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McDermott ER, Tennent DJ, Patzkowski JC. On-field Emergencies and Emergency Action Plans. Sports Med Arthrosc Rev 2021; 29:e51-e56. [PMID: 34730115 DOI: 10.1097/jsa.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sideline coverage can be an enjoyable experience and provide the opportunity to witness and evaluate an athlete's pathology at the time of injury. While the majority of on-field injury will likely be of low acuity, it is essential to develop an Emergency Action Plan (EAP) to deliver excellent medical care efficiently. The EAP should provide a written, standardized multidisciplinary approach involving key personnel. The EAP should be rehearsed on at least an annual basis and should highlight the initial assessment of the patient while also accounting for the various types of trauma that may occur on the field and appropriate field extrication procedures. As most players who have a true on-field emergency will not return to same-day play, a thorough understanding of how to deliver emergency care and transfer the player to a higher level of care is essential.
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Affiliation(s)
- Emily R McDermott
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - David J Tennent
- Orthopaedic Surgery Service, Evans Army Community Hospital, Fort Carson, CO
| | - Jeanne C Patzkowski
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX
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Vancini RL, Nikolaidis PT, Lira CABD, Vancini-Campanharo CR, Viana RB, Dos Santos Andrade M, Rosemann T, Knechtle B. Prevention of Sudden Death Related to Sport: The Science of Basic Life Support-from Theory to Practice. J Clin Med 2019; 8:jcm8040556. [PMID: 31022955 PMCID: PMC6517904 DOI: 10.3390/jcm8040556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 12/24/2022] Open
Abstract
The sudden cardiac arrest (CA) and death of athletes are dramatic and emotionally impacting events for health professionals, family, and society. Although the practice of sport participation improves general health, physical fitness, and quality of life, intense physical exercise can be a trigger for CA and sudden death occasionally in the presence of known or unknown cardiac disorders (mainly hypertrophic cardiomyopathy) and risk factors (environment, health style, family, and genetic). The present review found that sudden death associated with CA was not such a common event in competitive athletes, but it might be an underestimated event in recreational athletes. Thus, considering the exponential increase in sport participation, both in a recreational or competitive way, and the rate of sudden CA, knowledge of implementing prevention and treatment strategies is crucial. This includes preparation of health professionals and lay people in basic life support (BLS); screening and pre-participation assessment in sport programs and health education; and promotion for the recognition of CA and early completion of BLS and rapid access to automatic external defibrillator to improve the victim survival/prognosis. Thus, the purpose of this review is to provide for health professionals and lay people the most updated information, based on current guidelines, of how to proceed in an emergency situation associated with sudden CA of young adult athletes.
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Affiliation(s)
- Rodrigo Luiz Vancini
- Center for Physical Education and Sports, Federal University of Espírito Santo, Vitória 29075810, Brazil.
| | | | - Claudio Andre Barbosa de Lira
- Department of Physical Education, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia 74690-900, Brazil.
| | | | - Ricardo Borges Viana
- Department of Physical Education, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia 74690-900, Brazil.
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland.
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland.
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland.
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Attempts to prevent "tongue swallowing" may well be the main obstacle for successful bystander resuscitation of athletes with cardiac arrest. Heart Rhythm 2017; 14:1729-1734. [PMID: 28939206 DOI: 10.1016/j.hrthm.2017.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Indexed: 11/22/2022]
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Gradidge PJL, Constantinou D. A comparative study on the cardiac morphology and vertical jump height of adolescent black South African male and female amateur competitive footballers. Cardiovasc J Afr 2017; 29:32-35. [PMID: 28817153 PMCID: PMC6002788 DOI: 10.5830/cvja-2017-032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/13/2017] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this comparative study was to determine the gender differences in cardiac morphology and performance in adolescent black South African footballers. METHODS Anthropometry, electrocardiography and echocardiography data were measured in 167 (85 males and 82 females) adolescent black South African footballers (mean age: 14.8 ± 1.3 years). Vertical jump height was used as a performance measure of explosive lower-limb power. RESULTS The males had less body fat compared with the females (12.1 ± 3.6 vs 16.8 ± 4.1%, p < 0.05), while females had higher left ventricular end-diastolic diameters compared with males (48.7 ± 3.7 vs 40.7 ± 8.1, p < 0.05). Vertical jump height was higher in males (37.2 ± 10.3) compared with females (31.2 ± 8) and was inversely associated with body fat (β = -0.2, p < 0.05) and positively associated with lean mass (β = 0.5, p < 0.05). CONCLUSION The findings showed that adolescent black South African male footballers had a performance advantage over females for explosive lower-limb power, which was explained by differences in body composition and not cardiac morphology.
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Affiliation(s)
- Philippe Jean-Luc Gradidge
- Centre for Exercise Science and Sports Medicine (CESSM), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Demitri Constantinou
- Centre for Exercise Science and Sports Medicine (CESSM), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kramer EB, Dvorak J, Schmied C, Meyer T. F-MARC: promoting the prevention and management of sudden cardiac arrest in football. Br J Sports Med 2016; 49:597-8. [PMID: 25878076 PMCID: PMC4413678 DOI: 10.1136/bjsports-2015-094764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sudden cardiac death is the most common cause of unnatural death in football. To prevent and urgently manage sudden cardiac arrest on the football field-of-play, F-MARC (FIFA Medical and Research Centre) has been fully committed to a programme of research, education, standardisation and practical implementation. This strategy has detected football players at medical risk during mandatory precompetition medical assessments. Additionally, FIFA has (1) sponsored internationally accepted guidelines for the interpretation of an athlete's ECG, (2) developed field-of-play-specific protocols for the recognition, response, resuscitation and removal of a football player having sudden cardiac arrest and (3) introduced and distributed the FIFA medical emergency bag which has already resulted in the successful resuscitation of a football player who had a sudden cardiac arrest on the field-of-play. Recently FIFA, in association with the Institute of Sports and Preventive Medicine in Saarbrücken, Germany, established a worldwide Sudden Death Registry with a view to documenting fatal events on the football field-of-play. These activities by F-MARC are testimony to FIFA's continued commitment to minimising sudden cardiac arrest while playing football.
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Affiliation(s)
- Efraim Benjamin Kramer
- Division of Emergency Medicine, Witwatersrand University, Johannesburg, Gauteng, South Africa
| | - J Dvorak
- F-MARC, Schulthess Clinic Zürich, Zürich, Switzerland
| | - C Schmied
- Clinic of Cardiology, University Heart Center, Zürich, Switzerland
| | - T Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
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Kramer EB, Serratosa L, Drezner J, Dvorak J. Sudden cardiac arrest on the football field of play—highlights for sports medicine from the European Resuscitation Council 2015 Consensus Guidelines. Br J Sports Med 2015; 50:81-3. [DOI: 10.1136/bjsports-2015-095706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 11/04/2022]
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Zhao L, Li C, Liu B, Wang M, Shao R, Fang Y. The association of gasping and outcome, in out of hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2015; 97:7-12. [PMID: 26409219 DOI: 10.1016/j.resuscitation.2015.09.377] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/19/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Gasping is common after cardiac arrest, and its frequency decreases over time. The aim of this study was to conduct a meta-analysis to evaluate the association of gasping and survival to discharge in patients who suffered out-of-hospital cardiac arrest. METHODS Relevant studies were identified by searching in PubMed, Medline, Embase, OVID, Web of Science and Google Scholar. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to assess the association of gasping and on out-of-hospital cardiac arrest outcomes. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored. RESULTS Individual patient data was obtained from 10,797 participants suffered out-of-hospital cardiac arrest in five cohort studies of 4 articles. A fixed effects model suggested that patients with gasping were 3.525 times (95% CI: 3.028-4.104; P<0.01) more likely to survive to discharge than those without gasping, and there was no heterogeneity among studies (P=0.564). Also it may be a favorable factor for return of spontaneous circulation (RR: 2.170; 95% CI: 1.691, 2.785) with high heterogeneity (Q=5.26; P=0.022). CONCLUSIONS Findings of this meta-analysis demonstrated that gasping is common after cardiac arrest, and is associated with increased survival to discharge. Patients who are cardiac arrest with gasping should be promptly resuscitated.
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Affiliation(s)
- Lianxing Zhao
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No. BZ0370), 8# Worker's Stadium South Road, Chao-Yang District, Beijing 100020, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No. BZ0370), 8# Worker's Stadium South Road, Chao-Yang District, Beijing 100020, China.
| | - Bo Liu
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No. BZ0370), 8# Worker's Stadium South Road, Chao-Yang District, Beijing 100020, China
| | - Miaomiao Wang
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No. BZ0370), 8# Worker's Stadium South Road, Chao-Yang District, Beijing 100020, China
| | - Rui Shao
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No. BZ0370), 8# Worker's Stadium South Road, Chao-Yang District, Beijing 100020, China
| | - Yingying Fang
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No. BZ0370), 8# Worker's Stadium South Road, Chao-Yang District, Beijing 100020, China
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Safdar B, Stolz U, Stiell IG, Cone DC, Bobrow BJ, deBoehr M, Dreyer J, Maloney J, Spaite DW. Differential survival for men and women from out-of-hospital cardiac arrest varies by age: results from the OPALS study. Acad Emerg Med 2014; 21:1503-11. [PMID: 25491713 DOI: 10.1111/acem.12540] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/07/2014] [Accepted: 06/10/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of sex on survival in out-of-hospital cardiac arrest (OHCA) is controversial. Some studies report more favorable outcomes in women, while others suggest the opposite, citing disparities in care. Whether sex predicts differential age-specific survival is still uncertain. OBJECTIVES The objective was to study the sex-associated variation in survival to hospital discharge in OHCA patients as well as the relationship between age and sex for predicting survival. METHODS The Ontario Prehospital Advanced Life Support (OPALS) registry, collected in a large study of rapid defibrillation and advanced life support programs, is Utstein-compliant and has data on OHCA patients (1994 to 2002) from 20 communities in Ontario, Canada. All adult OHCAs not witnessed by emergency medical services (EMS) and treated during one of the three main OPALS phases were included. Clinically significant variables were chosen a priori (age, sex, witnessed arrest, initial cardiopulmonary resuscitation [CPR], shockable rhythm, EMS response interval, and OPALS study phase) and entered into a multivariable logistic regression model with survival to hospital discharge as the outcome, with sex and age as the primary risk factors. Fractional polynomials were used to explore the relationship between age and survival by sex. RESULTS A total of 11,479 (out of 20,695) OPALS cases met inclusion criteria and 10,862 (94.6%) had complete data for regression analysis. As a group, women were older than men (median age = 74 years vs. 69 years, p < 0.01), had fewer witnessed arrests (43% vs. 49%; p < 0.01), had fewer initial ventricular fibrillation/ventricular tachycardia rhythms (24% vs. 42%; p < 0.01), had a lower rate of bystander CPR (12% vs. 17%; p < 0.01), and had lower survival (1.7% vs. 3.2%; p < 0.01). Survival to hospital admission and return of spontaneous circulation did not differ between women and men (p > 0.05). The relationship between age, sex, and survival to hospital discharge could not be analyzed in a single regression model, as age did not have a linear relationship with survival for men, but did for women. Thus, age was kept as a continuous variable for women but was transformed for men using fractional polynomials [ln(age) + age(3) ]. In sex-stratified regression models, the adjusted probability of survival for women decreased as age increased (adjusted odds ratio = 0.88, 95% confidence interval = 0.81 to 0.96, per 5-year increase in age) while for men, the probability of survival initially increased with age until age 65 years and then decreased with increasing age. Women had a higher probability of survival until age 47 years, after which men maintained a higher probability of survival. CONCLUSIONS Overall OHCA survival for women was lower than for men in the OPALS study. Factors related to the sex differences in survival (rates of bystander CPR and shockable rhythms) may be modifiable. The probability of survival differed across age for men and women in a nonlinear fashion. This differential influence of age on survival for men and women should be considered in future studies evaluating survival by sex in OHCA population.
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Affiliation(s)
- Basmah Safdar
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Uwe Stolz
- Department of Emergency Medicine; Arizona Emergency Medicine Research Center; University of Arizona; Tucson AZ
| | - Ian G. Stiell
- Department of Emergency Medicine and Ottawa Hospital Research Institute; University of Ottawa; Ottawa ON Canada
| | - David C. Cone
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Bentley J. Bobrow
- The Arizona Department of Health Services Bureau of Emergency Medical Services and Trauma System; Phoenix AZ
- Maricopa Medical Center; Phoenix AZ
| | - Melanie deBoehr
- Department of Preventive Medicine and Community Health; University of Texas Medical Branch; Galveston TX
| | - Jonathan Dreyer
- Division of Emergency Medicine; Western University; London ON Canada
| | - Justin Maloney
- Department of Emergency Medicine and Ottawa Hospital Research Institute; University of Ottawa; Ottawa ON Canada
| | - Daniel W. Spaite
- Department of Emergency Medicine; Arizona Emergency Medicine Research Center; University of Arizona; Tucson AZ
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Adequate performance of cardiopulmonary resuscitation techniques during simulated cardiac arrest over and under protective equipment in football. Clin J Sport Med 2014; 24:280-3. [PMID: 24184851 DOI: 10.1097/jsm.0000000000000022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate (1) cardiopulmonary resuscitation (CPR) adequacy during simulated cardiac arrest of equipped football players and (2) whether protective football equipment impedes CPR performance measures. DESIGN Exploratory crossover study performed on Laerdal SimMan 3 G interactive manikin simulator. SETTING Temple University/St Luke's University Health Network Regional Medical School Simulation Laboratory. PARTICIPANTS Thirty BCLS-certified ATCs and 6 ACLS-certified emergency department technicians. INTERVENTIONS Subjects were given standardized rescuer scenarios to perform three 2-minute sequences of compression-only CPR. Baseline CPR sequences were captured on each subject. MAIN OUTCOME MEASURES Experimental conditions included 2-minute sequences of CPR either over protective football shoulder pads or under unlaced pads. Subjects were instructed to adhere to 2010 American Heart Association guidelines (initiation of compressions alone at 100/min to 51 mm). Dependent variables included average compression depth, average compression rate, percentage of time chest wall recoiled, and percentage of hands-on contact during compressions. RESULTS Differences between subject groups were not found to be statistically significant, so groups were combined (n = 36) for analysis of CPR compression adequacy. Compression depth was deeper under shoulder pads than over (P = 0.02), with mean depths of 36.50 and 31.50 mm, respectively. No significant difference was found with compression rate or chest wall recoil. CONCLUSIONS Chest compression depth is significantly decreased when performed over shoulder pads, while there is no apparent effect on rate or chest wall recoil. Although the clinical outcomes from our observed 15% difference in compression depth are uncertain, chest compression under the pads significantly increases the depth of compressions and more closely approaches American Heart Association guidelines for chest compression depth in cardiac arrest.
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Shurlock B. Expenses for meetings and fees for service: details of 'disclosure' required of pharmaceutical companies. Eur Heart J 2013; 34:3589-90. [PMID: 24335158 DOI: 10.1093/eurheartj/eht460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- Efraim B Kramer
- Divisions of Emergency Medicine + Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, , Johannesburg, South Africa
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Dvorak J, Kramer EB, Schmied CM, Drezner JA, Zideman D, Patricios J, Correia L, Pedrinelli A, Mandelbaum B. The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care. Br J Sports Med 2013; 47:1199-202. [PMID: 23940271 DOI: 10.1136/bjsports-2013-092767] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.
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Fuller CW, Junge A, Dvorak J. Risk management: FIFA's approach for protecting the health of football players. Br J Sports Med 2011; 46:11-7. [PMID: 22143999 PMCID: PMC3254133 DOI: 10.1136/bjsports-2011-090634] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sport and exercise have long-term health benefits, but there is also a risk that participants will sustain injuries and/or ill health from these activities. For this reason, international sports governing bodies have a responsibility to identify the risks that exist within their sport and to provide guidance to participants and other stakeholders on how these risks can be controlled within acceptable levels. PURPOSE To demonstrate how Fédération Internationale de Football Association (FIFA), as football's governing body, uses a risk management framework to identify, quantify, mitigate and communicate the risks of injury and ill health in football for men, women and children in all environments. METHOD All the research papers published by FIFA's Medical Assessment and Research Centre (F-MARC) during the period 1994 to 2011 were reviewed and categorised according to an established sport-related risk management framework. CONCLUSIONS F-MARC investigated and mitigated 17 areas of risk to footballers' health in a coherent and consistent approach through the process of risk management.
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Affiliation(s)
- Colin W Fuller
- FIFA Medical Assessment and Research Centre, FIFA-Strasse 20, PO Box 8044 Zurich, Switzerland.
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