Local Legislation Impacts Nursing and Those We Serve

Local Legislation Impacts Nursing and Those We Serve

Each year states and municipalities usher in a new set of laws and regulations that will affect the lives and well-being of everyday people. And while new federal laws are also introduced each year, local laws, rules, and regulations can have a very far reaching impact as well. In some instances, even more so. As nurses we may be challenged to stay abreast of the many new state laws that may impact the health of those that reside in our immediate communities.

For example, beginning January 1, 2020, two hundred and fifty-five (255) new laws will take effect in Illinois. These new laws focus on a number of things such as license plates fees, trade in vehicle tax, sexual harassment, and expanded immigrant rights, to name a few. However, some of the new laws will impact the health and well-being of those residing in the state of Illinois. Of the 255 new laws, 35 are categorized as being health related. (See the sidebar for a brief snapshot of select Illinois legislation that will have implications for the health of residents as well as for the nursing profession.)

Nurses may need to familiarize themselves with the new laws and regulations in their respective states as some may have reporting or continuing education requirements for nurses. For example, beginning January 2020, all nurses (LPNS, RNs, APNS) in Illinois seeking to renew their nursing license will need to complete one hour of continuing education on sexual harassment. Professional nursing organizations, health care employers, and the Illinois State Board of Nursing as well as the Illinois Department of Professional Regulation and others provided information on this new requirement through their various communication platforms.

With the tsunami of information that confronts us each day, where can nurses go to get information about new state legislative initiatives? There a number of avenues to pursue when looking for such information. As each year is winding down and states prepare for the upcoming new year, many news media outlets (e.g., television, radio, and written press) provide a brief snapshot on new legislation. These outlets traditionally do a recap of the year’s activities/milestones and may include this information during various news briefings. Nurses employed in health care settings may wish to ask their Office of Government Affairs to do a brief overview on new legislation with an emphasis on health-related aspects. In fact, health care institutions may have some reporting requirements when new legislation goes into effect, so an update may be helpful.

Select 2020 New Legislation in Illinois
(effective January 1, 2020)

Focus Provision
HB 2895 – Reduce Maternal Mortality  Hospitals providing care to pregnant and postpartum women must train for related issues and implicit bias training and support statewide quality improvement initiatives to reduce racial ethnic disparities.
SB 1702 APRN Practice Allows APRNs (Advanced Psychiatric Nurses) to complete certificates for commitment and authorize restraints and seclusion for patients.
HB 3435/HB 3113/HB 3509 – Expanded Insurance Coverage
HB 3435 Plans must cover medically necessary epinephrine pens for people under age 18.
HB 3113  Plans must include an annual office visit for a whole body skin examination without out of pocket cost.
HB 3509 Coverage for donated breast milk if prescribed by medical professional.
HB 3550 – Sex Education and Consent For students in grades 6–12, sex education is required to have age-appropriate materials and discussion on the meaning of consent.
HB 2045 – Eliminates Co-Pays for Committed Individuals Prohibits the Department of Corrections and the Department of Juvenile from charging co-payments for medical or dental services.

 

 

 

Departments of Nursing within our various health care settings share nursing related information so that staff can be in compliance of any new regulatory or legislative requirement. Noteworthy, in 2018 the Illinois General Assembly passed the Health Care Workplace Violence Prevention Act. This legislation focuses on protecting health care workers from violent encounters. An overview of this legislation has been disseminated by a number of professional and specialty nursing organizations, the Illinois Health Association, and many governmental offices. Many health care institutions presented an overview of this new legislation so that health care workers would be aware and that individuals visiting these facilities would know about consequences associated with harming a health care worker.

Locating this type of information need not be laborious. In addition to paying attention to the various news media outlets and working with our institutions to stay abreast of new legislation that may impact heath and the nursing profession, a number of resources are available to assist us in our pursuit of information.

For instance, each state legislature has a website and may post a listing of new legislation to be enacted at the start of a new year. For laws impacting nursing specifically, the National Council of State Boards of Nursing provides a link to the various state boards of nursing who provide information on new regulatory requirements that affect nursing practice, education, or nursing licensure. State nursing organizations or affiliates of the American Nurses Association also provide information through their various publications, town hall meetings, or periodic legislative updates. If you are not familiar with these offerings, reach out to see if your state nursing association can come to your facility to provide a legislative update. Staying active in one’s professional or specialty organization is yet another way to stay apprised of new pieces of legislation that will impact those you serve or the nursing profession. Each year, The Nurse Practitioner journal produces an annual legislative and regulatory update noting a number of legislative and regulatory implications for advanced nursing practice. In 2020, information for the 32nd Annual APRN Legislative Update is available here.

So, as the saying goes, all politics is local—and all politics on the local level are vitally important!

Gaining Policy Expertise and Influence Through Voluntary and Service Opportunities

Gaining Policy Expertise and Influence Through Voluntary and Service Opportunities

As nurses we are actively engaged in advocacy activities through our professional and specialty nursing organizations. However, an increasing number of nurses are informing the political discourse by serving as volunteers for a growing list of consumer oriented organizations such as the American Association of Retired Persons (AARP), Susan G. Komen, and the Lupus Foundation of America, all of which have local affiliates across the country. These and other organizations often provide advocacy training for their volunteers along with opportunities to engage in advocacy days.

Serving as a volunteer for these and other organizations enables nurses to use their expertise and strong familiarity with consumer concerns to inform advocacy efforts on behalf of diverse constituents.

Nursing’s engagement in this capacity compliments the current push to ensure that 10,000 nurses are placed on boards or coalitions by 2020. As of October 2019, 6,751 nurses have been placed on a diversity of boards which provide invaluable opportunities to utilize nursing expertise at the local, state, and national level, according to the Nurses on Boards Coalition.

Perhaps less popularized are calls for applications to serve on advisory boards and councils for elected officials. For example, in Illinois at the beginning of Governor Pritzker’s tenure as the state’s 43rd Governor, the governor’s office released a call for applications for volunteers to serve on a number of advisory boards. Some of the opportunities were directly related to health such as the State Board of Health. Other non-health specific opportunities were suitable for nurses to lend their expertise on topics such as aging, the environment, or child welfare. Such engagement

Resources

Nurses on Boards Coalition

Nurses can sign up for alerts and potential opportunities.

The Federal Register

Nurses can check this listing of federal agency meetings and calls for applications to serve on advisory councils in addition to a listing of meeting times and agendas for numerous federal agencies. Free subscription.

is critical to infusing a health-in-all-policies perspective into the decision making process. Illinois is not alone in this regard. Other states and municipalities have opportunities in which nurses can use their expertise to help inform elected officials about health-related matters.

For example, Catherine Waters, RN, PhD, FAAN, professor at the University of California Sans Francisco, is an accomplished nursing faculty member with expertise in community health, health disparities, and health equity. She served five years as a health commissioner for the San Francisco Health Commission. Waters not only used her expertise to shape the policy discourse around health issues impacting her city, but also developed additional skills in diplomacy, consensus building, and budgetary decision making.

In Minnesota, Shirlynn LaChapelle, an expert nurse clinician, serves as a nurse consultant to the state’s Attorney General Keith Ellison. In this capacity she serves as a member of the Attorney General’s Advisory Task Force to Lowering Pharmaceutical Drug Prices. As a nurse, she brings real life examples of how people struggle to secure access to affordable health care and life saving medications.

In Washington, D.C., Catherine Alicia Georges, EdD, RN, FAAN, professor and chairperson of nursing at Lehman College and the Graduate Center of the City University of New York is a long-term volunteer for AARP and an AARP board member. In 2017 she was elected to serve as the organization’s National Volunteer President from June 2018 through June 2020. Georges serves as the lead national spokesperson for the organization and helps to shape the policy agenda for AARP.

From a federal government perspective, some federal agencies or departments have been mandated by law to establish an advisory council. Advisory councils are mandated to include a variety of expertise including consumer representation. Many nurses serve on federal advisory councils providing recommendations to agency directors on issues germane to the agency’s mission or strategic initiatives. For example, a number of nurses continue to serve as members of the National Advisory Council for Nursing Research and the National Advisory Council on Nurse Education and Practice. Nurses also serve on federal advisory councils that are not specific to nursing but can benefit from nursing’s expertise in patient care and health care in general. For example, the National Institute on Minority Health and Health Disparities and the National Cancer Institute have selected nurses to serve as members of their advisory councils. These members join other members in weighing in on federal funding issues and shaping priorities for advancing the Institutes’ mission.

Nurses who aspire to serve in these capacities must always be prepared to respond in case there is a call for applications. Keeping one’s resume/CV up to date is key as some calls for applications may have a short turnaround for submissions. Keeping a nominator bank with a list of individuals who can provide an accurate and firsthand account of one’s excellence and contributions is also important. Nominators can be called upon to help verify an application or be asked to provide additional information that informs the selection process. In some instances, nurses can pursue opportunities to serve on advisory councils or committees through self-nomination. Either way, strong letters of nomination are often required.

Gaining additional expertise through volunteerism and service can be a strong catalyst for future opportunities in the policymaking arena. My earlier volunteer work with Susan G. Komen positioned me to pursue a board position creating a pathway to become chair of the local affiliate’s Public Policy Committee.  This volunteer experience continues to be one of my most influential gateways to more opportunities in the policymaking arena. Each time I apply for opportunities, I include this as one of my most valuable springboards for developing expertise in providing testimony and gathering evidence to provide a persuasive argument before elected officials. Nurses can gain substantive and meaningful expertise through voluntary and service activity that will enable them to rise to higher levels of engagement and influence in the policymaking arena. So, go for it!

Access to Health Care: Platforms and Agendas for the 2020 Presidential Election

Access to Health Care: Platforms and Agendas for the 2020 Presidential Election

Presidential candidates are gearing up for the 2020 presidential election and are sharing their platforms and agendas for creating a stronger and more prosperous nation. Presidential hopefuls have identified a number of proposals focused on ensuring access to health care. Some candidates vow to ensure access to health care by recommending universal health care coverage through a single payer national government health care program referred to as the Medicare- for-all proposal. Other candidates are in favor of some version of this proposal by lowering the Medicare eligibility age to 50 but also retaining the private insurance option. Still, some presidential hopefuls aim to ensure health care coverage by providing a public option for people under age 65 or by strengthening health care coverage by building on the Affordable Care Act. Regardless of a candidate’s position, the debate on how to achieve universal coverage will continue to evolve overtime leading up to the election and way beyond.

Findings from a Kaiser Family Foundation’s survey found that the majority of people who voted on a regular basis are not familiar with or clear on the Medicare-for-all proposal. Survey respondents are seeking solutions to everyday problems such as paying for care, eliminating red tape, and navigating the health care system.

While there are many proposals that are under consideration, the Medicare-for-all proposal is one of the most frequently cited proposals designed to ensure universal health care coverage. There are several versions of this approach to health care coverage, such as the proposed version introduced by Senator Bernie Sanders in 2017. Here we discuss the Medicare for All Act of 2019 (M4A), one of the most recently introduced iterations of the Medicare-for-all approach to health care coverage.

Resources

National news media such as CNN, The New York Times, and The Washington Post traditionally have provided an in-depth discussion and analysis on presidential campaign issues, including health care.    

The following are a few resources that can assist nurses in staying abreast of some of the campaign health care related discussions and other issues relevant to health reform:

This proposed legislation is similar to the legislation introduced by Senator Sanders in 2017 and other single payer legislation proposed by members of Congress. While there are some similarities, there are also some differences. For the most part, Medicare-for-all proposals will constitute a major shift in health care financing and will move from the traditional focus on providing health care coverage exclusively for those age 65 and older to more widespread care coverage for those under age 65.

Here is a brief snapshot of some of the basic components of the M4A introduced by Rep. Pramila Jayapal (D-WA) on February 27, 2019:

  • Single federal government administered program to cover all U.S. residents (including immigrants and possibly undocumented individuals)
  • Open enrollment to those age 19 and under as well as those 55 and older one year after enactment
  • Abolishes traditional benefits covered through traditional Medicaid/Medicare program, Children’s Health Insurance (CHIP), the Federal Employees Health Benefits Program, or TRICARE (health care for active and retired military)
  • Recommends a ban on cost sharing (e.g., copays, deductibles)
  • In addition to the 10 categories of the essential benefits in the Affordable Care Act, proposed additional covered benefits and services include hospitals services; ambulatory patient services; primary and preventive services; prescription drugs and medical devices; mental and substance abuse treatment services; laboratory and diagnostic services, comprehensive services across childbearing cycle; newborn and pediatric services; emergency services and transportation, early and periodic screening as outlined in Medicaid; transportation to health care services particularly for low income and persons with disabilities; and long-term care services and support.

    Source: Health Affairs

As the nation’s largest group of health care workers, nurses must possess a fundamental awareness of the various proposals devoted to ensuring access to health care. This will be particularly important for the many individuals, families, and communities who continue to lack access to care and suffer disproportionately from a number of health conditions and illnesses. As the most trusted profession, we are well suited to lend our voices to advocate for better access to care for all and are encouraged to do so. Our role in educating our policy makers has never been greater as we have firsthand knowledge of how the lack of access to quality health care coverage impacts the health and well-being and even life expectancy of those residing in the United States.

Be sure to stay informed of the various debates and proposals on universal health care coverage. Efforts to revise our current approach to health care financing and access to health care is complex and will require that we stay abreast of the discussions surrounding this issue. The American Nurses Association, the Kaiser Family Foundation, The Washington Post, and Health Affairs, to name a few, traditionally provide a synopsis on where candidates stand on health care issues and universal coverage. In addition to watching the presidential debates, nurses are encouraged to visit the web sites of the various presidential candidates to become more familiar with their position on health care ( e.g., access, universal coverage, health care reform) along with a myriad of other health care issues (e.g., prescription drug coverage, supplemental coverage). As we continue to support access to health care as a human right, our awareness of the issues and advocacy for access to quality health care for all will remain an important factor in the upcoming presidential campaign.  

The Indian Nurses Association of Illinois: Taking Matters to Heart

The Indian Nurses Association of Illinois: Taking Matters to Heart

Quite often a nurse will ask me how to become engaged in the health policy arena. I frequently advise nurses to get involved with their professional organizations as a start. Many nursing organizations have an advocacy and legislative agenda and are oftentimes engaged in advocating on behalf of patients and the profession. Here, we share a conversation with Aney Abraham, DNP, RN, NE-BC, who is a founding member and current president of the Indian Nurses Association of Illinois (INAI). Abraham discusses the origins of her organization and current issues they are addressing.

With regard to legislative issues, Abraham highlights a piece of legislation that was introduced during the 115th Congressional Session. The proposed legislation “H.R. 3592 South Asian Heart Health Awareness and Research Act of 2017” aims to address the high rate of cardiovascular disease in the South Asian community. And while the proposed legislation did not gain much traction during the 115th Congressional Session, the INAI is hopeful that the original sponsors of the proposed legislation will reintroduce it and continue to seek funding to support research focused on finding solutions to the high rate of cardiovascular disease in this population. This targeted approach to improving the health and well-being of this population takes into consideration cultural factors that may influence health status and calls for early intervention and treatment through education and awareness.

As president of the Indian Nurses Association of Illinois (INAI), can you share with me a bit about the INAI, its origins, its mission, and membership?

Aney AbrahamThe Indian Nurses Association of Illinois was established in 2002. I was a nurse with about 18 years of experience at this time and among one of the few nurses that thought of this idea of forming a professional organization for nurses of Indian origin. There were many reasons for starting this organization. The first and foremost was that Indian nurses who immigrated to the U.S. faced many challenges as they transitioned in the United States.

At a Glance:
South Asians and Heart Disease

  • South Asians are one of the fastest growing ethnic groups in the United States.
  • Family origins mostly from: Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka.
  • High cardiovascular prevalence not readily known due to lack of data.
  • Research examining heart disease in Asians in general lacks subgroup analyses.
  • Possible contributing factors include early onset of diabetes, cholesterol abnormalities, westernized diets, and lifestyle.

Source: American Heart Association

For a more detailed discussion of heart disease in South Asian populations, please see the American Heart Association’s Scientific Statement.

Foreign nurses become minorities overnight having little or no orientation to the country or health care facility that they worked for. We realized that many nurses were eagerly anticipating the birth of this organization and thus successfully established the organization in 2002.

The mission of INAI is to identify and meet the professional, cultural, and social needs of nurses of Indian origin. In addition to our mission, our purpose is to ensure that we provide representation and interact with other professional organizations as well as promote cultural awareness by communicating the uniqueness and diversity of the Indian culture.

What do you believe are the top nursing issues impacting our profession today?

Job safety is important to all professions; nurses are not exempt from working in unsafe environments. One of the top nursing issues impacting our profession is workplace violence. Every day, our nurses are impacted by violence perpetrated by patients, their family members, and visitors. Incidents that may start small can spiral out of control within minutes. Even though nurses are very familiar with incidents of violence, research seems to suggest that workplace violence is increasing. We certainly hear about these incidents through TV, print media, and reports from nurses.

The second issue that is impacting our nurses is stress and burnout. Nurses are on the front lines providing direct nursing care, advocating for patients’ medical needs, comforting patients/families, and working with a multidisciplinary team to ensure that patients receive safe high-quality patient care. Stress and busyness can easily escalate with the demands that are placed on nurses daily.

As nurse leaders and professional organizations, we need to work on finding ways to address awareness and ways to mitigate these issues that are facing our profession.

What are some of the top policy or regulatory issues impacting the Indian nursing community?

One of the issues impacting nurses of Indian origin is abusive employment practices. To address this, in 2008 the ANA released the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States. The code addresses minimum fair labor standards, civil rights, age discrimination, equal pay, and family/medical leave.

Another issue impacting Indian nurses (majority of which are of South Asian descent) is that they suffer from heart disease, high blood pressure, and diabetes too frequently and too early in life. Compared to other ethnic groups, South Asians are four times more likely to have heart disease, experience heart attacks 10 years earlier in average, and have a 50% higher mortality rate from heart disease. To address this, in 2017 Rep. Pramila Jayapal (D-WA-7) proposed H.R. 3592 “South Asian Heart Health Awareness and Research Act of 2017.” This is a very specific piece of legislation targeting Asian Americans.

What is the overall purpose of this legislation, and why is it important to you as a nursing organization and to the Asian community at large?

Representatives Pramila Jaypal and Joe Wilson co-sponsored this bill to raise awareness of the alarming rate at which the South Asian community is developing heart disease.

The overall purposes of this legislation are to:1) promote heart healthy eating among Asians; 2) conduct research to understand why South Asians are at an increased risk for developing heart disease and; 3) develop educational tools about heart disease for South Asians.

This legislation is important to us as a nursing organization and to the Asian community at large. The members of the Indian Nurses Association spend a tremendous amount of time offering free community services in the Indian community. Our advanced practice nurses spend time on the weekends visiting the various churches conducting health fairs, offering lectures, and educating the community on the dangers of heart disease and diabetes. Legislation that supports research will enhance our ability to learn more about the root causes of the high risk for the Asian community and prepare us to share lifesaving information with the community at large.

Are there any updates on this given this did not pass out of committee?

We will continue to monitor where this is going as the original sponsors are committed to raising awareness and supporting research in this area.

What are some of the ways that your organization has engaged in community education regarding Asian American cardiovascular disease?

Every year we host a minimum of three community health fairs and lectures in the Indian community. Our members, many of which are advanced practice nurses, have the skills, expertise, and knowledge to effectively lead these health fairs. In addition to the health fairs, we offer free BLS and ACLS certification.

How does INAI prepare its members to be influential advocates in the policymaking arena?

INAI invites public officials and elected officials to speak at our meetings and conferences. For example, some of our guests in the past have included, at that time, Senator Barak Obama before he went on to become President of the United States and Dr. Ann Kalayil, Bureau Chief, Cook County Bureau of Asset Management. Dr. Kalyil was the former President of the South Asian American Policy and Research Institute.

Additionally, members stay informed through educational seminars and educational offerings posted on social media outlets such as Twitter and Facebook. We also stay abreast of issues by following the legislative agenda of the American Nurses Association.

Are there other policy issues that are a part of your health policy agenda?

Many of our members are advanced practice nurses. Thus, we support the policy agenda of the National Association of Clinical Nurse Specialists (NACNS). Their priorities—including nursing workforce issues, health care reform, and health information technology—resonate with our legislative priorities.

The Indian Nurses Association is an organization of about 200 members. We can be more impactful when we combine our voices with other nursing organizations to enhance our policy advocacy on behalf of patients and the profession.

If you had to offer advice on why nurses should be engaged in advocacy and policy advocacy on behalf of patients and the profession, what would you say?

Nurses instinctively advocate for their patients. Equally important is for nurses to engage in legislative and political advocacy. This is needed to advance the profession and patient care. It is important for the voice of the nurse to be heard when any new legislation or bill is being introduced. An example of a recent bill is SB2151, a bill sponsored by Senator Hastings. This bill is about the Nurse Practice Act language surrounding delegation. Specifically, nurse delegation in community-based settings is of concern. Nursing has to provide the definition of what nursing practice entails, how nursing interventions and tasks can be delegated, and in what care settings the delegation can occur.

Nurses can stay informed on legislation that impacts their practice and profession by following nursing forums like @ANAnurses [and] @RN Action.

To stay engaged or not engaged in policy advocacy is a decision each nursing professional has to make, and he or she must always err on the side of staying actively engaged on behalf of the patients and those they serve.

Resources for Staying Informed and Engaged

Resources for Staying Informed and Engaged

As we usher in the 116th Congressional Session beginning January 4, 2019, lawmakers (newcomers and incumbents) will have the opportunity to address a number of legislative and regulatory issues. Immigration reform, access to affordable health care, climate change, and national and global security are among a long list of issues that will be discussed and debated during this new congressional session. And while there are numerous competing demands as with all other legislative sessions, nurses are encouraged to remain abreast of issues that impact health care and the nursing profession.

This year promises to be another great year to continue improving our policy acumen and advocating for those issues that are most important to us and the communities we serve.

Moving forward in 2019, newly elected Lauren Underwood, MSN/MPH, RN, of Naperville, Illinois will represent the 14th Congressional District of Illinois beginning January 3, 2019. Rep. Underwood is committed to ensuring that everyone has access to affordable health care. She is currently one of two nurses serving in the U.S. Congress. Other nurses across the country hold elected positions in their state legislatures and government appointed positions or serve on a number of advisory committees or boards.

This session, lawmakers committed to eliminating health disparities will work to enact legislation that will propel us toward achieving health equity, particularly for underserved populations who suffer disproportionality from a number of illnesses and poor social conditions. No doubt the issue of health care reform will remain front and center, especially in light of the recent ruling from a federal Texas judge deciding that the Affordable Care Act is unconstitutional. Because this debate is far from being over, we must remain vigilant in monitoring what is happening with this historic legislation. And just as 2018 was deemed the Year of Advocacy by the American Nurses Association, we must be mindful that advocacy is always in season calling us to lend our voices on behalf of those we serve. Regardless of position or setting, every nurse can seize the opportunity to weigh in on policy issues that are of importance to them.

So, consider how will you stay engaged and informed of federal and local policies or regulations that may influence your practice or even the degree to which health care is available to those you serve. Remaining updated on policy issues is becoming even more essential for today’s health care professional. Our professional and specialty nursing organizations provide key resources and often have a specific policy agenda. Have you explored what your professional organization’s position is on a number of policy issues important to nursing?

Consider attending an actual or virtual lobby day this year. Each year nursing organizations such as the American Association of Colleges of Nursing (AACN), the American Organization of Nurse Executives (AONE), and the American Nurses Association (ANA) convene lobby days in DC but also provide opportunities to participate virtually for those who cannot attend in person. Visit their web sites for more details. Numerous state nursing organizations and other health related organizations across the United States also convene lobby days providing yet another venue to lend your voice to a number of health-related causes. And remember to touch base with the Office of Government Relations within your health care system, university, or college.

Be resolved to visit a legislative official this year to learn more about their health policy agenda and promote the profession as well. Commit to reading the local news for policy hooks as they say, “all politics is local.” Subscribe to the Federal Register to stay informed about opportunities to offer comments on proposed regulations, policies or key reports. The Register also highlights opportunities to apply to serve on national advisory committees. Volunteer to give testimony at hearings and town hall meetings as lawmakers can benefit from hearing directly from nurses on health care matters. Well that should keep us all pretty busy. In the meantime, check out some of the resources listed on the right to help with advancing your engagement in policy advocacy.

Key Resources to Stay Abreast of Health Policy and Legislative Issues

 Nursing and Health Care Related Issues
Health Care Access and Other Health Care Related Issues
Health Equity and Disparities Reduction
State Specific Data

Check with your local and state Departments of Health to locate recent and local statistics.

 

Tracking Legislative Bills
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