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What you need to know about stroke.

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1 What you need to know about stroke.
This presentation will help you understand more about stroke – its prevention, treatment and recovery. It will cover stroke risk factors, prevention measures, how to recognize the symptoms of stroke and how to respond. This slide show was orginated by the National Stroke Association and provided for you by the Montana Cardiovascular Health Program of the Montana Department of Public Health and Human Services and the American Heart Association/American Stroke Association.

2 Be Stroke Smart Reduce—Stroke risk Recognize—Stroke symptoms
Respond—At the first sign of stroke, CALL IMMEDIATELY! We hope your participation in today’s presentation will support you in becoming more stroke smart. We want you to know and understand the three R’s of stroke: REDUCE risk RECOGNIZE stroke symptoms RESPOND by calling 9-1-1 © 2011 National Stroke Association

3 Stroke Facts A leading cause of death in the United States
795,000 people in the U.S. suffer strokes each year 133,000 deaths in the U.S. each year 1 stroke about every 40 seconds 1 death every 3.3 minutes 7,000,000 stroke survivors in the U.S. Stroke is a leading cause of death in the United States behind heart disease, all forms of cancer combined and chronic lower respiratory diseases. Approximately 795,000 people in the U.S. have a new or recurrent stroke each year. Stroke kills approximately 133,000 Americans each year. From 1997 to 2007, the stroke death rate fell approximately 35 percent and actual number of stroke deaths fell by 18 percent. Every 40 seconds someone suffers a stroke; every four minutes someone dies from a stroke. There are more than 6 million stroke survivors living in the United States. Men make up about 2,500,000 survivors and women make up 3,900,000. About one-third have mild impairments, another third are moderately impaired and the remainder are severely impaired. References: American Heart Association. Heart Disease and Stroke Statistics 2011 Update At-a- Glance. At © 2011 National Stroke Association

4 Stroke Facts The number one cause of adult disability
Up to 80% of all strokes are preventable through risk factor management Stroke can happen at any age Risk doubles every decade after age 55 Stroke is a leading cause of serious, long-term adult disability. Over the course of a lifetime, four out of every five families in the United States will be touched by stroke. Up to 80 percent of all strokes are preventable. References: American Heart Association. Heart Disease and Stroke Statistics Update At-a-Glance. At: Gorelick PB. Stroke Prevention. Arch Neurol. 1995;52: At: © 2011 National Stroke Association

5 Women & Stroke Stroke kills more than twice as many American women every year as breast cancer More women than men die from stroke and risk is higher for women due to higher life expectancy Women suffer greater disability after stroke than men Women ages are experiencing a stroke surge, mainly due to increased risk factors and lack of prevention knowledge Stroke kills more than twice as many American women every year as breast cancer. Each year, about 55,000 more women than men experience a stroke. More women than men die from stroke - accounting for more than 67 percent of all stroke deaths. Overall lifetime risk of stroke is higher in women then men because life expectancy is higher. Also, women who have already suffered a stroke are significantly more at risk for a second stroke than men after two years. Women suffer greater disability and functional outcomes because they are more likely to require institutionalized care than men, which adds to the economic burden of stroke. Women ages 45 to 54 are experiencing a stroke surge, mainly due to increased risk factors and lack of prevention knowledge. References: American Heart Association. Heart Disease and Stroke Statistics 2010 Update At-a-Glance. At: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System. National Vital Statistics Report. Volume 57, Number 14. Deaths: Final Data for April 17, 2009. Dearborn JL, McCullough LD. Perception of Risk and Knowledge of Risk Factors in Women at High Risk for Stroke. Stroke. 2009;40: © 2011 National Stroke Association

6 Well-known Stroke Survivors
President Gerald Ford Teddy Bruschi Sharon Stone Della Reese Kirk Douglas James Garner Mary Kay Ash Charles Schultz Harry Caray Charles Dickens Ed Koch Ted Williams “Seeing” a disease in the news always brings greater attention to it. Prominent people who have experienced strokes include: U.S. Presidents Gerald Ford, Thomas Jefferson, Woodrow Wilson, Warren G. Harding, Franklin Delano Roosevelt, Dwight Eisenhower, Richard Nixon Super Bowl player Teddy Bruschi Actors Sharon Stone, Della Reese, Kirk Douglas and Robert Guillaume Entertainers Luther Vandross and Roy Horn of Siegfried & Roy Cosmetics entrepreneur Mary Kay Ash Comics artist Charles Schultz Sports commentator Harry Caray Novelist Charles Dickens Former New York City Mayor Ed Koch Major league baseball player Ted Williams References: National Stroke Association. The Complete Guide to Stroke At: © 2011 National Stroke Association

7 A stroke occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain. When a stroke occurs, it kills brain cells in the area surrounding where the clot or breakage occurrs. There are 2 types of stroke: Ischemic Strokes can occur two ways and are the most common, accounting for approximately 87 percent of strokes. Embolic: Clot travels to the brain from another part of the body Thrombotic: Clot develops in an artery Hemorrhagic Stroke occurs when a blood vessel in the brain breaks or ruptures. While hemorrhagic stroke is less common, it is more deadly. References: American Heart Association. Heart Disease and Stroke Statistics 2010 Update At-a-Glance. At: National Stroke Association. The Complete Guide to Stroke At:

8 Stroke is a Brain Attack! If you waste time, you waste brain!
Every second 32,000 brain cells die Every minute 1.9 million brain cells die Within 12 minutes 23 million brain cells die The reason stroke is a major cause of disability is because of the damage it causes to the brain. Appropriate treatment can be more effective if given quickly. Every minute matters! References: National Stroke Association. The Complete Guide to Stroke At: 341. If you waste time, you waste brain! Call immediately! 8 © 2011 National Stroke Association

9 Stroke Symptoms Numbness or weakness of the face, arm or leg, especially on one side of the body Loss of vision, speech or understanding Trouble walking or dizziness Sudden severe headache or confusion So how do you know if someone is having a stroke? The most common stroke symptoms are: Sudden numbness or weakness of face, arm or leg, especially on one side of the body Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination Sudden severe headache with no known cause If you see someone having these symptoms or experience any of these symptoms yourself, call immediately. References: National Stroke Association. The Complete Guide to Stroke At: 341. If you, or someone you know, experience these symptoms, call immediately!

10 Stroke Strikes FAST You Should, Too. Call 9-1-1 F = FACE
Ask the person to smile. A = ARM Ask the person to raise both arms. S = SPEECH Ask the person to speak a simple sentence. T = TIME If you observe any of these signs, call immediately. One way to help remember the symptoms of stroke and what to do, is to learn the Face, Arms, Speech Test, otherwise knows as FAST: F = FACE Ask the person to smile – do both sides of the face move equally? (Normal) Or does one side of the face not move at all? (Abnormal) A = ARM Ask the person to raise both arms – do both arms move equally? (Normal) Or does one arm drift downward compared to the other? (Abnormal) S = SPEECH Ask the person to speak a simple sentence – Does the person use correct words with no slurring? (Normal) Or do they slur their speech, use inappropriate words or is unable to speak at all? (Abnormal) T = TIME To call 9-1-1 If you observe any of these symptoms, call immediately. Every minute matters! References: National Stroke Association. The Complete Guide to Stroke At: © 2011 National Stroke Association

11 Details of Facial Droop
When you ask the person to smile, one side of the face may not move. Strokes generally affect one side of the bodyムthe opposite side from where the brain damage is occurring.

12 Details of Arm Drift When you ask the person to raise both arms, one arm may drift or not move.

13 Transient Ischemic Attack (TIA)
TIA is a warning sign of a future stroke – up to 40% of TIA patients will have a future stroke Symptoms are the same as stroke Symptoms can resolve within minutes or hours (most last min. then go away) Seek immediate medical attention if you suspect that you are having, or have had, a TIA Transient Ischemic Attacks (TIAs) are a serious warning of an impending stroke. TIA symptoms are the same as for stroke. TIAs are brief episodes of stroke symptoms that resolve within minutes or hours, unlike stroke symptoms which can last longer. Up to 40 percent of all persons who experience a TIA will go on to have a full stroke. Within two days of a TIA, 5 percent of patients will have a stroke Within 90 days of a TIA, percent will have a stroke Management of TIAs focuses on preventing a future stroke. References: National Stroke Association. The Complete Guide to Stroke At: Easton JD, Saver JL, et al. Definition and Evaluation of Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke. 2009;40: © 2011 National Stroke Association

14 Stroke Myths Reality : Myth: Up to 80% are preventable
Requires emergency treatment Anyone can have a stroke Stroke is a “Brain Attack” Recovery can last a lifetime Myth: Is not preventable Cannot be treated Only strikes elderly Happens in the heart Recovery ends after 6 months There are many misconceptions about stroke…. MYTH: Stroke is not preventable. REALITY: Up to 80 percent of strokes are preventable. We’ll discuss steps you can take to reduce stroke risk in a minute. MYTH: Stroke cannot be treated. REALITY: Stroke can be treated, but requires emergency treatment. Call immediately if you experience or see someone with stroke symptoms. MYTH: Stroke only strikes the elderly. REALITY: Anyone of any age can have a stroke. MYTH: Stroke is like a heart attack. REALITY: Stroke is a “Brain Attack.” MYTH: Stroke recovery ends after 6 months. REALITY: Stroke recovery can continue throughout a survivor’s life. References: National Stroke Association. The Complete Guide to Stroke At: © 2011 National Stroke Association

15 Estimated direct and indirect cost of stroke was $73.7 billion in 2010
The Cost of Stroke Estimated direct and indirect cost of stroke was $73.7 billion in 2010 The mean lifetime cost of ischemic stroke in the U.S. is about $140,048 The cost of stroke: Direct and Indirect costs were estimated at more than $73 billion a year in 2010. Direct costs make up over 60 percent of this total and include things like: hospital nursing home physicians/other professionals drugs/medical home health care Indirect costs make up nearly 40 percent of the total and include things like: lost productivity mortality References: American Heart Association. Heart Disease and Stroke Statistics 2010 Update At-a- Glance. At: © 2011 National Stroke Association

16 How Do You Prevent Stroke?
Recommended Guidelines for Reducing Stroke from: Montana Cardiovascular Health Program & National Stroke Association Many strokes are preventable if you pay attention to pre-existing medical conditions and control lifestyle factors such as diet and exercise. The Montana Cardiovascular Health Program and the National Stroke Association recommend the following public stroke prevention guidelines... References: Gorelick PB. Stroke Prevention. Arch Neurol. 1995;52: At: Gorelick PB, Sacco RL, et al. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA. 1999;281: At: © 2011 National Stroke Association

17 Stroke Prevention Guidelines
Know your blood pressure. Check at least annually. If elevated, work with your healthcare professional to control. Find out if you have atrial fibrillation (Afib) – a type of irregular heartbeat. If you have it, work with your healthcare professional to manage it. If you smoke, stop. Know your blood pressure. Have it checked at least annually. If it’s elevated, work with your healthcare professional to keep it under control. Having high blood pressure, or hypertension, increases stroke risk four to six times. Find out if you have atrial fibrillation – a type of irregular heartbeat. If left untreated, Afib can increase stroke risk four to six times. If you smoke, stop. Smoking doubles stroke risk. References: Gorelick PB, Sacco RL, et al. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA. 1999;281: At: © 2011 National Stroke Association

18 Stroke Prevention Guidelines
If you drink alcohol, do so in moderation. Know your cholesterol number. If it is high, work with your doctor to control it. If you have diabetes, follow your doctor’s recommendations carefully to control your diabetes. If you drink alcohol, do so in moderation. Recent studies have suggested that modest alcohol consumption (up to two glasses of wine or the alcohol equivalent) may reduce stroke risk. More than one drink a day for a woman or for a man over age 65, or more than 2 drinks a day for a younger man can increase stroke risk. If you don’t drink, don’t start. Find out if you have high cholesterol. High cholesterol can indirectly increase stroke risk by putting people at greater risk of heart disease. Talk to your doctor if your total cholesterol is higher than 200 mg/dL or if your LDL cholesterol is higher than 100 mg/dL. If you have diabetes, follow you doctor’s recommendation carefully to control your diabetes. People with diabetes have a significantly higher stroke risk. This may be related to circulation problems that diabetes can cause. References: Gorelick PB, Sacco RL, et al. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA. 1999;281: At: © 2011 National Stroke Association

19 Stroke Prevention Guidelines
Include exercise in your daily routine. Enjoy a lower sodium (salt) and saturated fat diet. If you have circulation problems, work with your healthcare professional to improve your circulation. If you experience any stroke symptoms, call immediately. Every minute matters! Incorporate physical activity that you enjoy into your daily routine. Active people tend to have lower cholesterol levels. Regular exercise also seems to slow down or stop clogging of blood vessels. At least 30 minutes a day is recommended. Enjoy a low-sodium (salt) and low saturated fat diet. Too much salt may contribute to high blood pressure and make it more difficult to control. A diet that is low in fat will likely include fruits and vegetabl24es, lean meats such as chicken and fish, and low-fat dairy products. Ask your healthcare professional if you have circulation problems which increase your risk for stroke. If you do, work with your healthcare professional to control this condition. If you experience any stroke symptoms, seek immediate medical attention by calling Every minute matters! References: Gorelick PB, Sacco RL, et al. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA ;281: At: © 2011 National Stroke Association

20 Know the Signs of Stroke
Stroke Awareness Know the Signs of Stroke ACT Immediately Call 9-1-1 © 2011 National Stroke Association

21 Stroke is Treatable Clot-busting drug tPA approved for use within 3 hours of symptom onset tPA is very effective in preventing long-term disability Other therapies have proven effective within 6 hours of onset Only 1-3% of stroke victims receive treatment with tPA in the U.S. References: PowerPoint slide by Nicholas Okon, MD, Billings Neurologist and member of the Montana Stroke Work Group. © 2011 National Stroke Association

22 Acute Stroke Treatments
Ischemic Stroke (brain clot) Clot busting medication: tPA (tissue plasminogen activator) Clot-removing devices: Merci Retriever, Penumbra Hemorrhagic Stroke (brain bleed) Clipping Coiling There are two types of treatment for ischemic stroke (caused by clots): The Clot Buster – or tPA works by dissolving blood clots that are blocking arteries. tPA is an enzyme found naturally in the body. The drug was approved by the Food and Drug Administration in June for treatment of stroke and can improve outcomes, but can only be given within the first three hours of symptom onset. The Merci Retriever was FDA approved In This corkscrew-like device is an option for patients ineligible for t-PA treatment. The device is threaded through a catheter up through the body to the clot in the brain. The clot is then removed, restoring the blood flow to the affected area of the brain. The Penumbra System is a new embolectomy device specifically designed to remove the thrombus in acute ischemic stroke, secondary to large vessel thromboembolism. The device removes the thrombus through two mechanisms: aspiration and extraction. There are also FDA-approved surgical treatments available for hemorrhagic stroke: Clipping, currently the most common treatment, involves making an opening in the skull bone and placing a metal clip across the neck of the aneurysm to stop blood from flowing into the brain. Coiling, performed since the early 1990s, involves inserting a catheter through an artery in the leg, running it through the body into the brain, and filling in the aneurysm with tiny platinum coils. References: Kothari R, Sauerbeck L, JauchE, et al. Patients’ awareness of stroke signs, symptoms and risk factors. Stroke ;28: Levitt MA, Dawkins R, Williams V, Bullock S. Abbreviated educational session improves cranial computed tomography scan interpretations by emergency phsycians. Ann Emerg Med. 1997;30: Alberts MJ, Bertels C, Dawson DV. An analysis of time of presentation after stroke. JAMA. 1990; 1:65-68. NINDS rt-PA Study Group. Tissue plasminogen activator for acute ischemic stroke. New Eng J Med ;333(24): © 2011 National Stroke Association

23 Reasons for Lack of Treatment
People don’t recognize symptoms 40% of stroke patients can’t name a single sign of stroke or a stroke risk factor 75% of stroke victims misinterpret their symptoms 86% of patients believe that their symptoms aren’t serious enough to seek urgent care Many people don’t recognize stroke symptoms. A 2001 National Stroke Association survey reported that many older Americans could not identify stroke symptoms. A 2009 study revealed that despite numerous national stroke public awareness campaigns, public knowledge of stroke symptoms and risk factors has not improved over the last 5 years. References: National Stroke Association. Survivor Survey Kleindorfer D, Khoury J, et al. Temporal Trends in Public Awareness of Stroke Warning Signs, Risk Factors, and Treatment. Stroke. 2009;40: © 2011 National Stroke Association

24 Delay Increases Potential Disability
People don’t know the urgency Denial–don’t want to believe it’s serious Think nothing can be done Worry about cost Think symptoms will go away Fear or don’t trust hospitals People don’t want their fear of stroke to be confirmed. Stroke is one of the most terrifying medical emergencies, because many people would rather die than be disabled. Yet quick confirmation of stroke is the best way to receive the treatments that are proven to greatly reduce disability after stroke. Of those surveyed, only 40 percent would call immediately if they were having a stroke. Many people worried about the cost of stroke treatment, especially if they do not have health insurance. Studies show that acute treatment is significantly less expensive than the costs of extensive rehabilitation and long-term care. The survey also showed that two-thirds of respondents were unaware of the short time frame in which a person must seek treatment. Waiting to see if symptoms disappear can mean the difference between complete recovery and disability. Fear of hospitals may keep some individuals from calling to get help when they experience stroke symptoms. Those who call immediately when experiencing stroke symptoms are likely to have a much shorter stay in the hospital than those who wait. References: National Stroke Association. Survivor Survey Kleindorfer D, Khoury J, et al. Temporal Trends in Public Awareness of Stroke Warning Signs, Risk Factors, and Treatment. Stroke. 2009;40: © 2011 National Stroke Association

25 Stroke Recovery 10% of stroke survivors recover almost completely
25% recover with minor impairments 40% experience moderate to severe impairments requiring special care 10% require care within either a skilled-care or other long-term care facility 15% die shortly after the stroke There’s still so much we don’t know about how the brain can seemingly repair itself from the functional damage caused by stroke. Some brain cells may be only temporarily damaged and may resume functioning. In some cases, the brain can “relearn” what was lost. Sometimes, a region of the brain “takes over” for a region damaged by the stroke. People who have had a stroke sometimes experience remarkable and unanticipated recoveries that can’t be explained. General recovery guidelines show: 10 percent of stroke survivors recover almost completely. 25 percent recover with minor disabilities. 40 percent experience moderate to severe disabilities requiring special care. 10 percent require care within either a skilled-care or other long-term care facility. 15 percent die shortly after the stroke. Stroke survivors and their families can find workable solutions to most difficult situations by approaching every problem with patience, creativity and tenacity. © 2011 National Stroke Association

26 Types of Stroke Rehabilitation
Physical Therapy (PT) walking, range of movement Occupational Therapy (OT) taking care of yourself Speech Language Therapy communication skills, swallowing, cognition Recreational Therapy cooking, gardening There are different types of Stroke Rehabilitation: Physical Therapy helps restore skills like walking and range of movement. Physical therapy works on improving partial or one-sided paralysis, faulty balance and foot drop. Occupational Therapy involves relearning skills needed for everyday living such as eating, using the bathroom, dressing and taking care of yourself. Speech Language Therapy helps stroke survivors that have problems with aphasia – which is when stroke survivors are able to think clearly but cannot put those thoughts into words. Speech language pathologists can teach the aphasic stroke survivor and caregiver methods for coping with this frustrating condition. Speech therapy also helps stroke survivors cope with memory loss and other “thought” problems caused by stroke. Additionally, speech therapy treats stroke survivors with dysphasia, or swallowing problems, that could result in pneumonia if not appropriately managed. Recreational Therapy involves regaining enjoyable skills and pastimes such as cooking, gardening, sewing and playing cards. These activities also may help stroke survivors regain some lost thinking abilities and physical capabilities. References: National Stroke Association. The Complete Guide to Stroke At: National Stroke Association. National Stroke Association Web site. At: © 2011 National Stroke Association

27 Survivors and Caregivers
Lifestyle Changes for Survivors and Caregivers Daily living skills Dressing and grooming Diet, nutrition and eating difficulties Skin care problems Pain Sexuality/Intimacy Behavior Depression & Anger Emotional Liability One-sided Neglect Memory Loss Communication Problems After stroke, both the stroke survivor and his/her family are often concerned about being on their own at home. Among the common issues are: Behavior: Stroke survivors’ needs vary depending on what area of the brain has been affected. Care-partners need to be aware of the reasons for the stroke survivor’s behavior, without overlooking the possibility that he or she may also be depressed. Depression: Many survivors experience a form of depression after stroke. It can be overwhelming, affecting the spirit and confidence of everyone involved. Family can help by trying to stimulate interest in other people, encouraging leisure activities and providing opportunities to participate in spiritual activities. Chronic depression can be treated with individual counseling, group therapy or antidepressant drugs. Emotional Liability: Sudden laughing or crying for no apparent reason and difficulty controlling emotional responses, known as emotional liability, or Pseudo Bulbar Syndrome, affects many stroke survivors. The “inappropriate” emotional behavior will occur randomly and end as quickly as it started. Neglect: Some stroke survivors neglect the side of their world opposite the side of their stroke brain injury. This may impact their ability to complete some activities. Examples: eating only on one side of a dinner plate or recognizing only one side of a clock. Memory Loss: Also called vascular dementia, memory loss can be so subtle the family may not notice it at first. A stroke survivor may be anxious and cautious, needing a reminder to finish a sentence or follow-through with a behavior. Communication Problems: If a stroke causes damage to the language center in the brain, there will be language difficulties or aphasia. Communication problems are among the most frightening after-effects of stroke for both the survivor and the family, often requiring professional help. References: National Stroke Association. The Complete Guide to Stroke At: National Stroke Association. National Stroke Association Web site. At: © 2011 National Stroke Association

28 Types of Recovery Services
Rehabilitation unit in the hospital In-patient rehabilitation facility Home-bound therapy Home with outpatient therapy Long-term care facility Community-based programs Rehabilitation Unit in Hospital: Many general hospitals now offer a variety of rehabilitation services. These may include acute rehabilitation (comparable to free-standing rehabilitation facilities) and sub-acute or transitional care units (usually a skilled nursing facility is a long-term care facility). In-Patient Rehabilitation Facility: Patients admitted to a rehabilitation hospital must be able to tolerate a minimum of three hours of intensive therapy per day. These hospitals may also offer less intensive programs known as sub-acute rehabilitation units, similar to those in long-term skilled nursing facilities. Home-Bound Therapy: This form of rehabilitation is for patients who cannot leave their homes after discharge from an inpatient setting. A variety of therapies, along with follow-up nursing and social services, may be available. Clinicians can focus on personalized needs and unanticipated concerns for patients in this setting. References: National Stroke Association. The Complete Guide to Stroke At: National Stroke Association. National Stroke Association Web site. At: © 2011 National Stroke Association

29 Can YOU name the Signs of Stroke?
Ask the audience for a show of hands if they remember 3 or more signs of stroke: Numbness or weakness in face, arm or leg, especially on one side of the body Sudden dizziness Sudden loss of vision in one or both eyes Sudden severe headache with no known cause Sudden difficulty walking Sudden confusion or difficulty understanding Slurred speech or trouble speaking People need to train themselves to remember these signs, because when it happens it will be hard to think straight. Remember, stroke is a brain attack.

30 National Stroke Association
1-800-STROKES For more information about stroke or National Stroke Association: Call toll-free at STROKES ( ). Visit

31 American Stroke Association
For more information about stroke, you can also contact the American Stroke Assocation: Call toll-free at STROKE ( ). Visit


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