Jamaal Charles; No Different Then Vast Majority of Competitive Athletes


Last week when the Chiefs played the Chargers running back Jamaal Charles scored a touchdown and was blasted in the end zone by Brandon Flowers.  A shot that Charles bounced up from and headed to the sideline while Flowers was slow to get to his feet.  The hit was helmet to face mask and the resulting forces were a classic case of what is typically needed to produce a concussion for one or both of the players.  Whether or not it actually did, we will never “officially know.”

The issue is not with the hit or the fact that Charles apparently cleared the screening done on the sideline after such a hit, the issue is with his comments a few days after on the Dan Le Batard show;

“It definitely hurt,” Charles said. “A couple plays later, I just [saw] this light buzz around my eyes and I was trying to catch ’em. But I was like, ‘Let’s get the ball and run again.'”

I am 100% confident that Head Athletic Trainer Rick Burkholder did his job on Sunday – screening Charles after the hit – it was evidenced on Tuesday/Wednesday when Burkholder placed Charles in the protocol as a precaution solely due to the comments Charles made.

Why you may ask?  Simple, by the absolute letter of the definition of concussion – disruption of normal brain function following a traumatic event – Charles admitted he was “not normal”.

Whether or not Charles had a concussion is up for debate among many people, not only externally – us blogging/media type – but likely internally – Charles and med staff.  Here in lies the problem with concussions and the issue of concussions.

As we tried to explain in the University of Michigan post, concussion is most often a subjective injury, we as medical professionals rely upon the athlete or injured to tell us what is going on.  If there are no overt or outward signs (loss of consciousness, wobbliness, gaze, vomiting, etc.) then all we can do is screen the athletes.  And by screening I mean simply asking the athlete if they are OK.

GAMING THE SYSTEM

I heard Mark Schlereth on Mike and Mike this morning saying something to the effect of; “there has to be more than just asking the player if they are ‘OK’?”.  The truth of the matter is that there is not really anything other than that; although just asking one question is not due diligence.  In my experience I ask more questions and even try to trick athletes into giving up any ruse they are trying to pull on me.  I have a to questions and line of questioning that has produced many responses that then warranted them to be fully examined with a sideline evaluation, even for the best “liars” (I won’t share them here because it can be used for people to study and then find a way around it).

The more complex yet simple reason we as athletic trainers feel confident with screening, even with limited questions, is that we know the athlete.  Their usual demeanor, behavior and general presentation.  People often ask me how long it takes me to know if someone has a concussion.  When they are my players, the ones I am around on a daily basis, usually it takes me  about five (5) SECONDS.  Yes, I can detect a concussion that fast, and many other ATC’s can too.  Now, there are some players that are very good at hiding symptoms; those are usually the ones that have been concussed before (they know the routine) but what they cannot hide is their presentation after hits.

The root of the concussion problem, that does not produce the outward signs, is the player and their honesty/candor.  If the player does not tell the medical professionals that they are hurt, how can we help them?  Sure some will say “sensors we need sensors”…  That won’t fix much, in fact, it may make it worse.  Imagine if we did the full-blown sideline assessment for every player that sustained a hit beyond a predetermined threshold.  There would literally be 10’s of kids/players out of the game for at least six minutes (at the least) at a time, if you did that why not just have a “concussion time out” after every series to test them all?  Not every hit at high force creates a concussion; in the same breath not every hit below a “threshold” does not produce a concussion.

A vast majority of athletes, in any sport male or female, are not dissimilar to Jamaal Charles.  They want to compete and if they are not experiencing issues beyond their inherent “threshold” of pain or discomfort they are apt not to tell anyone or even lie if confronted with circumstantial evidence.

THERE IS A DIFFERENCE

Although we tell you that concussions are concussions are concussions; there are no “mild” or “severe” concussions at the time of injury.  There is a massive difference between a concussion in a professional athlete and adolescent.

The injury is pathophysiolocially the same, the management – in theory – should be the same, but the dynamics and minutia (I know I dislike minutia) is different.

A. Professional athletes are adults and can make decisions on their own volition, when not mentally compromised.  Sure a concussion can be defined mentally compromising, but if the injury did not inhibit their ability to reason and knowingly lie how would anyone be the wiser?

B. Professional athletes get paid A LOT of money to play their sport.  This is a massive factor in this subset of athlete not being fully truthful about injuries

C. Professional athletes have the best medical care possible surrounding them, seemingly at all times.

The adolescent athlete does not have any of those factors going for them.  This is why when dealing with concussions below the professional level we must be much more stringent and vigilant.  Other factors include: the adolescent athlete is in school and learning, the adolescent athlete brain is still developing, the adolescent concussion is far less researched, and quality of life, at this point, is not up to them.

STICKING POINT

Less accepted and often overlooked, but a real and present danger, is the fact that concussion symptoms can be delayed.  I have seen concussion symptoms be delayed up to three days.  It takes sleuthing and sticktoitiveness to make sure those with possible concussions do not slip through the cracks.  Most of the delayed symptoms present within 12-24 hours in my experience, that is why we/I run SCAT’s and other assessment tools up to 24 hours after a possible incident.

If we do not follow-up on the possible injury this can give the perception that no one cares or that it is acceptable to have a screaming headache the day after a game.  What this does is prolong the issue and injury, putting the player in danger.

This was not the case with Charles, however this is the case with many concussions.  At the professional level the adults can then rationalize the injury based on their years of experience and the “machismo” of sport.  Years and years of constant berating about weakness due to injury, especially an unseen injury, prevent the athlete from being honest.  This is a culture issue and yes it trickles all the way down to youth sports.

I wish there was an easier answer and one that did not have so much gray area, but there is not.  The best way to grasp this issue is to understand that concussions are part of sports and life.  Know the signs and symptoms, implore athletes to be honest, educate about ongoing risks and current information and be there for them.

The “Million Dollar” question is simple: How do we fix this loop-hole/problem?

The best answer, in my opinion, is also simple: invest in athletic trainers that can be around and protecting athletes at all times.

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8 thoughts on “Jamaal Charles; No Different Then Vast Majority of Competitive Athletes

  1. Mark Picot October 23, 2014 / 11:40

    Dustin, this is exactly the right time to introduce the issue of vestibular injury. Face mask forces have been shown in research to transfer forces through the chin strap to the jaw, cervical spine, neck musculature and nervous system. The misaligned jaw, when left unsecured or improperly so without aligning the jaw, is a danger, particularly when cartilage structures of the TMJ are out of place. This is not a coup contra coup issue and no mouth guard can prevent coup injury, but research shows positive vestibular results in the use of neuromuscular mouth guards.

    “I just [saw] this light buzz around my eyes and I was trying to catch ‘em”.

    UPMC is focusing on testing for these Ocular vestibular, eye nerve issues. The symptoms Charles describes are exactly what the University of Buffalo research is focused on, yet your discussions have not recognized this even though you have posted about it in the past. Lumping all concussions into the same bucket is a mistake. These are the type of symptoms that players can conceal and potentially may be the mechanism of how CTE initiates. The proper research needs to be done, this can only be done when the proper mechanisms are identified. Ocular vestibular trauma is not the only issue. Vestibular issues include the inner ear, cervical spine, neck and other issues that can result in cerviogenic headache, nausea, dizziness, dings basically mimicking coup contra coup injury symptoms, leading to misdiagnosis. This new data shows that 50% of all reported concussion may fall into this category because of misdiagnosis and have commonly been misconstrued as coup contra coup injury.
    If so, we know research confirms neuromuscular mouth guards help in aligning orthopedics, cervical spine and neck issues, helping open neuro paths and posture resulting in improved neck and upper body stiffness and strength in validated research. Particularly in those with a history of poor orthodontics, dental trauma, TMD, neck injury, poor posture, ect.

    https://vestibular.org/news/07-29-2014/it-really-concussion-symptoms-overlap-neck-injuries-making-diagnosis-tough-call

    https://theconcussionblog.com/2012/05/08/concussion-information-from-ub/#comments

    • Dustin Fink October 23, 2014 / 11:55

      Mark,

      Thank you for the information, but mouth guards do not effect the injury of concussion… Vestibular injuries are still up for research, but highly unlikely, IMO

  2. Derek Schumann October 23, 2014 / 11:55

    100% agree that there is a massive difference between a concussion in a professional athlete and adolescent.

    Dustin’s points out why when dealing with concussions below the professional level we must be much more stringent and vigilant.  Other factors include: the adolescent athlete is in school and learning, the adolescent athlete brain is still developing, the adolescent concussion is far less researched, and quality of life, at this point, is not up to them.

    The quality of oversight and ability to assess youth athletes for concussions remains the single biggest risk. I believe impact sensors like Shockbox that can communicate impact magnitude to a smartphone or tablet on the sidelines is an invaluable tool for anyone tasked with overseeing the health and well being of youth athletes.
    Impact sensors will not remove a player from play but they can alert a coach or trainer when a kid has been hit hard enough that they should be assessed. This is not something they can always see when watching a game or practice. Whether they see the impact or not, the responsibility ultimately remains with the person who makes the decision to allow a player back on the field.
    At the youth level, the people entrusted with making this call are ill equipped because they simply can’t see or catch all the occurrences of head impact.
    You can’t catch what you can’t see.
    #makesportssafer
    @bcbizman

    • Phil Colwell October 23, 2014 / 17:44

      i will put my contribution in from CFL concussioins ; when you get knocked out KO,d you do not remember anything of that happening until you watch game film ; many generations before that did not have the film to watch , to this day i can not see the hit on me because the cfl has not allowed the CBC to release it to lawyers.

  3. George Visger October 23, 2014 / 14:30

    Sensors are great. I can’t wait for when they come up with one that diagnoses cancer.

    I can just hear the warning.

    “Hey Dummie, you’ve got precancer or cancerous cells developing. Time to quit smoking.”

    Too little, too late to protect these young brains AFTER they’ve been rattled with a 65 G force hit. My worse concussion was at 13 years old during my 3rd year of Pop Warner. I knocked myself unconscious and was hospitalized. Any experts with data to show how much, if any, that impacted me developing hydrocephalus 9 seasons later? Even if it only contributed 10% to my problem. Any parents want to take that bet on their own children?

    I hope not.

    Studies have shown the earlier you are concussed, the lower your threshold is for the next.

    Mouth guards are another great piece of equipment. Again, using the Ol cancer analogy. A vestibular mouth guard would be akin to wearing a prophylactic for the oral cavity when smoking. Would do great to prevent carcinogens from contacting the mouth, tongue and lips I’m sure. But what happens once it heads down the Ol intake valve through the esophagus and into the lungs.

    Every one focuses on concussions. Mike Webster never had a diagnosed concussion. He had 1,000’s of subconcussive hits though.

    Joseph Chernach’s story is without a doubt the most horrific, heart wrenching, gut ripping story I’d ever heard. His mother Debra reached out to me a couple weeks ago via a TBI Facebook page we run. With Debra’s permission, I am able to relay Joseph’s story, and have included an entire chapter in the book I’m writing to Joseph.

    Joseph was a near perfect honor student while he attended Forrest Park High school in Hixton, Wisconson. He was the U.P. State Pole vault champ, a U.P. State wrestling champ and played football. Joseph was never diagnosed with a concussion while playing sports. Debra relayed to me Joseph’s last few years prior to his suicide in 2012 at age 25, were a constant battle with depression. His last night he left the house upset and told his mother he didn’t know if he could go on and was going to hang himself. When he didn’t return home Debra and her family drove the streets for hours that night looking in trees for his body.

    Looking in trees for your child’s body!

    Can there possibly be a worse nightmare than that for a parent or loved one?

    I don’t see how.

    I relay this nightmare and horror, not to sensationalize Joseph’s death, but to try to comprehend the torture and anguish Debra and her family must have felt those hours they spent in hell looking for Joseph. And the hell a young man in the prime of his life must have felt prior to taking his own life. The same hell 18 of our NFL brothers who have taken their lives since 85 have felt and hopefully, HOPEFULLY, with God’s help we can make something positive out of all this pain.

    Debra’s daughter found Joseph the next morning hanging in their shed. They were best friends. Joseph had been dead since leaving the house the night before.

    Debra and I spoke for well over an hour after our first email exchanges in September of 2014. I was beyond livid after we talked. I can feel her pain and anger as much as anyone can. As part of the so-called NFL Brain Injury lawsuit settlement in September of 2014, the NFL was not required to divulge any information on what they knew and when they knew it.

    It was basically, “Here, take $765 million, now get the hell out of our way so we can make another $10 Billion this season. By the way, we’ll only give you this money if we don’t have to admit to anything.”

    Thus, the League of Denial, as the Wainura brothers so eloquently produced for the PBS Frontline documentary of the same name, The League of Denial; The NFL Concussion Crisis, which aired on October 8, 2013. [186]

    Had the NFL stepped to the plate, and released the information they’re withholding regarding what they knew and when they knew it, maybe Joseph and others would still be alive today.

    How much of their $9.5 billion was Joseph’s life worth to the NFL?

    As Debra told me, she is on a mission to have all young, former high school football players who commit suicide tested for CTE.

    What if this is an epidemic which has been going on for years?

    Below are our first, unedited communications Debra and I had, beginning with her reaching out to me via our TBI Facebook page.
    From: Debra Pyka
    Subject: NFL research
    Date: September 16, 2014 at 10:46:40 PM EDT
    To: George Visger

    Message Body:
    My son died 2 years ago from suicide at the age of 25, later to be diagnosed with CTE stage 2 to 3 by Dr. Ann McKee. I have written letters to all my federal senators/ congress in my state of WI, Michelle Obama, the White House and last week sent a letter to John Conyers (House Judiciary Committee). I requested that congress force the NFL to turn over the research they have been hiding and denying re: head trauma and concussions, in my letter I explained the NFL sponsors our children who play pop-warner through high school football and the parents had a right to be informed of this research, the dangers and brain diseases playing football can cause. Our government oversees our schools and our children are playing sports on school property. I have not received a response from any of these politicians and the letters were sent in April 2014. They have all turned their backs on my dead son and not even acknowledged his death or our grief and loss. I’m still waiting for a response from John Conyers. What can I do, no one will listen to me?

    Debra
    I am so sorry to hear of your son’s death. Please keep in mind that CTE in the frontal lobe impacts your judgment. I’m sure your son would never have gone through with his suicide had he been able to think things through and thought of how painful it would be for you and your family.

    I have met with several of our Congressional representatives regarding traumatic brain injuries, particularly in the NFL. As a survivor of 9 NFL caused VP shunt brain surgeries and no NFL benefits, I’ve been forced to become an expert on the subject.

    I will pass on your email to Terry Wardley of Senator Ted Gaines office and Congresswoman Linda Sanchez, with whom The Visger Group sat down with last year regarding this issue,

    After forwarding Debra and Joseph’s information to Terry Wardley of Senator Ted Gaines’s office in Sacramento, Terry replied back that the Senator wanted to meet with me two weeks later on October 28th, 2014.

    My meeting with Senator Gaines happens to be the day before Debra will to be featured on Blog Talk Brain Injury Radio with Kim Justus. Kim had featured me on a show on October 15th, and I encouraged her to have Debra on to tell her story.

    ———- Forwarded message ———-
    From: Debra Pyka <deannp@centurytel.net>
    Date: Thu, Sep 25, 2014 at 7:01 PM
    Subject: CTE and forwarding my concerns to Linda Sanchez
    To: visgergeorge@gmail.com

    George: Thank you for relaying my concerns with my son and CTE. You are the only one who has listened to me so far. I am beyond pissed at my politicians for ignoring my letters. I read the enclosed stories on you and I am so shocked at all the suffering you have and will go through. If I could have only known about CTE before my sons suicide, all the signs were there and I knew nothing about CTE until after, when my oldest son asked me to have his brain sent to BU. I will not stop with making my voice heard until the day that I die. This mothers wrath will come down on someone soon. I will go to the newspaper if I don’t get a response/action from those I wrote letters to. I hope the research is made public soon and the NFL is shut down and heads roll. I would like to talk with you one day if you have time. I hope you can recover and there is a cure for this brain disease sooner than later. This is my sons story; http://www.sportslegacy.org/research/legacy-donors/joseph-chernach/

    Thank you> Debra Pyka

    Debra wrote this article on Joseph and posted it in the Sports Legacy Institute’s magazine shortly after Dr. Ann McKee diagnosed Joseph with stage 2 -3 CTE in December of 2013. DESPITE Joseph never having had a concussion.

    JULY 11, 1986 – JUNE 6, 2012
    Joseph Chernach traveled to his next journey on June 6, 2012, with his Forest Park Trojan and Green Bay Packer Jersey, his difficulties and struggles with depression finally came to end at the age of 25.

    Joseph was a competitive and talented athlete from an early age, playing summer baseball, wrestling since the age of 6 throughout high school, a pole vaulter in track and played pop-warner, JV and Varsity football in high school. He won many medals and trophies from grade school through high school.

    He was the Michigan high school U.P pole vault champion, Michigan high school state wrestling champion, named all U.P class D defensive back, all State class D defensive back, MVP of football along with senior athlete. He was proud to play in the Michigan High school state football finals in 2004 with the Forest Park Trojans. His greatest accomplishment was graduating with high honors from Forest Park High School in 2005.

    He also attended Central Michigan University in Mt. Pleasant, Michigan with plans to graduate with a degree in Physical Therapy.

    Joseph was baptized at the Northfield Lutheran Church, Hixton, WI, and confirmed at the United Christ Methodist Church in Crystal Falls, MI. His Facebook page reflects his religious views as “God Loves Me.”

    Joseph was fun, active and lived for making people laugh and his sense of humor touched many. He was a fan of the Michigan Wolverines, Milwaukee Brewers and Green Bay Packers. He loved to fish and deer hunt in Wisconsin on the family farm.

    Joseph leaves behind many family and friends, father Jeffrey Chernach, mother Debra (Fred) Pyka, brothers Tyler (Michelle) and Seth, sister Nicole, step-sister Samantha, Grandmother Lolly, nieces Braylee and Layla and the Forest Park Class of 2005.

    A yearly scholarship has been set-up in his memory.

    Joseph Chernach Memorial Scholarship
    Forest Park High School
    801 Forest Parkway
    Crystal Falls, MI 49920

    In Joseph’s final few years, he suffered with depression and unable to overcome all the struggles and difficulties with life. CTE was destroying his brain until he could no longer go on with life here. Looking at his headstone in the cemetery is very heartbreaking knowing he is gone. We will never see him graduate college, marry, become a father, and live a happy, healthy and successful life.

    We will always wonder what he would have accomplished in his lifetime and we know he will be waiting to see us all again, until that time comes, we are left with the devastation of losing him and living our lives without him. We are all grateful for having him in our lives for almost 26 years. Until we meet again, our love goes with you and our souls wait to join you.

    For almost 20 years, the NFL covered up and denied evidence to the connection between brain damage and football. How many people have died from this brain disease whose families are unaware? How much progress could have been made for research, a cure, and the safety and health of everyone had this evidence been made public 20 years ago?

    I have contacted the news media, local congressman, senator, representative, the National Federation of High schools and the White House with my son’s story and concerns with sports, head trauma and CTE. The safety and health of our children are at risk. I hope someone will finally listen.

    We love you and miss you Joseph and we’ll all be together again one day soon.
    Debra Pyka

    We are grateful to Sports Legacy Institute for the research and diagnosis to finally give us the answers to what caused Joseph’s depression and early death. Joseph never played college or pro-sports and we do not know of any concussions during his middle or high school years. This is the report we received from Dr. Ann McKee at Sports Legacy Institute in December 2013:

    SLI Dr Ann McKee Report

    “Fixed tissue samples were received from Sacred Heart Pathology Department, Eau Claire, Wisconsin on 9/6/12. There were no obvious abnormalities. However, microscopic analysis of the tissue revealed considerable pathological tau deposits as neurofibrillary tangles throughout the frontal brain regions. There were also very severe changes in the brainstem, with numerous tau neurofibrillary tangles in the locus coeruleus, an area of the brain thought to play a role in mood regulation and depression. The changes in the frontal lobes and locus coeruleus were the most severe I’ve seen in a person this age. These findings indicate Stage II, possibly Stage III (with Stage IV being most severe) CTE and are particularly noteworthy, given the young age of the subject.” [186]

    After our second email exchange I asked Debra for permission to share Joseph’s story and his reports from Boston University. Debra graciously opened her heart and soul and allowed me to do so. I told her Joseph’s legacy will be his story will touch and save lives for years to come. It was his role on earth, and a huge cross God gave him to bear. A cross he carried like a man and we’ll all be better for the pain Joseph suffered.

    Thank You Joseph.

    You will never be forgotten.

    Tell me again about sensors and mouth guards.

    • Derek Schumann October 25, 2014 / 14:08

      The scientific research on concussions suggests that second-impact syndrome (in other words, suffering another concussion while still recovering from one, which can cause second-impact syndrome regardless of how severe the first concussion is) can cause everything from permanent brain damage to death, and that’s been why developing standardized return-to-play protocols is so important.
      Parents and athletes — especially young ones — need to take every jolt to the head seriously, says David Hovda, a professor of neurosurgery and molecular and medical pharmacology at the University of California, Los Angeles, and director of the UCLA Brain Injury Research Center.
      Every reported case of second-impact syndrome has occurred in young people, Hovda says. And that’s because young brains are still maturing. And one of the big differences between the growing brain and a mature one is that it doesn’t have much room to accommodate swelling. So while an NFL player’s brain can survive some swelling without catastrophic consequences, young brains sometimes can’t.
      One of the theories that might explain what happens in second-impact syndrome involves swollen blood vessels, Hovda says. The idea is that after the second hit, the blood vessel walls become less stiff. So, they expand, like a garden hose that becomes fatter as it ages. If enough blood vessels swell, it makes the brain bigger, squashing tissue up against the skull.
      So does that mean kids shouldn’t play contact sports? No, says Hovda.

      “I’d tell parents to allow their children to play sports, even sports that have contact,” Hovda says. “But be aware that as in any activity there are risks, and the risks of concussion in contact sports are higher than in others.”

      Emerging wearable technologies like the sports helmet Impact Sensors are tools that can help prevent the occurrence of Second Impact Syndrome by alerting coaches and parents when a youth athlete has suffered a severe jolt to the head. The severity of a hit to the head is not always obvious from the sidelines and in much the same way that smoke detectors are used to alert us to the possibility of fire, wireless impact sensors capable of communicating with a smartphone or tablet on the sidelines can act as another set of eyes and alert coaches on the sideline when a hit is too hard. It is important to point out that while impact sensors cannot detect concussions, they can be an effective sideline monitoring tool to alert coaches and support staff when a player has suffered a major head impact.

      Counting and recording the total number of head impacts per player may become the most significant contribution impact sensors have toward making sports safer. Impact sensors can be used to record the total number of head impacts in real time, data that helps modify team behaviour and allows coaches, trainers and support staff to monitor each athletes exposure to head trauma. An increasing number of studies show the risk of short-term and long-term brain damage may be more closely related to an athlete’s cumulative brain trauma over their lifetime. Brain trauma includes both concussions and subconcussive impacts, (the rapid movements of the head that don’t cause any concussion symptoms).

      Counting Hits, similar in concept to the Pitch Count in baseball, can be used by coaches, trainers and support staff to restrict young athletes to a limited number of head impacts over a certain threshold (20g’s) per day, week, month & year, according to age.
      After a material head impact, recovery periods are key for the brain; knowing hit magnitude and hit count provides quantifiable data to the coaches and trainers decision making process.
      If we are able and willing to monitor pitch counts to protect children’s elbows, counting and monitoring impacts to a child’s head is IMO a “NO BRAINER.”

  4. George Visger October 23, 2014 / 21:12

    Phil
    Concussion hits don’t necessarily look like anything special though I did get my butt blown up on a Dallas tight end trap. Here is a link to my final concussion against the Cowboys in 1980. Not long after I developed hydrocephalus.

    KRON4 News in San Francisco …Cached – April 18, 2012 … George Visger, author of the ebook “OUT OF MY HEAD: My Life In and Out of Football” (January 2012), was featured in this report on KRON4 … http://www.youtube.com/watch?v=GZpnI6W2-Sg

  5. formyweeson October 24, 2014 / 04:01

    A concussion is a brain injury. Amongst the symptoms of concussion, visual signs of concussion must not be ignored. Throw into the mix delayed concussion. Adrenalin can mask the signs of concussion. A player may say they are ok ,when asked , but that’s like asking a drunk driver are they ok to drive. You cannot and should not rely on an injured player ( especially adolescents ) to tell you how they feel. Of course their responses should be noted. But if you are already testing for concussion ( especially with adolescents) you ve already starting suspecting it.. My 14 yr old son lost his life because his concussion was mismanaged during a school game of rugby. Should never have happened. Not one of those 30 kids had any education on the signs symptoms and risks of concussion.

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