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music therapy.pdf

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McMaster University
Rachael Finnerty

Firstclass May-01-12 2:28 PM Camean hour late: - Lastclass is june 7th - June18this next semesteriA - ReferralforminLTC: ○ Ontopsays persons name,date of birth and date etc. And persons namewhosemaking referral ○ Andhas a bunchof disorders onit ○ Whoeveris makingthe referralall they haveto do is circle whichitems are relevant to the individuals ○ Musictherapistwill also gather info i.e. Have they hadexperience with musicbefore? Justto gathersome relationship soyo uknowif the useof musicactually helped or not - Assessment form: ○ Showexample: name,date of birth,diagnosis,whicharea offacility they iv'e in, whywere they referred,andbrief summary ofmusicsessioni.e. This lady declined, wasn't interestedin engaging and as a result ofthat what might be the benefits in reference of referralect. And whatinterventi ons might be used ○ All that is documented andthen in long term care, musictherapists put all of that in computerand everybodyinthe facility can see it - Whymusic? ○ Musicis the tool used within musictherapyin orderto achieve a varietyof goals ○ Musicencompasses mood,emotions,acts as a distraction,evokes memories whenused either passivelyorin an actively meaning ful manner ○ Recordedhistoryrelates stories ofhumankinds'useof musicto sooththe body,mindand spirit,in this centre, musichas b een foundto alter physiologicalresponses,suchas heartrate and respirationrate  Thus usingmusicisn't newto therapyor health care, and as farback as you remember,musicwas used andits something as human beings its part imparcial of whowe are historically,andnowthat we have medical devices to report howit physiologicallyhelp us <<< bc we knowits emotional effect, sonowwe have evidence that its affecting ourphysiologicalstate ○ Musichas alsobeen foundto alter moodand elicit relaxation responses - WhymusicII? ○ Musiccanbe frighteningand threatening, yet there is a sense ofcontrol bybeing able t "turnit off". ○ Sloboda(1991),musicfunctions as acatalystorstimulus forthe experience of emotions ○ Stimulate endorphinproduction.( pleasure/pain)  Endorphins:hormones thatproducefeeling of pleasure,and they are alsoinvolved in pain ( can reduce sensationofpain when endorphins areheighted) □ Canbe very powerfulin how it physiologically affects us,so its not justsomethingthat's nice ○ Engages the limbic and paralimbic systems (emotions)  Itaffects ourbrainwhich is whyits affective in health care ○ This has been observedin studies using neuroimagingand PET scans whilean individual passivelylistens to music ○ Italsoeffects the productionof dopamine ( DA)/pleasure  Musicis the onlything that lights up ourwhole brain,activates everything! □ Every partofyour brain is engaged whenyouare listening to musicand is the only thing!!!!! □ Sofor health care goals,if one area isn't functioningyoustill have a chance to help the personbecauseother areas are being active as well soyou cancompensate - Becomingamusictherapist ○ Tobe recognizedby canadian associationofmusic therapyyouneed to have a minimum of BA in music therapyand in ontario th e only universitythat offers BA in music therapy=wilfirdlaurier,windsoe,acadia, winnipegmennonite, capilano,quebec city= 6universities that offerBA programin canada! ○ Thenyouneed 1000hours ofinternship ○ Theres 2master musictherapyprogram:laurier ○ Mcmasteris the onlyone that has intro class to music therapybut has no BA program - Associations: ○ Canadianassociationofmusic therapy(CAMT established1974)  ○ MusictherapyassociationofOntario  - Whydo we have a professionalorganization?CAMPT ○ Promotes excellence in musictherapypractice andeducation, furtheringdevelopment and awareness ofmusictherapyin Canada while alsoservingas an organizational agencyforits members ○ Mid-1950's,musictherapists wereworkingindependentlyin Canada; notable amont them were FranHermanin Toronto,Ontario,Norma Sharpein St.Thomas,Ontario,and TheresePagaeuin Montreal,Quebec. ○ Successiveconferences wereheldin May, 1975,attheUniversityof Manitoba,,Winnipeg, Manitoba, andin May,1976,atUnive rsityof WesternOntarioin London,Ontario.It was atthese conferences that thenational musictherapyassociationwas founded ○ May6,1977,CAMPTwas incorporatedandtheobjectives wereredefined as follows: - Government regulation ○ Theontario coalition ofmental health professionals (thecoalition) is an umbrella organizationwhosemembers are professio nalassociations inthefield ofmental health. The coalition was formedto address theissueof regulating counsellingand psychotherapyinontario  Pplwith autismhave to pay! And its really expensive  Currentlyits self regulated whichmeans a groupof musictherapists have come together and have created a boardof directors and these boardof directors state what individuals need to have to practice as a musictherapist and they are empoweredto reinforcethat □ Butb/c they areself regulated, the amount ofpower they have to reinforce is limited □ Ifsomethingis governmentregulated ( i.e. Gov.Has college) and state that in order to work as music therapy youneed to have : i.e. x,y,z andif you don't youwill get sued  Eventhoughwe are self-regulated we don't havemoney to enforce it  Onotherflip sidei.e. To workas an architect youneed to be recognized byraise andoaa<<< they are, justlike music thera py<< self regulated<<< they determine themselves whatone mustneed to be legally liable as an architect ◊ Butb/c there are enougharchitect whopay fees into selfregulated body,they can reinforce,and if architect doesn'thave stuffand say they are anarchitect they can be sued by oaa and personwhois getting work done by person ○ Onceyourrecognizedbygovernment,then the governmentdictates what needs to be done in orderfor personto have that title ○ Andinfohas been going backand forthbtwn musictherapybodies and governmentaroundwhatshould bethemin. Requirements t o beaccepted by gov.Bodyand they have placedeverythingand later they will bea governmentrelated body andin 2013thegovernmentis who everybodyneedto answe rbut nowits caa  Sothis means that government recognizes that we havean impact which can do harmand in orderto protect the public the governmentgets in to make sureeverything is workingproperlysothatthe public ppl are not harmed ○ Acceptingapplicants 2013 - Employment andIncome: ○ Full/part-timeemployment ○ Hospitals,schools,rehabilitation ○ Self-employed/privatepractise<<< majorityofppl in Ontarioare self-employed ○ Salarywithbenefits 55-85000approx ○ Privatecontracts 35-45/hr ○ Privateclients 75-115/hr Groups 50-220/hr ○ Groups 50-220/hr  Ifyourworkingwithprivateclient or group,youget 75 dollars an hourbut yourreally workingfor2-3hours inorderto get that one hourof 75dollars,b/c youhave to prepareeverything,whatto singset up workandthen have sessionandthen make notes after youobserveandthen after 3/6months later youwrite a reportand that's all included in that rate  Soit might seem a lot as a parent to pay that much but the music therapistis putting a lot of hours in to have that one hour sessionbeperfect and help the autistic kid for example - Musictherapyaroundthe world ○ Practisedin39 countries aroundthe world ○ Europe-Governmentregulated ○ USA-largestnumberof trained music therapists,75Universities offerMusictherapydegree.<<< comparedto 6in Canadaand that's both undergradandpost grad!There's manyuniversities that offermasters and PHDprograms,andthere's no PHDprograms inCanada ○ WorldFederationof Musictherapy: this is where there's music therapists fromeverycountrythat comes together to keep in t ouch with everythingthat's happeningaroundthe world ○ Interventions<<>class 4 2. Compositing:writingwholenewsongor fixing up a song ○ Computer is important now for composing ○ Workshops weregearedaroundusingi.e. Garageband as a way of mixing, pre-composingandgiving client a voice as a way to communicate ○ Backin the days pplwould gather aroundthe piano and singand play << ppl playpiano as a wayto interact with others<< tha t is gone now ○ Growingupmanyofus maynot have been aroundinstruments orbin comfortablewith instruments but we have been aroundgames for example, <<< so creating musici.e. Garagebandmayhave been less intimidating than usingactual instruments ○ Somusictherapists usedigital tools to help ppl in their therapy 3. Singing 4. Listening<<>everybodyplays different Hardforpersontodo it if they have had musicbackground Its individual>>everybodyplays different - Hardforpersontodo it if they have had musicbackground - Be carefulhowthis is usedwith thosewhohave mental health issues i.e. Skitz<< might be too muchfor them! - There's techniques for how a music therapistengages with improvisingandregardless ofwhatapproachor method is used,the therapist/clinician can useany type oftechnique - Gives therapisttools anda way to connect in an improvisationalway 1. Mirroringorcopying:i.e.Ifclient is on piano and is playingsomething i.e. Doing samething on same note over andover andif they wantt mir rorit the therapistwill do same thingback - Purpose:toreflect backto client whatthey are doing, bc they might not realize that that's whatit sounds like orthat's w hat they are doing  Italsoreassures theclient that you are listening and hearingthem and givingit back to them 2. Matching: - Samething but they do it at the sametime as the person,and might not be same notes,justmatching the tone and rhythm,so justtryingto match wherethe client is at 3. Reflecting: - Againsamething, the client might be doing something that's in the minorand doing somethingthat's softand then the therap ist might do somethingback,and reflect backthe feel<<< the therapist interpretation of the feel, capturingthe sound,rhythm,dynamics,soreflectingbackto them a feeling , a senseof whatthe therapistis hearing musically 4. Grounding/containing - i.e.You have someonethat's doing a lot of things all overthe place and all overthe map and therapist might do big open oc tives that's justsolid, holding andholding notes while the client is doing a lot of things,sothis gives it some senseof form,holding,soit sounds less chaotic sohope is to gi ve client as a senseof being held, that its okayto be like this andthat they're in a safeplace, and if they feel safethen the client will think its okayto move aroundin a place - Almostalways inan improvisationalpiece is that you end at same time, even whenyoudo it with a groupof ppl, youend at s ame time, there's something there, and it just happens ! 5. Dialoging: - Thetherapist and client talk to each otherthroughthe music,sohaving a musicdialogue<< this has many reasons tobe imple mented i.e. Workingwithteen whohates everybody,andfinsingwords towhatthey feel is hardb/c they don't even knowhowthey feel - Youcan havea convowithsomeone without havingto sayanythingand as times goes on these dialogues can start to have a the me ora sense ofecstasyor senseofdarkness ○ Youcould startt see patterns where i.e. Client dominates ○ Its awayclient canstart to notice their emotions, andthroughdialoguing then they could startto verbalize\kkkpsychoanalyticalmodelwhere youdo musicand see using words whatthathas evoked in person ○ Theycan talk at same time and then youcan see if the client is okaywith that<<< and usingthe blackkeys can be a safe way to do that becauseit never sounds bad 6. Gesturalcuse - i.eif client is playing instrument andis jumping,then therapist can jumpto << showingclient that your there with them , so not justplaying instrumentbut on how they move andact - Youdon't copy them, you justdo similarthings and this shows them that its okay to dothat kindof stuff,to get them feel comfortable - Sothe use of yourbodyis impart important in engaging with client <<<< all of these types of improvisationare in the book! 7. Melodycontainertransition<<>> startingto improvisea little bit beyondyoursafetynet andyourfeeling that you can dothis b/c the con tainer is there to bring youbackto a safeplace ○ i.e." youare my sunshine"andthen youget to the improvepart and encouragingthe personto vocally singand then take it to whereit goes and then go back to a safe place,singing" youare my sunshineagain"backto a safeplace  Firsttime she playedit she was selfconscious andthen shewent off and hadfun and whenshe came backshe had more jelly, even though backto pre-composedshe has somethingto give into it because shebroughtsomething into it fromthe improve  Socontainer then improveand backto container but it changed a bit ,bringing somethingto a new place - There's are justdifferenttechniques that one could bringin at different times! - i.e.Ifwe wantto make persongain social skills then wecan play and then listen to client and then he will do that stop li sten and stoplisten too whichis whatwe naturally do in a conversation! ○ Somebodywithautismmay not pick up onthe social cues when a personis trying to listen to youor whatkind of responsethe yare looking for  Sothroughmusicyouplay in a way to see if client responds appropriately i.e.You play and if they are justplayingnot respondingtoyou then that couldalso reflect how they engage in everyday life,so one of the goals ofworkingin this model could be to build that social skills,self awareness ofothers,interact and socially engage  Andhopefully once we know personhas capacity to respondandcommunicate throughmusic then goesl is that hopefully the musicwill transcendanduse in in social communication - Durationofa sessioncouldbe from5min.To 2 hours ○ Sometimes doing it for 5min is all that they canmanage and then over time it can be longer,6 min to 2 min ○ Or couldbe 1 or2 hours writingmusic,drawingand reflecting musicand playing music ○ Onaverageits 45minutes Case studyonpg 160: - Guy ,1 houronce a week and he was havingoutpatient musicthere out ofhospital and did it for2 years <<< that's hard to d o that after leaving hospital<<< hardto havethat kindofcontinuation of relationship - Goals tohave bettercontact withselfsohe couldinteract withcommunity ○ Clip 1:veryfirstsession:therapistand patient are both improvisingon2 different piano <<< sonow not limited, and perso n can fully explore the keyboard  Patient is askedto play note, listen to it carefully andlet note leave you to next note, to direct attention of note instead of thinking ofhow it shouldsound,not how it connects to the next key but to think aboutwhere youwant to go next<<< which means its about moving forward,gettingconfidence of" what's next"<<< one key at a time  Steady note was the music therapistand the others was the client  Purpose:was formusictherapistto hold the client, b/c she felt that it was the best way to do this, sheheld him □ Shedoes middle register and he goes everywherebutthat area<<<< he's not ready t connect withanybody<<< this shows notionofreferral<<< why he came in , in the firstplace  Firstsessionwantedtosee what he does with it! Andthen maybelater direct the client - Hada senseof musicalcenter that he belonged ti that mustbe there to allow himself to vernallycomment 32ndsessionnow - Boththerapist vocalizeand the patient startedhaving dreams while sleeping,and hasn't haddreams ○ Evenwater coloured ○ Persontalks aboutdreams,reflect on journaland then talk about ○ Is therelationshipbtwn the client and therapist that starts to drive how the sessions aregoingto be planned out orunfold and what's goingto workhere! - Vocallyimprovisationis most hardestinstrument<<< nobodylikes to do that <<<< singing<< makingsounds nwords couldcome  Butany useof voice is typically extremely intimidating so whenclient does this its like a break throughb.cto dothat you must haveconfidence in selfand be comfortablewithhumility <<< many ppl have fear of humility and don't wantto be put in a situation where they get humiliated  Theexample<<< they were matching,the therapist was takinglead ofclient - Beforehe didn't wantto play with he in areas she was andthen singing,he was allowingher to meet him<< which is the most intimidating instrument 42ndsession:patinetone - Herwehave botht he matchiungand the transitioning( movement) - Inexample,the man hadexplored himselfdifferently now and role Inexample,the man hadexplored himselfdifferently now and role - Finishes witha patent narrative<<< odn't often get to that point in [email protected] and once they leaves there isn't a wayto inte racts wit - Butin this casethey werr gfortunate to hhe able to do that to talk - Hehti a breakthroughpoint! - about his therapy and his eei - This was a long process Fornext class wehave reading abotu workignwithelderly and precomposedmusic,androda - Withbrain imagery< - Improvisationcanbedirected anda free place - Inbookreadit <<< give you ideas ofwarmup techniques<<< thigns therapist might t with client to get them - Improvisingis liketakingyourclothes off,its all bareand outthere so whenmusic therapistuse improvisationthere are - i.e.Can clap and tlak at sametime, clap the saythings and clap the sylabbles ofthe words - Whenwe playor connecting piece ofcomposedmusic,you canhide behind it ! Il; - Yourimrpovizationis veryexposing,and youcan't hide behind anybhidy Assignment: - Givelike 3referralexamples and their goals and specific interventions that you could gothroughto help them - Whyis musictherapya health care dicipline<<< tlak abotu tis importance - Tlakabout how ppl aren't refered b.c its entertaining or like it but referredbc of their health car goles i.e. Challenges w ith social inm to increas rangeof motion etc. - Whyis it affective in health care<<< we talked abotu whyyouwouldn't refer to someoneto musictherapyiif they havespeech and not music???<<>> it motivates >>> tlak abotu differentthings musiccan do to reach health caregoals - Refersals andgoal andhow musicreaches that goal i.e. Self motivation= - Subheadings is fine Midtermforthis class: - Improvisation - Mirroringandcopying << what it is and implementations - Matching - Groundingtechnique - Containing - Thedialoguing - Hest - gesturing - With4th classreadingsb/fcomeintoclasshaveit done>>>>> 4thclass May-10-12 1:32 PM - Younggirl was healthyand then shegot sick andhad a fever ○ Itwouldn'tbreakand the doctors weren't surewhatwas behind that and then she wentout ofbed and collapsed, couldn't use her upperlimb and was very disoriented  Turns outshehad a virus that caused the fever andthen it went to her brainand causeddamage of her brain  This resultedin hernot able to walk,speechor cognitively process information  Thedoctors told parents that she wouldn'tregain ability to walkagain or talk again and hercognitive abilities wouldn't be age appropriate<<< but her parents tookher torehabilitation and had herin rehabthroughspeech and workingwitha walker>> she did gain ability to walkagain □ Sheis in grade6 now,9 years later, sheis fully bodily able and shedoes gymnastics,horseridingandeverythingthat a 12year old woulddo □ Her speechdidn't start to really come ( there was somehappening though) □ Lots ofbehaviours startedto develop as well i.e. Frustration, andvomiting << as a result of her tryingto express herself! - Teachermet this girl whenshe was 7years of age, andshe was in a no boundprogram=music education programshefoundedfor anybodywhowanted to learn to play a instrumentandwouldbenefit fromlearning at a different way <<< b/c normally typical way wouldn't workespecially forppl w hohad autismetc. - Soshethought her how to play piano and shewas good andshe was even reading musicand learning this languageand reading t hese notes andprocessingthe informationand executing the music ○ Parents toldher that their daughterdoesn't know how to read b/c teacher said its not in the cards forher,docs saidshe ha s reached her cognitive capacity to read ○ Butnotes is like a letter ○ They broughtbookin to profand the profsangthe bookto the girl  b/cbrain that process musicis differentthen the part of the brain that processes word  Toexecute singingis fromdifferent area of brain fromwords  Thenshe movedinto musictherapyb/c shecan workat academic books andstarted at letter a andnow sheis now at the same r eadingletter as her peers<<<< she is able to partakeacademically in the things that her peers are doing - This is an example of a behaviouralapproach b/c were not takingthe clients lead<<>80 yearold, his body is week fromcancer and is dying alone but he finds comfortand piece throughmusic therapy  Pre-composedmusichadaconnection to him and his relationship to his wife was the most meaningfulto him ○ Aren:has downsyndromandgets help frommusictherapy  Thepre-composedmusichelped 2ppl  Adry:gavehis life meaning,and evoked memory and connected with ppl andnurses now,makingconversation<<<<>> soanybody whosays thatthey can't domusic<<< thats not likely to be true becuaseth e brainhas the ability to do so  Youmight not call yourselfmuscialbut the brainhas the ability to do it i.e. You usemusic in yourspeech  Sothats whyprecomposedmusicwith i.e. Demensia ppl<<< even if they aren't musicians musiccan still evokememory andhelp them ! Itcan be very effective with all individuals bcthe brainhas the ability to connect with music - Non-Musicians canextrapolate musicalinformation Emotion: - Whenwe evokememory we are inherently evokingemosion - i.e.Foraudry the sickman it was the musicthat evokedmemory which causedemotion that made him feel mroe alive!  Musicactivates same areas of the brain as other emotional stimuli  Linkedwith reward,motivation,arousal Memory: - Demensianis a relative term and alzymers is in demensia - Alzheimer's pplcan be confusedand disoriented andthen sit at the piano andthen go crazy andare amazing<<< that memory is preserved  Alzhiemer's memory toplay instrumental may be preserved<<>> different ways oflyrics creation <<<< like improvisingand the different techniques in it  Thereapeuticlyriccreation  Guidingfree brianstorming>>>already talkedabout  Guidingoriginallyricsanmusic>>> alreadytalked about  Selectingwordsfromalist:things even like pecks i.e. Ppl whoa re in wheelchair canpick with their hand froma list ofwords,sotheypick the wordsfromabig list  Clientselfgenerates words:clients spontaneouslygenerates words andtherapistformulates itin a song □ This can alsohappen with improvisingthe words ofa songandmusic therapist might justbringin words in  Clientwritesapoem  Role playing/actingout □ Storytelling: could as client i.e. " whatshouldstorybe about?"an play piano andclient keeps askingquestions andacting out while playingpiano and helps bringstory intoplace □ Eveenif personisn't able t cosnciouslyexpress something,theycan do it in a shadow ofa topic i.e. They could realize that if they make a storythat they couldrealize thatits actually them and how they feel abotu themselves and whatis actually going on, sothis frameworkoflyrics writingand writinga songcan providepersonto exploringself withoutexploring self, and it was a wayto removeit, andby talking about monsterit became more mamagable and withtime she was able to make the connectionthat what shewas really talking about was herself.  Openendedordirectquestions □ Askingtheclient if she is red orblue orshoudlthis be family" yes or no"you wantall ppl in yourfamily " yes orno" sojusthelping to direct the clients ability to communicateto help bringthe lyrics into the forfrontto help create a song □ Theres 9stages,a process increating the lyrics,anddifferent techniques that one can useas a musictherapist oranybodycan useto facilitate lyrics writing - - Someoutcomesinregaurdstosongwriting: ○ Canfacilitate grieving  i.e.Write a songand dedicate it to their parnts,knowingthat their parents aregoing to havea difficult time  Sothat songwritingprocess can help individual with their wn kindof life process  Grievingisn'talways specificallyto deaht, it couldbe becauseof the loss ofan ability i.e. Marriageyou had,loss of famiyl that youcan't engage in the waythat youruse to, loss ofyourlife style , logn term care, wehreyousue to be indipendent and now yourin a facility anddepend on others □ Sosongwritingcan help facilitate the grieving process ○ Selfawareness  i.e.Even with younggirl with monster,shemade self awareness withwriting  Sometimes patter occurs,i.e.Everysongstarts bright and everyhtinggoes horrible,so sametheme happens ine eryusong,s otheres a pattern, so" whatdo youthink is going on" ○ Communicatingwithothers  Throughsahringthatself-composedpiece of musicwith otehrs,were able to communicate i.e."im feeling helpless, lsos,andbeing abel to communicateanger" Casestudyexample:  Nonemusic-centered  Very little musichappened at each session ○ Sunnybrook(Audio)  Aman whowas in hospital whorefusedto partake in anything  His biggestthing was his angerwith his daughters frombringinghim in this house b/c as a result of his cognitive decline he was unawarethat he was a dangerto himself by continuingto live at home independently, and in his mind he could continue to live at home independently, and no mayterhowhis daughters tried to explain or dangerous for himto live at home, he thought they were justconspiringagainsthim and that he knew better  Hewouldn't doanyt8inhgwouldn't wantto eat his meals, andthere's a lazy boychair fromhis house,and that was the only thing he wouldg to, sit and sleep on  Sohe was referredto musictherapy □ Shenoticed that he had cassettes □ Heis originally fromgrease,soGreek is his firstlanguage and he is a veryreligious man,and he had started to lose his vision,he could see now but at one point his vision startedto deteriorate and also his hand eye co-ordination □ Heloved writingpoetry andwrote it in Greek,and once his daughters realized that his health was declining, they gave him arecorder,sohe had audio copies ofhis poem,becausehe could no longer read his poetry orwrite his music  SO NOWTHERESLYRICS □ There's material here to help fosterrelationship and domusic with him □ Hewas religious and music was seenas the highest formof prayerforthem andshe mentioned this to him, andhow its a greatwayto sharehis workandthe connection formusicandreligion □ Hesaid but its all in Greek □ Andshesaid its okayyoucan teach me Greek>>>> give me lessons in Greekand then wecan start pitting words andsongs together □ Thenhe sits up really tall now b/c he feels empowered andhe said" youneed to bring yournotebookand give youlist of words"  Shecomes back withher book andpen andwe go throughthe greetings  Sohewas verypoweredand motivated and they even translatedit to English and put musicto them  Soeven thoughthey weren't doing musictogether, there was the process ofmusichappening,so hewas self -expressingthroughhowthesecord shouldsound,so heis composingwhatthe melody is goingto belike for thelyrics that hewrote  Sothis process enabled him to feel excited aboutsomething, hewas engagingin somethingand was theonly thing hewas looki ng forwardtodo, andwhen hewas inthe sessionhewasn'tangryor defensive,hewas enjoyinghimself,which could contribute to his health ○ Rememberme<<> example sof MTin relationtoworkingwith those withelderlyi.e.Demensia,what were theydoing,what were theyworkingonand why? - Pre-composedmusic<<
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