PENNSYLVANIA NURSING HOME ABUSE ATTORNEY BLOG
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Preventing hip fractures and increasing the rate of recovery must be a top priority in all nursing homes across the United States. A recent study published in the medical journal JAMA Internal Medicine discusses the survival rates of nursing home residents after having a hip fracture surgery. The study used data from nursing homes and Medicare claims totally roughly 60,000 nursing homes residents who had been hospitalized for a hip fracture during the years of 2005 to 2009. The study’s objective was to get hard evidence on both the mortality rate and the decline in activities of daily living for residents of nursing homes who had received surgery for a hip fracture. The lead author of the study, Dr. Mark D. Neuman, from the Perelman School of Medicine at the University of Pennsylvania reported that six months after surgery one in three patients had died with 28 percent of those who had survived became newly dependent on others for basic care. As a Pennsylvania and New Jersey nursing home injury specialist I am well aware of the dangers of neglect in a nursing home setting. Falls in particular pose a real threat to individuals’ ability to live mobile self-sufficient lives.

The Centers for Disease Control and Prevention estimates that the number of hip fractures will online likely rise as the population continues to age. Approximately 95 percent of all hip fractures occur because of a serious fall normally onto one’s side. At the centennial annual meeting for the Clinical Orthopaedic Society Dr. Erika J. Mitchell addressed the mortality rate and severity of hip fractures in the geriatric population. Dr. Mitchell bringing to light the scope of the problem stated that, “Statistically speaking, up to half of all women will have fragility fractures in their lifetime, and up to a third of all men.” Further stating, “Far more people will have a fragility fracture than will have a heart attack, cancer, or stroke.” Once one fracture occurs the chance of a second fracture within 3 to 5 years is nearly 50 percent.

Preventative Measures:

According to the CDC one in five patients will die within a year of having hip fracture surgery with a large portion of those deaths attributable to complications from the surgery. Pneumonia after a hip fracture can increase the patient’s mortality rate by as much as 43 percent. Osteoporosis is a disease that causes bones to become porous and thus more susceptible to factures after sustaining a fall effects over 10 million people in the United States with another 34 million at risk of the disease. Helping to strengthen your bones into old age can reduce the chance of suffering a hip fracture, but there are other steps as well that both nursing homes and health advocates should take into consideration when working with aging patients.

If you or your loved one takes both prescribed and over the counter medication including supplements inform your doctor of all of your medicines to ensure that no drug interactions are causing dizziness or balance issues. Make nursing home residents eyesight is checked every year as loss of eyesight steady increases with age. Throw rugs and other trip inducing items should be cleared to ensure a path that is free from obstructions. Added guardrails around a tub and toilet can also help reduce instances of falls. Sometimes in nursing homes falls occur because a resident is tired of waiting for assistance often verging on neglect and instead independently tries to go about their daily activities without assistance leading to a severe fall or other injury. Nursing home staff levels play a vital role in the safety and wellbeing of the nursing home residents. When choosing a nursing home facility make sure to look to the staff levels and frequency in staff overturn.
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The American Thoracic Society met for their annual conference where findings from a recent sepsis study was presented. Sepsis infections also known as blood infections can cause whole body inflammation, organ decay, and in some severe cases death. Sepsis is particularly fatal among the elderly and those with weakened immune system such as infants and those with HIV/AIDS. At the annual conference the researchers of a recently published study in the Journal of American Medical Association discussed the deadly effects of sepsis and the increased rate at which emergency departments are seeing patients present with sepsis along other infections. The occurrence of sepsis has been steadily rising with about one of out every 10 patients being treated for sepsis in U.S. hospitals. Even more telling the study found that 52 percent of those who died in a hospital were diagnosed even if sepsis was not the direct cause of the patient’s death. Dr. Vincent Liu, the lead study author indicated that the researchers were surprised at the number of deaths in which sepsis was present. Approximately as many as “1 in 2 patients dying in the US hospitals had sepsis.” Further stating the need for improved care for sepsis patients in order to save many more lives.

Sepsis and the Elderly:

Sepsis deaths have been on the rise according to the U.S. Centers for Disease Control and Prevention. During a ten-year span from 2000 to 2010, the rate of deaths associated with sepsis infections increased 17 percent equating to a death toll of 135,000, an increase from 45,000 deaths. The Mayo Clinic defines sepsis as a “potentially life-threatening complication of an infection.” Sepsis, which is the body’s response to fighting a severe infection often caused by pneumonia, abdominal infection, kidney infection or a bloodstream infection such as bacteremia, can trigger inflammation throughout the body. The inflammation can prove deadly as damage to multiple organ systems can occur, if left to progress sepsis can also cause blood pressure to severely drop which may also lead to death. The longer a patient goes untreated with sepsis the lower the chances of survival. Early treatment is particularly important for those with advanced aging.

It has even been suggested that for those over the age of 65 who contract sepsis the long-term effects may include being susceptible to cognitive impairment. A 2010 study in the Journal of the American Medical Association authored by the lead researcher Theodore J. Iwashyna, MD, PhD, of the University of Michigan Medical School, found that sepsis may have a direct link to 20,000 new cases of dementia among those 65 years or older who contract sepsis each year in the U.S. While there have been advances in the treatment of sepsis prevention among the elderly is vital to their survival and overall quality of life. Vaccinating those with compromised immune systems against the flu and pneumonia is still one of the best practices available.
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Often with aging comes the necessary need of daily medications to help control pain, cholesterol, blood pressure, and other ailments. In nursing homes across Pennsylvania and New Jersey strict maintenance and dispensing procedures of patient medication is key to both the patient’s ailments and survival. In some cases the pain medication has attracted unscrupulous characters that take advantage of elder patients often robbing them for their pain medication. Withholding medication from a nursing home resident can amount to nursing home abuse. Chronic pain is both under treated and a common ailment according to a recent study published by the Archives of Gerontology and Geriatrics. The study made up of 105 nursing home patients with the mean age of 82, living in two separate nursing homes in Torino, Italy, found that chronic pain was wide spread. The study suggests that chronic pain was present in 82.9 percent of the sample of patients studied, and that persistent pain lasting more than 24 months was present in half of the residents. Chronic pain can affect every part of a resident’s daily life. From their mood, nutrition consumption, sleep pattern, and overall quality of life, chronic pain can play a direct role in making a resident’s life enjoyable. That is why instances of prescription theft are particularly disheartening in the nursing home setting.

Many of those who work in nursing homes who steal prescription medication from residents are caught and prosecuted, as was the case for a former nurse at North Muskegon senior care facility in Missouri. Former registered nurse Ruth Ellen Everett unknowingly was under investigation by local police as she worked at Hillcrest Nursing Center in North Muskegon. As reported by MLive News affiliate, Everett was arrested on charges of elder abuse and larceny in connection with stolen morphine from a patient at the senior care facility on Monday, April 28. Unfortunately many residents are unaware that their medication has been tampered with and therefore are unable to press charges. Prescription theft in a nursing home or extended care setting can be slow and steady process leaving the victim often helpless and disoriented or writhing in pain. If you or a loved one is in a nursing home or being cared by another it is important to note what medications the resident has been prescribed. In some instances when a medication is stolen by a care provider the doctor may assume that the medication is not working and change the dosage. In some instances lethargy, weight loss, and anti-social behavior may result. If you are advocating on behalf of a loved one feel free to ask more information regarding medication tracking and rules over who and how medications are doled out in your specific nursing home or special care facility.
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Earlier this month the Social Security Administration adopted new representative payee policies originating from a Philadelphia based pilot program with new screening requirements for all potential representative payees. Representative payees are individuals who collect on the behalf of a disabled individual who is deemed unable to competently manage their own finances and therefore require a legal proxy. The new backgrounds checks disqualifies individuals who have been convicted of one of twelve listed crimes from being able to serve as a payee. The crimes include human trafficking, false imprisonment, rape or sexual assault, first-degree homicide, kidnapping, robbery, multiple forms of fraud, abuse, neglect, forgery, and identify theft. According to the Huffington Post “Bob Casey: Social Security Screening Program Should Be Expanded” January 27, 2013 article, U.S. Senator Bob Casey has been a strong advocate of tougher screening policies for individuals granted representative payees for years. In Pennsylvania and other states such as California and Massachusetts with a significant older adult population, financial elder abuse is a rising area of concern as it impacts an older adult’s overall quality of life. As a Pennsylvania and New Jersey nursing home injury specialist some typical signs of financial abuse may include drastic changes in behavior, weight loss, medical decline due to shortage in medication, and even unusual financial behaviors such as large cash withdrawals, or signing over a piece of property. If you suspect that you or a loved one has suffered financial elder abuse feel free to talk to a Pennsylvania and New Jersey elder abuse specialist today.

The initial pilot representative screening program began this past June in Delaware, Maryland, Virginia, West Virginia, and Pennsylvania. As of this March program has become standard practice for the Social Security Administration. While Senator Bob Casey has been advocating for tougher policies to combat finical abuse of elders and those who are disabled for many years, it was not until a recent horror was discovered of extreme abuse and neglect in Philadelphia that made the topic ripe for action. What has been referred to as the “Philadelphia Dungeon Case” only describes a fraction of the alleged horror that at least six victims were subjected to by those who they thought they could trust. The Philadelphia Police Department discovered the victims in the Tacony section of Philadelphia on October 15, 2011. The accused ringleader Linda Ann Weston and five others were charged with a laundry list of offenses including a federal hate crime involving acts against the disabled. For over a decade the Philadelphia resident allegedly lured children and the disabled into her care, and then imprisoned and drugged her victims for their Social Security checks.
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The death of 94-year-old nursing home resident Irene Sansone has left her loved ones with may questions, primarily was it an avoidable tragedy? In August 2013, Irene Sansone was admitted to the Golden Living Center in Waynesburg, a small borough in Greene County, Pennsylvania, about 60 miles outside of Pittsburgh. For over 7 months Ms. Sansone was a resident at the nursing home until her death on the evening of February 22, 2014. It has been reported by the Pittsburgh Post-Gazette that during the night in question Ms. Sansone may have attempted to get out of bed and in the process her head became lodged between the mattress and the bed rail. Ms. Sansone’s torso fell to the ground trapping her body in the bedrail and mattress, ultimately making it so that Ms. Sansone was unable to free herself. According to the Greene County coroner’s office, Irene Sansone died as a result of “accidental asphyxiation.” While accidental asphyxiation was the official cause of death, Ms. Sansone’s niece and caretaker, Stephanie Jupina, strongly believes that the tragic accident could have been avoided with proper supervision. Ms. Jupina stated, “I think this is a serious case of neglect.” In such instances when you have a loved one seriously injured or killed while in a nursing home, and there are lingering doubts, it may be advisable to speak with an experienced Pennsylvania and New Jersey nursing home injury specialist.

Golden Living Center in their past yearly inspection had fewer minimal harm deficiencies than the state average. With the nagging feeling lingering Ms. Jupina scheduled a meeting with administrators from Golden Living Center the following day. The executive director of the Golden Living Center, Jackie Hainer, stated that the nursing home has 24-hour staff on site, with 106 employees, some full-time, many part-time, including what they call, “casual employees.” With ample staff coverage, Ms. Jupina questions who was the last staff member to check on her Aunt, and what was the nursing home’s policy for checking on nursing home residents throughout the night? Golden Living Center declined to comment citing privacy restrictions of the Health Insurance Portability and Accountability Act. If you are considering admission to a nursing home, especially if the resident is advanced in age or disabled, knowing the nursing home’s night policy and use of bed alarms can be the difference between life and death.
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The Department of Health and Human Services’ Office of the Inspector General (“OIG”) released the March 2014 edition of Compendium of Priority Recommendations, (“Compendium“) which for the first time addressed the need for reform in nursing home care. The Office of the Inspector General is required under the Inspector General Act of 1978, to report to Congress problems, abuses, and deficiencies, which still need to be addressed, as well as the duties listed in the Consolidated Appropriations Act of 2014 which requires the reporting of the top 25 unimplemented recommendations that best protect the integrity of the Health and Human Services programs. It is common for OIG recommendations to require legislative, regulatory, or administrative action to become policy. Even Congressional appeal can be required, especially if financial backing is necessary to implement the new ideals. As I have reported before when it comes to elder abuse tracking the problem can be one of the biggest challenges. That is why as a nursing home injury specialist I was pleased to see the latest Compendium specifically addressing “Medicare Quality of Care and Safety Issues.” Three areas of concern were included in the Compendium regarding nursing home reform, (1) improving quality of care plans and discharge procedures in nursing homes, (2) decreasing preventable harm and hospitalization of nursing home residents, and (3) improve emergency response and preparedness in nursing homes. While these recommendations may be incorporated in future elder abuse studies and possibly help to reform elder abuse rights, for many the help can come too late. If you or a loved one were seriously injured, neglected, or abused as a resident in a nursing home in Pennsylvania or New Jersey, our dedicated team of nursing home injury specialists may be able to help you get the compensation you deserve.

Improve Care Plans Improve Nursing Home Safety

Of the three proposed areas of nursing home reform, I found the quality of care plans and oversight to be of particular importance as it spells out the individualized plan of care that the resident is to receive. A care plan can assist in tracking any significant changes of the resident, including their mental, physical, and emotional health. The individualized care plan is also important as it details what kind of medication and what level of supervision the resident needs. For instance, a person who has dementia will need different care from someone who is bedridden, yet without proper supervision both resident’s health could greatly suffer. Insufficient care plans are also costly to both the government and private nursing homes. The Compendium report found that Medicare paid approximately $5.1 billion in 2009 for stays in which the nursing home did not meet quality-of-care requirements. Oversight for care plans and implementation is also an area that needs to be focused and addressed on a state and federal level according to the report. Nearly 37 percent of nursing home care plans do not meet federal requirements and the report also found that services were not provided as specified by the care plans. Increased oversight alone has a tremendous opportunity to help decrease instances of low quality of care in nursing homes. To read more about the areas for improvement and suggestions in long term care by the Office of the Inspector General read the latest issue of the March 2014 edition of Compendium of Priority Recommendations.
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On Thursday March 7, 2014 the members of the newly formed Pennsylvania Long-Term Care Commission, along with the Secretary of Public Welfare and the Secretary of Aging, met for the first time to begin developing long-term fiscally responsible recommendations for the current Pennsylvania long-term care health care system. By executive order Governor Tom Corbett on January 31, 2014 established a 25 person commission with the goal to “ensure the system and its services are person-centered, efficient, effective, and fiscally accountable.” According to Secretary of Public Welfare Beverly Mackereth, Pennsylvania spends an estimated $4.7 billion each year on Medicaid long-term care services. As the demands of the aging Pennsylvanian population is expected to grow so to will the cost of the long-term care services. As a nursing home injury specialist I am hesitantly hopeful that true change will be initiated on a state level.

The need for long-term care is inevitable with one of four citizens expected to be over the age of 60 by 2015. Governor Tom Corbett established the commission as part of the Healthy Pennsylvania plan that helps to ensure affordable quality health care. One of the more serious and common injuries sustained by nursing home residents are falls. In 2000, the cost of all fall injuries in the United States for people 65 and older exceeded $19 billion. It seems that if Pennsylvania wants to lower the cost of Medicaid long-term care services then we must invest in proper staffing in all long-term care facilities as well as training to reduce preventable injuries such as falls. While a fall to a young health individual may only require time to heal and a little rest, a fall sustained by an older American can be severe and costly.

The cost of a fall increases rapidly with age. According to a 2005 study entitled “The acute medical care costs of fall-related injuries among U.S. older adults,” the average cost for hospitalization for a fall injury was about $17,500. In nursing home setting falls are often caused by lack of supervision, unrevised fall risk plans, medications that causes dizziness or lack of coordination, and understaffing. Traumatic head injuries, hip fractures, and broken bones caused by a fall can require extensive care and hospitalization and can even be fatal. A long-term care patient may have to undergo surgery, take pain medication, and have physical therapy when released, all of which can lead to a loss in their quality of life. As mobility and independence tend to go hand in hand it is common to see residents who after suffering a severe fall suffer bouts of depression as their daily routines become interrupted. By the end of the year the Long-Term Care Commission will submit their recommendations to the Governor, hopefully plans to lower the rate of preventable injuries will be among the suggestions.
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Earlier last week, nursing home advocates took to the Oklahoma governor’s office in hopes of initiating desperately needed nursing home reform talks. Of particular importance a meaty Oklahoma nursing home reform Bill, which sought to address many elder abuse and neglect concerns, was defeated last month. As a Pennsylvania and New Jersey nursing home abuse attorney I was interesting in a proposed Oklahoma House Bill 2901 much of which was geared towards supplementing elder care resources as a means of preventing nursing home abuse and neglect. House Bill 2901 was tailored to increase nursing home staff, create medical director oversight, and other measures. The House Bill did not make it to committee, but it did help shed light on staggering cases of elder abuse that on average is greatly underreported. The Oklahoma based grassroots long-term care reform organization, A Perfect Cause, estimates that more than 3,500 nursing home residents in Oklahoma die each year from nursing home abuse and neglect. The House Bill 2901 would have address preventable deaths and injuries in two separate areas of interest, mandated increased nursing staff, and the state required investigation of family members and the accused, while investigating elder abuse claims. As reported by Oklahoma’s Own News 9, there were disagreements in the language and content of the bill, but lawmakers look optimistically to the next session in which to work out their disagreements. Wes Bledsoe, an advocate for nursing home reform, and President and Co-Founder of A Perfect Cause, estimates that about 62,000 cases of nursing abuse goes unreported nationwide. Underreporting is one of the many hurdles in addressing nursing home abuse and elder abuse on both a state and federal level.

Nursing home abuse reform has remained in Oklahoma’s legislature since the December 2012, disturbing nursing home abuse that was caught on tape. A hidden camera in 96-year-old Eryetha Mayberry’s nursing home room exposed the devastating abuse she was being subjected to on a daily basis by members of the nursing staff. Mayberry suffered from dementia, which requires greater care and more supervision as the patient’s capacities diminish. Dementia patients are particularly vulnerable to unscrupulous residents and staff members in nursing homes that take advantage of a patient, knowing full well that their victim will not be able to fully recall the transgressions. Mayberry’s daughter, Earlene Adkisson, installed the camera after she believed items were disappearing from her mother’s room. The extreme instances of abuse caught on camera including rough handling, choking, blocking the resident’s airways and more, totally shocked and horrified Mayberry’s family. The reported images left many questioning whether “granny cams” or monitoring devices were needed to keep themselves and their loved one’s safe. Oklahoma lawmakers say they have seen a rise in proposed legislation for the installation and monitoring of cameras in common areas of nursing homes. However, informed consent for monitoring in nursing homes is a complicated legal terrain, as you have to balance the general welfare of the residents and the individual resident’s right to privacy. Many opponents strongly believe that the safer alternative is to add more quality staff to help ease the burden of daily care.
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When a family makes the decision to transition a loved one into a nursing home it can be an overwhelming and understandably emotional experience. The daily care, safety, and overall wellbeing of your loved one are being placed in the hands of another. It is a duty that many nursing home staffs and facilities pride themselves in excelling in. U.S. News & World Report has released their sixth annual data and ratings results of nearly every nursing home in the United States. The search tools and valuable information within the detailed U.S. News database can help make choosing a nursing home a better, quicker, safer, more informed experience. The user-friendly search tools gives a multi-layer approach in finding a suitable nursing home that meets the needs for you or a loved one. It is estimated that over 3 million Americans live in approximately 16,000 nursing homes throughout the United States. That number is expected to only increase as the nation’s older adult population continues to steadily climb. Much of the raw data relied on by U.S. News in rating nursing homes comes from Nursing Home Compare, the federal database detailing every Medicare and Medicaid certified nursing home in the country. You can search by state, region, city, or zip code, or by a numerical star rating of 1 to 5. The 2014, ratings of 1,893 nursing homes in Pennsylvania indicate that 702 nursing homes, about 25 percent, earned a five-star rating, while less than 5 percent of Pennsylvania nursing homes earned a one-star rating.

Distilling the ratings:

There are three key areas that the overall ratings correlate to, the nursing home’s individual ratings of their (1) state-conducted health inspections, (2) sufficient nursing staff and, (3) the quality medical care measures. As a nursing home injury specialist with practices in both Pennsylvania and New Jersey, when looking at a nursing home’s overall rating, I place particular importance on a nursing home’s nursing staff rating. The nurse staff rating relates to the average number of hours per day of care received per resident from nurses and physical therapists. A nursing home with a low rating for nursing staff raises concerns as understaffing is the leading cause of neglect and abuse in nursing homes and long care facilities. When a nursing home is inadequately staffed the required daily care to stave off fatal infections, pressure sores, devastating falls, and to meet the minimal quality of care required by both federal and state regulation, is often found lacking. Sufficient staffing is a critical component in running a safe, clean, well managed nursing home, so much so that all nursing homes participating in Medicare are required to meet specified requirements of the Federal Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987. Specifically facilities are legally required to have “sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.” Therefore, when narrowing down the choices of a nursing home facility remember to pay close attention to the nursing home’s staff rating, as this singular component can have life-altering effects.
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I have spoken extensively about nursing home arbitration clauses often placed within nursing home admission papers. An arbitration clause has the power to dictate which causes of action can go before a jury and which must go through arbitration, a more discrete out of public view dispute resolution option. Arbitration agreements are construed according to contract law, requiring a valid offer, acceptance, and consideration. The recent case brought before the Pennsylvania Court of Common Pleas, Tyler v. Kindred Healthcare Operating, the court overturned the defendant’s preliminary objections to plaintiff’s wrongful death and survival complaint. The court held that the meeting of the minds could not be established when the decedent signed her admission papers for admittance into Kindred Healthcare nursing home. Further finding that the decedent’s daughter was also unable to act as the decedent’s power of attorney as the decedent had not given away any rights nor did the decedent authorize any family member to make any legal decisions on her behalf.

In Tyler v. Kindred Healthcare Operating, plaintiff Avenia Tyler brought a wrongful death and survival action against two nursing homes, Kindred Healthcare Operating, Inc. (“Kindred”), and St. Francis County House (“St. Francis”). Plaintiff alleged that decedent Ruth McNear, had developed necrosis, advanced pressure sores on her right lower extremity, and a second fracture to her right femur which required surgery. Plaintiff further stated that Ruth McNear had passed away due to complications from the second leg fracture and subsequent surgery. At the time decedent’s death, McNear was in complete control and care of defendants. When proper care is taken bedsores should not be present in residents of nursing homes. Part of care plans for residents that have limited mobility is a reposition of the resident approximately every 2 hours. If repositioning continues to be overlooked or ignored, often as a means to save limited time in understaffed facilities, a resident can suffer bedsores, urinary tract infection, and even a wrongful death. As part of the Federal Nursing Home Reform Act of 1987, all nursing homes that receive federal funding are required to have “sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.” Bedsores are the most common form of negligent care given in nursing homes. It takes time and pressure for a bedsore to begin to form and even more time for the pressure wound to become infected.

Ultimately the court held that the arbitration clause could not be enforced as the decedent was not competent at the time of signing and therefore there was no meeting of the minds when the contract was executed. Medical records note at the time of signature decedent was disoriented and her thoughts were cloudy. While a resident at the nursing homes, nurses noted that decedent was both confused and impaired. St. Francis the second nursing home for the deceased Ruth McNear wanted to enforce the arbitration clause despite the late McNear state of confusion. The court held that the decedent’s daughter could not act as her mother’s agent simply because there is a familial relationship. Instead, the court held that the decedent would have had to given Lynette, her daughter power of attorney or at the very least the authority to make legal decisions on her late mother’s behalf. Accordingly, the court held in favor for the plaintiff finding that the survival action could not be severed from the wrongful death action.
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