Summary
In this insightful episode of Care Lab, host Emilia Bourland talks with Noel Guidry, a board-certified occupational therapist specializing in low vision care. With decades of experience, Noel shares how low vision OT can transform lives by helping individuals adapt to vision loss using personalized, practical solutions—from simple tactile markers to advanced assistive technology.
The episode explores common barriers like poor contrast in public spaces and emphasizes the power of occupational therapy to restore independence in daily activities such as reading, cooking, and navigating technology. Noel also offers guidance on finding low vision resources and highlights the importance of individualized care.
Key Questions Answered
-
What is considered “low vision”?
Low vision refers to vision loss that cannot be corrected with standard glasses, contact lenses, medication, or surgery. It’s often caused by conditions like macular degeneration, glaucoma, diabetic retinopathy, or stroke-related damage. -
What does a low vision occupational therapist do?
Low vision OTs help individuals regain independence in daily tasks affected by vision loss—like reading, cooking, or using technology—by introducing customized tools, strategies, and training in both low-tech and high-tech solutions. -
What are some common design issues that impact people with low vision?
Poor contrast curbs, dark restaurants, and uneven flooring thresholds are common hazards. These environmental factors can cause falls or make navigation difficult—even for those without diagnosed low vision. -
How can people find low vision specialists or services?
Start by asking an ophthalmologist for referrals. Other helpful resources include state services, support organizations like the Foundation Fighting Blindness, and certification directories from AOTA and ACVREP. -
Are high-tech or low-tech tools better for managing low vision?
Both have value. High-tech options (like AI readers and accessibility settings on phones) offer powerful support, while low-tech tools (like tactile dots or large-print items) are often more accessible and just as effective depending on the person’s needs.
Transcript
Emilia Bourland
Hi everyone, welcome to Care Lab!
Welcome to Care Lab. I'm so excited today because we have Noelle Gidre here and she's an OT. So we got an all OT episode, of course, my favorite. And she's been an OT since 1998. And after working many years in inpatient rehab, treating clients post stroke and traumatic brain injury, plus in acute care and in skilled nursing facilities. all the things in 2018.
She transitioned her career to specialize in the care of low vision and worked in a low vision rehab clinic. And in 2020, she got her doctorate and her graduate certificate in low vision from the University of Alabama, Birmingham, which has an amazing low vision program. She's also AOTA board certified in low vision and is a certified low vision therapist from ACV rep. Now, Noel owns Inside OT Services and Consulting, which is a mobile outpatient low vision OT practice in Northeast Florida. And she delivers these outpatient services in the client's home, which is like the best place to deliver OT of all kinds, but especially low vision. And she enjoys educating future OT practitioners as a contributing faculty at the University of St. Augustine for Health Sciences. So Noel is passionate about spreading the word about low vision services and how these services can help clients who have experienced vision loss.
And so I'm so excited to have you here. So welcome.
Noel Guidry
Thank you so much, Brandy. It's great to be here.
Well, hopefully you still think that after I ask this question. Actually, this is a good one, I think. This is not too spicy, but I think it will be very insightful for people. My question is, what is a small design detail in the world, anywhere in the world, that drives you crazy because it's not low vision friendly? And like you'd be easily fixed, but we just don't do that thing.
All right.
Noel Guidry
My goodness. Low contrast drop offs outside restaurants and public locations. I can't tell you how many people have told me they did not see the curb and stepped right off. And like because they're not marked.
Yes, and not necessarily because they have a low vision.
Right, no, it's the same color as the street and so it all just blends. And so that is something that I would love to see changed, an issue.
Yeah, that's a good one. Even there was a church member at my church who stepped off of a small curb at a church that wasn't painted yellow and broke her ankle. And she doesn't have a low vision and she's very mobile. But like that was a problem. The curb was even that high. It's like two or three inches, but you land wrong. like, that's a
Yes, how about you? have to ask.
Brandy Archie
Amelia, you gotta go.
So like Noel stole mine. That's exactly what I was going to say. absolutely. And like the example that you gave Brandy about someone stepping off a curb and break their ankle, I couldn't tell you how many people I have treated who have had falls and broken their ankles as a result of stepping off a curb that they didn't see was there. Most of them did not have low vision, but maybe it was nighttime or they just like, it's not drawing your awareness to it, right? And broken ankle.
Like it is crazy common and absolutely something that we should fix. I'm trying to come up with a secondary one though, since Noel stole mine. Geez, Noel. I was absolutely stalling. I would say I'm going to keep stalling because I actually had one in my brain and then I talked to stall and I forgot. Brandy, you go and then I'll come back to
So you were stalling with that hole.
Brandy Archie
So, don't know, you probably don't know this, but I've talked about this on the show before that my dad has low vision. And so I have seen this for my whole life, like all these different issues. And I know people are going to hate this answer. I don't think restaurants should have dark lighting. Like it's really challenging when you have low vision and almost all of us have some change in our vision as we get older to see menus, see people walk through spaces because the floor is dark and the lighting is dark. Seats are dark.
And I know that creates a certain kind of ambiance, but it's a huge challenge. So that's the thing that I would change.
Yes, totally agree with that one too. Mood lighting is quite a barrier when you have reduced vision.
Mm-hmm.
That's another good one. Okay, so my backup one is going to be thresholds in general, like these little flooring changes that we have that most of the time are just there because we didn't necessarily take the time to do like good finishing work between the two different layers of flooring going from like a kitchen to a living room or bathroom or something like that. Yeah, exactly. And but those threshold changes, if you cannot see them, then
Emilia Bourland
they can be really, really hazardous and people trip over that kind of thing all the time for a variety of reasons. But especially like when you add on low vision to that, they become even more significant tripping hazards. And again, it's something if we planned in the design for it to eliminate those, it doesn't necessarily cost a whole lot more money, but it makes things so much safer and accessible for people from all walks of life.
those are good ones. So, okay, I think it'll be really great if we could start with like, what does it mean to have low vision? What is low vision? What's the definition? It feels squishy. Talk to us about that.
Totally agree.
Noel Guidry
Right, so low vision are conditions that cannot be corrected by medications, surgery, contacts, or glasses. So these conditions can potentially damage the eye, whether it be the retina, the optic nerve, the cornea, and
They may be related to macular degeneration, diabetic retinopathy, glaucoma, maybe field cuts after a stroke, perhaps there's a vascular issue to the eye. It could be congenital conditions and many other diagnoses. While the low vision condition may not be corrected with glasses surgery medication or contacts, there are treatments to manage it. And it's very important that people get regular follow up with their ophthalmologist.
because these conditions can certainly be managed. And if there is a situation in which there is damage, sometimes there are treatments to mitigate that damage and to reduce the extent of the damage. So it's very important that there is regular follow-up with ophthalmology. And I always want to ensure that anybody that I see is under the care of ophthalmology.
Let me ask another question to follow up on that before you jump in Amelia. How important do you feel like it is that somebody actually see a low vision ophthalmologist, particularly if they have access to one?
well, I think that would be wonderful. I, although, gosh, I think they are pretty few and far between. Yeah. To have a specialization of low vision. Now the ophthalmologist, my goodness, they are amazing. There's doctors of the cornea, there's doctors of the retina, there's doctors of the optic nerve. And before I jumped into this field, I had no idea. And in my training, I went and shadowed.
Brandy Archie
I between.
Noel Guidry
ophthalmologists in all different fields just to see what their diagnostic exams were, what their treatments were, what the clients went through when they met with the doctors. And it was fascinating. And so these doctors are amazing. Now, in my experience, I've worked with low vision optometry. the ophthalmologist referred to low vision optometrist. And from there, the low vision optometrist
referred to us, low vision occupational therapists. And so they also are amazing resources. I love working with low vision optometry and I actually trained under a really amazing one. And they are very aware of the optical devices that can really help somebody, whether that be high powered readers, maybe.
bioptic systems and so on and so forth. There's so many optical devices that can assist clients with low vision. And so I absolutely love working with low vision optometry. There aren't too many of them out there. So that is one of the conundrums of low vision care. There aren't many of us that really have gone into the niche deeply, right? So you do have to seek out those resources in order to gain that help.
Would you talk a little bit about the role of occupational therapy in low vision? Because like you said, there are low vision devices and obviously being under the care of a really well-qualified ophthalmologist and optometrist are incredibly important. But what do occupational therapists do that is also so important for folks with low vision?
absolutely. Now you're getting me fired up to my passion. OTs, we have such a unique, awesome role when it comes to low vision because we get to focus in on the daily life. I get to go into the details of what people need to do and what they want to do in their everyday life. So I sit down on the first day and I talk to them and I ask them what vision dependent ADLs or instrumental IADLs, excuse me.
Noel Guidry
do you need to do or what are you struggling with? And it can be very individual. Maybe it's their phone, maybe it's a computer. Some people don't have smartphones. So it's very, very individual. And then I get to go into the details of how to help return function. So a lot of times with bull vision conditions, clients want to return to reading and we help train in the use of devices that could potentially enable somebody to return to reading.
There are many devices out there and we have knowledge of those devices and we also, the specialists carry those devices on them and allow the clients to trial them. That is a differentiating factor for the specialists versus any practitioner treating clients with low vision. Okay, so we have the equipment, whether that be an array of magnifiers or electronic magnifiers, telescopes, text to speech devices.
talking devices, and so on and so forth. So we're well aware of what these devices are, and we ascertain what the person already has and see if they can use what they already have perhaps, and let them explore other devices for reading.
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Emilia Bourland
Start making home more accessible today. Now back to the show.
Gosh, that's just the tip of the iceberg though. That is a major one. But so I do a lot as it pertains to reading because I want you to step back for a minute and think about what you did today, just this morning in which you relied upon your vision to complete the task. Perhaps it was looking at your face in the mirror. Maybe it was operating your microwave. Maybe it was reading your phone. Maybe it was getting on the computer.
And I want you to imagine what it would be like if you really struggled or could not do those things and how frustrating that would be. You would have to ask people to help you, right? And there's such a sense of dependency and helplessness that can develop when you simply cannot see things in detail. And I remember in my training, a light bulb moment, and that was
the realization that people with the right tools can do amazing things. And I think the crux, the whole crux of low vision OT is to help the people get the correct tools and know how to use them in order to return to function. And I've seen so many people return to reading and if they can't or if they get tired, then we're gonna convert it to what they can listen to and they re-engage. So.
There's so much more I can go. I could probably talk a whole hour about what Lovis and OG does, but I highlighted reading for now.
Emilia Bourland
Well, because like you said, it's the job of the occupational therapist to help people with whatever they need or want to do. So it could be reading, it could be being able to take care of your baby, it could be cooking a meal in the kitchen, could be making sure that you can access your work emails, like it could be any of those things, which is of course also what makes the job so interesting too, right? Is you never know exactly what kinds of problems you're gonna be solving that day.
That's right, absolutely.
And you know the thing that I loved about the thing I love about OT is that no matter who you're working with it's always different even if they have the same diagnosis but like specifically in low vision because I spent so many years doing low vision rehab is that like their activities are different but also the way they want to solve the problem is different too. So like if you think about just like paying for something at a store I remember when I was a kid my dad would have his wallet this is back in the day
wasn't as many cards, you know, we didn't have as many, much as the technology we had now. So he had cash, he fold the cash in different ways. So he knew what was a dollar 10, 20, 50, right? And so we learned a lot about keeping the same thing, the same thing, and doing things the same way, putting things back in the same order, so that they can be found without looking with your eyes. And, and then that's one way to deal with paying for things and cash. Now, most people
would use a card. You don't even have to know how to swipe at the terminal. I remember working with people to like swipe at a terminal. Now you can tap it. You tap your phone. It just depends on what level of how you want to interact with it. Now you can just like order the stuff online if you didn't even want to engage with the store. And so the ways to solve the problem are kind of vast too, which is interesting to like provide people as many options as work for them, I guess.
Noel Guidry
Yes, absolutely. And I think that's another key point as to why we're so occupational therapists that is are so suited for low vision care because we look at the person as a whole and we have a deep understanding of the physical abilities, the cognitive abilities, the, you know, the, we look at everything, right? And we see what the person's skills are, what their strengths are, where they might be struggling. And we capitalize upon those strengths.
in order and their preferences were a client centered profession. So like you were saying, Brandy, I see that all the time. For example, I was working with a woman and her goal was to return to reading the Bible. And I said, I really think the Kindle is the way to go. And she just after 10 minutes handed it back to me. She's like, I'm not going to use this. I'm not. So I said, all right, well, let's turn to an electronic magnifier on your Bible and we're going to do it. We're going to let you try it this way.
And so then she said, I think this is the better way for me. Okay, there we go.
I really need you. I sorry I didn't mean to interrupt you. just wanted to say like I love that example is a way to highlight that there's not a one size fits all solution for everyone that it is so individualized. I'm sorry continue.
No, that's okay. I was just saying, you know, we just look at what the person wants to do. We may think that, here's the perfect solution. And someone may tell us no, and we have to generate another solution, which I think is another strength of occupational therapists. We love to problem solve, right? And we love to be creative. Yes.
Brandy Archie
Absolutely. I think like it is so interesting to think about that. No one size fits all. It's probably true all the time. I think the one thing that people are often saying is like, if my glasses can't fix it, then this is the end of the road for me. Right? Like my optometrist said that this is as strong as it could be. This is the best correction I can get and good luck. And so like you just give up on trying to do anything. Those are just things that I can't. Do you have any like...
connection with or stories of clients and maybe had some similar like didn't have access to resources. Didn't they get access to you or some other kind of resource and then that changes.
my gosh, Brandy, you just tapped on to why I'm in this field. Absolutely. Okay. So when I heard about the position in a low vision rehab clinic, I took the time to discern whether I wanted to dive fully into low vision. And I went to a support group meeting.
that was held at the Wilmer Eye Institute at Johns Hopkins. was living in Maryland at the time. And this woman was telling her story about how she had sudden vision loss and she didn't know what she was going to do. She was in nursing school and suddenly she couldn't read. She couldn't do what she needed to do in order to complete school. that led her to a very dark place.
And when she met low vision specialists, it was then that she realized she could use her vision with the proper tools and the proper strategies. And I will never forget driving home that night after that meeting through Baltimore in the dark. And I thought no one should ever feel that way. Someone should never have that lack of hope.
Noel Guidry
if there are resources available. And I thought, my gosh, I need to do this. I need to do this in my whole mission. What really fires me up is just that, spreading the word that there is more that can be done. It may not be changing the eye, but there's so much more function that can be returned in a compensatory manner that can change the quality of someone's life exponentially.
And so that's my whole mission to be very honest with you, to spread the word that there is hope, there are resources. So thank you for asking that question.
I okay, I have another question to go along with this. It's sort of a pivot, but so we've talked a little bit about like devices and like high tech solutions. There's also like low tech solutions too. I'm really curious. Well, I have a couple of questions about this, but I'll start here. I'm really curious. How often do you feel like you're using high tech solutions versus low tech solutions for people? And like, what's the difference between those things? Like how does that work?
my goodness, another great question. So there is a wealth of high tech solutions today and it is ever evolving. It's absolutely amazing. And it actually is one of the biggest challenges of my professional life is keeping up with it and knowing it and tapping people into these resources, right?
It's so plentiful. Our phones and tablets can do so much. If you know the proper apps, the proper ways to train, if you understand the visual condition of the person and what they need, you can connect them in amazing ways. And it's mainstream technology. Okay. And then of course we are now having a boom of artificial intelligence. Holy smokes. We, just worked with a woman in artificial intelligence, read her thermostat to her. was like,
Noel Guidry
This is fabulous because thermostats are a huge issue. But she was open to
Big problem, but that was that.
This is crazy. But high tech was suited for her. She was open to it. She wanted to use it. She had resources to those devices that she wanted to do it. Now, some clients don't want to use the high tech. So when I talk high tech, we're talking about the devices, maybe their phones, tablets, maybe their electronic magnifiers, their text to speech things, very specific devices for low vision.
Low tech are more of your more simple interventions. Perhaps maybe it's a liquid level indicator that sits on the edge of a cup and beeps when it fills the liquid so you don't overfill the cup. Maybe it's a large print card, playing card, you know, very simple interventions that can make a world of difference. And oftentimes those do enhance the quality of life exponentially. So
Again, we're going back to what the person needs, what they want to use, but also, you know, what they what they're interested in. Does that make sense? Sometimes it's the most simple interventions, even taxable markings on appliances, where I come back and people are like, wow, I never realized how those little dots would make me so much faster and independent.
Emilia Bourland
Absolutely.
Brandy Archie
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No.
Brandy Archie
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Yes, and sometimes they hesitate to let me put them on. like, just try it for a week and let me, let me do this for just a week. And if you don't like it, we'll pluck them off. But usually they're like, my gosh, I love this because it makes their life easier. Right. So I think it's a very good combination to be honest with you between the low tech and the high tech. And I bounced between the two continually.
And maybe even, and correct me if I'm wrong, people who are open to some of the high tech solutions also are using low tech solutions.
absolutely. Yes, absolutely.
Because of course, like the high tech solutions and the high tech solutions are really wonderful. And I don't not a certified low vision therapist and I never have been. I know just enough to help someone a little bit and then direct them towards the correct resource. Like that's often my role if I'm if I'm seeing someone who presents with a low vision issue. But the high tech stuff is so wonderful because, you said, it's universally accessible for people, know, smartphones, tablets. These things are making huge differences.
Emilia Bourland
But you can't always apply that to everything. Like you can't apply that high tech solution to making your cup of coffee or a cup of tea or, you know, cooking your breakfast. So having that like integration between the high and low tech has got to be really important for people.
Yes, absolutely. It is definitely a combination. And sometimes it is the most simple things that work the absolute best. And I do find in my job too, and this is another highlight for occupational therapists, is that we really know how to analyze the task. we really, in low vision, I try to make things just as simple as possible. And when we're learning this, and it's challenging when it comes to these high tech devices, because
there's many steps involved sometimes and sometimes people aren't as familiar with the technology because simply they didn't grow up with it, right?
So my question for you would be, so we have maybe clinicians and OTs listening, as well as family caregivers. And kind of how Amelia just mentioned that like you recognize low vision symptoms and that you can create some level of help for them, but then you might like refer to a CLVT for something strong. What are some of those things that like a general OT or practitioner or a family caregiver, and those might be different things, could do like right away maybe, or be aware of or learn about right away that could help a person?
in that middle time before they are able to access more specialized services.
Noel Guidry
That's a great question. So I think the marking of the appliances, I do often go in and see appliances marked with simple things that you can get from the dollar store. That could certainly be done. Maybe any technique to make the environment more visible.
is always welcome. You can look up large print things on Amazon. I can't tell you how many people love the jumbo print, the bicycle jumbo print playing cards. Oh my goodness, I can see it and not only see it here, but across the table, which is very cool. Maybe it's large print bingo cards, right? I've even been into facilities and I've stopped off at the front desk and I'm like, do you have large print bingo cards? I think it would really help some people and they might.
engage in bingo if you had them and they're like, yeah, let's think about that. Let's do it. You know, so just simple things. If you think about larger print, okay, bolder contrast, you want to think about contrast. So if you're trying to see something, you want to think about the background that that item is on. So for example, this is the classic example, plating, food plating, okay.
If you're eating chicken and mashed potatoes on a white plate, it's going to be much harder to see than chicken and mashed potatoes on a black or navy blue plate. I guarantee it. I show it to people. I wad up a little napkin. I put it on a white background and I say, can you see this very well? And then I put it on a black background. I flip my board and they're like, whoa, I see it. Something as simple as that goes a long way.
And also paying attention to lighting. Now, lighting can be a little bit tricky and that does lead into where the specialists are very helpful because low vision conditions either can crave light or they can be very aversive to light and glare. And so low vision specialists really dive more deeply into the of light, the intensity of the light and the placement of the light. So that's another perhaps differentiating factor when you pull in.
Noel Guidry
low vision specialists. does that answer your question? Think about daily life and how to make things more visible.
And the other thing I just might throw in there too is like on your devices that you already have like you were mentioning, go in and play with the accessibility setting. Like I know there's apps and stuff that can be downloaded and I think that's what's great for our specialists to like know, keep up with all the things and get the right thing on. But if you've got a phone already and texting is hard or using the computer and that's hard, use your accessibility setting and help a patient set that up, help your person change and it's really just about.
trying it like is this better or this better? Okay, we're gonna keep that setting.
Right. And I do, when I talk to the students, I also encourage them to look at, you know, what size print, what do clients need? What, when you're working with somebody, see what size print they need and try to tell the team, hey, this client needs at least this size font. And I tend to go a little bit bigger, you know, now certain, it does depend on a person's contrast sensitivity, whether they will be able to read it in their scotoma patterns, meaning their blind spot patterns.
But if we can at least start with seeing, what size font does somebody need? That goes a long way. And when it comes to devices, I know that I was a little nervous, so to speak, to tap into settings before I started this job. Now I'm, you know, all in the vision settings and adjusting it and whatnot, but it's really not that hard. I think a lot of our clients feel a little bit nervous about going into those settings and trying to make
Noel Guidry
you know, can they get it back the way it was if something changes? And they can have had many clients have their caregivers and family members adjust those settings. So sometimes it's just going in and looking at the size of the font, which is often found under the accessibility or display, okay? Maybe looking at whether the person responds better to the light background or the dark background.
Sometimes people love that dark background. provides a nice pop of contrast for the eyes. And then of course there's also settings for contrast in the phones. So those, absolutely, at least start with those. And then also reduce any visual clutter in the background. I mentioned contrasting colors, right? But if for backgrounds, you wanna make them plain and simple so that what's in the forefront pops to the eye. So sometimes,
Well, all the time, if a person will allow me, will change the wallpaper to something that's very plain and simple so that then the apps and whatnot will pop to the app.
So I think this has been like an incredible episode full of like really good tips for stuff. I have a couple of questions for you though. First is where can people find out more about you and your services? And then for people who might not be in your area or might not be able to access you, what kind of tips or advice do you have for people to find certified low vision therapists, maybe where they are?
That's a great question. So I'll start. know that you all are in a different state, so I'll start on a more global level. I think the first place to ask is your ophthalmologist because the ophthalmologists often have a preferred way of referring to local low vision resources. Okay. I would start there. Now I could, you could also look at your community resources, whether it be support groups, the foundation fighting blindness.
Noel Guidry
and the NFB also have local chapters and they could tap you into resources. Additionally, the state provides services for people with low vision and blindness. So you could start with completing an application for state services. Now, oftentimes not across the board, but sometimes it's not with occupational therapy, but it's low vision and services for people with visual impairment, which is amazing. And I...
encourage people, look into all of these resources. There's even groups, national groups that have support groups like AMD, where you could tap in and meet with support groups online or call in. so really, I know sometimes looking things up online is difficult, but if a caregiver or a family member could assist with that, if needed to find those resources, it could go a long way. Now I would also look for any low vision optometrists in the area.
The American Occupational Therapy Association, of course, does have a list of specialty certified low vision therapists in each state. You could Google that. And I have done that when I'm referring clients out of state. The ACVREP, it's hard to determine who might be an occupational therapist at this point by looking at a list of CLBT's, right? But you could look at their list of resources online for professionals in the area.
And so when someone approaches me, that is exactly what I do. I tell them, well, go discuss it with your ophthalmologist. Tell them that you heard about what I'm doing and you are interested in low vision occupational therapy. And so that often is the first step and we take it from there.
And is there, do you have a website that you want to share with folks to kind of learn more about your services?
Noel Guidry
Yes. And I will, I will get to my services, but also look for low vision specialists in your area. And very often it may be low vision optometry as well. Does that make sense? So look for that. Okay. Because these professionals, like I was saying earlier, we'll have the devices and knowledge of what is out there on a wider basis and have access for trial. Now,
In terms of me, yes. My website is insight. O T Jax. That's I N S I G H T O T J A X dot com. And my information, my contact information is on that website and anybody is welcome to call my business and call me and speak to me. I'm happy to give that number. It is 904 616
I'm always happy to share what low vision rehab can do for clients and help them connect to those resources.
That is awesome. Thank you so much. will make sure to link that in the show notes as well. So that if you were listening to that website from Noel, you should be able to scroll down to the show notes, whether you're watching this on YouTube or you're listening to it, wherever you get your podcasts and you can get that link right there as well. Noel, thank you so much for being on this episode of Care Lab. We so appreciate having you on. It's been amazing.
Listener, if you made it to the end of this episode, then please take a moment. If you enjoyed it, go back, download some of our other episodes, leave a comment, subscribe, and share this with other folks who might benefit from it. Until next time, we'll see you right back here on Care Lab. Bye.
Brandy Archie
Bye everybody!
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