Brevard College Policies and Procedures Manual Policies and Procedures Manual

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1 Policies and Procedures Manual

2 TABLE OF CONTENTS Sports Medicine Team...2 Medical Documentation and Physicals...4 Prescription and Over the Counter Medication Management...10 ADD/ADHD Medication...13 Alcohol, Tobacco, and Other Drug Education Guidelines...15 Event Coverage...16 Lightning Safety...19 Cold Stress and Cold Exposure Policy...21 Prevention of Heat Illness...25 Brachial Plexus Injuries...28 Concussion Management...30 Skin Infection Management...35 Asthma Management...39 Sickle Cell Trait Management...43 Disordered Eating Management...46 Participation by the Student-Athlete with Impairment...51 Mental Health Interventions...53 The Pregnant and Parenting Student-Athlete...56 Use of the Head as a Weapon in Football and Other Contact Sports...59 References...60 Appendix 1: Emergency Action Plan...61 Appendix 2: Substance Abuse Education and Drug Testing...93 Appendix 3: Discontinuance of Brace/DME AMA Form Appendix 4: Return to Play AMA Form Appendix 5: Post-Participation Release Form Appendix 6: Student Patient Privacy Contract Appendix 7: Parent-Guardian Notice of Injury, Insurance Coverage Letter Appendix 8: ACL Return-to-Play Criteria Policy...118

3 ROLES OF BREVARD COLLEGE SPORTS MEDICINE TEAM POLICY Brevard College is obligated to provide health care that puts the safety and well being of the student-athlete first. The athletics department works in conjunction with the sports medicine department to create a qualified interdisciplinary health care team; this team consists of athletic trainers and team physicians. Brevard College has designated a qualified health care provider who is in charge of the coordination, monitoring, and evaluation of how well the health care is delivered; this both practice and competition coverage. At no point in the process of creating a health care team will a coach have any input as to who is hired and/or fired in a specific position. PROCEDURES Health Care Providers The Athletics Health Care Providers at Brevard College Team Physician The team physician should be a medical doctor (MD) or osteopathic physician (DO) who is in good standing with the medical board of the state where the school is located. It is the duty of the team physician to integrate medical expertise with the athletic trainers, medical consultants, and other health care professionals. Ultimately, it is up to the team physician as to whether or not a student-athlete is cleared to play to Brevard College Athletics. Athletic Trainers In order for the athletic program to run smoothly, there needs to be enough athletic trainers to cover all practices and/or games. Athletic trainers provide health care services both clinical and sideline care. Each athletic trainer is certified by the Board of Certification as well as being licensed by North Carolina s Board of Athletic Training. Day to Day Operations Responsibilities of the Sports Medicine Team include but are not limited to: Medical Services Injury evaluation and treatment Injury rehabilitation and reconditioning After hours/on-call consultation and injury/illness management Outside medical provider services Team Physician services 2

4 Concussion pre-injury baseline testing Concussion Management Championships/tournament event coverage Visiting team services Risk Minimization Mental health counseling referrals Create/maintain appropriate medical referral system Appropriate use of preventive and post-injury taping, bracing, and padding Protective equipment selection, fitting, and use Make appropriate play/no play decisions Infection control Practice/event coverage Knowledge of and recommendations for institutional and governing body drug testing Organization and Administration Budgeting Electronic medical record management Pre-participation examination (PPE)/medical history Emergency action plans Insurance claims management Drug use prevention Inventory management Fiscal Management Insurance premiums Staffing and workload management Medical services Budget management Fundraising Academic success Contracts 3

5 MEDICAL DOCUMENTATION AND PHYSICALS POLICY Brevard College student-athletes are to report all injuries and illnesses affecting their physical or mental health status to one of the staff athletic trainers as soon as possible. Injuries and illness occurring during the off-season should be reported as well. The Brevard College Sports Medicine Department will keep a record of all injuries, illnesses, and surgical procedures along with daily injury records and daily treatment records using SportsWareOnLine, the injury tracking software utilized by all Brevard College Sports Medicine Staff Members. All medical records will be secured under double-locked conditions, and all computer records will be password protected. All the information gathered and kept private by the Sports Medicine Department is highly confidential and is protected by the Health Insurance Portability and Accountability Act (HIPAA). A student-athlete must sign a waiver for release of any information to any family member, media source, health care professionals, and/or professional scout. All new student-athletes participating on Brevard College Athletics teams must have a preparticipation physical exam, before they can participate with his/her team; returners are required to fill out an updated medical questionnaire with vital sign assessment. The purpose of the physical is to identify any pre-existing conditions that could put the student-athlete at risk during practice or competition. The physician will determine the extent of the physical exam and if any follow-up medical testing is necessary. PROCEDURE Athletic Training Reports The Brevard College athletic training staff documents all initial evaluations, treatments, daily progress notes, and rehabilitation sessions using SportsWareOnLine and appropriate forms. Injury/Illness report Reports are written for any student-athlete sustaining an injury or reporting an illness that affects their participation status for that day. All injuries/illnesses are recorded in SportsWareOnLine. Reports are documented in SportsWareOnLine by selecting the studentathlete s name, clicking on the injury icon (located on the top of the page), followed by clicking on the Add link (located on the top left side of the page). Treatment Record Treatments are logged for any student-athlete every time they receive treatment for a documented injury/illness. 4

6 All treatments are recorded in SportsWareOnLine. Documented on SportsWareOnLine by selecting the student-athlete s name, clicking on the treatment icon (located on the top of the page), followed by clicking on the Add link (located on the top left side of the page). You may then select any entry under Existing Injuries for treatment on an existing injury or you may select No Specific Injury for treatment when no specific injury is applicable. When documenting a reoccurring treatment for a specific injury on a studentathlete, select the student-athlete s name, click on the treatment icon, select the treatment that you are duplicating, and then click on the Duplicate link (located on the top left side of the screen). Progress Note Written a minimum of one time per week for any student-athlete receiving treatment continuously for the same injury. Written for any change in status. Written in SOAP note format. All progress notes are to be recorded on SportsWareOnLine. Documented on SportsWareOnLine by selecting the student-athlete s name, clicking on the injury icon (located on the top of the page), and then clicking on the Update tab (located on the top left side of the page). Progress notes are then recorded under the Notes tab (located at the top of the page). The date and time is recorded at the beginning of each note. Rehabilitation Chart Written for student-athletes on a long term rehabilitation program. Daily exercises are recorded. Scanned and attached to student-athlete s injury record when completed. All rehabilitation charts are to be recorded on SportsWareOnLine. Attached to SportsWareOnLine by selecting the student-athlete s name, clicking on the injury icon (located on the top of the page), and then clicking on the Update tab (located on the top left side of the page). Rehabilitation charts are then attached under the Attachments tab (located on the top of the page) 5

7 Physician Reports Team Physician Referrals The ATC will determine if the student-athlete needs to see a team Physician. The ATC will then schedule the student-athlete to be seen either in the Athletic Training Room or the Physician s office (on a case by case basis). The ATC should then begin a Physician Referral Form on SportsWareOnLine. After the appointment has taken place and the Physician s Report has been received, it will be scanned and attached to the student-athlete s injury record on SportsWareOnLine. Attached to SportsWareOnLine by selecting the student-athlete s name, clicking on the injury icon (located on the top of the page), and then clicking on the Update tab (located on the top left side of the page). Physician s reports are then attached under the Attachments tab (located on the top of the page). Other Medical Documentation (i.e., Doctor s Notes, MRI Reports, etc.) All medical documentation concerning any injury or illness that effects the student-athlete s participation in his or her sport should be submitted to the Sports Medicine Department, where it will then be scanned and attached to the studentathlete s injury record. Any document that is scanned is saved and named using the following format: Last Name, First Name; Date of Document (mm/dd/yy); Type of Document (i.e., Doctor s Notes, MRI Report, etc.). Attached to SportsWareOnLine by selecting the student-athlete s name, clicking on the injury icon (located on the top of the page), and then clicking on the Update tab (located on the top left side of the page). Medical documents are then attached under the Attachments tab (located on the top of the page). Surgery Reports/Documents Any student-athlete that has had a prior surgery before attending and/or while enrolled at Brevard College must submit all of the test results, imaging, and surgery reports pertaining to the specific procedure to the Brevard College Sports Medicine Department. The documentation will then be scanned and attached to the student-athlete s surgery file on SportsWareOnLine. A surgery file is created in the SportsWareOnLine software by selecting the athlete s name, choosing the surgery icon located at the top of the page, and then clicking on the Add link located on the top left side of the page. You may then select any entry under Existing Injuries for surgery that was performed on an existing injury or you may select No Specific Injury for surgery that was performed when no specific injury is applicable. All medical documentation pertaining to this particular surgery will then be attached to this file. A new surgery file will be created, if necessary, for multiple surgeries. 6

8 Surgery documents are important to the Sports Medicine Department in order to provide the best possible care to the student-athlete, as well as aiding in the process of obtaining a Medical Hardship Waiver in certain cases. It is the responsibility of the studentathlete to submit all medical documentation concerning any injury/illness that may affect the student-athlete s participation status in his or her sport. There are two different types of waivers that an athlete can receive: a hardship waiver or an extension waiver. A hardship waiver deals with a student-athlete s seasons of competition and may only be granted if a student-athlete has competed and used on of the four season of competition. Objective documentation containing these key three elements must be included in the documentation: Contemporaneous diagnosis of injury/illness. Acknowledgement that the injury/illness is incapacitating. Length of incapacitation. An extension waiver deals with time on a student-athlete s eligibility clock and may be granted if, within a student-athlete s period of eligibility (five years or ten semesters), he or she has been denied more than one participation opportunity for reasons beyond the student-athlete s and the institution s control. Medication All prescription medications taken by a student-athlete are to be recorded on SportsWareOnLine. Documentation of prescription medications are completed by selecting the studentathlete s name, clicking on the medication icon (located at the top of the page), and then clicking on the Add tab (located on the top left side of the screen). You may then select any entry under Existing Injuries for medication that was prescribed for an existing injury or you may select No Specific Injury for medication that was prescribed when no specific injury is applicable. It is the responsibility of the student-athlete to inform the Sports Medicine Department if he or she is taken a prescribed medication or if any changes occur concerning the prescription (i.e., dosage, etc.). This information is important, especially pertaining to medication prescribed for Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) because medication for these conditions are on the NCAA banned substance list will result in a failed drug test if the student-athlete and Brevard College do not have the proper documentation regarding the student-athlete s use of these medications. Please refer to the Brevard College Sports Medicine Policies and Procedures: ADD/ADHD Management Policy for further information regarding ADD and ADHD. 7

9 Student-Athlete Health History and Physical Examination Pre-Participation Physical Examinations It is the Coaching Staff s responsibility to ensure that all student-athletes have their physicals prior to the beginning of athletic participation. The Coaching Staff and Sports Medicine Department will work together in the off-season to come up with a team s scheduled time for on-site physical s performed by Brevard College Team Physicians. These scheduled dates and times will be prior to the first date of any scheduled practice for the academic school year. Coaches will also notify the Staff Certified Athletic Trainers of any student-athletes who join the team after the season begins. These student-athletes will not be allowed to participate until all Brevard College Athletic Department pre-participation requirements are met. Only physicals administered by Brevard College Team Physicians will be acceptable for clearance of participation. New and Transfer Student-Athlete Pre-Participation Physical New and transfer athletes must complete a New Athlete Medical History Form as part of required paperwork on SportsWareOnLine. Returning Student-Athlete Pre-Participation Physical Returning student-athletes must complete a Yearly Medical History Questionnaire Form and take blood pressure and pulse. If the student-athlete has had a significant injury or illness since their last physical, they must have a full pre-participation physical completed by a Brevard College Team Physician for clearance. All student-athletes will be given the opportunity for a complete physical if they so choose. Post-Participation Physical Examinations Non-returning student-athletes must complete a Post Physical Form on SportsWareOnLine. In order to ensure the health of a student-athlete before leaving Brevard College, the student- athlete is required to complete an Exit Physical Form when their athletic career is over. The exit physical form will determine the student-athlete s health status and allow the student-athlete to disclose on-going athletically-related injuries that may need to be addressed before leaving. The Prospective Student-Athlete (Tryout) A student who would like to try out for a varsity team must initiate the process by meeting with the compliance coordinator and obtaining a try-out form; this form outlines the terms of the try-out and to ensure that they are eligible for participation. 8

10 Once the student has received clearance for participation, the student must provide the coach with proof of a passed medical physical, examined within the last 6 months, sickle cell status form and a copy of his or her primary insurance card (front and back). Once the athlete receives a physical and turns it into their coach, the athletic trainer will review it to make sure the athlete has been cleared and no further tests or examinations have been ordered. 9

11 PRESCRIPTION AND OVER THE COUNTER MEDICATION MANAGEMENT POLICY This policy should be followed for any student-athlete who requires medical attention due to illness or injury. OTC medication may be administered by Licensed and Certified Athletic Trainers and Physicians only. Prescription medications may be administered by a Licensed Physician only. The purpose of this policy is to prevent the spread of disease and serve the population in which we cover by providing Physician directed OTC medication therapy. PROCEDURES Over The Counter and Prescription Medication Administration Over the Counter (OTC) medication is provided to Brevard College student-athletes on a case by case basis by a member of the Sports Medicine department. The use of OTC medications is approved by a team physician(s) and follows federal and state laws. Only single doses of OTC medication will be provided. Prescription medications will be provided for student-athletes for conditions related to sports participation as determined by the team physician(s). The Team Physician or an Athletic Training Staff Member must approve the purchase of the medication. The Sports Medicine Department will try to offset prescription costs by filing claims to the student-athlete s primary insurance carrier. The Sports Medicine Department follows all recommendations made by the NCAA regarding prescription medication to include, but not limited to the following: Drug-dispensing practices are subject to and should be in compliance with all state, federal, and Drug Enforcement Agency (DEA) regulations. This includes appropriate packaging, labeling, counseling and education, record keeping, and accountability for all drugs dispensed. Certified athletic trainers cannot be assigned duties that can only be performed by a physician or pharmacist. A team physician cannot delegate diagnosis, prescription-drug control or prescription-dispensing duties to athletic trainers. All prescription and OTC medications are stored in designated areas that assure proper environmental (dry with temperatures between 59 and 86 degrees Fahrenheit) and security conditions. All drug stocks should be examined at regular intervals for removal of any outdated, deteriorated, or recalled medications. All emergency and travel kits containing prescription and OTC drugs should be routinely inspected for drug quality and security. Individuals receiving medication should be properly informed about what they are taking and how they should take it. Drug allergies, chronic medical conditions, and concurrent medication use should be documented in the student-athlete s medical record and readily retrievable. 10

12 Follow-up should be performed to be sure student-athletes are complying with the drug regimen and to ensure that drug therapy is effective. This procedure is performed through record keeping in the student-athlete s medical file. Any medications on the NCAA Banned Substance List will be prohibited. If any student-athlete does not show improvement while taking OTC medication, arrangements will be made for evaluation by a Team Physician. Medication Tracking and Storage All OTC medication is maintained in locked offices and/or cabinets that provide sufficient safe, dry, well ventilated storage that is temperature controlled and free from dust, insects, rodents and contamination. The medication is in the possession of an Athletic Training Staff Member and Team Physicians. Prescription medications are recorded in the student-athlete s electronic medical record. Purchase of OTC and prescription medications will be conducted within the rules of procurement as set by the state of North Carolina and Brevard College. Team Physicians will issue written prescriptions for prescription medication in the name of the student-athlete, who will then proceed to the pharmacy of his or her choice to obtain medication at their own expense. The Student-Athlete with Asthma It is the responsibility of the student-athlete to make certain that his or her rescue inhaler is present for all practices, games, and strength and conditioning sessions, as well as at all informal summer workouts. During practices and games, the Sports Medicine Staff may hold the inhaler for the student-athlete in their medical kit at his or her request. Exceptions to this will be made when the student-athlete is outside the physical or visual confines of the Sports Medicine Staff. In such sports, affected student-athletes will be responsible for carrying their rescue inhaler. The Sports Medicine Department will not be responsible for the cost of asthma medications. Anaphylactic Shock and the use of an EpiPen EpiPen (epinephrine) 0.3 mg and EpiPen Jr (epinephrine) 0.15 mg Auto-Injectors are for the emergency treatment of life-threatening allergic reactions (anaphylaxis) caused by allergens, exercise, or unknown triggers and for people who are at increased risk for these reactions. 11

13 It is the responsibility of the student-athlete to make certain that his or her EpiPen is present for all practices, games, and strength and conditioning sessions, as well as at all informal summer workouts. During practices and games, the Sports Medicine Staff may hold the EpiPen for the student-athlete in their medical kit at his or her request. Exceptions to this will be made when the student-athlete is outside the physical or visual confines of the Sports Medicine Staff. In such sports, affected student-athletes will be responsible for carrying their EpiPen. The Sports Medicine Department will not be responsible for the cost of epinephrine medications. 12

14 ADD/ADHD MEDICATION POLICY Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are two conditions that affect a number of Brevard College student-athletes. The prescribed medications to control ADD/ADHD are on the NCAA Banned Substance list and will result in a positive drug test for a banned substance. The student-athlete and Brevard College must provide proper documentation regarding the student s use of these medications to explain why a student-athlete tested positive for a banned substance. If the parent and/or student-athlete have any questions, please refer to the NCAA Medical Exceptions Policy regarding obtaining an exception for the use of ADD/ADHD medication. PROCEDURES New Student-Athletes The following documents must be on file before a student-athlete is allowed to participate in intercollegiate athletic practices, conditioning or competition at Brevard College. Required Documents Completed Brevard College ADD/ADHD Medication Usage and Documentation Policy upon matriculation (first year) into Brevard College Documentation from the student-athlete s prescribing physician, including a comprehensive clinical evaluation, recorded observations, results from ADHD rating scales, physical exam, lab work, previous treatment for ADHD, the diagnosis and recommended treatment for the student-athlete using ADHD stimulant medication. The physician can provide documentation of the above either with a cover letter and attachments (recommended) or provide the actual medical record. A copy of the student-athlete s most recent prescription for the medication to be turned into the Sports Medicine Department with each new prescription Physician Exam A follow up medical exam must be performed and cover letter provided annually to the Sports Medicine Department; this information can be found in the Sample Letter in the Brevard College ADD/ADHD Medical Documentation Packet Returning Student Athletes Returning student-athletes must also submit the following documents annually in order to remain eligible to participate in intercollegiate athletic practices, conditioning or competition at Brevard College. Required Documents 13

15 Annual letter from the prescribing physician following an annual follow-up examination (see Sample Letter in the Brevard College ADD/ADHD Documentation Packet) A copy of the student-athletes most recent prescription for the medication (to be turned into the Sports Medicine Department with each new prescription) 14

16 ALCOHOL, TOBACCO, AND OTHERDRUG EDUCATION GUIDELINES POLICY The NCAA mandates that the Brevard College athletics director or an employee designated by the athletics director must educate and review the list of banned drug classes with the studentathletes for that school year. These athletic administrators are encouraged to participate in different drug education sessions. PROCEDURE Develop a written policy on alcohol, tobacco, marijuana, opiate, and other drug use. Make sure to include statements on recruitment activities, drug testing, disclosure of all medications and supplement, discipline, and counseling or treatment options. Review the NCAA, conference, and institutional drug-testing program policies and update handbook materials accordingly. Include the NCAA list of banned drug classes and NCAA written policies in the studentathlete handbook Identify NCAA, conference, and institutional rules regarding the use of street drugs, performance-enhancing substances, and nutritional supplements, and consequences for breaking the rules. Warn athlete that the ingredients of any dietary supplement need to be reviewed with an athletic trainer and/or strength & conditioning coach; banned substances may be included, and the student-athlete could inadvertently test positive for a banned substance. Before reporting to campus for pre-season practice Send out the NCAA list of banned drug classes, the dietary supplement warning and Resource Exchange Center (REC) information to all returning and incoming student-athletes. Orientation at the start of each academic term Ensure that student-athletes sign NCAA compliance forms Provide student-athlete with a copy of the written drug policies as outlined prior. Explain all relevant drug policies: Banned drug classes Drug testing policies for NCAA, conference, and institution Risks of using dietary supplements without knowing all of the ingredients and as to whether or not they are banned. Repeat all relevant information during team meetings Continue to remind and educate coaches and student-athletes about the guidelines for drug use. 15

17 EVENT COVERAGE POLICY It is the goal of the Sports Medicine Staff at Brevard College to cover every practice, game, and conditioning session that is feasibly possible; however, due to the number of sports and the yearround nature of collegiate athletics, there are times where it is simply not possible to have someone at all of the events. In such cases, precedence will be given to the in-season sports over the out-of-season sports, then contact or high risk sports over the non-contact or low risk sports. Below is a matrix of which sports will have precedence during each season regarding sports medicine coverage. PROCEDURE Captains Practices (Open Gyms, Free Play, etc.) Captain s practices are practices that occur without the presence of a coach and are organized by the student-athletes only. These practices will not be covered by a member of the Brevard College Sports Medicine Staff. If an athletic injury or accident occurs during these practices, the student-athlete should report to the Athletic Training Room. Please refer to the Brevard College Sports Medicine Emergency Action Plan for further information concerning emergency situations. 16

18 Coverage Matrix FALL SPORTS MEDICINE COVERAGE Risk Team Practice Individuals Home Events Away Events Football High Yes ATR Yes Yes Soccer, Men Moderate Yes ATR Yes TBD Soccer, Women Moderate Yes ATR Yes TBD Basketball, Men Moderate ATR ATR Yes TBD Basketball, Women Moderate ATR ATR Yes TBD Lacrosse, Men High ATR ATR Yes TBD Lacrosse, Women Moderate ATR ATR Yes TBD Baseball Moderate ATR No N/A N/A Softball Moderate ATR No N/A N/A Volleyball Low ATR ATR Yes No Track and Field Low No No N/A N/A Cross Country Low ATR No Yes No Tennis Low No No Yes No Golf Low No No No No Cheer/Dance Low No No N/A No 17

19 SPRING SPORTS MEDICINE COVERAGE Risk Team Practice Individuals Home Events Away Events Football High Yes ATR Yes N/A Soccer, Men Moderate ATR ATR Yes TBD Soccer, Women Moderate ATR ATR Yes TBD Basketball, Men Moderate ATR ATR Yes TBD Basketball, Women Moderate ATR ATR Yes TBD Lacrosse, Men High Yes ATR Yes TBD Lacrosse, Women Moderate Yes ATR Yes TBD Baseball Moderate ATR ATR Yes TBD Softball Moderate ATR ATR Yes TBD Volleyball Low ATR ATR N/A N/A Track and Field Low ATR ATR N/A No Cross Country Low N/A N/A N/A N/A Tennis Low ATR ATR Yes No Golf Low No No No No Cheer/Dance Low No No No No 18

20 LIGHTNING SAFETY South Atlantic Conference Lightning Policy Lightning is the most consistent and significant weather hazard that may affect intercollegiate athletics. Within the United States, the National Oceanographic and Atmospheric Administration (NOAA) estimated those fatalities and about 10 times as many injuries occur from lightning strikes each year. While the probability of being struck by lightning is low, the odds are significantly greater when a storm is in the area and the proper safety precautions are not followed. Excerpt from the NCAA Guide Line (1d Lightning Safety) from the Sports Medicine Handbook, , pages Chain of Command The responsibility of removing athletes from tournament play due to the threat of lightning and/or severe weather lies with the SAC Administrator in-charge and/or the host-site administrator in-charge of that particular sport/activity. The host site staff athletic trainer(s) and/or host-site administrator present or their designee(s) will monitor the weather and advise the attending SAC Administrator, officials/umpires and coaches on the situation as deemed necessary. Once the ruling is made to halt play and remove the athletes from the area of play is deemed necessary by the event administrators due to the threat of severe weather/lightning; the official/referee or umpire in charge will be notified to suspend such play and the coaches must get their players as quickly as possible to a designated safe zone. The host-site administrator is responsible for alerting and informing the spectators to seek safe shelter in the event of severe weather/lightning. This policy should be reviewed by the Tournament Committee, officials, and host athletic trainer(s) prior to the first outdoor activity of each tournament. Means of Monitoring the Weather The host site staff athletic trainer(s) and/or host-site administrator present will monitor the weather and advise the officials/umpires and coaches on the situation as deemed necessary. The use of commercial, real time lightning detection service (ex. Telvent DTN Weather Sentry Service Schneider Electric) if available at the host-site, should be used for severe weather including lightning notification for use during practices and competition. Flash-to-Bang Count: The number of seconds which pass between a lightning strike (flash) and the following sound of thunder (bang). The number of seconds between the 19

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