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Zúnica-García S, Moya-Cuenca C, Gracia-Sánchez A, García-Cremades S, Chicharro-Luna E. Influence of blistering lesions on foot functionality in hikers. J Tissue Viability 2023; 32:395-400. [PMID: 37258334 DOI: 10.1016/j.jtv.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Friction blisters are formed by abrasion from frictional forces on the upper layer of the epidermis and can make physical activity an uncomfortable experience. To our knowledge, no previous studies have considered how these injuries affect the functionality of the foot. For this reason, the main aim of this study was to evaluate foot function in hikers, with or without blisters. MATERIAL AND METHODS This case-control study examined 298 hikers who walked the Camino de Santiago long-distance trail (in northern Spain); 207 had one or more blistering foot lesions and 91 had no blisters. Sociodemographic and clinical variables were collected, and the number of blisters and their locations on the foot were recorded. All participants self-completed the Foot Function Index (FFI) questionnaire, in their native language. RESULTS Pain and disability were significantly greater among the hikers with blisters (pain p=<0.001; disability p = 0.015). However, there were no significant differences in the limitation of physical activity between those with blisters (case group) and the control group (p = 0.144). Neither was there any correlation between the number of blisters and pain, disability or limitation of activity. However, the location of the lesion did influence foot functionality. Blisters on the metatarsal heads were more limiting and caused greater pain (right foot p = 0.009; left foot p = 0.017), greater disability (right foot p = 0.005; left foot p = 0.005), greater limitation of activity (on right foot p = 0.012) and more loss of foot functionality (right foot p = 0.002; left foot p = 0.007). CONCLUSION The hikers with blisters experienced reduced foot functionality in terms of pain and disability. The number of blisters was not related to foot functionality. Blisters located on the metatarsal heads caused the greatest increase in pain, disability and limitation of activity.
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Affiliation(s)
- Sara Zúnica-García
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
| | - Coral Moya-Cuenca
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
| | - Alba Gracia-Sánchez
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
| | | | - Esther Chicharro-Luna
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
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Environmental Influences on Patient Presentations: Considerations for Research and Evaluation at Mass-Gathering Events. Prehosp Disaster Med 2019; 34:552-556. [DOI: 10.1017/s1049023x19004813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAim:This paper discusses the need for consistency in mass-gathering research and evaluation from an environmental reporting perspective.Background:Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A minimum data set (MDS) has been proposed to standardize collection of biomedical data across various mass gatherings, and there is a need for an environmental component. The environmental domain includes factors such as the nature of the event, availability of drugs or alcohol, venue characteristics, and meteorological factors.Method:This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing MDS as a framework.Results:In total, 39 manuscripts were identified that met the inclusion criteria.Conclusion:In collecting environmental data from mass gatherings, there must be an agreed-upon MDS. A set of variables can be used to collect de-identified environmental variables for the purpose of making comparisons across societies for mass-gathering events (MGEs).
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Procter E, Brugger H, Burtscher M. Accidental hypothermia in recreational activities in the mountains: A narrative review. Scand J Med Sci Sports 2018; 28:2464-2472. [PMID: 30203539 DOI: 10.1111/sms.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 01/16/2023]
Abstract
The popularity of recreational activities in the mountains worldwide has led to an increase in the total number of persons exposed to cold and extreme environments through recreation. There is little conclusive evidence about the risk of hypothermia for specific activities or populations, nor is it clear which activities are represented in the literature. This is a non-systematic review of accidental hypothermia in different recreational activities in the mountains, with a specific focus on outdoor or winter activities that potentially involve cold exposure. Cases of hypothermia have been reported in the literature in mountaineering, trekking, hiking, skiing, activities performed in the backcountry, ultra-endurance events, and databases from search and rescue services that include various types of recreation. Of these activities, hypothermia as a primary illness occurs most commonly during mountaineering in the highest elevation areas in the world and during recreation practiced in more northern or remote areas. Hypothermia in skiers, snowboarders, and glacier-based activities is most often associated with accidents occurring off-piste or in the backcountry (crevasse, avalanche). Organizers of outdoor events also have a role in reducing the incidence of hypothermia through medical screening and other preparedness measures. More complete collection and reporting of data on mild hypothermia and temperature measurement would improve our understanding of the incidence of hypothermia in outdoor recreation in future.
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Affiliation(s)
- Emily Procter
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen/Bolzano, Italy
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine and Mountain Medicine, Innsbruck, Austria
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Laskowski-Jones L, Caudell MJ, Hawkins SC, Jones LJ, Dymond CA, Cushing T, Gupta S, Young DS, Starling JM, Bounds R. Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions. Emerg Med J 2017; 34:680-685. [PMID: 28784607 DOI: 10.1136/emermed-2017-206695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/28/2017] [Accepted: 06/04/2017] [Indexed: 11/03/2022]
Abstract
Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources.
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Affiliation(s)
- Linda Laskowski-Jones
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware, USA
| | - Michael J Caudell
- Augusta University Medical College of Georgia, Center of Operational Medicine, Augusta, Georgia, USA
| | - Seth C Hawkins
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Lawrence J Jones
- Appalachian Center for Wilderness Medicine, Morganton, North Carolina, USA
| | - Chelsea A Dymond
- University of Queensland Ochsner Clinical Foundation New Orleans, Los Angeles, California, USA
| | - Tracy Cushing
- University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Sanjey Gupta
- Long Island Jewish Medical Center, Emergency Medicine, New Hyde Park, New York, USA
| | - David S Young
- Rush University Medical Center, Chicago, Illinois, USA
| | - Jennifer M Starling
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Richard Bounds
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware, USA
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Miller RT, Barth BE. Health Supply Utilization at a Boy Scout Summer Camp: An Evaluation for Improvement and Preparedness. Wilderness Environ Med 2016; 27:482-491. [PMID: 27818116 DOI: 10.1016/j.wem.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 08/06/2016] [Accepted: 09/03/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the health conditions treated by a health services center at a Boy Scout summer camp and make recommendations for appropriate resources and supplies. METHODS We conducted a retrospective review of health center utilization at a Boy Scout camp in central Missouri during the summers of 2012 and 2013. Health logbook data were compiled and analyzed using descriptive and comparative statistics. RESULTS During the study period 19,771 camp participants made 1586 visits to the health care center. The overall incidence rate of health center visits was 6.20 visits per 1000 camp days. Two-thirds of visits were for illness and the remainder for injury. Over 90% of patients were returned to camp, 7.3% were transferred to another health facility, and 1.6% were advised to leave camp and return home. The most common treatments were rehydration (17.8 %) and administration of analgesics (13.4%) and topical creams (12.3%). CONCLUSIONS Summer camps need to be prepared for a wide range of conditions and injuries in youth campers, leaders, and staff members. Over 90% of presenting complaints were managed on site, and the majority of conditions were easily treatable minor injuries and illnesses. We provide recommendations for appropriate medical supplies and suggest opportunities for improvement to aid health centers in planning and treatment.
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Affiliation(s)
- Ross T Miller
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS.
| | - Bradley E Barth
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS
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Counseling for the Wilderness Athlete and Adventurer During a Preparticipation Evaluation for Preparation, Safety, and Injury Prevention. Wilderness Environ Med 2015; 26:S92-7. [PMID: 26617383 DOI: 10.1016/j.wem.2015.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Wilderness sports and adventures continue to increase in popularity. Counseling is an essential element of the preparticipation evaluation (PPE) for athletes in traditional sports. This approach can be applied to and augmented for the wilderness athlete and adventurer. The authors reviewed the literature on counseling during PPEs and gathered expert opinion from medical professionals who perform such PPEs for wilderness sports enthusiasts. The objective was to present findings of this review and make recommendations on the counseling component of a wilderness sports/adventure PPE. The counseling component of a PPE for wilderness sports/adventures should take place after a basic medical evaluation, and include a discussion on sport or activity-specific injury prevention, personal health, travel recommendations, and emergency event planning. Counseling should be individualized and thorough, and involve shared decision making. This should take place early enough to allow ample time for the athlete or adventurer to further prepare as needed based on the recommendations. Resources may be recommended for individuals desiring more information on selected topics.
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Counseling for the Wilderness Athlete and Adventurer During a Preparticipation Evaluation for Preparation, Safety, and Injury Prevention. Clin J Sport Med 2015; 25:456-60. [PMID: 26340739 DOI: 10.1097/jsm.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Wilderness sports and adventures continue to increase in popularity. Counseling is an essential element of the preparticipation evaluation (PPE) for athletes in traditional sports. This approach can be applied to and augmented for the wilderness athlete and adventurer. The authors reviewed the literature on counseling during PPEs and gathered expert opinion from medical professionals who perform such PPEs for wilderness sports enthusiasts. The objective was to present findings of this review and make recommendations on the counseling component of a wilderness sports/adventure PPE. The counseling component of a PPE for wilderness sports/adventures should take place after a basic medical evaluation, and include a discussion on sport or activity-specific injury prevention, personal health, travel recommendations, and emergency event planning. Counseling should be individualized and thorough, and involve shared decision making. This should take place early enough to allow ample time for the athlete or adventurer to further prepare as needed based on the recommendations. Resources may be recommended for individuals desiring more information on selected topics.
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Hoffman MD, Rogers IR, Joslin J, Asplund CA, Roberts WO, Levine BD. Managing collapsed or seriously ill participants of ultra-endurance events in remote environments. Sports Med 2015; 45:201-12. [PMID: 25326844 DOI: 10.1007/s40279-014-0270-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Increasing participation in ultramarathons and other ultra-endurance events amplifies the potential for serious medical issues during and immediately following these competitions. Since these events are often located in remote settings where access may be extremely limited; the diagnostic capabilities, treatment options, and expectations of medical care may differ from those of urban events. This work outlines a process for assessment and treatment of athletes presenting for medical attention in remote environments, with a focus on potentially serious conditions such as major trauma, acute coronary syndrome, exertional heat stroke, hypothermia, hypoglycemia, exercise-associated hyponatremic encephalopathy, severe dehydration, altitude illness, envenomation, anaphylaxis, and bronchospasm. A list of suggested medical supplies is provided and discussed. But, given that diagnostic and treatment options may be extremely limited in remote settings, it is important for medical providers to understand how to assess and manage the most common serious medical issues with limited resources, and to be prepared to make presumptive diagnoses when necessary.
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Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA,
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Lund A, Turris SA, McDonald R, Lewis K. On-Site Management of Medical Encounters During Obstacle Adventure Course Participation. Curr Sports Med Rep 2015; 14:182-90. [DOI: 10.1249/jsr.0000000000000161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Greenberg MR, Kim PH, Duprey RT, Jayant DA, Steinweg BH, Preiss BR, Barr GC. Unique obstacle race injuries at an extreme sports event: a case series. Ann Emerg Med 2013; 63:361-6. [PMID: 24239287 DOI: 10.1016/j.annemergmed.2013.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/22/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022]
Abstract
Obstacle course endurance events are becoming more common. Appropriate preparedness for the volume and unique types of injury patterns, as well as the effect on public health these events may cause, has yet to be reported in emergency literature. We describe 5 patients who presented with diverse injuries to illustrate the variety of injuries sustained in this competitive event. In particular, 4 of the patients had a history of contact with electrical discharge, an obstacle distinctive to the Tough Mudder experience.
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Affiliation(s)
- Marna Rayl Greenberg
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA.
| | - Pamela H Kim
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA
| | - Robert T Duprey
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA
| | - Deepak A Jayant
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA
| | - Brent H Steinweg
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA
| | - Benjamin R Preiss
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA
| | - Gavin C Barr
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA
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Chang WH, Chang KS, Huang CS, Huang MY, Chien DK, Tsai CH. Mass Gathering Emergency Medicine: A Review of the Taiwan Experience of Long-distance Swimming Across Sun-Moon Lake. INT J GERONTOL 2010. [DOI: 10.1016/s1873-9598(10)70025-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Thackway S, Churches T, Fizzell J, Muscatello D, Armstrong P. Should cities hosting mass gatherings invest in public health surveillance and planning? Reflections from a decade of mass gatherings in Sydney, Australia. BMC Public Health 2009; 9:324. [PMID: 19735577 PMCID: PMC2754454 DOI: 10.1186/1471-2458-9-324] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 09/08/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mass gatherings have been defined by the World Health Organisation as "events attended by a sufficient number of people to strain the planning and response resources of a community, state or nation". This paper explores the public health response to mass gatherings in Sydney, the factors that influenced the extent of deployment of resources and the utility of planning for mass gatherings as a preparedness exercise for other health emergencies. DISCUSSION Not all mass gatherings of people require enhanced surveillance and additional response. The main drivers of extensive public health planning for mass gatherings reflect geographical spread, number of international visitors, event duration and political and religious considerations. In these instances, the implementation of a formal risk assessment prior to the event with ongoing daily review is important in identifying public health hazards.Developing and utilising event-specific surveillance to provide early-warning systems that address the specific risks identified through the risk assessment process are essential. The extent to which additional resources are required will vary and depend on the current level of surveillance infrastructure.Planning the public health response is the third step in preparing for mass gatherings. If the existing public health workforce has been regularly trained in emergency response procedures then far less effort and resources will be needed to prepare for each mass gathering event. The use of formal emergency management structures and co-location of surveillance and planning operational teams during events facilitates timely communication and action. SUMMARY One-off mass gathering events can provide a catalyst for innovation and engagement and result in opportunities for ongoing public health planning, training and surveillance enhancements that outlasted each event.
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Affiliation(s)
- Sarah Thackway
- NSW Department of Health, Locked Mail Bag 961, North Sydney NSW 2059, Australia.
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Abstract
BACKGROUND National parks are popular travel destinations worldwide. Unfortunately, negative health experiences can and do occur during travel in national parks. This study investigated search and rescue (SAR) trends associated with recreational travel in US National Park Service (NPS) units. METHODS A retrospective study was conducted of the Annual US National Park Service Search and Rescue Report for the years 2003 to 2006. RESULTS From 2003 to 2006, there were 12,337 SAR operations involving 15,537 visitors. The total operational costs were US$16,552,053. The operations ended with 522 fatalities, 4,860 ill or injured visitors, and 2,855 saves. Almost half (40%) of the operations occurred on Saturday and Sunday, and visitors aged 20 to 29 years were involved in 23% of the incidents. Males accounted for 66.3% of the visitors requiring SAR assistance. Day hiking, motorized boating, swimming, overnight hiking, and nonmotorized boating were the participant activities resulting in the most SAR operations. The vast majority of visitors requiring SAR assistance were located within a 24-hour period, and the most common rescue environments were mountain areas between 1,524 and 4,572 m, lakes, rivers, oceans, and coastal areas. An error in judgment, fatigue and physical conditions, and insufficient equipment, clothing, and experience were the most common contributing factors. CONCLUSIONS SAR incidents can be expensive and end with severe health consequences. NPS management should develop education and preventive efforts focused on hikers, boaters, and swimmers who are males and aged 20 to 29 years, addressing issues of adequate judgment, preparation, and experience.
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Affiliation(s)
- Travis W Heggie
- Recreation & Tourism Studies Program, University of North Dakota, Grand Forks, ND 58202, USA.
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Schöffl VR, Kuepper T. Injuries at the 2005 World Championships in Rock Climbing. Wilderness Environ Med 2006; 17:187-90. [PMID: 17078315 DOI: 10.1580/pr26-05] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the injury risk associated with indoor rock climbing competition. METHODS All injuries reported to medical personnel at the 2005 World Championships in Rock Climbing were recorded and analyzed. RESULTS Four hundred forty-three climbers (273 men, 170 women) from 55 countries participated in 3 separate disciplines totaling 520 climbing days. Only 4 of 18 acute medical problems that were treated were significant injuries, resulting in an injury rate of 3.1 per 1000 hours. CONCLUSIONS Indoor rock climbing competition has a low injury risk and a very good safety profile.
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