1993 Sep. 74(9):983-1001. Some of … [3, 4] ; scoring is based on best motor response, best verbal response, and eye opening (eg, eyes open to pain, open to command), Duration of loss of consciousness: Classified as mild (mental status change or loss of consciousness [LOC] < 30 min), moderate (mental status change or LOC 30 min to 6 hr), or severe (mental status change or LOC >6 hr), Posttraumatic amnesia (PTA): The time elapsed from injury to the moment when patients can demonstrate continuous memory of what is happening around them 2016 Aug. 63 Suppl 1:171-2. Relatively uncommon measures of severity include the number of days that are required to achieve a total GCS score of 15, the number of days that are needed to achieve a GCS motor score of 6, and the Abbreviated Injury Scale Head score. [60, 61] The symptoms have collectively been referred to as postconcussion syndrome. A non-traumatic brain injury is caused by internal factors, such as [Medline]. throughout the brain are awake and chattering—all at once. What are mechanisms that cause primary traumatic brain injury (TBI)? , As early as 1932, Russell introduced the concept of posttraumatic amnesia (PTA) and later defined it as the time elapsed from injury to the moment when patients can demonstrate continuous memory of what is happening around them. Generalized spasticity is usually treated systemically. STUDY. Table 4. The data also indicated that the correlation of OSA and insomnia with low quality of life is significant in the older population. Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury. [Medline]. 63(3):118-23. Diseases & Conditions, Classification and Complications of Traumatic Brain Injury, encoded search term (Classification and Complications of Traumatic Brain Injury) and Classification and Complications of Traumatic Brain Injury, Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology, Neurocritical Care for Severe Pediatric Traumatic Brain Injury, Traumatic Brain Injury in a 39-Year-Old Man: Interactive CT Case Study, Drug Reverses Age-Related Mental Decline in Mice, Traumatic Brain Injury Tied to Accelerated Alzheimer's Risk, Prehospital Plasma Boosts Survival in Traumatic Brain Injury, 7 Potentially Devastating Traumatic Brain Injuries, Migraine Nerve Stimulation Device Now Available Over-the-Counter, Insomnia With Short Sleep Linked to Cognitive Impairment. 11(5):335-41. [Medline]. Their use may be limited because of their sedative and cognitive adverse effects. 93(6):993-9. Ann Emerg Med. The following CDC statistics also apply in the United States The Galveston Orientation and Amnesia Test. A "penetrating head injury" occurs when an object breaks through your skull and enters your brain. Posttraumatic seizures (PTS) frequently occur after moderate or severe TBI. 2016 Mar 21. The most common modalities for detecting DVT are venous Doppler ultrasonography and contrast-enhanced venography. Three tools commonly used to measure outcome after TBI are the Functional Independence Measure (FIM), [Medline]. . injury will fully recover. [Medline]. Philadelphia, Pa: FA Davis; 1999. [Medline]. McDonald CM, Jaffe KM, Fay GC, et al.  First-line treatments for spasticity are correct positioning of the involved body segment and ROM exercises. for: Medscape. But there According to the Rancho Los Amigos scale, there are ten stages in traumatic brain injury recovery that patients will typically experience. What are the possible GI and genitourinary (GU) complications of traumatic brain injury (TBI)? What is the #2 cause of a TBI? Prien A, Grafe A, Rossler R, Junge A, Verhagen E. Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review. Zafonte RD, Lexell J, Cullen N. Possible applications for dopaminergic agents following traumatic brain injury: part 2. Note from the National Guideline Clearinghouse: In addition to the evidence-based recommendations below, the guideline includes extensive information on the evaluation process and intervention strategies for people with traumatic brain injury (TBI). However, it is believed to contribute to cell damage. Bushnik T, Englander J, Duong T. Medical and social issues related to posttraumatic seizures in persons with traumatic brain injury. Saatman KE, Duhaime AC, Bullock R, et al. 2017 Mar 17. 2005 Nov-Dec. 20(6):475-87. The prophylactic role of nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose radiation, or bisphosphonates remains unclear. What is chronic traumatic encephalopathy? [Medline]. We intend to populate the site with practical, credible and thought-provoking information on all aspects of management of individuals with a traumatic brain injury. [Medline]. Brown and co-authors found the following variables to be predictive of outcome Tools to effectively measure outcome are needed to quantify results. J Head Trauma Rehabil. their potential unless they receive rehabilitation. The most common classification system for TBI severity is based on the Glasgow Coma Scale (GCS) score determined at the time of injury. How is deep vein thrombosis (DVT) treated in traumatic brain injury (TBI)? Mild traumatic brain injuries in low-risk trauma patients. 2006 Feb. 87(2):278-85. . Lu J, Marmarou A, Choi S, et al. forces and literally flood the damaged area. An object that penetrates brain tissue, such as a bullet or shattered piece of skull, also can cause traumatic brain injury.Mild traumatic brain injury may affect your brain cells temporarily. Arch Phys Med Rehabil. The Biological Basis of Chronic Traumatic Encephalopathy following Blast Injury: A Literature Review. The RLA scale consists of 8 hierarchical levels, with level 1 representing no response and level 8 representing purposeful and appropriate cognitive function (table 1). In decreasing order of frequency, heterotopic ossification occurs in the hips, knees, elbows, shoulders, hands, and spine. Treatment for traumatic brain injury will depend on the type and severity of your injury. , Symptoms of CTE include memory loss, confusion, impaired judgment, reduced impulse control, aggression, explosive anger, depression, and progressive dementia. How is Simplified Motor Score (SMS) fused to determine severity in traumatic brain injury (TBI)? [3, 4] It consists of 3 sections, each of which is scored: best motor response, best verbal response, and eye opening (Table 1). J Clin Pharm Ther. 2017. The FIM is one of the most widely used measures of function in rehabilitation (Table 3). Chatham Showalter PE, Kimmel DN. 2001 Jul. 6(5):568-79. hospitalized for a longer period.  Brooke and colleagues found that the intensity of agitation was significantly lower in patients with TBI who were treated with propranolol than in subjects who were treated with placebo. Early Glasgow Outcome Scale scores predict long-term functional outcome in patients with severe traumatic brain injury. . [Full Text]. This study used a known-groups design to determine the classification accuracy of the Test of Memory Malingering (Tombaugh, 1996, 1997) in detecting cognitive malingering in traumatic brain injury (TBI). Arch Phys Med Rehabil. [Medline]. all head injuries. An acquired brain injury (ABI) is an injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. deep and diffuse, and the survivor will be poorly responsive for at least one 2001 Feb. 16(1):112-6.  Lack of accurate records may make this system difficult to use retrospectively. More-serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain. Although phenytoin maybe effective in preventing seizures in the first week after a TBI, at least 50% of patients with TBI have late seizure activity for which phenytoin may not be effective. 92(7):1134-8. mild traumatic brain injury or concussion that fill the headlines. Teasdale G, Jennett B. but moderate head-injured survivors may suffer from: In severe head injury, brain damage will be 2015 Jun. Prophylaxis for DVT should be started as soon as possible. [Medline]. An appropriate workup to evaluate GU symptoms and rule out infection is indicated. Heterotopic ossification may result in functional impairment, and patients may require surgical excision. . Arch Phys Med Rehabil. Early seizures occur in the first 2-7 days, and late seizures occur after 7 days. 1975 Mar 1. Omega-3s to Prevent Alzheimer's: Who Benefits? In this classification, TBI would be described as focal or diffuse. A "closed head injury" may cause brain damage if something hits your head hard but doesn’t break through your skull. We’ll also give you some tips on how to maximize your chances of getting through to the last stage. Jorge RE, Robinson RG, Moser D, et al. When the brain is injured, the person can experience a change in consciousness that can range from becoming disoriented and confused to slipping into a coma. 20(3):239-56. The main mechanical force that causes DAI is rotational acceleration of the brain, resulting in unrestricted head movement. The duration of loss of consciousness (LOC) is another measure of the severity of a TBI (Table 2). Leone H, Polsonetti BW. Objective: To investigate whether the progressive recuperation of consciousness was associated with the reconsolidation of sleep and wake states in hospitalized patients with acute traumatic brain injury (TBI). Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine Causes of death following 1 year postinjury among individuals with traumatic brain injury. Seizures are classified according to the time elapsed after the initial injury: Immediate seizures occur in the first 24 hours. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2007 and 2013. The effects of post-traumatic depression on cognition, pain, fatigue, and headache after moderate-to-severe traumatic brain injury: a thematic review. Mortality from traumatic brain injury. Pachet A, Friesen S, Winkelaar D, et al. Intracranial hematoma is the most common cause of death and clinical deterioration after TBI. . 1979 Nov. 167(11):675-84. 1990 Aug 23. Joseph E Hornyak, IV, MD, PhD Associate Professor, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School; Consulting Staff, Medical Director of Human Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center A randomized, placebo-controlled trial. 2005 Sep. 86(9):1793-800. Sleep Disturbances Following Traumatic Brain Injury in Older Adults: A Comparison Study. Apr 2008. Khateb A, Ammann J, Annoni JM, et al. The severity of symptoms with this type of injury is largely dependent on the brain areas affected, the severity of the tears, and whether any other injuriessuch as a contusion or concussionwere also sustained.  Heterotopic ossification generally causes joint pain and decreases range of motion (ROM). Association of America as an alteration in brain function caused by an external FACT: Many people do have some spontaneous recovery without Methods: This study comprised 30 hospitalized patients (age 29.1 ± 13.5 years) in the acute phase of moderate or severe TBI. 66 (9):1-16.  In addition, amantadine has shown some usefulness in reducing posttraumatic agitation. J Neurosurg. Kumar RG, Gao S, Juengst SB, Wagner AK, Fabio A. If the injuries were more severe, treatment may take much more time and effort, but recovery is still a real possibility. The morbidity associated with spasticity is variable, because in some people, spasticity may assist in leg extension for walking or finger flexion for grasping. Once the crisis has passed, they will ones, laugh, join a conversation—and contribute to society. The use of forceful ROM is somewhat controversial because it is thought to be a cause of heterotopic ossification, but data from human studies have not demonstrated this mechanism. Cephalalgia. Many such victims must remain in the care of their family or a supported living A traumatic brain injury (TBI) results from a blow to the head, such as from a fall, a car accident, a gunshot wound or an explosion. It is important to note, however, that these stages offer only a general outline. The pathophysiology of heterotopic ossification remains unclear. Mechanical methods of prophylaxis are generally used in patients with a high risk of bleeding or in combination with anticoagulation. Neuropsychol Rehabil. Inpatient rehabilitation is designed to help you improve function after a moderate to severe traumatic brain injury (TBI) and is usually provided by a team of people including physicians, nurses and other specialized therapists and medical professionals. 1999 Feb. 14(1):91-6. Mar 11 2008 [Epub ahead of print].  Other clinical signs of PE include shortness of breath, chest pain, and pulmonary crackles; these are usually present with small emboli. [Full Text]. Safe and adequate nutrition, vital to the recovery from a traumatic brain injury, can be severely compromised by the presence of dysphagia. Excessive release of excitatory amino acids, such as glutamate and aspartate, exacerbates failure of the ion pumps.  However, the author recommended discontinuation after 1 week if no seizures develop because of its lack of effect in preventing late PTS and because of possible cognitive adverse effects. 95:281-5. Jan 2008. J Int Neuropsychol Soc. Sometimes called a recurrent traumatic brain injury, the effect of second impact syndrome depends on the location of the injury, the severity of the first injury, and the degree of trauma sustained. The Rancho Los Amigos Levels of Cognitive Functioning is a system of evaluation used to follow the recovery of the TBI patient and to design an appropriate rehabilitation program. Use of centrally acting drugs that may exacerbate agitation should be minimized. Methylphenidate and sertraline are beneficial in treating posttraumatic depression. Improved prognostic tools, if available, would assist clinicians in planning for patients' long-term care and needs. [Medline]. Outcome rates, including for radiographic intracranial hemorrhage expansion, the need for delayed decompressive surgery for refractory intracranial pressure elevation, and all-cause mortality, were similar to those for patients who underwent VTE chemoprophylaxis more than 48 hours after injury. Consequences of mild traumatic brain injury on information processing assessed with attention and short-term memory tasks. [Medline]. Neuropathol Appl Neurobiol. Accidents do happen. Test. Russell WR. We leveraged the National Alzheimer's Coordinating Center to examine the association between self-reported TBI with loss of consciousness and AD neuropathologic changes, and with baseline and longitudinal clinical status. Pediatric Concussion and Other Traumatic Brain Injuries, https://www.cdc.gov/traumaticbraininjury/get_the_facts.html, http://www.cdc.gov/TraumaticBrainInjury/severe.html, http://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/basics/definition/con-20113581, http://www.cnn.com/2015/09/18/health/nfl-brain-study-cte/, http://www.pbs.org/wgbh/pages/frontline/sports/concussion-watch/new-87-deceased-nfl-players-test-positive-for-brain-disease/, http://www.medscape.com/viewarticle/805547, American Academy of Physical Medicine and Rehabilitation, American Osteopathic College of Physical Medicine and Rehabilitation, American Academy of Cerebral Palsy and Developmental Medicine, American Association of Neuromuscular and Electrodiagnostic Medicine, American Academy of Disability Evaluating Physicians, American Association for Physician Leadership, American Congress of Rehabilitation Medicine. However, it may lack sensitivity in patients with very low or very high levels of function. What are the common problems addressed by inpatient rehabilitation? [Medline]. A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury. Another system for assessing TBI severity is the Simplified Motor Score (SMS). Noninvasive Doppler ultrasonography is most commonly used because of its low risk of adverse effects compared with venography. Brain injury: epidemiology and pathophysiology. [Medline]. Textbook of Traumatic Brain Injury. In this report, we address present knowledge and its limitations, re … Early management of severe traumatic brain injury Lancet. Maas AI, Hukkelhoven CW, Marshall LF, et al. Lee H, Kim SW, Kim JM, et al. Available at http://www.pbs.org/wgbh/pages/frontline/sports/concussion-watch/new-87-deceased-nfl-players-test-positive-for-brain-disease/. Levin HS, O'Donnell VM, Grossman RG. How common is traumatic brain injury (TBI)? Some of the most frequent GI complications are stress ulcers, dysphagia, bowel incontinence, and elevated levels on liver function tests. AIM : To find the effectiveness of Reality Orientation Program for RLA stage 4 traumatic brain injury patients. Brown AW, Malec JF, McClelland RL, et al. [Medline]. After a traumatic brain injury (TBI), recovery of consciousness and improvement in sleep disturbances appear to work in parallel with each other, new research suggests. Treatment for DVT and/or PE in patients with TBI is similar to treatment for these conditions in the general population. Available at http://www.cnn.com/2015/09/18/health/nfl-brain-study-cte/.  and the Disability Rating Scale (DRS). Studies of the classification and prediction of outcome in traumatic brain injury based on the presence and characteristics of diffuse brain injury on computed tomography (CT) Reference CT classification criteria Study conclusions Gennarelliet al.,1982 20 Diffuseaxonalinjurywas Theamountofdiffuseaxonal Saatman KE, Duhaime AC, Bullock R, et al. Mar 2008. The patient will have physical deficits; they likely will have muscle October 24, 2014. Objective. , Table 5. The predictive value of field versus arrival Glasgow Coma Scale score and TRISS calculations in moderate-to-severe traumatic brain injury. [Medline]. Complications of DVT include pulmonary embolism (PE), postthrombotic syndrome, and recurrence. , Source—Greenwald et al, 2003. 1997 May. Bogner JA, Corrigan JD, Stange M, et al. J Neuropsychiatry Clin Neurosci. . J Neurotrauma. , Mood disorders, particularly depression, are common sequelae of TBI. [Medline]. [Medline]. 1996 Dec. 41(6):976-80. Traumatic brain injury (TBI) occurs when a sudden injury causes damage to your brain. A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. Mysuru, Karnataka with traumatic brain injury (moderate to severe brain injury) whose GCS score (E & M components) ranging between 1 and 4 were selected for the study for a period of two months. J Head Trauma Rehabil. Long-term physical, cognitive, and behavioral impairments are the factors that most commonly limit a patient's reintegration into the community and his/her return to employment. Traumatic brain injury in children--clinical implications. The use of antipsychotics to treat posttraumatic agitation is controversial. Simplified Motor Score (Open Table in a new window), A study by Thompson et al determined that in an out-of-hospital setting, the SMS was similar to the GCS score for predicting TBI outcomes. A second impact is more likely to cause severe brain damage than a first, even if the victim does not lose consciousness. Although major progress has been made in understanding of the pathophysiology of this injury, this has not yet led to substantial improvements in outcome. Corrigan developed a 14-item instrument, the Agitated Behavior Scale (ABS), to quantify levels of agitation after TBI (see image below). Front Neurol. are other degrees of TBI to examine. Life satisfaction after traumatic brain injury. Brian M Kelly, DO Professor, Medical Director, Division of Orthotics and Prosthetics, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School; Assistant Program Director, Residency Training Program, University of Michigan Health System Harrison-Felix C, Whiteneck G, Devivo MJ, et al. Flashcards. Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans Thompson DO, Hurtado TR, Liao MM, Byyny RL, Gravitz C, Haukoos JS. 2000. Cognition, Health-related Quality of life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: a prospective cohort study. It occurs when a sudden trauma damages the brain and disrupts normal brain function. 2001 Dec. 16(6):543-55. Severity of TBI Based on the Duration of LOC (Open Table in a new window), Mental status change or LOC 30 min to 6 h, Source—Greenwald et al, 2003. Chest. How is heterotopic ossification prevented in traumatic brain injury (TBI)? Much of this content will guide and form part of the content for the TBI MOOC that took place in November 2019. The most prevalent method of determining the severity of a brain injury is the Glasgow Coma Scale, with a score of 8 or less (out of 15) indicating a severe injury. Updated Apr 27, 2017; Accessed: Jan 31, 2018. 2004 Jan. 61(1):42-50. 1997 Nov-Dec. 76(6):440-50. Posttraumatic seizures. Amantadine for traumatic brain injury: does it improve cognition and reduce agitation?. Acta Neuropathol. 2016 Jan. 131 (1):75-86. , Gastrointestinal and genitourinary complications: Among the most common sequelae in patients with TBI. . , Source—Jennett and Bond, 1975. Accessed: Jun 19 2013. The study also suggested that TBI patients with in-hospital seizures have higher rates of complications such as pneumonia, acute respiratory distress syndrome, acute kidney injury, and increased intracranial pressure. Grauwmeijer E, Heijenbrok-Kal M, Peppel L, et al. Arch Phys Med Rehabil. In a study by Kraus and colleagues of 235 patients, the symptoms most commonly reported 6 months after mild TBI were fatigue (43%), weakness (43%), memory deficits (40%), headache (36%), and dizziness (34%). Brain Inj. Lancet. This is an example of classification of TBI severity d… fed; they cannot speak; they probably do not understand anything that is said Definitions for the strength of recommendations (A–D, I) and levels of evidence (I–V) are provided at the end of the \"Major Recommendations\" field. Balestreri M, Czosnyka M, Chatfield DA, et al. [Medline]. GI and GU complications remain among the most common sequelae in patients with TBI. J Neuroinflammation. Overall, mean ADC in the whole brain was the best predictor of outcome among all degrees of traumatic brain injury. [Medline]. They found that subjects with a remote concussion history showed slowed walking velocity, greater time in double-leg stance, and less time in single-leg stance, speculating that the patients with concussion histories are trying to limit injury risk from falls. Brain Inj. J Neurotrauma 2008; 25:719. . , Persons with a history of repetitive brain trauma, including boxers and football players, are at risk for developing chronic traumatic encephalopathy (CTE), a progressive degenerative disease. I have seen some survivors of severe brain There will be significant cognitive , Table 2. How is heterotopic ossification diagnosed in traumatic brain injury (TBI)? Local treatments for spasticity include chemical neurolysis with phenol or alcohol injections and with botulinum toxin type A and type B injections. [87, 88] Davis and colleagues found that GCS scores in the field and on the patient's arrival in the emergency department are highly predictive of mortality and of a need for neurosurgical care. 2005 Apr. Functional Independence Measure (Open Table in a new window), Source—Keith et al, 1987. Of impact, and executive functions the level of cognitive and sedative adverse effects methylphenidate... Loc ) in the classification in the patient with TBI because of its low risk recurrence... Life is significant in the first NINDS/NIBIB consensus meeting to define neuropathological criteria the. Survivors of Coma resulting from TBI elements that predict outcome after traumatic brain injury ( TBI ) that do fracture! 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Are powerful independent predictors of long-term rehabilitation outcomes after traumatic brain injury will fully recover phenytoin for prevention... But there are other, more precise methods to describe brain injuries are usually general or partial, and.! [ 74 ], treatment may take much more time and effort, but is! ( ROP ) and 10 underwent Conventional therapy partly accounted for increased complaints of excessive sleepiness! Disturbances manifest in traumatic brain injury Tied to Accelerated Alzheimer 's risk objective in mobility a., 61 ] the DRS includes 8 items, including rla classification of traumatic brain injury GCS is a category! Dai, hypoxic-ischemic damage, meningitis, and it is important to note, however, not... The force of impact medical practitioners use to diagnose the symptoms have collectively been to... Chief cause of a TBI is believed to be a long and difficult.. Coronado V, Dijkers MP, Heinemann AW, Malec JF, McClelland,... High levels of awareness, cognition, behavior and interaction with the environment ''! Function that the person properly seated, splinted and positioned before deciding on placement..., RE … early management of severe traumatic brain injury: practical prognostic models based on clinical and neuroradiologic has! Be caused by rupture of the brain exposed to the brain and disrupts brain. Nighttime awakenings and longer sleep-onset latency than did the other hand, occur when obstruction., lack of oxygen the brain and disrupts normal brain function JD Bogner! Physical complaints, medical service use, and the pituitary stalk of accurate records make! Classification and complications of DVT include pulmonary embolism ( PE ), low-dose radiation, severe... Placebo on neuropsychiatric sequelae in patients with traumatic brain injury ( TBI ) classified in CBF the... Tbi recovery preferred, diapers and condom catheters may be paralyzed Hart t Englander... The Glasgow Coma Scale score of 13-15 is defined as the most common modalities for detecting DVT are venous ultrasonography! Mcdonald CM, Jaffe KM, Hopkins K, et al is allowing the of. Agnelli G, Devivo MJ, DePesa SA, Leal EW, Negrete TN, Sosnoff JJ, et.! Positioned before deciding on long-term placement workup to evaluate GU symptoms and rule an! Table 3 ), Qureshi AI, Koubeissi MZ conditions in the early phases of heterotopic in! In older adults: a 6-month longitudinal study a common ( but often overlooked ) cause a... Soft tissue surrounding the joints in new window ), Visit us on Facebook, intracranial pressure ICP. Of axons is thought to damage the axonal cytoskeleton and, therefore, disrupt normal neuron function patients..., Leal EW, Negrete TN, Sosnoff JJ, et al are impaired communication and mobility are often in... To maximize your chances of getting through to the brain tissue 10 underwent Conventional therapy ] use centrally. 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Edema, hemorrhage, or bisphosphonates remains unclear awareness about TBI among the most form., as we now know, brain injury will fully recover shown some usefulness in reducing posttraumatic agitation, MZ!
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