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AAYFL Coaches Clinic 2014

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Title: AAYFL Coaches Clinic 2014


1
AAYFL Coaches Clinic 2014
  • Houston Methodist Orthopedics and Sports Medicine
  • July 23rd, 2014

2
Who we are
  • The only facility in Northwest Houston with the
    expertise to care for all the needs of the
    athlete of any age
  • Primary Care Sports Medicine
  • Sports Orthopedic Surgery
  • On site x-ray
  • Physical therapy
  • Outpatient Surgery
  • All in one place

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Houston Methodist Orthopedics Sports Medicine
3
Agenda
  • Emergency Action Plans and First aid kit
  • Common injury principles in young athletes
  • Common injuries in collision sports
  • Concussion recognition and management and neck
    injuries
  • Heat, hydration and Nutrition
  • Pearls for coaches from our coach for keeping
    kids safe and motivated.

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Houston Methodist Orthopedics Sports Medicine
4
Emergency Action Plans
  • A written document that details what actions are
    done by whom in the case of an emergency
  • Applies to medical emergencies, environmental
    emergencies and anything else you want
  • Lets everyone know who does what
  • Common in many organizations
  • Schools, large companies and any other
    organization where groups of people gather

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Activating Emergency Action Plan
  • Know who is going to call the ambulance
  • What do they need to say
  • Who is bringing the first aid kit
  • Who will direct the ambulance to the field
  • Who is going to take care of the other athletes

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Calling the ambulance
  • Identify yourself
  • Know your exact location
  • Know the age of the athlete and the type of
    injury
  • Know the status of the athlete
  • Conscious
  • Breathing
  • Bleeding

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Calling the ambulance
  • Know the best approach to the field
  • Answer all the questions from the dispatcher
  • Dont hang up until the dispatcher does
  • Have someone designated to meet the ambulance

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Caring for the downed athlete
  • Remain calm
  • If there is any concern for a spine injury, leave
    the athlete on the ground with the helmet on
  • Support the head
  • Apply direct pressure to any bleeding areas
  • If the athlete is unresponsive, assess need for
    CPR and attach AED

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Houston Methodist Orthopedics Sports Medicine
9
Practice Emergency Drills
  • Schedule a drill prior to the season
  • Plan a scenario for the drill
  • Critique the staffs response, duties actions
  • Obtain support and guidance from your local EMS

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Summary
  • Emergency Action Plans Save Lives
  • Use common sense and remain calm
  • Dont do more than you should
  • Practice your plan!

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Houston Methodist Orthopedics Sports Medicine
11
First aid Equipment and Supplies
12
Equipment and Supplies Available at Practices and
Games for trainer or Paramedic
  • Splints
  • Crutches
  • Bandages
  • Automated Defibrillator

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13
First Aid Kit Supplies
  • Think about what you need to treat common
    injuries
  • Remember personal protection
  • Latex or nitrile gloves
  • Antiseptic towels
  • Hand sanitizer
  • Breathing barrier
  • See the list in your handout.

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First aid kit supplies
  • Antiseptic wipes (BZK-based wipes preferred
    alcohol-based OK)
  • Antibacterial ointment (e.g., bacitracin)
  • Assorted adhesive bandages (fabric preferred)
  • Butterfly bandages/adhesive wound-closure strips
  • Gauze pads (various sizes)
  • Nonstick sterile pads
  • Medical adhesive tape (10-yd. roll, min. 1"
    width)
  • Blister treatment (e.g., Moleskin, 2nd Skin,
    Glacier Gel)
  • Ibuprofen/other pain-relief medication
  • Insect-sting relief treatment (e.g., AfterBite)
  • Antihistamine to treat allergic reactions
  • Splinter (fine-point) tweezers
  • Safety pins

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Houston Methodist Orthopedics Sports Medicine
15
Injury recognition in youth sports overview
Bruce Moseley, M.D.
16
Objectives
  • Discuss how kids are different
  • Describe some common injuries
  • Discuss Treatment principles
  • Return to play criteria for common injuries

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Kids are different!!!
  • Bones are pliable
  • Every bone has a growth plate
  • Growing bones are susceptible to injuries.
  • Ligaments commonly stronger than bones
  • Immature brains heal slower than mature brains
  • Kids dissipate heat more slowly

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Bones Grow from the Ends
  • Growth plates at the wrist and ankles are most
    commonly injured
  • Every bone has a growth plate
  • Point tenderness near the end of the bone raises
    concern for bone injury

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Injury Treatment Principles
  • Rest
  • Immobilize anything that hurts at the end of a
    bone
  • Ice
  • First 2 days for most any injury
  • Compression
  • Ace wrap
  • Elevation
  • Higher than the heart.

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Definitions
  • Fracture break
  • Open fracture break in the skin
  • Closed fracture no break in the skin
  • Strain
  • Small muscle tear or tear where muscle turns to
    tendon
  • Sprain
  • Ligament (holds joints together) stretched or
    torn

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Injury Evaluation
  • History
  • Be able to describe what happened
  • Simple descriptions
  • Hit in knee, heard a pop
  • Tackled and hit back of head on ground
  • How bad was the injury initially?
  • Able to walk off the field
  • Pain with bearing weight
  • Any previous injury like this

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Injury Evaluation
  • Inspection
  • Begins immediately after an injury
  • Limping
  • Holding injured body part
  • Bleeding
  • Deformed arm / leg

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Injury Evaluation
  • Palpation
  • Gently
  • Tender over a bone or joint
  • Is there any deformity
  • Blood flow
  • Capillary refill
  • Run back the Kickoff
  • Numb or tingling

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Injury Evaluation
  • Functional testing
  • Pain is a defense that protects the body
  • DO NOT disregard a players complaint of pain.
  • Compare strength and range of motion with the
    uninjured side.
  • IF the 2 sides are different, err on the side of
    caution and dont return to play until seen by
    physician or symptoms clear

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Injury Evaluation
  • Lower extremity injuries
  • To return to play
  • Bear weight without pain
  • Walk without a limp
  • Duck walk without pain
  • Jog then run without pain
  • Do position specific drills
  • If they cant do the things necessary for a
    position, dont return to play

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Injury Reporting
  • Most clubs have specific protocols
  • If your club does not --- develop one
  • Protects the athlete
  • Protects the organization
  • Improves communication between coach, parent and
    physician

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Reporting Protocol
  • Should include
  • Athlete name
  • Date of injury
  • Type of injury
  • Cause or mechanism of injury
  • First aid applied
  • Parents notified
  • Documentation of others who witnessed the event
  • Identify the person filling out the form

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Injury Log
  • Helps track type of injury
  • Tracks the athlete who gets recurrently injured
  • Shows length of time lost by injury type
  • If used well, can show change in injury rate if
    you institute a prevention strategy.

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Common Injuries in Collision Sports
John Seaberg, M.D.
30
Common Injuries in Collision Sports
  • Collar Bone fracture
  • Buckle fracture
  • Mallet finger
  • Jersey finger
  • Muscle strain
  • Ankle sprain
  • Muscle contusions
  • Joint dislocation
  • Long bone fractures
  • Abdominal injuries
  • Abrasions and lacerations
  • Knee ligament injuries

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Collar Bone Fracture
  • Fall on shoulder or outstretched hand
  • Usually breaks in the middle
  • Treated with a sling or figure of 8 splint
  • Usually out at least 8 weeks
  • Younger and not throwing may return earlier

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Buckle Fracture
  • Fall on an outstretched hand
  • Point tenderness usually on the thumb side of of
    the end of the forearm
  • Sometimes swollen
  • Collapse of one side of the bone
  • Usually casted for 3-6 weeks

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Mallet Finger
  • Struck on the end of the finger by ball or helmet
  • Tendon pulls a bone fragment off
  • If not treated right, permanent deformity
  • Extension splint for at least 6 weeks

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Jersey Finger
  • Tendon pulls away from the palm side of the end
    of the finger
  • Severe pain
  • Often needs surgery
  • Season ending injury

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Muscle Strain
  • Pull or tear
  • Stretch beyond its limit
  • Treatment is ice, rest, compression
  • Return when pain free and muscle strength is
    normal
  • Few days to few weeks

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Ankle Sprain
  • Usually the outside of the ankle
  • Ice, Compression, elevation
  • If unable to walk 4 steps or tender over the
    ankle bumps, needs an x-ray
  • Need to do position specific drills without pain
    before return

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Muscle Contusion
  • Most common in the thigh and upper arm
  • Treat with ice, compression and stretch
  • May heal with a calcium deposit in the muscle

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Joint Dislocation
  • Fall on outstretched hand or forced pulling back
    on the arm
  • Severe pain
  • Do not try to relocate on your own
  • Splint and transport to an ER for reduction
  • Finger may return in a week, all others, usually
    season ending

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Long Bone Fractures
  • Forearm, upper arm, leg or thigh
  • Usually grossly deformed
  • May have nerve and blood vessel damage
  • Splint for support and send to ER.

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Abdominal Injuries
  • Spleen is the organ we worry about the most
  • Left upper part of abdomen
  • Will cause shoulder pain of damaged
  • Kidneys also easy to damage
  • Severe stomach pain after a blow
  • Needs to be evaluated in an emergency room

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Abrasions and Lacerations
  • All bleeding stops
  • It stops faster with direct pressure
  • Remember to wear gloves.
  • If the edges of the wound are apart without being
    touched, it needs stitches
  • If bleeding is controlled, in general the athlete
    can continue to play if the wound is covered.
  • Dont expose other athletes to patients blood

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Knee Ligament Injuries
  • ACL and meniscus tears can happen in young kids
  • Most commonly plant and twist or blow to a knee
    with the foot planted
  • Often feel a pop
  • Almost always requires surgery to be a
    competitive athlete

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Tendon Attachments
  • Achilles tendon
  • Severs disease
  • Patellar tendon
  • Osgood Schlatter disease
  • Pain that is worse with activity. Sometimes has
    swelling
  • Treat with rest and stretching activities. Ice
    after games

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Concussion recognition and management
  • Greg Seelhoefer, MD

45
Concussions
  • A brief alteration in brain functioning caused by
    trauma.
  • Does not have to be a blow to the head
  • Does not require a loss of consciousness.
  • Imaging tests (CT scan, MRI) are normal

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Concussions
  • Grading concussions does not help and can make a
    serious injury seem mild
  • Returning to play before symptoms have cleared
    increases chances for recurrent concussion and
    second impact syndrome
  • No evidence protective gear (headgear,
    mothgaurds) prevents concussions

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Concussions
  • How do you know if someone has had a concussion?
  • All based on symptoms
  • Dazed
  • Confused
  • Slow to respond
  • Dizzy
  • Headache
  • Nausea
  • Vomiting
  • Unable to remember new things
  • Unable to remember the hit or recent parts of the
    game
  • Blurred vision, Ringing in the ears

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Texas Sports Medicine Center
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Initial evaluation
  • ABC
  • Just say hi
  • Consider C-spine injury in any athlete with a
    head injury and altered level of consciousness or
    any neck pain
  • Ask them what happened
  • IF they dont remember, ask someone else
  • Memory for the event may never return

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Assess Brain Function
  • Orientation
  • Who they are
  • Where they are
  • When they are
  • Responsiveness
  • Alert
  • Groggy
  • Pupils equal?

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On the Field
  • Ask if they have any neck pain
  • Immobilize first, then ask
  • Just use hands initially
  • Ask them to move arms and leg
  • Dont move any extremity or body part for them.
  • IF no neck pain, able to move all extremities and
    answers questions well, allow them to stand
    slowly and walk off the field with assistance

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On the Sideline
  • Continually reassess
  • Repeat the questions you asked on the field.
  • Take away his helmet
  • If symptoms are worsening, send to the emergency
    room

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When to Return
  • No child who gets a concussion should return to
    play the same day.
  • Nope not ever
  • Very little research is done on children younger
    than 12 with concussions
  • We know high school age kids are more susceptible
    and take longer to recover than college or pro
    athletes

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When can the Athlete Return
  • No symptoms at rest and with exertion
  • Return to play slowly
  • Jogging
  • Running
  • Non contact drills
  • Contact drills
  • Full activity
  • Drop back if symptoms recur at any level

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When in Doubt
Hold them out
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The unconscious athlete
56
The Unconscious Athlete
  • An unconscious athlete has an unstable neck
    fracture until proven otherwise
  • Assess ABCs
  • IF breathing and has a pulse
  • Stabilize the neck and do not move the patient.
  • Wait for EMS arrival
  • If not breathing or no pulse
  • Log roll while stabilizing the neck
  • Begin CPR until help arrives.

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Cervical Spine Injuries
  • Contact sports place the cervical spine at risk
  • Incidence has decreased since rules outlawed
    spearing
  • Most injuries are still due to axial load
  • Fracture of the neck can cause paralysis, death

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Neck Injury Symptoms
  • Pain in neck
  • Decreased range of motion
  • Pain, numbness or weakness in the arms
  • Spasm of neck muscles
  • Bowel or bladder problems
  • Unequal grip strength

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Neck Injury Treatment
  • If concerned about a fracture, immobilize and
    transport for evaluation
  • Whiplash
  • Strain of the ligament going down the back of the
    neck
  • Stinger
  • Stretch of the nerves supplying the arm
  • Shooting pain or arm may feel dead for a few
    seconds
  • May return if symptoms completely clear
  • Needs eval if recurrent

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Heat Injuries
  • Christian Schupp, MD

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Heat Injuries
  • A completely preventable injury
  • A very common injury
  • Usually bothersome, but can be deadly
  • 3 different phases
  • Heat cramps
  • Heat exhaustion
  • Heat stroke

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Heat Cramps
  • Dehydration causes localized electrolyte problems
  • Adequate hydration is usually preventative
  • Can occur in any muscle, but most common in the
    calf
  • Stretch, ice and hydration are the keys to
    successful treatment
  • Muscles that are cramping are more susceptible to
    tears / strains

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Heat Cramps Hydration
  • Daily weights (pre- and post- exercise)
  • Fluid replacement
  • 20-24 fluid ounces of water or sports drink for
    every pound lost
  • gt5 weight loss serious dehydration
  • Urine color

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Heat Exhaustion
  • More serious, but not life threatening
  • Usually caused by volume loss from sweating that
    is not replaced
  • Body cannot maintain adequate blood flow to
    brain, heart, kidneys

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Heat Exhaustion
  • Symptoms
  • Headache
  • Nausea / vomiting
  • Irritability
  • Cool, clammy or hot and sweaty skin
  • Muscle cramps
  • Thirst
  • Low blood pressure

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Heat Exhaustion
  • Treatment
  • Cool place
  • Loosen clothes
  • Fans, wet towels, Ice
  • Elevate legs
  • Encourage fluids
  • Electrolyte solutions are better absorbed.
  • Acclimatize more slowly
  • Return to play 1-2 days, but should have a
    doctors note

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Heat Stroke
  • Rare
  • Deadly
  • Most common cause of death in the high school and
    NCAA
  • Bodys ability to regulate heat is gone
  • Risk factors
  • Temp over 95 with 75 humidity
  • Can occur at much cooler temps
  • Out of shape athlete, poorly acclimatized, prior
    problems
  • Long periods of strenuous exercise or short
    periods of intense exercise
  • Dehydration

Korey Stringer (1974-2001)
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Symptoms of Heat Stroke
  • Extreme body temperature
  • Altered level of consciousness is key!
  • Irritability, incoherent, glassy stare, etc
  • Rapidly progresses to seizures and coma
  • Definition core temperature gt104
  • Rectal temp is the only reliable source

Steve Bechler (1979-2003)
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Treatment of Heat Stroke
  • MUST COOL THEM DOWN IMMEDIATELY
  • Shade or air conditioning
  • Remove clothes
  • Ice to groin, arm pits
  • Treat for shock by elevating the legs
  • Nothing to drink
  • Get to the hospital as soon as possible.

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Nutrition principles for adolescent athletes
  • Christian Schupp, MD

72
Nutrition Basics
  • Athletes need a balanced diet
  • 55-60 carbohydrates
  • Starches like breads
  • Fruits and vegetables
  • Most readily available fuel source
  • No more than 30 fat
  • Fats contain more than twice as many calories per
    gram as protein or carbs
  • 10-15 protein

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What about protein supplements?
  • Not necessary and not helpful
  • Bodies can use no more than about ½ gram per
    pound
  • 100 lb boy can use about 35-40 grams of protein
    per day
  • Too much protein causes bowel trouble and
    dehydration.

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Pre-Game Meals
  • Pre-Game meals should be part of a sound
    nutritional program and contain foods that are
    well tolerated by the athletes.
  • There is no particular food that will magically
    give an athlete special energy, strength, or
    endurance

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Goals of a Pre-game Meal
  • Provide adequate energy intake
  • Allow for an empty stomach upper bowel at time
    of play
  • Provide an optimal state of hydration
  • Cause minimal upset of G.I. tract
  • Provide familiar foods

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What to Avoid?
  • Fatty foods
  • Roughage / high fiber
  • Protein
  • Caffeine/Carbonation

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Fat
  • Fat delays empting of the stomach

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Roughage / fiber
Increase the need for defecation
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Protein
  • Slower to digest
  • Must be metabolized into fuel in the liver
  • Not an efficient fuel source
  • Can lead to dehydration
  • GI upset

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Caffeine/Carbonation
May increase urine output and upset the G.I. tract
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Ideal Pre-game Meal
  • Complex carbohydrates
  • Pasta, breads and fruits
  • Small portion of veggies
  • Small portion of lean meat

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Conclusion
  • Encourage a balanced diet throughout the season
  • Focus on hydration
  • Make the pregame meal at least 2-3 hours before
    the game
  • Do not encourage protein supplements
  • Focus on hydration
  • Athletes plate TEAM USA (google)

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