of care to an unconscious George Washington, and by the next morning, George was dead. Now, what was that standard of care? It was bloodletting. And while medical historians quibble over whether or not the bloodletting hastened his demise or outright killed him, the fact of the matter is that they continue to apply the same treatment despite direct evidence from the patient that it clearly was not working and making it worse. And that’s exactly what people do today. They will continue to administer the same treatment to a client despite direct evidence that the treatment isn’t working. That code creates chronicity in clients. It causes them to get worse over time. We used to call that bloated files syndrome. It was more about the person who’d been in so many unsuccessful treatments, more so about that than about the person themselves. The people began to have a mentality about themselves, that they’re untreatable, they’re too sick, they’ll never get better rather than having it look to the outside and saying, gosh, maybe the treatments I’ve been getting or not what I am needing and let me try different people, different treatments to see if I can get to a better place.

Gabe Howard: I think that this leads to patients just giving up. I hear the word quackery a lot. I hear that they the therapist just wanted to talk to me and it didn’t do any good. And you hear a lot of terms to describe therapists from the disgruntled. Do you think that part of that disgruntled-ness comes from what you’ve just described?

Barry L. Duncan, Psy.D.: Absolutely. People become disgruntled when there’s no change and when they see no possibility for change or no hope for change, one of the factors that makes treatment beneficial for people is that it inspires hope. A very famous psychiatrist, Jerome Frank, had a very nice perspective on this. And he thought that when people come to treatment, they are demoralized by their lives and they believe that every day is going to be just as miserable as today. But what therapy does is, in his words, re-moralizes or gives them the possibility that’s not true. And then that inspires people to catalyze them into action. And then they do things to make meaningful changes in their lives when it’s not helping. Therapy can make you quite disgruntled and start to believe that you’re unchangeable, which is the worst conceivable outcome.

Gabe Howard: So this begs the question, Dr. Duncan, how do we get therapy, which, as you stated, hasn’t really changed all that much in the last hundred years? How do we get them all to change?

Barry L. Duncan, Psy.D.: There has been a movement within psychotherapy, this called systematic client feedback, and Michael Lampert is the pioneer of this. And he had this idea that why not measure in each encounter with a client’s believe they’re benefiting from their therapy and then those clients who aren’t benefiting will be identified so that the therapist can then do something different with them? That’s a great idea. But there’s a more radical side that really appealed to me. And that was that don’t make it an expert kind of a process. Don’t make it to where it just gives information to the therapist. Why not let it be a collaborative process that’s done together with the client and the provider and have that process of monitoring outcome to see whether or not the person is benefiting and then collaboratively figuring out what else can be done and or to move them on to greener pastures with somebody else, if indeed they can’t collaboratively come up with different ideas to be beneficial to the client. The relationship is called the Therapeutic Alliance, which if the alliance isn’t good, it’s very unlikely for anything good to happen in the therapy. We also check in with people in each and every encounter about how was this experience for you today? Are we talking about the right stuff, the approach that we’ve taken to address your goals? Do you really think that’s going to be helpful to you? So we check that out with these two four item scales.

Barry L. Duncan, Psy.D.: It takes less than five minutes. And when you do that, you identify the consumers who aren’t benefiting. Because an important thing we know, Gabe, is that who is providing the service accounts for most of the change of any treatment being administered. Now, what that means is that it doesn’t matter whether your psychodynamic or your cognitive behavioral, who you are as a person accounts for much more how change happens with clients than the models and techniques that you use. If that isn’t in line with the clients, the best thing you could do is to fire yourself and let the person see someone else.

Gabe Howard: Let’s step away from therapy for a moment and even step away from mental health treatment and into physical health treatment or just patients versus doctors. There’s a huge movement in America right now for patients voices to be heard. And again, I want to be very clear. This isn’t a therapy relationship or even a mental health relationship. This is all of patients feel that they are not being partnered with. And when I say all of patients, they don’t have the downside of having the discrimination or the stigma of being out of their mind or crazy or not thinking straight or we need to do this for their own good, because after all, they can’t advocate for themselves because they’re sick. And I point that out because if it’s happening over on the quote unquote, physical health side, meaning for somebody with cancer, for example, what hope does the mental health side have? Because we’re much easier to ignore? Can you talk on that for a moment? Because I know that many patients are like, look, even in the best of circumstances, we’re not believed.

Barry L. Duncan, Psy.D.: From a medical point of view, it’s really the same dynamic that exists, you have an expert and the patient who needs the help of the expert. What you find is that relationship and medical treatment is also predictive of eventual outcomes, even with biological markers has been a recent research in the last five years that when patients believe they have a good relationship and good communication with their medical provider, they get better outcomes and even biological marker better outcomes. So the same processes could be helpful in medical care. In fact, my colleagues and I have developed measures for primary care docs, so the same dynamics exists there. So we validated our measures in primary care science and our next step is to actually try and see if it improves outcomes. Once we started measuring outcomes and doing this collaborative process with clients and psychotherapy to solicit their views and whether they’re benefiting and solicit their views of how the experience of therapy was going. We then started doing randomized clinical trials, which is the language of science, where you compare clients who didn’t have the support of their treatment and clients who did. And we’ve done eight randomized clinical trials now and it doubles overall treatment outcomes for those clients who have systematic client feedback as part of their therapy. 

Gabe Howard: I don’t know why we separate mental health and physical health out, but for the purposes of this conversation, moving it out of the physical health realm and into the mental health realm, patients know that we have to be involved. We see a therapist one hour a week and then all the other hours or hours. Essentially, if we don’t participate in therapy, it does not work. We know that hard stop. You cannot send an unwilling person to therapy and expect it to do any good. They’ll just sit there and ignore you for an hour and then go off and do whatever they want. So knowing that is an absolute fact, why do you think you’re getting any pushback whatsoever? Is there I’m going to use a mean word. Is there just an arrogance among therapists that they can convince people who don’t want to listen, to listen, or is it just deeper than that?

Barry L. Duncan, Psy.D.: I think there’s certainly an arrogance there, but I think that there’s I call organizational apathy toward doing anything, that it’s a change. We like to work the way we’ve always worked. That’s always worked for us before. They see it as adding to what they’re already doing. A lot of therapists believe that they are overworked and underpaid. The master’s in social work and master’s in counseling are the two lowest paid master’s degrees in the United States. It’s different in Europe, but here in the US, it’s a very low paid master’s degree. People feel up against it a lot of times. And so when they’re asked to do more, know someone comes in from the outside and said, this is the greatest thing since sliced bread and it improves outcomes and decreases dropouts. It’s a way to be collaborate with people like. Oh yeah, I heard that was the last paradigm shift. So people tend to hunker down. Implementation is a long term process for people and it takes training and use and supervision. And I basically tell people when I’m implementing an agency that about twenty five to thirty three percent of therapists will say, I really like this, I’m going to do it. I see the benefit from it right away. But then everybody else has to be brought along. And most people learn from their own experience. So they need to have the experience of it being useful to them before they’ll completely buy in.

Barry L. Duncan, Psy.D.: Arrogance is certainly part of it. And there’s that, that this is an old old idea, back and from the beginning, the sanctity of the closed room, nobody else in there except me and the client, no outside influences. And this is this private time. And I don’t want to let anybody else or anything else in and doing any measurement process or formally soliciting the client’s voice. It’s not what I’m about. The really sad part is that a lot of therapists and this is the arrogance or believe that they know what the client needs and wants without ever asking them. That’s the part that drives me crazy. They think they already know the answer. You did an RCT in Norway, and the person I was working with, Morten Anker, he is a good friend of mine. He did a survey of the therapists before we did the trial and there were ten therapists. And he asked them, do you think that getting systematic client feedback about the client’s view of benefit and their view of the alliance? Do you think that will improve your effectiveness? All ten said no. We already know whether people are benefiting. We already know whether we have a good alliance with people. And guess what happened? Only one of the ten was correct because nine out of ten improved their effectiveness with this systematic feedback from the client.

Gabe Howard:  Stay tuned and we’ll be right back after these messages.

Sponsor Message: Gabe here and I wanted to tell you about Psych Central’s other podcast that I host, Not Crazy. It’s straight talk about the world of mental illness and it is hosted by me and my ex-wife. You should check it out at PsychCentral.com/NotCrazy or your favorite podcast player.

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Gabe Howard: Welcome back, everyone. We’re here with Dr. Barry L. Duncan, discussing how to hold therapists accountable and their need to evolve.  Dr. Duncan, is that you’re met with this resistance and you are able to overcome it, but what do you say? There’s this knee jerk reaction in me to say, hey, I told you that this would be better for your patients. Why are you arguing with me? But I know as an advocate, yelling at people doesn’t ever work. So I’m curious as to your method, because, as you said, you’re overcoming years of thinking and people’s ways of doing things. 

Barry L. Duncan, Psy.D.: Yes, we’ve implemented many places. In fact, we have one point five million administrations of our measures in our database, so there are many people doing it there. Thirty thousand registered users on our website. But there is this kind of initial response. And I first started training people. I was shocked that they didn’t say, wow, this is such a great idea. We’re going to do this right away because it identifies our people who are benefiting in mixed therapy, more collaborative and honoring the client’s voice and all of these values that people are always reporting that they have, that when push came to shove, they wouldn’t actually do it. And I was shocked by that. I had to develop ways of inspiring people rather than mandating people do this. And what really got me into it was it’s about social justice and client privilege and making sure that we level the playing field with clients and we got them engaged and involved. But other people get on board for other reasons. It identifies the people who are likely to drop out before they drop out. It improves effectiveness. It’s been proven in real world settings to raise the bar of everybody’s performance. It involves the known predictors of how people change. My kind of go-to in helping win people over is to show them the work. Therapists really like to see the work itself, because then I go from being a talker about it to showing them.

Barry L. Duncan, Psy.D.: And I, of course, releases from my clients and anonymize the videos. But I show them the actually doing this with people and people’s comments about liking being involved in the process, liking being involved in all of the decisions, liking how transparent the process is and getting better, recapturing some people that would have otherwise not benefited. I have a video that’s very popular with therapists where it’s a client who I was not successful with. I really wanted to be successful with her. I really liked her. She was a great young person, couldn’t have wanted her to work through her struggles more, but I was not the right fit for whatever reason. And then I do a consult with one of my colleagues who took over therapy, and then she changed quite rapidly. So the message is that we all have clients who don’t benefit and there’s nobody that’s one hundred percent effective, the very best therapist on the planet, or about two thirds effective, which means that one third of their clients do not benefit, that if we identify who those third are, we can either change up what we’re doing or we can get them in front of somebody else. That is a better fit. In the old days before I started doing this, I think I would eventually figure out that I wasn’t being helpful to people, but they may have dropped out by the time I figured it out.

Gabe Howard: Right, and then you can’t refer them.

Barry L. Duncan, Psy.D.: They can’t be referred, and it means they walk away saying therapy wasn’t helpful rather than saying therapy with Barry wasn’t helpful and it could be helpful with somebody else, with different ideas, different trainings, different kind of personality, whatever. It got me to the end of right away with people from the second or third encounter saying, does it look like things happened? What do you think we should do about that? And that conversation is really cool because it does comment on the partnership. And we can get to maybe if there is something that’s holding us back, have a frank conversation about it and move on, or we need to change approaches altogether or think about it in a different way. 

Gabe Howard: Dr. Duncan, is there any downside to holding therapists accountable and to your method? We’ve talked a lot about the positives, but let’s be fair. Does the pendulum swing back the other way?

Barry L. Duncan, Psy.D.: There could be potential downsides, for example, if the payers, managed care companies, insurance companies use this as the sole decision to throw people out of their you reach maximum gain, no more sessions for you rather than that being. This is information, the decisions made between the client, the therapist, about when therapy should end or when it should be cut back or what have you. It also could be a downside if management decided to use it in a punitive way. For example, to say you’re your therapist, Gabe, and I say to you, well, we measure outcomes here with this system. And if you don’t attain 60 percent effectiveness with your clients, you’ll be reprimanded. Or if you get 60 percent, I’ll give you a raise. That would be a really horrible consequence. So in all of my contracts and all of my agreements, I spell those things out that it can’t be used that way. It can’t be used to reward or punish therapists. It can’t be used as the sole determinant, whether a person continues in therapy or not, because, again, those decisions are far more collaborative than that, than a number from a scale. But the number from the scale, it’s our insurance policy in that it keeps us honest so that we have those conversations with. And one thing that I really is troubling to me as I look at therapy across many organizations and many therapists, is that therapy can devolve into a place where there’s only a processing of the client’s life.

Barry L. Duncan, Psy.D.: It’s just an ongoing commentary on what’s happened that week with no thematic connection to a change that is being tried for. That winds up happening because it’s a much easier thing for people to do rather than being accountable for making a meaningful difference in people’s lives. And that’s why measuring outcomes is very important. You can prevent that. I do implementation a lot of agencies that wind up doing supervision and I’ll say, what are you working on? And I’ll say he’s been through a lot. And this is a place where you can come and get support and say, so what’s the end game to providing support? This is the only place that he can get that. I said, wouldn’t it make sense to have a discussion about a goal that he could get support in his real world because you’re not going to invite him home for Thanksgiving dinner? Right.

Gabe Howard: All right.

Barry L. Duncan, Psy.D.: We’re not really a support system. Not really. We’re temporary support system for people. We hope that they can get support systems in their natural world and that we are not a replacement for those things. And that’s what happens. A lot of time therapy can become replacement. And we’re not that kind of relationship. And those lines can get really blurred when those circumstances when you’re not accountable to person, to clients and first to there being some results that come from it, we can have these endless process oriented, support oriented therapies now in saying that there’s nothing wrong with process or support, but there shouldn’t be that change component. That’s a part of it.

Gabe Howard: Dr. Duncan, as both a patient and a mental health advocate, I like anything that improves outcomes for patients because that’s me. I want outcomes to improve. I do believe that therapists want outcomes to improve as well. It’s just we’ve always done it this way. Why do we need to change? Change is scary. It’s the kind of thing that you often go to therapy for.

Barry L. Duncan, Psy.D.: Absolutely. You know, one of my favorite agencies of working with, they’re called Wesley Community Action, and they have a big poster in their waiting room and it says, We pledge to have as much courage as the people that we serve. We have to be courageous ourselves as therapists to make changes that we know are for the better, rather than saying the way we’ve always done them, because that’s where our comfort zone is. And we ask clients to make changes all the time. We ourselves aren’t willing to do it. Sad commentary on us, basically, but it takes courage to do things that are different. It’s hard for some therapists to get feedback that therapy is not helping. OK? Wouldn’t you rather know? It’s not helping them believing that it does and then the client drops out. You don’t know why some therapists are squeamish about getting direct feedback about the relationship. Those are incredible things for people to say to you because they’re trusting you enough that there won’t be some negative consequence by their being candid with you. And that’s exactly what we want clients to be with us is as candid as possible. It’s a gift when clients say things negative to you, because if you can work through that with them, it will build the alliance even stronger and the client will be more likely to benefit from the service.

Gabe Howard: I like that, I like that a lot, Dr. Duncan, do you have any last words or comments on the topic? And also where can people find you online?

Barry L. Duncan, Psy.D.: BetterOutcomesNow.com is the Web site, BetterOutcomesNow.com and there’s a section called Resources and there’s all kinds of free resources there, articles, videos about a lot of the stuff we talk about there, brief videos about. Lots of free stuff, in fact, 253 downloads are on the website.

Gabe Howard: Wow, lots of cool stuff.

Barry L. Duncan, Psy.D.: And something I’d like to leave you with is if you were a client in therapy, if you would like for that therapy to be accountable, it would be a nice thing to bring up to your therapist. And you could tell your therapist that he or she can download the measures for free from the website. BetterOutcomesNow.com and watch a video and could learn how to use them quite readily. They want to go so far as to read a book. They can do that too. In my book, What’s Right With You, which is written for a general audience, I recommend that you monitor the progress of your own therapy. Even if your therapist says that you do it, you monitor your own progress so that you have a sense from session to session whether or not you are gaining. And of course, that book tells you how to do that. There’s also stuff online that would help you how to do that. That’s a free download.

Gabe Howard: And advocating for yourself as a patient is something that, well, Gabe Howard, Psych Central and pretty much every organization that I’m involved with highly recommend. Steer your own bat. I think that’s really the bottom line. When we wait for stuff to happen to us, we’re not really in control. And when we advocate for ourselves with our doctors, our medical teams and even in our own families, workplaces and general society, I think it really does impact our outcomes, our mental health and, of course, our overall lives.

Barry L. Duncan, Psy.D.: Absolutely.

Gabe Howard: Thank you, Dr. Duncan, and thank you to all of our listeners for listening. My name is Gabe Howard and I am the author of Mental Illness Is an Asshole, which is available on Amazon. Or you can get a signed copy for less money over a gabehoward.com and I’ll even throw in stickers from the show. Remember, we have a super secret Facebook page over at PsychCentral.com/FBShow. I recommend that you sign up for that. If you have any topic ideas, please, please, please send them to me at show@PsychCentral.com. Wherever you downloaded this podcast, please, please subscribe. Use your words and tell other people why they should subscribe. Ratings are powerful and remember, you can get one week of free, convenient, affordable, private online counseling any time anywhere simply by visiting BetterHelp.com/PsychCentral. We’ll see everyone next week.

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Ambulance patient died in Port Wakefield Road crash because paramedic fell asleep, jury told


A South Australian paramedic accused of causing the death of a patient he was transporting to hospital fell asleep at the wheel of the ambulance, causing the vehicle to roll, a jury has heard.

Matthew James McLean, 42, is standing trial charged with death by dangerous driving, after Karen Biddell, 48, sustained fatal chest injuries in the August 2016 crash on Port Wakefield Road.

The court heard the bariatric patient was being transported from her home in Port Pirie to the Royal Adelaide Hospital for treatment when the accident occurred.

Mr McLean has pleaded not guilty to causing Ms Biddell’s death and injuring her daughter in the same accident.

In the opening address, the prosecution told South Australia’s District Court that Mr McLean had worked 11 shifts in the 12 days prior to the accident after volunteering to work overtime, and was suffering from fatigue.

Mark Norman SC said Mr McLean told a number of people at the scene after the accident that he had fallen asleep.

“To drive a five-tonne ambulance in the dark on a highway at speeds of around 95 kilometres per hour when you are so tired you can’t stay awake that is dangerous as a matter of law, it’s dangerous as a matter of common sense, irrespective of who you are and irrespective of why you are doing it.”

Transfer was delayed, court told

Mr Norman told the jury that the morbidly obese patient had cellulitis and had been suffering from serious leg ulcers that needed hospital treatment.

A bariatric ambulance to transfer Ms Biddell left Adelaide just after 6:00pm on the night of the crash.

Karen Biddell died in the crash on Port Wakefield Road.(ABC News)

But the prosecution said when the ambulance driven by Mr McLean arrived in Port Pirie there was a delay getting her out the house because of her size.

“She couldn’t walk properly unaided, she needed a specially adaptive wheel chair to move her out of the house,” Mr Norman said.

“The problem of getting her out of the house on that chair through the door at the same time meant the fire service had to be called, they had to remove a piece of that door and remove a piece of the wall to get her out.”

Mr Norman said that, because of the delay, the ambulance did not depart for Adelaide until after midnight.

Accused has sleep apnoea, defence says

Mr McLean’s defence argued that he was not fatigued and the reason he fell asleep while driving and crashed near Virginia was because he unknowingly had sleep apnoea.

His lawyer Stephen Apps said the ambulance officer has since been diagnosed with the sleep disorder.

“Mr McLean suffered from sleep apnoea at the time of the accident and that caused him to fall asleep suddenly and without any warning,” he said.

“One moment he was driving ambulance and the next thing he knew the accident had occurred, he didn’t know how, he wasn’t aware of it happening.

The trial is expected to run for three weeks.



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Patient at Irish Children’s Hospital Rides Around in Style in Mini BMW



Children at hospitals in Dublin and Cork now have a chance to ride to treatment in style after the donation of several mini electric cars. Video shared by pediatric consultant Dr Nuala Quinn shows her “little hero” Anthony riding around the corridors of the National Children’s Hospital in Dublin in a toy BMW. The mini electric cars were delivered to hospitals in Dublin and Cork by Keary’s Motor Group, who devised the plan with a local entrepreneur, reports said. Credit: Nuala Quinn via Storyful



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Singapore Patient Plasma Used To Create Trump’s COVID-19 Antibody Cocktail | Asian Scientist Magazine



AsianScientist (Oct. 5, 2020) – One of the two antibodies in the cocktail used to treat US president Donald Trump for COVID-19 was developed using blood samples from three patients in Singapore. REGN-COV2, a combination of two antibodies against the SARS-CoV-2 spike protein, was developed by US-based biotechnology company Regeneron. Two papers describing preclinical studies of REGN-COV2 have been published in Science.

Convalescent plasma from patients who have recovered from COVID-19 could contain protective antibodies that can be used to either prevent or treat the disease. Although the US Food and Drug Administration has authorized the emergency use of convalescent plasma to treat COVID-19, the difficulty of obtaining sufficient blood from volunteers means that it is not possible to use it at a large scale.

Instead of relying on large amounts of convalescent plasma, Regeneron cloned SARS-CoV-2 binding antibodies from both ‘humanized’ mice and recovered COVID-19 patients to produce a reliable source of monoclonal antibodies. While the humanized mice were based on a technology owned by Regeneron, the human plasma used was supplied through an agreement with Singapore’s National Centre for Infectious Diseases. According to a commentary published in The Straits Times in May, there have been talks for Singapore to potentially participate in further clinical trials of the treatment.

On September 29, 2020, Regeneron announced positive data from a Phase 1 trial of 275 patients, showing that REGN-COV2 reduced viral levels and improved symptoms. Shortly after, on October 2, 2020, it was revealed that Trump had received a high dose of the experimental therapy, which has not received emergency use approval but was administered under a compassionate use request.
The articles can be found at:
Hansen et al. (2020) Studies in Humanized Mice and Convalescent Humans Yield a SARS-CoV-2 Antibody Cocktail.
Baum et al. (2020) Antibody Cocktail to SARS-CoV-2 Spike Protein Prevents Rapid Mutational Escape Seen with Individual Antibodies.

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Copyright: Asian Scientist Magazine. Photo: Shutterstock.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.


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Trump’s doctors grapple with competing demands – from the public and an image-conscious patient, experts said


“When you’re in a complicated situation like this, you can only go so far,” said Dr. Benjamin Aaron, the chest surgeon who in 1981 removed the bullet from President Ronald Reagan, and said he and his colleagues “felt a sense of duty to level with the American people.

“It’s appropriate to be open, but there has to be a certain amount of implied trust” with his VIP patient,” he said.

The man standing at the crossroads of these competing interest now is Dr. Sean Conley, an Afghan War veteran and military physician who has addressed reporters twice over the weekend about the president’s battle with the novel coronavirus, a diagnosis he received late last week.

Conley offered conflicting statements about the president’s health status and treatment timeline, prompting a crisis of credibility emanating from the esteemed hospital’s medical staff. On Saturday, Conley said he and his staff were “extremely happy with the progress the president has made,” and described his symptoms as mild. But after the briefing concluded, White House chief of staff Mark Meadows offered a vastly more dire prognosis, calling the president’s vitals on Friday “concerning.”

Conley attempted to clean up the diverging takes on Sunday, telling reporters that Meadows’ comments had been “misconstrued,” but acknowledged he was “trying to reflect the upbeat attitude of the team and the president, over the course of the illness, has had,” in describing the president’s status.

“I didn’t want to give any information that might steer the course of illness in another direction,” Conley said, “and in doing so, it came off that we were trying to hide something, which wasn’t necessarily true.”

The president’s critics have accused the White House of deliberately misleading the American people. Senate Minority Leader Chuck Schumer, of New York, issued a call on Sunday for the full details of Trump’s health status to be released, along with the names and health status of everyone who has tested positive at recent related events.

“When you don’t have full transparency, when there’s cover-up’s, contradictory statements, even lying about something as vital to the nation’s security as the president’s health, the nation is severely endangered,” Schumer said.

White House Communications Director Alyssa Farah sought to defend Conley’s apparent reversal Sunday on Fox News, claiming that it is a “very common medical practice” to “convey confidence and you want to raise the spirits of the person you’re treating.”

The challenges Conley faces now not new – but may be heightened given Trump’s past proclivity to shroud his health assessments in secrecy. After his 2016 presidential bid, for example, a New York-based doctor who penned a glowing letter proclaiming that Trump would “be the healthiest individual ever elected to the presidency,” said the president had dictated the letter to him for publication under the doctor’s name. In 2019, the president made an unannounced visit to Walter Reed Medical Center for what Conley later described as “a routine checkup.”

But in this current medical crisis, experts not involved in the president’s treatment described to ABC News the difficult balance Conley must try to strike. Dr. Mark Siegel, a Yale University critical care physician and medical ethicist, said scrutiny of the Walter Reed physicians underscores the unique tension of transparency in treating a president.

“The physicians who are sharing information with the public have to wrestle with these competing interests,” Siegel said. “One is to protect the privacy of their patient, but I think an overriding concern is that the public has a right to know how their president is doing.”

A challenge for past presidents

Balancing the competing interests described by Siegel is hardly a new challenge for those who treat presidents of the United States. In fact, obscuring the sometimes dire medical conditions of a sitting president has significant precedent in American history.

In 1893, Grover Cleveland went so far as to undergo surgery on a yacht to avoid media attention. When William McKinley nearly died of pneumonia in 1901, his spokesperson slammed reporters’ inquiries as “foolish stories.” Perhaps most famously, aides to Franklin Delano Roosevelt long sought to hide their boss’ paralysis.

After Reagan was shot outside the Washington Hilton, Aaron said the medical team made a pointed effort to present a clear message to the public.

“We didn’t want to put out a hodgepodge,” he told ABC News in an interview on Saturday. “We wanted to report accurately on what’s going on, not create missed information, misdirection and misinterpretation.”

Aaron watched the Saturday briefing at Walter Reed and commended Conley’s professionalism. But he marveled at how the pressure of transparency has evolved in an era of social media and polarized politicization.

After Reagan was shot, Aaron said he and his medical team “let the dust settle” before divulging details of his condition. The president’s medical staff waited multiple days before offering a “full accounting of the facts” – but even then made strategic omissions.

“In a situation like this, the doctors have to be as professional, and as truthful, as they can be,” Aaron said. “Honesty is the best policy in all regards, but honesty does not necessarily mean lay it all out, lay all the blood on the table for the public to try to digest.”

As for the historical precedence, Aaron said examples of past presidents hiding ailments for political purposes further illustrates the evolution of transparency and what is expected of leaders who fall ill.

“Look at Roosevelt — there was nothing transparent about his care at all. There are an awful lot of people in this country never even knew he was paralyzed,” Aaron said. “Same thing with a number of other presidents along the way and, admittedly, a lot of this stuff was done for devious goals — and so the whole issue of what transparency amounts to, and responsibility of transparency, has been evolving over the years.”

Honesty is Conley’s ‘ethical duty’

Critics have latched onto Conley’s opaque descriptions of Trump’s vital biometrics. Dr. Seema Yasmin, a former CDC investigator and science communications professor at Stanford University, called the press briefing “a master class in all the things not to do.”

“This was a physician who was prevaricating, who was speaking half-truths, and just not being transparent and giving us clear answers to very basic questions,” Yasmin said Saturday on CNN.

David Gergen, an aide to Reagan who briefed reporters in 1981 the day the president was shot, said Sunday on CNN that “the most important lesson is to tell the public the hard truths – the unvarnished truths – and do it in a competent way.”

Under normal circumstances, doctors are limited in what they can divulge publicly about their patients under stringent rules dictated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). But with a president, there is no clear roadmap for what information Americans deserve to know in the context of patient privacy.

Regardless of how much information the president’s medical staff is willing to share, doctors “have an ethical duty to be honest and not to share information that’s misleading,” added Siegel, the Yale ethicist.

Aaron said that same sense of duty guided his team’s decisions back in 1981.

“Our purpose was just to put the facts out as they were,” Aaron said. “History sort of demanded that – that there be a true, and well-documented historical record of a major event in American history.”

ABC News’ Elizabeth Thomas contributed reporting.



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