Summer Fest

Author: Krista Flack, MS OTR/L

Reaching Milestones is hosting their First Annual Summer Fest this weekend!  This event will be a great opportunity for families to connect with each other!  The event will have a bounce house, face painting, water balloons, a sensory table, and so much more, including information for families on services they may benefit from for their children.  It will be from 8am-12pm on Saturday, June 24th.  It will be located in Beaufort (Belleview Business Park, across from Bi-Lo on Parris Island Gateway).

The Reaching Milestones clinic in Beaufort provides South Carolina families with expert autism programs and treatment, including Applied Behavior Analysis services, language assessments, center and home based behavioral therapy, social skills, treatment of problem behavior, and more.  At the Beaufort location, families will find a skilled team of clinicians who are dedicated to the importance of individualized treatment, parental involvement and the belief that every child, regardless of their disability or deficits, can make progress.

Find out more about Reaching Milestones here:

We hope you can join us this Saturday!

Safety in Your Neighborhood

Author: Krista Flack, MS OTR/L

To continue our series on June is National Safety Month, which focuses on reducing leading causes of injury and death at work, on the road and in our homes and communities, today I am writing about a few outdoor safety topics, including bike riding, pedestrian safety, and safety at the playground.

Bike Safety

One of the most important safety tips for bike-riding is to wear a properly-fitted helmet.  It is the best way to prevent head injuries and death.  Properly-fitted helmets can reduce the risk of head injuries by at least 45 percent – yet less than half of children 14 and under usually wear a bike helmet.  Make sure the helmet fits and your child knows how to put it on correctly. A helmet should sit on top of the head in a level position, and should not rock forward, backward or side to side. The helmet straps must always be buckled, but not too tightly. Safe Kids recommends kids take the Helmet Fit Test:

  • EYES check: Position the helmet on your head. Look up and you should see the bottom rim of the helmet. The rim should be one to two finger-widths above the eyebrows.
  • EARS check: Make sure the straps of the helmet form a "V" under your ears when buckled. The strap should be snug but comfortable.
  • MOUTH check: Open your mouth as wide as you can. Do you feel the helmet hug your head? If not, tighten those straps and make sure the buckle is flat against your skin.

There are many great links with resources about safe bike-riding for the whole family!

Pedestrian Safety

Unintentional pedestrian injuries are the fifth leading cause of injury-related death in the United States for children ages 5 to 19. Teenagers are now at greatest risk. Teens have a death rate twice that of younger children and account for half of all child pedestrian deaths.

  1. Teach kids at an early age to look left, right and left again before crossing the street. Then remind them to continue looking until safely across.
  2. Teach kids to put phones, headphones and devices down when crossing the street. It is particularly important to reinforce this message with teenagers.
  3. It’s always best to walk on sidewalks or paths and cross at street corners, using traffic signals and crosswalks. If there are no sidewalks, walk facing traffic as far to the left as possible. 
  4. Children under 10 need to cross the street with an adult. Every child is different, but developmentally, most kids are unable to judge the speed and distance of oncoming cars until age 10.
  5. Be a good role model. Set a good example by putting your phone, headphones and devices down when walking around cars.

For young children, start teaching commands like “stop,” “freeze,” and “walk.”  This is very important in situations where your toddler or child may run off in a parking lot or near a street.  Playing games like ‘Red Light, Green Light,’ ‘Mother, May I?,’ and ‘Simon Says’ can teach these skills in a fun way, so children are ready to use the skill when it matters most!  More tips can be found here and here!

Safety at the Playground

Playgrounds can be a wonderful place for children to explore, play, and learn.  It is important for children to have opportunities to practice new gross motor skills and experience new sensations, like climbing, jumping, swinging, and sliding.  This blog talks about how exploring at a playground, and even “breaking some rules” (like climbing up the slide), can help foster important developmental skills and teach important life lessons.  Of course, practicing these skills can also pose a safety risk.  Sometimes it is hard to find a compromise between keeping kids safe and fostering exploration and developmental play.  The National Safety Council reports that emergency departments see more than 20,000 children ages 14 and younger for playground-related traumatic brain injury each year.  The link above has numerous tips about keeping playground play time safe, and warns of potential dangers to consider at the playground. While these two sources have some contradicting information, it is most important to consider your child’s skills, and always supervise your child’s play.  There is no reason that playground play can’t be both safe AND full of exploration!

Sensory Friendly Movie

THIS SATURDAY we will be joining Cinemark for our 4th Sensory Friendly Movie Screening. We will be screening the movie Cars 3. A sensory friendly movie means that the lights are dimmed not completely off, the volume is turned down lower, and children have the freedom to get up and move around the theater.

This environment is a great place for children with sensory processing disorder. The low volume helps children with sound sensitivities, and allows them to be able to enjoy the movie without needing head phones or to cover their ears. Keeping the lights dimmed allows children who are fearful of the dark to be more comfortable and allows children with vision problems to see a little bit better. A movie is usually an hour and a half to two hours long. This is a long time for some children (and myself) to sit still for. The ability to allow children to get up and move around without worrying about disturbing other people helps to make the experience more enjoyable for them and for you as a family.

This event will take place THIS Saturday, June 17th at 10:00am.  Tickets can be purchased at Lowcountry Therapy Center’s Bluffton or Port Royal locations, or can be purchased the day of the event at the theater.  Reservations are REQUIRED for this event (even if paying the day of the event), so that appropriate planning can take place.  The cost is $10 per person and includes a ticket voucher, popcorn, drink, and snack.  For questions, please call (843) 815-6999

Here is a link for the Car’s 3 trailer KACHOW!!!!!

-Matthew D’Antonio, DPT, PT

-Pediatric Physical Therapist

Cytomegalovirus (CMV)

CMV or Cytomegalovirus is a common virus and is typically harmless to the general population. A CMV infection causes cold like symptoms such as a sore throat, swollen glands, a fever, and fatigue. According to the Centers for Disease Control between 50 and 80 percent of people in the United States have had a CMV infection by the time they are 40 years old. The symptoms last for a couple weeks and are rarely a concern for healthy children and adults, according to the National CMV Foundation. CMV can cause serious problems in people with weak immune systems and in babies who were infected before birth.

CMV is the most common congenital viral infection that is transmitted before birth. 1 in 150 children is born with congenital CMV, according the National CMV Foundation. It is difficult to predict future health problems and developmental prognosis for babies because congenital CMV is very diverse and can affect people differently. 90% of babies born with CMV with appear to be asymptomatic. They tend to follow standard growth and development and live healthy lives, but can develop problems such as hearing, vision, and learning difficulties. About 10% of babies born with CMV will be symptomatic at birth and can experience some major challenges such as hearing loss, cerebral palsy, microcephaly, learning disabilities, seizures, and weight problems.

It is important to get screened for CMV before you plan to conceive. If a woman has been exposed to a recent CMV infection, it is recommended that she wait until her CMV IgM antibody levels decline to an undetectable level, and her CMV IgG avidity index climbs to a highly favorable percentage, before trying to conceive. This can take anywhere from six to twelve months. It is important to wait until the CMV infection has resolved because it minimizes the risk of CMV transmission from the pregnant woman to her baby in utero.

CMV is very easily preventable. According to National CMV Foundation, contact with children’s saliva and urine is a major cause of CMV infection among pregnant women. If you are pregnant or trying to get pregnant follow these easy steps.

  • Do not share food utensils, drinks, or straws
  • Do not put your child’s pacifier in your mouth
  • Avoid kissing children on the lips
  • Do not share a toothbrush
  • Wash your hands and toys that were mouthed thoroughly

If your baby is diagnosed with CMV it is important to have regular check-ups for vision and hearing. Early diagnosis of hearing and vision loss is critical and can help long term development. Therapies such as PT, OT, and ST are also important and can help with cognitive and physical disabilities such as fine motor delay, gross motor delay, feeding difficulties, and more.

For more information on CMV =

-Matthew D’Antonio, DPT, PT

-Pediatric Physical Therapist

Safety at Home and On the Go!

Author: Krista Flack, MS OTR/L

As we mentioned last week, June is National Safety Month, which focuses on reducing leading causes of injury and death at work, on the road and in our homes and communities.  Today I am writing about a few important topics: car seats, handling emergencies, and welcoming Hurricane Season!

Car Seat Safety Updates

Did you know that the Car Seat Safety laws in South Carolina were updated in May of this year

According to the bill:

  • motor vehicle crashes remain the leading cause of accidental death for children ages one to nineteen,
  • South Carolina's motor vehicle death rate per 100,000 is 20 as compared to a national average of 10.9,
  • each week approximately one South Carolina child seventeen years of age or younger dies from a preventable transportation-related incident,
  • child safety seats, when used correctly, can reduce fatalities by seventy-one percent for infants and fifty-four percent for toddlers, and
  • the proper use of age- and size-appropriate child restraint systems is the most effective way to minimize injuries and fatalities to children.

Under this new bill,

  • An infant or child under two years of age must be properly secured in a rear-facing child passenger restraint system in a rear passenger seat of the vehicle until the child exceeds the height or weight limit allowed by the manufacturer of the child passenger restraint system being used.
  • Children 2-4 years of age (or a child under two years of age who has outgrown his rear-facing child passenger restraint system) must be secured in a forward-facing child passenger restraint system with a harness in a rear passenger seat of the vehicle until the child exceeds the highest height or weight requirements of the forward-facing child passenger restraint system.
  • Children 4-8 years of age who has outgrown his forward-facing child passenger restraint system must be secured by a belt-positioning booster seat in a rear seat of the vehicle until he can meet the height and fit requirements for an adult safety seat belt as described in item (4). 
  • A child at least eight years of age or at least fifty-seven inches tall may be restrained by an adult safety seat belt IF the child can be secured properly by an adult safety seat belt, which means:
    • the lap belt fits across the child's thighs and hips and not across the abdomen;
    • the shoulder belt crosses the center of the child's chest and not the neck; and
    • the child is able to sit with his back straight against the vehicle seat back cushion with his knees bent over the vehicle's seat edge without slouching.
  • For medical reasons that are substantiated with written documentation from the child's physician, advanced nurse practitioner, or physician assistant, a child who is unable to be transported in a standard child passenger safety restraint system may be transported in a standard child passenger safety restraint system designed for his medical needs.

Handling Emergencies

As much as we hate to imagine all of the worst-case scenarios that could play out, doing so can help you prepare for emergencies, which can result in less stress and better outcomes in the moment.  There are many services, products, and programs available that can help you and your family be more prepared in case of an emergency, many of which have features that can specifically help families of children with special needs.

One such resource is a program called Smart 911.  By creating a free profile that is linked to your phone number and/or address, the emergency dispatchers at Beaufort County Sheriff’s Office can access important information instantly when you call.  For example, you can list medical conditions and precautions, such as autism, behavioral difficulties, communication deficits, allergies, and/or physical impairments.  This information can help dispatchers, paramedics, fire fighters, and police officers help you and your family more effectively if an emergency arises. 

If your child has autism, you may qualify for a Big Red Safety Box, a free-of-charge safety toolkit for families in need of wandering-prevention tools.  These kits include:

  • Educational materials and tools, including NAA’s Be REDy Booklet
  • Two (2) GE Door/Window Alarms including batteries
  • One (1) RoadID Personalized, Engraved Shoe ID Tag
  • Five (5) Adhesive Stop Sign Visual Prompts for doors and windows
  • Two (2) Safety Alert Window Clings for car or home windows
  • One (1) Red Safety Alert Wristband
  • One (1) Child ID Kit from the National Center for Missing & Exploited Children

 Autism Speaks has a great list of numerous other resources available for families of children, and adults, with special needs, including social stories to promote safety, and equipment to increase safety in the home and the community and prevent wandering

AWAARE has additional resources and items available for families to download and purchase, as well as free  Social Stories  you can personalize to educate your child on how to handle emergency situations.

The Red Cross has a booklet on preparing for disasters for people with special needs, which gives practical tips and guidelines for emergency and natural disaster preparedness.

Many companies, such as Road ID, offer ID bracelets and other wearables for adults and children, for quicker identification in case of an emergency, which can be especially helpful for those that are nonverbal, have difficulty communicating, or for emergencies that may make you unable to effectively communicate.

It is important to think about the unique characteristics and needs of your family and child, in order to plan accordingly and be as prepared as possible for an emergency.  Having a kit and supplies ready and having practiced escape routes and evacuation plans provides a little extra peace of mind that, when an emergency happens, you’re prepared.  

Hurricane Preparedness

The 2017 South Carolina Hurricane Guide can be downloaded on the South Carolina Emergency Management Division website, where you can also sign up to receive alerts and access numerous resources for family disaster planning.  Some organizations, including the Red Cross, FEMA,, and Autism Speaks, offer resources to specifically address disaster preparedness considering those with special needs.  

FREE Screenings for Scoliosis Awareness Month!

FREE Screenings for Scoliosis Awareness Month

Scoliosis affects about 3% of the population and is the most common spinal deformity according to Spine Health. Scoliosis is when there is an irregular curve and rotation in the spine. Most often this deformity has no known cause, in which case it is called idiopathic scoliosis. The curve can occur anywhere in the spine and there can be more than one curve.

Scoliosis can cause a number of potential problems if left untreated. A small curve can grow into a bigger curve and even create a new curve in a lower segment of the spine. Curves will continue to grow and worsen as skeletal growth occurs. It can cause muscle spasms in the back which can lead to back pain. It can also cause abnormal walking patterns and malalignment of the hips. This can lead to pain in the knees, ankles, and hips and makes the areas more susceptible for injury.

Early diagnosis is crucial and helps to slow or stop the progression of the curve. Children’s bones are not fully hardened yet, so non-surgical options such as bracing and therapy are effective treatments for slowing or stopping the progression of the curve. Screenings are the best way to catch scoliosis early even though it can occur at any age. Some schools offer yearly screenings for scoliosis. You can also ask the pediatrician to do a screening during your child’s annual exam.

We will be offering a FREE scoliosis screen on June 29th from 10:30 – 11:00 am at both our Bluffton and Port Royal Clinics. This screen is not only for patients, but also for parents, siblings, relatives, and anyone else who would like to be screened for scoliosis. Please call ahead to reserve your spot!

IF you are unable to make it, Lowcountry Therapy Center provides FREE screenings for children all year round! Please call our office at (843) 815-6999  for further information!

Here is a link for more information on signs/symptoms, diagnosis, and treatments

-Matthew D’Antonio, DPT, PT

-Pediatric Physical Therapist

Water Safety

Water Safety                                     Author: Krista Flack, MS OTR/L

June is National Safety Month, which focuses on reducing leading causes of injury and death at work, on the road and in our homes and communities.  This month, we will talk about increasing safety in a variety of situations, beginning this week with water safety!  According to the National Safety Council:

“Not including boating incidents, about 10 people drown every day. It's the fifth leading cause of unintentional-injury-related death over all ages, and the #1 cause of death for children ages 1 to 4, mostly due  to children falling into pools or being left alone in bathtubs.”

They recommend the following tips to increase safety and reduce risk:

  • Always watch your child while he or she is bathing, swimming or around water
  • Gather everything needed (towel, bath toys, sunscreen) before the child enters the water; if you must leave the area, take the child with you
  • Empty all buckets, bathtubs and kiddie pools of water immediately after use and store them upside down and out of your child's reach
  • Do not allow your child to play or swim in canals or streams
  • Install a 5-foot-tall fence with self-closing gate latches around your pool or hot tub
  • Consider installing door alarms to alert adults when a child has unexpectedly opened a door leading to a pool or hot tub
  • Keep a phone and life preserver near the pool or hot tub in case of emergency
  • Use snug-fitting life jackets instead of floaties, but remember that a child can still drown with a lifejacket on if not carefully watched
  • Become certified in first aid and CPR
  • Find age-appropriate swim lessons for your child, but keep in mind that lessons do not make your child "drown-proof"

Affordable swim lessons are offered through Beaufort County PALS ($45 for 8 half-hour group lessons, or $60 for 6 half-hour individual lessons) at their indoor and outdoor pools located throughout the county, and the YMCA (prices vary depending on group/individual and membership status). 

Additional water safety resources:

Accommodations and Tips for Traveling!

Accommodations and Tips for Traveling!

Everybody looks forward to a family vacation, but the closer you get to the departure date, the more you feel some of the stressors that come along with what should be a relaxing vacation.  Traveling with kids in general can mean a few curve balls being thrown your way, but when you have children with special needs, those curve balls can multiply!  Below are some tips for making your trip run as smoothly as possible so you can enjoy your time away!

  • First, always check to see if the attractions you will be visiting have programs or accommodations for children with special needs.  Some parks and museums offer sensory-friendly events or areas.   
  • Think about your daily routine – there are likely some things that make your day run smoothly that are such a part of your daily life that it would be very missed if you had to go without it, like specific snacks, a special blanket, or a swing.  Many things are easy to pack so that you don’t have to worry about finding it at your destination.  But you may not be able to pack everything that you use on a daily basis, so get creative and think about how you can replicate some of the things you can’t pack.  For example, a travel hammock could replace a swing and compacts down to a small pouch; a wiggle cushion or inflatable mattress are much smaller than a trampoline but can give similar input.   
  • Use visual schedules or social stories to prepare your child for the upcoming events and to add an element of routine/predictability.  This will reduce stress and prevent meltdowns. 
  • If your child is sensitive to sensory input:
    • Use a billed hat, sunglasses, or a sleep mask to reduce visual input.
    • Pack ear plugs or headphones to reduce noise, or to play calming sounds at times.
    • Use a weighted blanket, lap pad, or ankle weights to provide calming deep pressure. 
  • Heavy work activities can help regulate a child's arousal level, concentration, and ability to sit still and attend to a task.
    • While driving or flying, use theraband or exercise bands for heavy work.  Try stretching the band between your arms, or tie it into a loop and stretch between your feet!  
    • Stress balls, putty, pop beads, clothes pins, and other fidgets can make good heavy work activities for fingers and hands.  
    • Chewy snacks (licorice, gum, bagel, beef jerky) and sucking through a straw are great heavy work activities for your mouth!
    • Before boarding the plane or at rest stops, try to work in some heavy work tasks.  Push/pull a suitcase or cooler, carry a backpack, do jumping jacks, pushups, or animal walks.
  • A note about Car Sickness: Car sickness is caused by the discord within the brain’s ability to process movement with visual input. For example, your visual system says you are moving as the landscape passes by; however, your body and the proprioceptive receptors of the brain say you are sitting still. As your sensory receptors cannot find a way to process both sides of the sensory input, your body begins to have a visceral reaction, leading to nausea.  Another example occurs as you are trying to read a book in the car; your eyes are stationary on the book while the fluid in your ear canals are moving as the car goes over bumps and the car accelerates/decelerates; your brain has difficulty in processing if you are moving or if you are stationary as the input it is receiving does not match up.

Here are some popular vacation spots that offer special accommodations for children with special needs.  

  1. Carowinds = Charlotte, NC
    • Boarding Pass Program = Guests with mobility impairments or with autism spectrum disorder are able to receive a ride boarding pass with wait times. This allows guests to access the rides at specific times via the exit ramp in order to avoid crowds and waiting in the regular lines.
    • Guests with disabilities need to stop at guest services at the front gate upon arrival for details on special accommodations.
    • Here is the link to Carowinds for more information
  2. Georgia Aquarium = Atlanta, GA
    • They offer wheelchairs free of charge to guests and have a transportation system from the parking lot to the entrance.
    • The touch pool (where you can touch animals) has a special wheelchair access entry.
    • For children with visual and hearing impairments tactile elements have been added to each exhibit. They also have cell phone and Ipad tours available.
    • They have handicapped trained divers for anyone who wants to purchase the SCUBA or snorkeling package.
    • More information can be found at
  3. Disney, Universal, and SeaWorld = Orlando, FL
    • All 3 parks provide assistance passes for individuals with disabilities.
    • Passes can be obtained at guest relations when you enter the park.
    • The passes are different at each park, and this website helps to explain how each pass works and different tips and tricks to navigating the parks

-Matthew D’Antonio, DPT, PT

-Pediatric Physical Therapist

AAC: Interview with LTC’s Sarah Hanson, MS, CCC-SLP

AAC: Interview with LTC's Sarah Hanson, MS, CCC-SLP                                         Author: Krista Flack, MS OTR/L

1. What is AAC?

AAC stands for Augmentative/Alternative Communication.  It is utilized when natural speech is not intact.  It is used across all ages from children who have delayed speech or a diagnosis that impedes natural speech development, to the geriatric population for a man who has suffered from a stroke and no longer has functional speech.


 2.      Is AAC different than low-tech options, like PECS? 

AAC is an umbrella term for all augmentative/alternative communication.  Sign language, PECS, low-tech devices, and high-tech devices fall under that umbrella.  Anything that facilitates communication when the speech mechanism is not in tact is AAC. An AAC device is an electronic or mechanical tool that facilitates language.  AAC is a term that then falls into an even broader category termed assistive technology (AT) which encompasses wheelchairs, ramps, etc. 


3. What are the prerequisite skills needed to be successful with an AAC device?

In my short 10 years of practicing speech and language pathology, I have come across only 2 prerequisites for using an AAC device. The first is the patient must be breathing and the second is the patient must be awake.  In all seriousness, there are no cognitive prerequisites to use an AAC device.  It is up to the speech and language pathologist and the team of professionals to determine WHICH device will benefit the child the most and implement. 

4. My child has significant behavioral issues/cognitive delays/motor delays; does that preclude him from trying a device?

Absolutely not, in fact, it makes him a great candidate! 

Generally speaking, "behavioral issues", usually stem from the inability to communicate-pair that with processing delays (communication partners sound like Charlie Brown's mother) and we've got some HUGE communication breakdowns.  For these kiddos, the "behaviors" that they exhibit are the only way, up to this point, that they have been able to control their environment and feel safe.

For children who are pre-verbal, there is no way to tell the significance of a cognitive delay, if any.  When working with children with AAC, it is imperative that a high cognitive level is assumed and competence is expected by the team of professionals and family members. 

Motor delays do not stop AAC users either.  The patient must have a controlled motor movement. An isolated finger pointing to the screen or low-tech overlay is the best motor movement for effective communication. However; there are many other access options including eye-gaze, blinking, head movements, foot movements, air puffs, etc.  If there is a reliable motor plan, AAC can be utilized.  Generally, OT's and PT's will assist the team in choosing the best access method for a child using AAC

5. If my child uses an AAC device, will it limit his progress towards verbal speech?

NO, NO, NO!!!   AAC enhances speech production.  Study after study has shown that the majority of pre-verbal, limited verbal, or children who are highly unintelligible (even after intense phonological treatment) become more vocal with the use of an AAC system.  It can act as a bridge to verbal speech.  Natural speech is always the goal!!!

6. How do I get an AAC device for my child?

It takes a team of professionals to determine which type of AAC device will be most beneficial for a child.  The professionals may include a speech and language pathologist, an occupational therapist, a physical therapist, ABA therapists, the child's teacher, and parents. The process can be lengthy, but do not let it discourage you.  Speak with your speech and language pathologist and they will head up and guide you through the process. 

7. I have an AAC device.  What now?

It is imperative that a team of professionals work together WITH the family.  Parents, family members, and caregivers should attend as many therapy sessions as possible and follow a home program in order to learn the device themselves.  Devices can be overwhelming and daunting.  It is up to parents to learn the device right along with their child in order for the child to accept the device and use across all environments.  It may take months and years for a child using AAC to become proficient.  Don't give up!!!!

Therapy Treatment for Children who are Bilingual

Therapy Treatment for Children who are Bilingual

Interview with one of LTC's speech therapists, Alexandra Acheson, M.S. CFY-SLP, on treating kids who are bilingual.

1. Are milestones different for bilingual children?

There is a misconception that bilingualism can cause a language delay, but there has been no empirical evidence that indicates any sort of language delay in bilingual children. Studies have shown that bilingual and monolingual children achieve the basic milestones of language development around the same time. Like monolingual children, most bilingual children will speak their first words by the time they are 1 year old and by two years old, they can use two-word phrases.

2. Do you only work on 1 language at a time?

To a degree, yes. I ask the child/parent what language they would prefer to speak in during the session. If, however, during the session, there is a question that is difficult for the child to answer, I repeat the question in the other language to provide additional support.

3. Do you ask the family to only speak English at home?

No! Families should speak in the language that feels the most natural to them. Having the family interact and speak in the language they are comfortable in will be the best way to help promote language acquisition.

4. How can an English-speaking therapist help if they don't know Spanish?

I would suggest they try to integrate as much Spanish as they can during their session by using any resources they have. For example, if the child’s parents speak Spanish and English, bring them back to the session and have them translate. If the parents do not speak English, try finding a coworker who speaks Spanish to help translate the home program for them to work on at home. Translation apps (like Google translate) are another resource that can be utilized to help translate words and/or short phrases that you can use with the child during the session and when explaining the home program to parents.

-Matthew D’Antonio, DPT, PT

-Pediatric Physical Therapist

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