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Elektroschockdistanzwaffen Taser® X2 und T7. Notf Rett Med 2022. [DOI: 10.1007/s10049-020-00791-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungDie medizinische Beurteilung von Verletzungen und potenzieller todesursächlicher Relevanz einer Stromexposition durch eine Elektroschockdistanzwaffe beschränkt sich nicht allein auf die situativen Gegebenheiten und die morphologische Befunderhebung, sondern beinhaltet auch eine intensive Analyse polizeilicher Ermittlungen und die Auswertung von Zeugenaussagen sowie vorangegangener medizinischer Maßnahmen. Insbesondere bei zeitlich relevanter Nähe zwischen Exposition und Todeseintritt muss die Wirkung der übertragenen Stromimpulse in Zusammenhang mit der meist komplexen Einsatzsituation und der medizinischen Vorgeschichte des Geschädigten beurteilt werden. Ein detailliertes Wissen über die konkrete und auch abstrakte Wirkungsweise, Wirksamkeit und Risiken von Elektroschockdistanzwaffen ist hierfür unabdingbar.
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Barbhaiya CR, Moskowitz C, Duraiswami H, Jankelson L, Knotts RJ, Bernstein S, Park D, Holmes D, Aizer A, Chinitz LA. Inappropriate ICD Shock as a Result of TASER Discharge. JACC Case Rep 2020; 2:1166-1169. [PMID: 34317440 PMCID: PMC8311712 DOI: 10.1016/j.jaccas.2020.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/03/2022]
Abstract
Conducted energy weapon (commonly known as TASER) discharge in patients with implantable cardioverter-defibrillators is known to cause electromagnetic interference and inappropriate ventricular fibrillation sensing without delivery of implantable cardioverter-defibrillators therapy during conducted energy weapon application. We report the first known case of conducted energy weapon discharge resulting in inappropriate implantable cardioverter-defibrillators therapy. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Chirag R Barbhaiya
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Craig Moskowitz
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Harish Duraiswami
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Lior Jankelson
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Robert J Knotts
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Scott Bernstein
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - David Park
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Douglas Holmes
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Larry A Chinitz
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
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Mattei E, Censi F, Calcagnini G. Electrical Stun Gun and Modern Implantable Cardiac Stimulators. HEALTH PHYSICS 2019; 116:18-26. [PMID: 30489364 DOI: 10.1097/hp.0000000000000942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of the study is to investigate systematically the possible interactions between two types of stun guns and last-generation pacemakers and implantable defibrillators. Experimental measurements were performed on pacemakers and implantable defibrillators from five leading manufacturers, considering the effect of stun gun dart positioning, sensing modality, stun gun shock duration, and defibrillation energy level. More than 300 measurements were collected. No damage or permanent malfunction was observed in either pacemakers or implantable defibrillators. During the stun gun shock, most of the pacemakers entered into the noise reversion mode. However, complete inhibition of the pacing activity was also observed in some of the pacemakers and in all the implantable defibrillators. In implantable defibrillators, standard stun gun shock (duration 5 s) caused the detection of a shockable rhythm and the start of a charging cycle. Prolonged stun gun shocks (10-15 s) triggered the inappropriate delivery of defibrillation therapy in all the implantable defibrillators tested. Also in this case, no damage or permanent malfunction was observed. For pacemakers, in most cases, the stun guns caused them either to switch to the noise reversion mode or to exhibit partial or total pacing inhibition. For implantable defibrillators, in all cases, the stun guns triggered a ventricular fibrillation event detection. No risks resulted when the stun gun was used by a person wearing a pacemaker or an implantable defibrillator. This work provides novel and up-to-date evidence useful for the evaluation of risks to pacemaker/implantable defibrillator wearers due to stun guns.
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TASER-Einsatz – ein notfallmedizinisches Problemfeld? Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0544-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kunz SN, Calkins H, Adamec J, Kroll MW. Cardiac and skeletal muscle effects of electrical weapons. Forensic Sci Med Pathol 2018; 14:358-366. [DOI: 10.1007/s12024-018-9997-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
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A comparative brief on conducted electrical weapon safety. Wien Med Wochenschr 2018; 169:185-192. [DOI: 10.1007/s10354-018-0616-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
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Causes and Prevention of Inappropriate Implantable Cardioverter-Defibrillator Shocks. Card Electrophysiol Clin 2017; 10:67-74. [PMID: 29428143 DOI: 10.1016/j.ccep.2017.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Use of implantable cardioverter-defibrillators as a primary prevention therapy has been shown to reduce mortality in patients after cardiac arrest and also with left ventricular systolic dysfunction. Yet, inappropriate shocks are variably reported and associated with a reduction in quality of life. Inappropriate shocks are the result of environmental causes leading to electromagnetic interference and inappropriate sensing of external noise, device-related causes from inappropriate sensing of physiologic or pathologic signals, and supraventricular arrhythmias. Strategies to reduce inappropriate shocks include aggressive treatment of supraventricular tachycardia, changes in device programming including prolonged detection time, programming antitachycardic pacing and using discriminator algorithms, and cardiac rehabilitation.
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Intracardiac electrocardiographic assessment of precordial TASER shocks in human subjects: A pilot study. J Forensic Leg Med 2017; 52:70-74. [PMID: 28866284 DOI: 10.1016/j.jflm.2017.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/06/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Case reports of cardiac arrest in temporal proximity to Conducted Electrical Weapon(CEW) exposure raise legitimate concerns about this as a rare possibility. In this pilot study, we respectfully navigate the oversight and regulatory hurdles and demonstrate the intra-shock electrocardiographic effects of an intentional transcardiac CEW discharge using subcutaneous probes placed directly across the precordium of patients with a previously implanted intracardiac EKG sensing lead. METHODS Adults scheduled to undergo diagnostic EP studies or replacement of an implanted cardiac device were enrolled. Sterile subcutaneous electrodes were placed at the right sternoclavicular junction and the left lower costal margin at the midclavicular line. A standard police issue TASER Model X26 CEW was attached to the subcutaneous electrodes and a 5 s discharge was delivered. Continuous surface and intracardiac EKG monitoring was performed. RESULTS A total of 157 subjects were reviewed for possible inclusion and 21 were interviewed. Among these, 4 subjects agreed and completed the study protocol. All subjects tolerated the 5 s CEW discharge without clinical complications. There were no significant changes in mean heart rate or blood pressure. Interrogation of the devices after CEW discharge revealed no ventricular pacing, dysrhythmias, damage or interference with the implanted devices. CONCLUSIONS In this pilot study, we have successfully navigated the regulatory hurdles and demonstrated the feasibility of performing intracardiac EKG recording during intentional precordial CEW discharges in humans. While no CEW-associated dysrhythmias were noted, the size of this preliminary dataset precludes making conclusions about the risk of such events. Larger studies are warranted and should consider exploring variations of the CEW electrode position in relation to the cardiac silhouette.
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Cardiac Implantable Electric Devices: Indications and Complications. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40138-017-0128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lésions induites par les pistolets à impulsion électrique de type Taser®. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-014-0487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Comeaux JA, Jauchem JR, Cox DD, Crane CC, D'Andrea JA. 40-Hz square-wave stimulation requires less energy to produce muscle contraction: compared with the TASER® X26 conducted energy weapon. J Forensic Sci 2013; 58:1026-31. [PMID: 23682682 DOI: 10.1111/1556-4029.12122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 02/09/2012] [Accepted: 04/29/2012] [Indexed: 11/29/2022]
Abstract
Conducted energy weapons (CEWs) (including the Advanced TASER(®) X26 model produced by TASER International, Inc.) incapacitate individuals by causing muscle contractions. In this study using anesthetized swine, the potential incapacitating effect of primarily monophasic, 19-Hz voltage imposed by the commercial CEW was compared with the effect of voltages imposed by a laboratory device that created 40-Hz square waves. Forces of muscle contraction were measured with the use of strain gauges. Stimulation with 40-Hz square waves required less pulse energy than stimulation with the commercial CEW to produce similar muscle contraction. The square-pulse stimulation, at the higher repetition rate, caused a more complete tetanus at a lower energy. Use of such a simple shape of waveform may be used to make future nonlethal weapon devices more efficient.
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Affiliation(s)
- James A Comeaux
- General Dynamics Information Technology, 3650 Chambers Pass, Fort Sam Houston, TX, USA
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Khaja A, Govindarajan G, McDaniel W, Flaker G. Cardiac safety of conducted electrical devices in pigs and their effect on pacemaker function. Am J Emerg Med 2011; 29:1089-96. [DOI: 10.1016/j.ajem.2010.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 06/09/2010] [Accepted: 07/14/2010] [Indexed: 11/26/2022] Open
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Azadani PN, Tseng ZH, Ermakov S, Marcus GM, Lee BK. Funding source and author affiliation in TASER research are strongly associated with a conclusion of device safety. Am Heart J 2011; 162:533-7. [PMID: 21884872 DOI: 10.1016/j.ahj.2011.05.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 05/21/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Controversy exists regarding the safety of electrical stun guns (TASERs). Much of the research on TASERs is funded by the maker of the device and, therefore, could be biased. We sought to determine if funding source or author affiliation is associated with TASER research conclusions. METHODS MEDLINE was searched for TASER or electrical stun gun to identify relevant studies. All human and animal studies published up to September 01, 2010, were included. Reviews, editorials, letters, and case reports were excluded from the analysis. Two independent reviewers blinded to this study hypothesis evaluated each article with regard to conclusions of TASER safety. RESULTS Fifty studies were reviewed: 32 (64%) were human studies and 18 (36%) were animal studies. Twenty-three (46%) studies were funded by TASER International or written by an author affiliated with the company. Of these, 22 (96%) concluded that TASERs are unlikely harmful (26%) or not harmful (70%). In contrast, of the 22 studies not affiliated with TASER, 15 (55%) concluded that TASERs are unlikely harmful (29%) or not harmful (26%). A study with any affiliation with TASER International had nearly 18 times higher odds to conclude that the TASER is likely safe as compared with studies without such affiliation (odds ratio 17.6, 95% CI 2.1-150.1, P = .001). CONCLUSIONS Studies funded by TASER and/or written by an author affiliated with the company are substantially more likely to conclude that TASERs are safe. Research supported by TASER International may thus be significantly biased in favor of TASER safety.
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Electronic Control Device Exposure: A Review of Morbidity and Mortality. Ann Emerg Med 2011; 58:178-88. [DOI: 10.1016/j.annemergmed.2011.01.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 12/20/2010] [Accepted: 01/28/2011] [Indexed: 11/21/2022]
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Vanga SR, Bommana S, Kroll MW, Swerdlow C, Lakkireddy D. TASER conducted electrical weapons and implanted pacemakers and defibrillators. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2009:3199-204. [PMID: 19964055 DOI: 10.1109/iembs.2009.5333136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Conducted electrical weapons (CEW) have generated controversy in recent years regarding their effect on heart rhythm and on their suspected interaction with implanted devices such as the pacemakers and ICDs (implantable cardioverter defibrillators). We review the current evidence available on device interactions and pre-sent a new case series of 6 patients. LITERATURE We used the available case reports and animal studies on TASER or CEW related publications in PubMed. CONCLUSION Oversensing of TASER CEW discharges may cause noise reversion pacing in pacemakers and inappropriate detection of VF in ICDs. The nominal 5-second discharge is sufficiently short that neither clinically significant inhibition of bradycardia pacing nor inappropriate ICD shocks have been reported. Current evidence indicates that CEW discharges do not have adverse effects on pacemakers and ICDs.
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Biria M, Bommana S, Kroll M, Panescu D, Lakkireddy D. Multi-organ effects of Conducted Electrical Weapons (CEW) -- a review. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:1266-1270. [PMID: 21095915 DOI: 10.1109/iembs.2010.5626415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since the introduction of the Conducted Electrical Weapons (CEW) several studies have been conducted and multiple reports have been published on safety of these devices from a medical point of view. Use of these devices in different situations and reported deaths attracts media attention and causes general anxiety around these devices. These devices have several limitations- such as rate of fire or maximum effective range in comparison to fire arms. Here we wish to review medical publications regarding the safety of these devices based on different systems.
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Affiliation(s)
- Mazda Biria
- University of Kansas Hospital, Kansas City, Kansas, USA
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Robb M, Close B, Furyk J, Aitken P. Review article: Emergency Department implications of the TASER. Emerg Med Australas 2009; 21:250-8. [PMID: 19682009 DOI: 10.1111/j.1742-6723.2009.01194.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The TASER is a conducted electricity device currently being introduced to the Australian and New Zealand police forces as an alternative to firearms in dealing with violent and dangerous individuals. It incapacitates the subject by delivering rapid pulses of electricity causing involuntary muscle contraction and pain. The use of this device might lead to cardiovascular, respiratory, biochemical, obstetric, ocular and traumatic sequelae. This article will summarize the current literature and propose assessment and management recommendations to guide emergency physicians who will be required to review these patients.
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Affiliation(s)
- Megan Robb
- Emergency Department, The Townsville Hospital, Queensland, Australia.
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Taser X26 discharges in swine: ventricular rhythm capture is dependent on discharge vector. ACTA ACUST UNITED AC 2009; 65:1478-85; discussion 1485-7. [PMID: 19077646 DOI: 10.1097/ta.0b013e31818bc17a] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data from our previous studies indicate that Taser X26 stun devices can acutely alter cardiac function in swine. We hypothesized that most transcardiac discharge vectors would capture ventricular rhythm, but that other vectors, not traversing the heart, would fail to capture the ventricular rhythm. METHODS Using an Institutional Animal Care and Use Committee (IACUC) approved protocol, four Yorkshire pigs (25-36 kg) were anesthetized, paralyzed with succinylcholine (2 mg/kg), and then exposed to 10 second discharges from a police-issue Taser X26. For most discharges, the barbed darts were pushed manually into the skin to their full depth (12 mm) and were arranged in either transcardiac (such that a straight line connecting the darts would cross the region of the heart) or non-transcardiac vectors. A total of 11 different vectors and 22 discharge conditions were studied. For each vector, by simply rotating the cartridge 180-degrees in the gun, the primary current-emitting dart was changed and the direction of current flow during the discharge was reversed without physically moving the darts. Echocardiography and electrocardiograms (ECGs) were performed before, during, and after all discharges. p values < 0.05 were considered significant. RESULTS ECGs were unreadable during the discharges because of electrical interference, but echocardiography images clearly demonstrated that ventricular rhythm was captured immediately in 52.5% (31 of 59) of the discharges on the ventral surface of the animal. In each of these cases, capture of the ventricular rhythm with rapid ventricular contractions consistent with ventricular tachycardia (VT) or flutter was seen throughout the discharge. A total of 27 discharges were administered with transcardiac vectors and ventricular capture occurred in 23 of these discharges (85.2% capture rate). A total of 32 non-transcardiac discharges were administered ventrally and capture was seen in only eight of these (25% capture rate). Ventricular fibrillation (VF) was seen with two vectors, both of which were transcardiac. In the remaining animals, VT occurred postdischarge until sinus rhythm was regained spontaneously. CONCLUSIONS For most transcardiac vectors, Taser X26 caused immediate ventricular rhythm capture. This usually reverted spontaneously to sinus rhythm but potentially fatal VF was seen with two vectors. For some non-transcardiac vectors, capture was also seen but with a significantly (p < 0.0001) decreased incidence.
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Walter RJ, Dennis AJ. In Reply. Acad Emerg Med 2008. [DOI: 10.1111/j.1553-2712.2008.00143.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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LINK MARKS, ESTES NAMARK. Cardiac Safety of Electrical Stun Guns: Letting Science and Reason Advance the Debate. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:395-7. [DOI: 10.1111/j.1540-8159.2008.01007.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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