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Trauma and Injury Prevention Section Newsletter - March 2011

circle_arrowChair’s Corner - Trauma & Injury Prevention Section Newsletter, March 2011
circle_arrowGlobal Injury Prevention - Trauma & Injury Prevention Section Newsletter, March 2011
circle_arrowSociety for the Advancement of Violence and Injury Prevention: Annual Meeting Update - Trauma & Injury Prevention Section Newsletter, March 2011
circle_arrowInjury Prevention Center Update - Trauma & Injury Prevention Section Newsletter, March 2011
circle_arrowTrauma - Trauma & Injury Prevention Section Newsletter - March 2011
circle_arrowCDC Funds New Project Examining Graduated Driver Licensing - Trauma & Injury Prevention Section Newsletter, March 2011
circle_arrowEmergency Medicine Action Fund Announced - Trauma & Injury Prevention Section Newsletter, March 2011
circle_arrowNewsletter Contributions - Trauma & Injury Prevention Section Newsletter, March 2011

Chair’s Corner - Trauma & Injury Prevention Section Newsletter, March 2011

Brendan G. Carr, MD, MS 

BrendanCarrIt is my pleasure on behalf of the Trauma & Injury Prevention Section of ACEP to thank all members for their ongoing energy and involvement, and to welcome new members to the section.  The section met at Scientific Assembly in September and was fortunate to hear a presentation on workforce violence by Terry Kowalenko, MD from the University of Michigan.  In addition, the group discussed the history and overlap of ACEP committees and sections dedicated to injury, trauma, EMS, and public health.  There was specific discussion of the desire to improve collaborations and broaden the section membership to include members with an interest in this broad subject matter.   

This newsletter features pieces that speak to the broad nature of work in the realm of trauma and injury prevention.  General updates on the multidisciplinary efforts of the CDC funded Injury Research Center at the Medical College of Wisconsin are complemented by specific CDC funded projects including West Virginia University’s work to examine the overall safety effects of graduated drivers licenses, and the University of Pennsylvania’s work developing trauma systems.  In addition to CDC funded work, the Injury Prevention Center at Rhode Island Hospital highlights a new National Institute on Alcohol Abuse and Alcoholism funded study examining the effectiveness of a series of brief telephone interventions to injured emergency department patients. 

Finally, we detail the upcoming conference cosponsored by the Society for Advancement of Violence and Injury Research (SAVIR), the Safe States Alliance, and the Centers for Disease Control and Prevention.  The semi-annual injury conference will be hosted this year by the University of Iowa and held at the Coralville Marriott Hotel and Conference Center, Iowa City, April 6-8, 2011.  We hope to see many of you there as we continue to build a collaborative enterprise bridging EMS, trauma care, public health, and injury prevention to create a safer future.

Please consider submitting an article for the next newsletter in the summer of this year.

 


Global Injury Prevention - Trauma & Injury Prevention Section Newsletter, March 2011

The Ghana Emergency Medicine Collaborative: A novel training program to improve the treatment of injury and emergency medical patients in developing countries 

Patrick M. Carter MD, Rockefeller A. Oteng MD, Sarah Rominski MPH and Rebecca Cunningham MD 

The University of Michigan (UM) Department of Emergency Medicine (EM) and Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana were recently awarded a grant from the National Institutes of Health (NIH) Fogarty International Center as part of the Medical Education Partnership Initiative, a program supporting the development of new models of medical education to meet a congressional goal of producing 140,000 new healthcare workers in sub-Saharan Africa. This pilot grant is focused on the development of novel training programs for physicians, nurses and medical students in EM in Kumasi, Ghana.

The NIH support will expand a development project that originated at the request of leaders within the Ghana College of Physicians and Surgeons (GCPS) in 2008 after a recognized need for improved injury care. Injury represents a significant and growing problem, accounting for 5.8 million deaths every year worldwide and 32% more deaths every year than HIV, Malaria and TB combined1. Injury disproportionately affects developing countries such as Ghana that have limited resources to address prevention and treatment2. Several high profile events, including the Accra Soccer Stadium collapse that lead to 127 deaths as a result of inadequate EMS and emergency care, highlighted the need and led to the Ghana EM Collaborative, a partnership between the GCPS, Ministry of Health, KNUST, Komfo Anokye Teaching Hospital (KATH) and UM. The mission of the collaborative is to improve emergency care by developing an in-country training program that will retain healthcare workers within Ghana and combat the “brain drain” phenomenon associated with developing health systems.

The Ghana EM Collaborative initially focused on developing the EM residency and hospital infrastructure at KATH in Kumasi, Ghana.  Collaborative leaders met in July 2009 with the GCPS and received accreditation for a 3-year residency program. The first class of seven residents began training in October 2009 and the second class recently began training in September 2010.  UM EM faculty have been present at KATH to provide didactic lectures, and clinical bedside staffing since the residency initiation. Clinical Simulation utilizing low-tech simulation tools developed in conjunction with UM Clinical Simulation Center has been used to develop procedural skills. As part of the training program, residency trainees are also receiving education in operations, leadership and research to ensure that they are competent to become clinical and research leaders of EM within Ghana. UM EM faculty have also engaged hospital stakeholders to introduce improved clinical operations in the newly constructed Accident and Emergency Center to provide the necessary clinical environment for residency and nurse training. Since February 2009, the department has been restructured to improve patient flow and available resources. Nurse-driven triage, utilizing the previously validated South African Triage Scale, was introduced in July 2009 to improve identification of critically ill patients requiring immediate treatment.

This NIH support has solidified ongoing support of the residency-training program and allowed for the broader development of EM nurse and medical student training. A one-year EM Nursing certificate program is currently being developed for accreditation by KNUST and the Nurses and Midwife Council and is set to begin training nurses in October 2011. A medical student rotation has been approved by the KNUST Department of Surgery, which will expose all 4th year medical students to the practice of EM beginning in September 2011.  Trainees at all levels will participate in a team-training curriculum to improve critical EM resuscitation and communication skills. All curricular materials are being developed in open resource format creating a portable, non-copyrighted library of EM material that has the potential to be used to develop EM in other areas in Sub-Saharan Africa. 

This combination of open resource lectures, low-tech clinical simulation and team training at all levels to teach the EM curriculum, EM research skills and leadership/operational training will help to develop the human resource infrastructure necessary to sustain long-term Ghanaian EM development. This will provide a roadmap for future EM development within West African and sub-Saharan Africa that can improve the treatment of injury and acute medical illness. 

References:

  1. Global Burden of Disease, WHO, 2004
  2. World Report on Road Traffic Injury Prevention 2004

University of Maryland Fogarty International Grant: Cairo, Egypt 

Through a Fogarty International Grant (sponsored by NIH), the University of Maryland's National Study Center for Trauma and EMS has spent the last 6 years working with doctors in Cairo, Egypt to improve both their injury prevention research and their clinical skill sets.

The recent crisis in Egypt highlighted the importance of this important collaboration.  Physicians trained by Dr. Jon Mark Hirshon and his team played an important role in treating the injured during the protests leading to Hosni Mubarak’s resignation.  For further descriptions, please see:

http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/24680

 http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/246 

http://www.fic.nih.gov


Society for the Advancement of Violence and Injury Prevention: Annual Meeting Update - Trauma & Injury Prevention Section Newsletter, March 2011

SAVIR Injury and Violence Prevention Conference 

Michael J. Mello, MD, MPH  - Injury Prevention Center at Rhode Island Hospital

The Society for Advancement of Violence and Injury Research (SAVIR) has joined forces with Safe States Alliance, and the Centers for Disease Control and Prevention (CDC) to host a dynamic and collaborative conference this spring. It will be hosted by the University of Iowa and held at the Coralville Marriott Hotel and Conference Center, Iowa City, April 6-8, 2011.

The theme of this year’s meeting is "Progress through Partnerships." Through the development of strong and rewarding partnerships, the fields of practice and research can mutually inform one another to create injury and violence prevention programs that are evidence-informed and effective. 

There are several outstanding featured speakers during the two day conference including Linda Degutis, Jeffrey Levi, and Matt Richtel. Linda Degutis, DrPH, MSN, is the Director of the National Center for Injury Prevention and Control. Dr. Degutis most recently was Research Director for the Department of Emergency Medicine at Yale School of Medicine, Director of the Yale Center for Public Health Preparedness at the Yale School of Public Health, and a former Robert Wood Johnson Health Policy Fellow. Jeffrey Levi, PhD, is Executive Director of Trust for America's Health, where he leads the organization's advocacy for a modernized public health system. He has appeared as an expert commentator on CNN, ABC, NBC, CBS and Bloomberg TV. Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.  Matthew D. Richtel has been a reporter for The New York Times since in January 2000 as a technology reporter in the San Francisco bureau.  In 2010, he won the Pulitzer Prize for National Reporting for "Driven to Distraction," a series of articles on the troubling collision of 20th and 21st century technologies—driving and multitasking. The series generated the biggest impact of anything The Times published in 2009. By the end of the year, state legislators had proposed more than 200 bills variously barring drivers from texting or phoning or requiring hands-free headsets. The term "distracted driving" became so familiar that Webster's New World chose it as its 2009 "Word of the Year."

Meeting registration is now open.  For additional information please go to the conference link at https://m360.safestates.org/event.aspx?eventID=20417


Injury Prevention Center Update - Trauma & Injury Prevention Section Newsletter, March 2011

IPC Awarded NIH Grant for ReDIAL Study 

Michael J. Mello, MD, MPH
Injury Prevention Center at Rhode Island Hospital 

The Injury Prevention Center at Rhode Island Hospital was awarded a five year grant totaling $3,291,074 through the National Institute on Alcohol Abuse and Alcoholism to examine the effectiveness of conducting a series of brief telephone interventions to injured emergency department (ED) patients.  ReDIAL conceptually replicates, strengthens and seeks to understand the findings of DIAL, our completed CDC-funded randomized controlled trial. In DIAL we found that a telephone brief intervention for alcohol use was effective in reducing impaired driving and decreasing the frequency of alcohol-related injuries among injured ED patients with risky alcohol use. ReDIAL will examine the effects of a more intensive telephone BI for alcohol use (added booster session) on alcohol related outcomes. As part of the research we will estimate the cost effectiveness of screening in the ED and then delivering these interventions by phone and examine the mechanisms underlying behavioral changes.

The project began recruitment in the ED in July 2010 of injured ED patients who can communicate in English or Spanish and who screen positive for risky alcohol use. Eligible patients will be consented in the ED, complete assessment questionnaires in the ED then randomized into group receiving a telephone brief intervention on alcohol use or another control comparison intervention.  All participants will receive an appointment for an initial contact call within 1 week when the research participant will receive their assigned intervention. Both interventions will be provided over three telephone sessions: the initial call and two booster calls at 2 weeks and 6 weeks after the initial call. Participants are assessed for changes in alcohol use or alcohol-related negative consequences at 4, 8, and 12 months.

For more information about this project, please contact Michael Mello, MD, MPH
 

Update from the Medical College of Wisconsin Research Center 

The Injury Research Center (IRC) at the Medical College of Wisconsin is located within a medical school whose faculty direct pediatric and adult Level 1 Trauma Center Programs. The IRC’s location and its multidisciplinary faculty have contributed to outstanding research, education, and clinical accomplishments in the acute care of injuries. This strength in acute care provides unique opportunities to inform and influence the other phases of injury control: prevention and rehabilitation. Some examples of the IRC’s activities are highlighted below:

  • In 2008, Karen Brasel, MD, MPH from the Department of Surgery/Trauma Critical Care was funded to create the first questionnaire to specifically ask about quality of life after trauma and injury. The significance of this work is that with the ability to easily measure quality of life, treatments aimed specifically at improving quality of life after injury will become possible. Injured Wisconsin residents being treated at Froedtert Hospital are identified and treated for post-traumatic stress disorder as a direct result of findings from this questionnaire. Eventually the questionnaire will be made available to hospitals across Wisconsin and the rest of the country.
  • In 2008, Brian Stemper, PhD from the Department of Neurosurgery was funded to test the ability of existing automobile seats to protect occupants in rear impact crashes against whiplash injuries. The findings will influence the development of new seat designs by automotive safety engineers and governmental safety regulations for automotive seats.
  • In 2009, Brooke Lerner, PhD from the Department of Emergency Medicine was funded to study whether injured pediatric patients are being transported by emergency medical service (EMS) providers to the most appropriate hospitals based on the severity of their injuries. The results of this study will assist EMS providers in identifying severely injured pediatric patients being sent to hospitals with adequate services to care for them and, for those with more minor injuries, that they are not going to hospitals with large scale resources, thus diverting those resources from more acutely injured patients. This study will help inform the current Field Triage Guidelines for transporting injured patients established by the American College of Surgeons. These Criteria are used by EMS providers across the country.
  • In 2007, Peter Layde, MD, MSc from the Department of Emergency Medicine was funded to lead a five-year randomized community trail to assess the organizational and community capacity needed by local public health departments and aging units to translate community-based fall prevention research into broad community practice.  The results of this study provide insight into the processes communities undertake to develop local fall prevention coalitions, utilize fall injury data for program planning and evaluation, and establish and sustain fall prevention programs.
     

 

     


Trauma - Trauma & Injury Prevention Section Newsletter - March 2011

University of Pennsylvania work on CDC Trauma System Planning grant 

BG Carr & CC Branas 

The trauma systems research team at the University of Pennsylvania was awarded a research grant by the Centers for Disease Control & Prevention (R01 CE001615) to examine the mismatch between population access to trauma care and injury death in the United States.  This work is an extension of ongoing work done at Penn in conjunction with the American Trauma Society (www.amtrauma.org) to create visual representations (access maps) that use the Trauma Information Exchange Program’s national inventory of trauma centers, prehospital time estimates, and census data to demonstrate population access to trauma care (Figure). ATSmap  

The grant proposes to create and evaluate the use of an interactive web page to answer research questions and to inform policy planning for trauma care.  The investigators use prehospital care time estimates and geographic information science to calculate and visually demonstrate the population able to rapidly access trauma care (within 60 minutes) by ground or air ambulance (shaded areas in Figure).  This assessment of the “supply-side” of trauma care uses small units of analysis (block groups), and is thus scalable, allowing policy makers and planners to examine geographic regions of local interest.  In addition to describing the overall population with prompt access to trauma care, the new application will also allow  for sub-group analysis of the “demand-side” of trauma care including the examination of county level injury death rates, and populations of interest including children and the elderly.  Ultimately the application will allow for a quantitative and visual examination of the mismatch between the “supply” (rapid access) and the “demand” (injury death) for trauma care. 

This work is part of a broader compliment of work being done by our investigative team to develop population planning tools for critical illnesses requiring time-sensitive intervention.  In unplanned illness such as trauma, the entire population is at risk for the disease and planning must take place not from the traditional perspective of the hospital, but rather from a broader population based perspective.  With the correct tools, systems of care that bridge hospitals and health systems to develop a web of care across the US can be developed to improve outcomes for unplanned illness.

 


CDC Funds New Project Examining Graduated Driver Licensing - Trauma & Injury Prevention Section Newsletter, March 2011

Jeff Coben, MD
Department of Emergency Medicine & Injury Control Research Center
West Virginia University
 

Graduated driver licensing (GDL) laws reduce the incidence of crashes among young drivers, but it is unclear whether they actually produce safer drivers or how they affect the rate of crashes among older drivers.  A new study funded by the CDC’s National Center for Injury Prevention and Control seeks to clarify GDL’s overall safety effects.  The two-year R21 grant, which started in September 2010, was awarded to Motao Zhu, M.D.,M.S., Ph.D., (principal investigator) and Jeff Coben, MD (co-investigator) at the West Virginia University Injury Control Research Center.

Under GDL laws, which are in place nationwide, teenage drivers must pass two stages before being permitted to drive without restrictions. The first stage is the learner’s permit, or level 1 license, which permits 15- to 16-year-olds to drive only under adult supervision; this stage usually lasts for six to 12 months. Next, 16- to 17-year-old drivers can apply for a level 2 license, which permits them to drive alone during certain hours only (with possible exceptions for employment and school), and limits the number of passengers permitted. After a level 2 driver has been driving for at least one year without any traffic violations, a level 3, unrestricted permit is issued.

The newly funded project uses three national sources of data (e.g., National Household Travel Survey, Fatality Analysis Reporting System, and Police Incident Reports) to examine the impact of GDL laws on driving behaviors, alternative transportation choices, crash rate per mile driven and non-driver injuries per

person-year among teenagers aged 15-17 years, and crash rate per mile driven among 18 year olds. The specific aims of the study include: 1) Identify changes in driving behaviors and crash rate per mile driven among 15-17 year olds due to GDL implementation; 2) Identify how GDL affects the use of alternative means of transportation (public transport, walking, bicycling, being driven by others) by teenagers aged 15-17 years and how GDL affects deaths and injuries among 15-17 year olds who are vehicle passengers,  

pedestrians, and bicyclists; 3) Assess changes in driving behaviors and crash rate per mile driven among 18 year olds due to GDL implementation.

This comprehensive evaluation of GDL at the national level is expected to provide strong scientific evidence needed to assess whether GDL does, in fact, produce safer drivers, and the extent to which GDL affects transport choices. The study has the potential to advance the field by being the first to estimate the impact of graduated driver’s licenses on traffic crash rate per mile driven.  Given that GDL influences nearly all adolescents and their families nationwide, the information is important so that decisions can be made as to whether GDL should be continued in its current form or substantially modified for safer driving as opposed to limiting driving.

For more information, please contact Dr. Coben 

The Injury Research Center (IRC) at the Medical College of Wisconsin is located within a medical school whose faculty direct pediatric and adult Level 1 Trauma Center Programs. The IRC’s location and its multidisciplinary faculty have contributed to outstanding research, education, and clinical accomplishments in the acute care of injuries. This strength in acute care provides unique opportunities to inform and influence the other phases of injury control: prevention and rehabilitation. Some examples of the IRC’s activities are highlighted below:

  • In 2008, Karen Brasel, MD, MPH from the Department of Surgery/Trauma Critical Care was funded to create the first questionnaire to specifically ask about quality of life after trauma and injury. The significance of this work is that with the ability to easily measure quality of life, treatments aimed specifically at improving quality of life after injury will become possible. Injured Wisconsin residents being treated at Froedtert Hospital are identified and treated for post-traumatic stress disorder as a direct result of findings from this questionnaire. Eventually the questionnaire will be made available to hospitals across Wisconsin and the rest of the country.
  • In 2008, Brian Stemper, PhD from the Department of Neurosurgery was funded to test the ability of existing automobile seats to protect occupants in rear impact crashes against whiplash injuries. The findings will influence the development of new seat designs by automotive safety engineers and governmental safety regulations for automotive seats.
  • In 2009, Brooke Lerner, PhD from the Department of Emergency Medicine was funded to study whether injured pediatric patients are being transported by emergency medical service (EMS) providers to the most appropriate hospitals based on the severity of their injuries. The results of this study will assist EMS providers in identifying severely injured pediatric patients being sent to hospitals with adequate services to care for them and, for those with more minor injuries, that they are not going to hospitals with large scale resources, thus diverting those resources from more acutely injured patients. This study will help inform the current Field Triage Guidelines for transporting injured patients established by the American College of Surgeons. These Criteria are used by EMS providers across the country.
  • In 2007, Peter Layde, MD, MSc from the Department of Emergency Medicine was funded to lead a five-year randomized community trail to assess the organizational and community capacity needed by local public health departments and aging units to translate community-based fall prevention research into broad community practice.  The results of this study provide insight into the processes communities undertake to develop local fall prevention coalitions, utilize fall injury data for program planning and evaluation, and establish and sustain fall prevention programs.


Emergency Medicine Action Fund Announced - Trauma & Injury Prevention Section Newsletter, March 2011

ACEP's new grassroots effort aims to influence health care reform’s regulatory implementation. 

With changes in the health care system already underway, a new initiative is looking to positively impact the regulations that will be written and implemented under this sweeping reform. 

The Emergency Medicine Action Fund, launched by ACEP in February, will pool contributions from individual emergency physicians and groups, ACEP Sections of Membership, and anyone else interested in advancing emergency care to provide financial support for advocacy activities in the regulatory arena.     

“This is probably the most important, defining moment for emergency medicine in our lifetime,” said ACEP President Dr. Sandra Schneider. “The decisions that are made now will set the course for us for years to come and we must positively influence the regulatory agenda. This Action Fund will help us do that and create a practice environment we can thrive in.”    

The Emergency Medicine Action Fund will pursue a regulatory agenda that supports emergency physicians and quality emergency care.  For example, evolving practice models and demonstration projects, such as accountable care organizations and bundled payments, are two areas of the Patient Protection and Affordable Care Act where the Action Fund might be able to wield some influence.    

“We need to be out there with the rule writers, working to ensure that emergency medicine’s perspective is valued,” said Dr. Angela Gardner, ACEP Past President who first proposed a national grassroots initiative focused on federal regulatory affairs. “It is critical that we be involved in these decisions regarding the formation of the future of health care delivery. This is our opportunity to be part of it.”    

The following organizations have been invited to designate representatives to the initial Board of Governors – American Academy of Emergency Medicine (AAEM), Association of Academic Chairs of Emergency Medicine (AACEM), American College of Osteopathic Emergency Physicians (ACOEP), Emergency Department Practice Management Association (EDPMA), Emergency Medicine Residents’ Association (EMRA), and Society for Academic Emergency Medicine (SAEM).    

One of the unique features of the Emergency Medicine Action Fund is that multiple Sections can band together to form coalitions that would be eligible to have a seat on the Board of Governors.  Or Sections can organize their individual members for collective representation. The first 10 groups of contributors at $100,000 will be granted seats on the Action Fund’s Board of Governors.     

“We are encouraging Sections, chapters and small to mid-sized groups to combine their resources,” Dr. Schneider said. “This is intended to be an inclusive effort, and everyone’s contributions are needed.”    

The Emergency Medicine Action Fund is modeled on a successful initiative sponsored by CAL/ACEP, CAL/AAEM, EDPMA, and rural emergency physicians in California that has raised several million dollars for  state advocacy since 2004.     

Wes Fields, chair of the California Emergency Medicine Advocacy Fund, said their program doubled the size of the CAL/ACEP advocacy staff, increased the number of lobbyists and consultants, and engaged in legal activities related to physician payment practices.  He has been appointed by Dr. Schneider as the founding chair of the new national Action Fund.     

“I view this as the best form of free speech on behalf of emergency physicians and our patients,” Dr. Fields said. “It is not partisan. It is not political.     

“The rule writers and the policy makers will hear emergency medicine speaking with one voice, with one set of goals, one approach,” he added. “We need wide and deep support, even from those who are not members of the College.”    

CEP America, the nation’s largest emergency medical partnership, will be the inaugural donor to the Emergency Medicine Action Fund, pledging  $100,000.    

Activities planned by the Emergency Medicine Action Fund are intended to enable participants to make contributions that would be tax-deductible business expenses (tax deductibility can be determined only by participants’ tax advisors).   

NEMPAC, the National Emergency Medicine Political Action Committee of the ACEP, gives contributions to candidates who have listened to the needs of emergency medicine and made a positive change. However, NEMPAC may be used only to support candidates.    

The Action Fund can enhance regulatory advocacy with policy makers to ensure emergency physicians receive fair payment for their services. It can also fund numerous meetings with regulators to help guarantee that patients receive the best care, and provide funding for studies to demonstrate the value of emergency medicine.    

“With the new Congressional session upon us, it is as important as ever to be active on both the legislative and regulatory fronts,” Dr. Schneider said. “We will depend on all of these funds to make our case. This will be the year we ask everyone to dig a little deeper. In these challenging times, we need contributions to both the Action Fund and NEMPAC.”    

Find out more about the Emergency Medicine Action Fund at www.acep.org/EMActionFund.  

 

 How is the Emergency Medicine Action Fund Different from NEMPAC? 

Both are valuable tools that need our continued support, but the Emergency Medicine Action Fund serves a different purpose than NEMPAC.   

   

NEMPAC 

EM Action Fund 

Gives campaign contributions to Congressional candidates 

YES 

   

Funds meetings with regulators and policy makers   

   

YES 

Enhances emergency medicine advocacy efforts 

YES 

YES 

 


Newsletter Contributions - Trauma & Injury Prevention Section Newsletter, March 2011

Megan L. Ranney, MD
Rhode Island Hospital
Section Newsletter Editor

Do you have an idea for an upcoming newsletter? E-mail me your articles, news items, or questions for future newsletters!


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