Upper Peninsula Diabetes Outreac by fjzhangxiaoquan


									   Upper Peninsula Diabetes Outreach Network

          UPDON                        (906) 228-9203
220 West Washington, Suite 340       (906) 228-4421 Fax
     Marquette, MI 49855         www.diabetesinmichigan.org
            The Upper Peninsula
             Outreach Network

  Strengthening diabetes care & prevention
       in our communities since 1986

  Our mission:
      To promote innovative partnerships to strengthen
  the prevention, detection and management of diabetes
  across the Upper Peninsula of Michigan.

“Ontonagon had the highest amputation rate in the U.P. and no diabetes services,
until UPDON intervened. They helped to get a diabetes self-management
program established, and we also started a support group. Recently, one of my
patients said, ‘Before you got here, there was no one in this county that people
with diabetes could go to obtain information on how to take better care of their
diabetes.’ ”

                                       - Winnie Huron, RN, CDE
                                         Diabetes Educator
                                         Aspirus Ontonagon Hospital
                    UP Diabetes Outreach Network
                                   Quick Facts

We Accomplish Our Mission By

  •   Improving access to care, services and supplies.
  •   Helping health care professionals stay up-to-date on diabetes care through
      educational and independent study programs.
  •   Raising public awareness of diabetes through community programs and events.
  •   Providing tools and expert assistance to measure outcomes, analyze data, and
      assess the quality of diabetes care.
  •   Helping to develop and assist diabetes self-management programs, chronic care
      management in primary care and diabetes support groups.

We Have a Proven Record of Success

  •   Patients of Home Care agencies we worked with from 1986 to 1991 showed:
             45% lower hospitalization rate
             31% lower amputation rate
             27% lower mortality rate
             Estimated $28 million saved in direct hospitalization care

  •   All of Diabetes Outreach Networks (MDON) recognized as a Best Practice
      Initiative in 2002 by the U.S. Dept of Health and Human Services because:
               Blood glucose control of people with diabetes in MDON quality
               improvement project dropped by almost 2%.
               Rates of diabetes tests and exams improved.
               Strong regional networks, quality improvement project and aggressive
               collaboration with managed care, advocacy groups, state certified
               diabetes programs, health insurers and many others were noted as keys
               to MDON success.

We Continue to Work

  •   Between 1994 and 2000 data shows:
            The number of people with diabetes in Michigan increased by 32% (31%
            in the UP)
            Diabetes Death rate declined 15.7% statewide (17.8% in the UP)
            Diabetes-related hospitalizations increased by 36% in Michigan but only
            15% in the UP.
            In the year 2000, the UP diabetes related hospitalization rate was 13%
            below state average.
            That saved the UP: 4261 hospital days and $4,687,482 in hospital
                             U. P. Diabetes Outreach Network

Grant Awarded for the formation the U.P. Diabetes Outreach Network,
to focus on the higher morbidity rates due to diabetes in the U.P., as
compared to the rest of the state.

                                                        UPDON begins

                                                                            1989 - 1990
By 1989 the UP mortality rates due to diabetes have dropped and are
lower than the rest of the state. UPDON participant hospitalization rate
is 45% lower than for non-participants.

          Program Delivery Award presented by the Association of
          State and Territorial Chronic Disease Program Directors & the
          National Center for Chronic Disease Prevention and Health
          Promotion Centers for Disease Control. The award is for
          developing and implementing a program based on sound
          epidemiologic and evaluation data that shows significant
          impact in reducing the chronic disease burden.

   UPDON model is expanded throughout the state of Michigan,
   creating 5 more regional Diabetes Outreach Networks and the birth of
   the Michigan Diabetes Outreach Network (MDON)

        MDON is recognized by the U.S. Department of Health and
        Human Services as a Best Practice Initiative and specifically
        highlighted for helping to make improvements in diabetes care
        and outcomes in such a short time.

                 MDON highlighted as a Promising Practice in Chronic
                 Disease Prevention and Control. It is noted to be “an
                 integral part of quality diabetes care throughout the
                 state” of Michigan.

   UPDON receives the Good News Award, in recognition of work that
   affirms positive values and uplifts the human spirit from the
   Evangelical Lutheran, Presbyterian, United Methodist, Episcopal and
   Catholic Churches, for it’s work on the “Diabetes Hero” video. This
   video highlights 5 people in the UP who are living well with diabetes.
“UPDON has been involved in the creation and management of MCAC’s programs.
UPDON is interwoven into both the fabric of my agency, and into the healthcare
community of the Upper Peninsula. Developing that connectedness over many
years is a substantial investment.”
            ~ Melissa White, Executive Director, Medical Care Access Coalition, Marquette

        “In of all impressed the how creative they are at initiating new
“I am mostorder to improve withhealth of employees and control health and
innovative ways to accomplish their mission. UPDON is always open to suggestions
        related costs, Mead Westvaco has initiated numerous wellness
        programs that include activities, education, screening and history of success
and quick to respond to whatever question is asked. They have athe
        the Upper Peninsula and have earned the UPDON able to continue
here in development of personal fitness programs.right to be has been a great to be a
very efficient and effective initiator of services that would not be available in this
        asset to our programs.”
                            ~ remote area of Michigan.”
expansive, highly rural and Anne Stein, Health Services Supervisor, MeadWestvaco
                                            ~ Michael Lovelace, Marquette County Sheriff
       “Thanks to UPDON, we have created effective working relationships
       across the entire UP which synergistically serve those impacted by
       diabetes.”         ~Jim Brogan, President and CEO of Portage Health
"UPDON has been THE DRIVING FORCE behind advancing the chronic disease
       UPDON has of the valuable partner in the work to support the
model for the patientsbeen aUpper Peninsula. Without their support and needs
       of those have every reason those who are at risk for developing
encouragement I with Diabetes andto believe that we would still be using a
       diabetes in the in the Peninsula.”
model of care developed Upper 1950's. UPDON has been a catalyst for
              ~Beth Waitrovich, MSU Extension
change and improved care for patients with diabetes in our region."
                                                       Dr. Larry Skendzel, U.P. Physician
       “There are many other ways UPDON touches our programs on a
       daily basis that are too numerous to mention here.”
       ~Rick Hav
“UPDON has been a valuable partner in the work to support the needs of those with 
Diabetes and those who are at risk for developing diabetes in the Upper Peninsula.”
                                                       ~Beth Waitrovich, MSU Extension

“In order to improve the health of employees and control health related costs,
New Page has initiated numerous wellness programs that include activities,
education, screening and the development of personal fitness programs.
UPDON has been a great asset to our programs.”
                                     ~ Anne Stein, Health Services Supervisor, New Page
“There are many ways UPDON touches our programs on a daily basis that
are too numerous to mention here.”
                                           ~Rick Haverkate, Michigan Inter-Tribal Council

“UPDON has been instrumental in helping us monitor and improve care that
people with diabetes receive at Portage Health - first with scannable forms and
now with the Chronic Disease Electronic Management System. These tools have
been critical in helping us provide ongoing chronic care management to people
with diabetes.”
      ~Carol Grafford, RD, CDE, former Diabetes Education Coordinator for Portage Health

“UPDON has worked extensively with the U.P. Area Agency on Aging to ensure that
seniors have the care and services they need. UPDON was also instrumental in
getting the Personal Action Toward Health (PATH) program started in the UP, and
we are working together to expand it across the UP ”
                                             ~Tonya LaFave, U.P. Area Agency on Aging

“On a personal note, I have been getting my test strips free since turning 65, because 
of information I gained, and a contact I made at a Diabetes Expo, using Medicare 
and my other insurance.  Because I test 6 to 8 times a day, this is a considerable 
savings for me.”  
          ~ Karen Johnson, UPDON Advisory Council Member, person living with diabetes

In both the medical and non-medical community, UPDON is a highly respected
organization. UPDON was developed locally and is a highly successful and cost
effective program that reaches out to all residents of Upper Michigan. UPDON is
committed to the rural and remote regions of the Upper Peninsula in a manner
unmatched by any other organization.”
                                       ~Elmer Moisio, PhD, RN, Professor Emeritus, NMU
Key Recommendations From the UPDON Strategic Plan

          Consumer Empowerment/Education – helping people with diabetes
          take responsibility for their health and providing them with additional
          opportunities, which support them in making lifestyle changes.

          Health Care Delivery System – working to ensure that all persons
          with diabetes have equal access to the minimum clinical practice
          recommendations set by the American Diabetes Association. Also
          included are the financial concerns people experience in paying for
          health care, which prevent them from accessing care.

          Funding Issues – making certain that cost-effective diabetes
          prevention, detection, and treatment strategies will be funded and
          health care costs in the U.P. will be reduced. This includes keeping
          legislators informed about and involved with setting policies to reduce
          the burden of diabetes.

          Lifestyle and culture – striving to help Upper Peninsula residents eat
          a more healthful diet and move more to achieve and/or maintain a
          desirable weight and reduce their risk of developing diabetes and its
          related complications.

       Diabetes detection, treatment, and prevention strategies, which are
evidence-based, exist. However, they have not been universally implemented.
In addition, physical and financial barriers prohibit some from receiving
appropriate care. To stop this epidemic, which is costing billions of dollars and
causing untold human suffering, we have to act now, and we have to engage
multiple levels of intervention. Not taking prompt and broad-sweeping action will
lead to an even larger financial and physical burden which will further cripple our
health care system and society.
    The Upper Peninsula
     Outreach Network

      Projects and Partnerships

I know of no more encouraging fact than
the unquestioned ability of a man to elevate
his life by conscious endeavor.
                  - Henry David Thoreau
                             UP Diabetes Outreach Network
                               Projects and Partnerships
                    Help for YOUTH & YOUNG ADULTS with Diabetes

Sharing With Insulin-using Mentors (SWIM)
  • Purpose: Match youth with type 1 diabetes to adults with type 1 diabetes; enhance health
      behaviors and health outcomes for youth.

   •   Partners: Big Brothers/Big Sisters of Marquette and Alger Counties, Marquette General
       Health System and Bell Memorial Hospital.

   •   Four youth with type 1 diabetes have been matched with adults with type 1 diabetes.

   •   “I knew that my Little Sister was not really taking care of herself and kind of rebelling against
       the diabetes. I have been there. Since our time together she seems to have a much better
       attitude about the diabetes & even told me that she was glad she had diabetes instead of
       some other disease because ‘with diabetes you can actually have control over it & not the
       other way around.’ ”                                                           Kelly Z, Big Sister

Camp for Youth with Diabetes (Camp UPeninsulin)
  • The American Diabetes Association discontinued the U.P. camp in 1993. After nearly a
     decade of no camp for kids with diabetes in the Upper Peninsula of Michigan and many
     complaints from parents, school nurses and diabetes educators, UPDON initiated a 2-day
     family camp in 2002. Health care professionals from across the U.P. helped make it happen.

   •   Supported by fundraisers and private donations, camp is now overseen by a committee and
       has evolved into a five-day, youth only camp.

   •   “Since we live in a small community, it gives our son a chance to be with other children who
       have diabetes. He doesn’t feel so alone having this condition.”
                                                                        ~Michelle, mother of a camper

Help for U.P. College Students
   • This program was developed in coordination with some U.P. hospitals to assist U.P. college
      students with diabetes who are under or uninsured.

   •   “I appreciated all the help with getting the supplies for my pump and for testing. It definitely
       helped financially. I could concentrate on school and not have to worry about getting
       diabetes supplies.”                                                  Samantha, LSSU student

                       Youth and Young Adult Programs
                                 2006 - 2008

                                Keweenaw +
          Houghton +
     Ontonagon +                                    Alger +
*                                     *                           Luce +
                                Marquette   +                       *         Chippewa
                                                Delta +
                   Dickinson +
                                                              Schoolcraft +

                                  Diabetes Assistance Program for

                         *        U.P. College Students offered

                                  Diabetes Assistance Program for U.P.

                         *        College Students- enrolled students

                                  Kids Camp Attendees
                                  +Volunteer medical support staff

                                  SWIM (Sharing With
                                  Insulin-Using Mentors)
                            UP Diabetes Outreach Network
                              Projects and Partnerships
                                Help for Adults with Diabetes

Personal Action Toward Health (PATH)
   • A Chronic Disease Self-management Program developed by Stanford University and
     designed to be facilitated by 2 trained lay leaders. The project has been shown to help
     people with chronic conditions feel better and use hospital services less often.

   •   UPDON has offered four leader trainings, one each in Marquette, Escanaba, Houghton and
       Sault Ste. Marie. The Sault Ste. Marie class trained leaders from tribes across the state of

   •   Four people in the UP are trained as “Master Trainers”, people who will train more lay

   •   Since the beginning in February 2007, 20 classes serving 231 people in Alger, Marquette,
       Houghton and Delta counties have been offered by UPDON and our partners.

   •   “Having been diagnosed with Type 2 diabetes fairly recently, I have found the PATH classes
       invaluable in helping me learn to deal with the daily ups and downs of a chronic illness. From
       simple relaxation techniques to the value of exercise and good eating to end-of-life planning, I
       have learned a great deal about a great many things. There’s a great therapeutic value to
       PATH classes as well, in that all attending have similar conditions and share common
       problems and solutions with the group. I am deeply grateful to the Diabetes Outreach
       Network for providing this type of program.”            ~Linda, Munising PATH graduate 06/08

Other Programs for Adults
   • UPDON has also helped pilot other programs like Move More Yoopers, which matched adults
      who wanted to be more active with mentors.
   • UPDON has helped train diabetes support group leaders and has acted as a resource for
      these groups.
   • UPDON facilitated an annual Diabetes Expo with free health screenings in collaboration with
      a Senior Health & Leisure Expo for 10 years. Approximately 2000 people attended the event
      each year. Volunteer diabetes educators and other healthcare professionals helped make
      the event successful.

                          Personal Action Towards Health


      Ontonagon                  Marquette*+-



                              + PATH classes held
                              - PATH class scheduled
                              *Trained leaders

                              Leader training held

                              Classes in coordination with Wisconsin agencies

                              Tribal PATH Leaders

                               UP Diabetes Outreach Network
                                 Projects and Partnerships
                                     Professional Education

Professional Continuing Education
   • We have helped develop and update 8 on-line continuing education programs for nurses and
      dietitians. These programs include:

                           Basic Nutrition and Diabetes
                           Diabetes, Genetics & Genomics
                           Diabetes and Kidney Disease
                           Diabetes and Tobacco Use
                           Foot Care and Diabetes
                           Gestational Diabetes Mellitus
                           Type 1 Diabetes
                           Type 2 Diabetes in Adults

   •   In coordination with the UP Telehealth Network, we provide monthly video-teleconferencing of
       Continuing Education programs for health care professionals on various aspects of diabetes

   •   In 2000, the first year of video-teleconferencing, 14 programs with an average of 24
       participants occurred.

   •   In 2002, a revised schedule offered only 9 total programs but saw an average of 31 attendees
       per program.

   •   In January of 2006, a videotape program was introduced as an alternative for those unable to
       attend the scheduled video-teleconference. This addition resulted in an average of 47 people
       receiving continuing education credits through the video-teleconference program.

   •   UPDON is working with Marquette General Health System and the Midwest Alliance for
       Health Education to offer web-based educational programs.


“The educational opportunities that UPDON provides to all educators in the UP and
the State of Michigan are tremendous. They have developed a network of monthly
continuing education opportunities on a videoconference system that allows us, as
educators, to keep on top of the latest changes and care that directly impact our
patient care while not losing many hours of travel time that can be spent with our
                           ~ Lynn Kihm, Diabetes Educator, Helen Newberry Joy Hospital
                                 Professional Education
                                       2000 - 2009

          Houghton          ●●
●                      Baraga         ●    ●                        Luce
                                                                                     ●     ●
    Gogebic                       Marquette           ●               ●
                     Iron                          Alger                        Chippewa
                        ●                                            Mackinac
                                               Delta       ●                     ●
                  Dickinson                    ●

                                          ● Menominee

                            ●     Video-teleconference sites

                                  On-Site Professional Education

                                  Video-teleconference video tape viewers
                            UP Diabetes Outreach Network
                                Projects and Partnerships
              Professional Collaborations for Health Care System Change

Monitoring & Improving Diabetes Care
  • Until 2006 UPDON had a scannable form used with a variety of agencies to help them
      monitor and improve diabetes care. Individually and collectively we saw improvements in
      care and outcomes for people with diabetes. Of special note, UPDON has been nationally
      recognized for helping to improve diabetes care and outcomes.

Chronic Disease Electronic Management System (CDEMS)
  • We brought in the managers of this system, which was designed for the state of Washington,
     to do an informational meeting.

   •   With technical assistance from UPDON, Marquette General Health System started using this
       tool in their largest family care practice.

   •   MGHS has expanded use of CDEMS to 5 other clinics.

   •   Over 1200 patients with diabetes are in the system.

   •   The use of CDEMS helped FamilyCare Doctors achieve NCQA (National Committee for
       Quality Assurance) Diabetes Recognition status.

   •   Several other health systems have instituted CDEMS.

Strengthening Diabetes Care
   • In UPDON continues to explore how we can help healthcare systems strengthen diabetes
      care and outcomes.

                         Professional Collaborations
                        For Healthcare System Change
                                  2006 - 2009


                              Marquette                               Chippewa
Gogebic          Iron                      Alger



                         Strengthening Diabetes Care

                          Advisory Council Members

                             UP Diabetes Outreach Network
                                 Projects and Partnerships
                                  Sample Community Initiatives

Lifestyle Change Initiatives

   •   Convenience Store Project – UPDON facilitated a campaign to improve offerings of healthy
       foods in convenience stores including identification of healthy items, addition of healthy items
       and promotion. Project was funded through a grant from the Active Living Task Force of
       Marquette County.

   •   Get Moving UP – Since 2003, UPDON has helped the Wellness Council of the U.P. promote
       and recruit participants for the annual Get Moving UP, a team-based incentive program
       designed to get people active 30 minutes most days of the week.

   •   Eat 5 – a month-long promotion of the Eat 5 program was promoted to U.P. diabetes support
       groups and diabetes educators by UPDON.

School Initiatives
  • Helping schools form Wellness Teams.

   •   Assisting U.P. schools with the completion of the Healthy School Assessment Tool (HSAT)
       and identifying action plans to provide healthful environments for youth.

   • Providing assistance to secure grants to facilitate changes needed as identified by the
       Wellness Team.

                        Sample Community Initiatives
                                2003 - 2009


  Houghton           *
                   Baraga                                          Luce
                             Marquette                                            *
                 Iron                                Schoolcraft     *     Chippewa

                 Dickinson               *

                               Convenience Store Project

                               Get Moving UP (all 15 counties were involved)

                    *          Eat 5

   Diabetes Resource Guide &
  Assistance By County Sheets
       Do people with diabetes that you know or work with

                        need extra help with their diabetes?

                     The U.P. Diabetes Outreach Network

       has a resource guide and a listing of assistance

                    available by counties on-line to help!

     For information about diabetes education, support groups,

 pharmaceutical help, & a host of other helpful resources go to


                                Click on the map of the U.P.

               and then choose “U.P Wide Resource Directory”

                     or “Assistance Available in U.P. Counties.”

UPDON                                                            Phone: 906 228-9203
220 W. Washington, Suite 340                                     Fax: 906 228-4421
Marquette, MI 49855                                              Email: updon@diabetesinmichigan.org
                                   Diabetes is always serious!
The Upper Peninsula
 Outreach Network

    Awards and Publications

With regard to excellence, it is not enough
to know but we must try to have and use it.
                              - Aristotle
    “First of the Best”
    Best Practices Initiative Fact Sheet
•   Michigan’s Diabetes Outreach Network has been cited by the
    United States Department of Health and Human Services as a
    national “Best Practices Initiative” for its community collaboration

•   Department of Health and Human Services Assistant Secretary of
    Health recognizes the impact of the statewide Diabetes Outreach
    Network in spreading information, establishing cooperative
    programs, and strengthening the management of diabetes in
    Michigan residents.

•   Upper Peninsula Diabetes Outreach Network was the first program
    of its kind in the state. After ten years, the initial success of
    UPDON’s efforts in the reduction of diabetes related amputations,
    hospitalizations, and mortality resulted in the establishment of 5
    additional Diabetes Outreach Networks in Michigan.

•   Michigan Diabetes Outreach Network’s practices and collaborations
    are being disseminated by the federal department to other health
    agencies across the nation.

•   Ann Constance, UPDON Director, gives credit to the many health
    care providers in health departments, home health agencies, state
    certified diabetes self-management programs, Veteran’s
    Administration health system, clinics, hospitals, and tribal health
    centers for their patient care and collaboration with the network

Diabetes & Exercise Safety; By Lisa Flood, MSN, RN, CS and Ann Constance,
MA, RD, CDE. AJN, June 2002, Vol. 102, No. 6.

       Changes in glucose levels and the risk of foot injuries are two of the many concerns of
people with diabetes as they embark upon an exercise program. But with proper assessment
and instruction, they can exercise safely.

MPA and MDON – Partnering for Diabetes Outreach; By Karl Widak, R.Ph. and
Sandra Parker, RD, CDE. Michigan Pharmacist, November/December 2002,
Vol.40, No. 6.

       November is National Diabetes Month and the Michigan Pharmacists Association and
the Michigan Diabetes Outreach Network have partnered to bring important diabetes
information to the MPA membership.

The Role of Michigan Schools in Promoting Healthy Weight, A Consensus Paper.
Michigan Department of Education, Office of School Excellence, September
Ann Constance, UPDON, was a member of the Healthy Weight Advisory Group
       The purpose of the paper is to provide practical guidelines and policy recommendations
to school districts for promoting healthy weight for all students.

Community Based Screening for Diabetes in Michigan; Bahman Tabael, MPH,
Ray Burke, MA, Ann Constance, MA, RD, CDE et. al. Diabetes Care, March
2003, Volume 26, Number 3.
       Community screening for diabetes conducted according to ADA recommendations was
extremely inefficient at identifying individuals with undiagnosed diabetes. The ADA diabetes-
screening questionnaire resulted in many false positive tests, and the ADA criteria for positive
plasma glucose tests likely missed a substantial portion of individuals with undiagnosed
diabetes. Relying on biochemical tests such as random plasma glucose, changing the criteria
for a positive plasma glucose test, targeting racial and ethnic minority groups, and targeting
medically underserved individuals might improve the yield of community-based diabetes
MDON: A Network of Community Partnerships; Ann Constance, RD, MA, CDE
et. al. Family & Community Health, Vol. 25, #3, October 2002.

       This model for strengthening diabetes care in communities teams the public health
system with the professional lay community to address prevention, early detection, and
treatment of diabetes. This article describes how the Michigan Diabetes Outreach Network
(MDON) develops local, regional, and statewide partnerships to increase professional and
public knowledge and to improve care delivery for this chronic and complex disease.
 The Upper Peninsula
  Outreach Network


Use what talents you possess: the woods
would be very silent if no birds sang there
except those that sang best.
                         - Henry Van Dyke
                  U.P. Diabetes Outreach Network

                        Ann Constance, MA, RD, CDE
                        UPDON Director
                        Ann holds a bachelor degree in Nutrition and a master
                        degree in Exercise Physiology from Michigan State
                         University. She is also a Registered Dietitian and a
                        Certified Diabetes Educator. Ann started with UPDON in
                        1992, first as a Special Projects Coordinator and since
                        1997, the director. Ann has also worked in a variety
                        of settings from clinical dietetics to therapeutic
                        recreation and cardiac rehab. She has also
                        worked as a seminar leader and has conducted
                        workshops across the country. Ann is also a
                        trained PATH leader as well as a Master Trainer.

Paula Ackerman, MS, RD, CDE
UPDON Diabetes Educator
Paula is a master degree prepared Registered
dietitian and Certified Diabetes Educator. Paula
received her bachelor degree from Central Michi-
gan University and her master degree was
earned at Rush University in Chicago. Paula has
also worked as a clinical dietitian and has been a
health department based health educator. In
addition to working for UPDON Paula coordinates
a diabetes self-management program in
Munising. Paula volunteers many hours to the
local school system and is a trained PATH leader.
                     U.P. Diabetes Outreach Network

                       Kay Bammert, BS
                       UPDON Office Manager
                       Kay comes to UPDON with personal business
                       experience. Prior to joining UPDON, Kay was the
                       owner and operator of Little Steps Daycare. She
                       holds a bachelor of science degree in Health
                       Education with a minor in social welfare from Northern
                       Michigan University. Kay also has worked as a
                       substitute teacher, day camp director and secretary.
                       An active volunteer with the local school system, Kay
                       is also a trained PATH leader.

Janet Harry, BS
UPDON Community Programs
Janet brings to UPDON years of experience and expertise
working with a variety of groups and individuals from her
many years employed in the Marquette County Friend of the
Court office. Janet’s gentle yet encouraging attitude are a
tremendous asset to UPDON. Janet is active in the commu-
nity through yoga, a knitting club, cycling and a book club.

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