1 school nurse for 6 schools and 2000 kids

  1. Hello and hope all are well. I am a school nurse for 6 schools and 2000 kids. Worn out right now. State coming in 3 weeks and desperately trying to finish everything. I have care plans to do on the chronically ill students but also emergency care plans as well. Having trouble finding a website that would help with the emergency ones...I also have a boss who is mainly over special education and got handed my job title. She has no idea what I do..Is nt a nurse and doesn't care anything about what I do....Have been doing this for 31/2 years now.....Basically am having to face the fact that one person can't do it all and it is okay....I don't know what do you do with no support and no resources. i have 275.00 in a budget to help with 6 schools, had to buy my own computer, dont have a phone and my office is in the back of a classroom. Anyone has any ideas, please let me know.
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  2. 9 Comments

  3. by   bergren
    The Hass, M. B. et al. (1993). School Nurse Source Book. North Branch MN: Sunrise River Press. Has a template in it for an emergency plan. TIf your district has that book it would be a good guideline, but it is out of print and the new updated edition should be out by June.

    Some of the individaul articles in the Journal of School Nursing contain emergency plans for specific problems www.nasn.org


    The Schwab, N., Panneteirri, M. J. & Bergren, M.D. (1998). Guidelines for school nurisng documentation. Scarborough, ME: NASN. has an example if you have that obbk around - this book is alos outdated. NASN most likley has other references for sale that provide templates.

    Your case load is too big. There is no way you can met the standard of care with that many schools and 2000 kids. Are there health aides at each school?

    The budget is also too small. The worst budgets I am familiar with are .50 - 1.00 per student. Yours is .14 cents per student. Keep track of what you need and document it.

    What state are you in? Can you get some advice from the state association?




    Quote from seabreezern
    Hello and hope all are well. I am a school nurse for 6 schools and 2000 kids. Worn out right now. State coming in 3 weeks and desperately trying to finish everything. I have care plans to do on the chronically ill students but also emergency care plans as well. Having trouble finding a website that would help with the emergency ones...I also have a boss who is mainly over special education and got handed my job title. She has no idea what I do..Is nt a nurse and doesn't care anything about what I do....Have been doing this for 31/2 years now.....Basically am having to face the fact that one person can't do it all and it is okay....I don't know what do you do with no support and no resources. i have 275.00 in a budget to help with 6 schools, had to buy my own computer, dont have a phone and my office is in the back of a classroom. Anyone has any ideas, please let me know.
  4. by   seabreezern
    I am the only one who does my job. There are people who help out with the medications. They each had to go to a class for this and all of the other nurses I talked with who held their classes did so with no problem. I had to do a self study because these people had other classes to attend to. There are no aids that assist me. Ocassionally I will have someone who can put a band-aid on but that is it. I am now having to check one school with over 300 kids every week for headlice. Last week I also had to check another school with 2oo + by myself in one day. I had to buy my own laptop, there is no phone this year because I dont use my own, and I have lost my office for the last 3 years. I was sharing a classroom with a teacher earlier this year. I fought to get an office and then my boss who was put over my position gives me excessive amounts of grief. That is a story in itself. I already spent money on a care plan book for myself and so I only have 150.00 or left for medical supplies. This also includes any paper or other supplies I might need. I am so worn out and tired of feeling like a failure. I have no support. My boss isnt a nurse and has made it clear that special ed is her main priority. She has been nasty more than once and has called me Pussycat in a ***** meaning way as well. With state coming in I am nervous enough and knowing that I have all of these care plans and other things left to do is not helping. I think it is time for me to move one...One person cant do an efficient job dealing with that many kids or schools. Last year I had 7 schools, but because of finances the 7th school closed down.....Anyway don't mean to be negative but I am at my wits end. Thanks again I will try your idea with the Journal of School Nursing. I am in Conecuh County which is a rural area in lower Alabama. Have a good day. Look forward to hearing back from you.
    Quote from bergren
    The Hass, M. B. et al. (1993). School Nurse Source Book. North Branch MN: Sunrise River Press. Has a template in it for an emergency plan. TIf your district has that book it would be a good guideline, but it is out of print and the new updated edition should be out by June.

    Some of the individaul articles in the Journal of School Nursing contain emergency plans for specific problems www.nasn.org


    The Schwab, N., Panneteirri, M. J. & Bergren, M.D. (1998). Guidelines for school nurisng documentation. Scarborough, ME: NASN. has an example if you have that obbk around - this book is alos outdated. NASN most likley has other references for sale that provide templates.

    Your case load is too big. There is no way you can met the standard of care with that many schools and 2000 kids. Are there health aides at each school?

    The budget is also too small. The worst budgets I am familiar with are .50 - 1.00 per student. Yours is .14 cents per student. Keep track of what you need and document it.

    What state are you in? Can you get some advice from the state association?
  5. by   bergren
    You state that you boss only cares about special education. If the reimbursement is like most other states, they could be paying your salary out fo the special education direct and indirect services you provide to the children. You should try to find out how muych revenue you are bringing in. Also, try to get the PTA and or some local businesses to donate some of the supplies you need. You are serving triple the nubmer of studnets the national association and CDC recommends.

    "I am now having to check one school with over 300 kids every week for headlice. Last week I also had to check another school with 200+ by myself in one day." School wide headchecks are not recommended by the NASN, AAP, and the Harvard School of Public Health.

    I cannot conceive of how you can do your job without a phone. How would they contact you in the event of an emergency? How do parents call? How can you call providers and how do they call you back?

    Alabama Association of School Nurses
    www.aasn.org
    3060 Mobile Highway
    Montgomery, AL 36108

    NASN Director
    Carol Austin, RN, BSN
    email: caustin@scs.k12.al.us

    Association President
    Catherine Davis
    email: catdavis@mindspring.com

    State Department of Education, Health Services Specialist
    Martha Holloway, RN, BSN, MHSA
    email: mholloway@alsde.edu




    QUOTE=seabreezern]I am the only one who does my job. There are people who help out with the medications. They each had to go to a class for this and all of the other nurses I talked with who held their classes did so with no problem. I had to do a self study because these people had other classes to attend to. There are no aids that assist me. Ocassionally I will have someone who can put a band-aid on but that is it. I am now having to check one school with over 300 kids every week for headlice. Last week I also had to check another school with 2oo + by myself in one day. I had to buy my own laptop, there is no phone this year because I dont use my own, and I have lost my office for the last 3 years. I was sharing a classroom with a teacher earlier this year. I fought to get an office and then my boss who was put over my position gives me excessive amounts of grief. That is a story in itself. I already spent money on a care plan book for myself and so I only have 150.00 or left for medical supplies. This also includes any paper or other supplies I might need. I am so worn out and tired of feeling like a failure. I have no support. My boss isnt a nurse and has made it clear that special ed is her main priority. She has been nasty more than once and has called me Pussycat in a ***** meaning way as well. With state coming in I am nervous enough and knowing that I have all of these care plans and other things left to do is not helping. I think it is time for me to move one...One person cant do an efficient job dealing with that many kids or schools. Last year I had 7 schools, but because of finances the 7th school closed down.....Anyway don't mean to be negative but I am at my wits end. Thanks again I will try your idea with the Journal of School Nursing. I am in Conecuh County which is a rural area in lower Alabama. Have a good day. Look forward to hearing back from you. [/QUOTE]
  6. by   seabreezern
    I don't believe my salary comes out of special ed services, and I recently learned that all of that money has been spent anyway. I am not sure what you mean about the cdc or the national association but I read a while back and as of now there can be a nurse for every 8,000 students I believe. The associations may not require head checks but my principals ask that I do this as needed. The principal at the school I check each week asked me to do this. I am thinking of training people to help me with this. It has become to big of a job at times with everything else going on. I will see about asking the PTA and see what I can get. I have asked for donations from people before but that in itself is time consuming. As far as a phone is concerned I am at one school every morning and then I have the other 5 schools by schedule. If I am needed then one school has to call me at whichever school I am at. Sometimes I have to drive to check on a student in a school 15 to 20 miles away and then return back to the school I was at. I dont so much mind this as I am the school nurse and the students need me. I just wish I had more resources than I do. I am kind of the lone duck in the fact that I am the only nurse and usually am in a whole other category. I learn more and more each year of what works and what doesn't.`I am hoping state will let me know what I need working on and what I am doing that is working. Care plans for every chronically ill child including ones on medicine has been time consuming but I hope eventually I will master it....Like my mom says they can't put me in jail....




    Quote from bergren
    You state that you boss only cares about special education. If the reimbursement is like most other states, they could be paying your salary out fo the special education direct and indirect services you provide to the children. You should try to find out how muych revenue you are bringing in. Also, try to get the PTA and or some local businesses to donate some of the supplies you need. You are serving triple the nubmer of studnets the national association and CDC recommends.

    "I am now having to check one school with over 300 kids every week for headlice. Last week I also had to check another school with 200+ by myself in one day." School wide headchecks are not recommended by the NASN, AAP, and the Harvard School of Public Health.

    I cannot conceive of how you can do your job without a phone. How would they contact you in the event of an emergency? How do parents call? How can you call providers and how do they call you back?

    Alabama Association of School Nurses
    www.aasn.org
    3060 Mobile Highway
    Montgomery, AL 36108

    NASN Director
    Carol Austin, RN, BSN
    email: caustin@scs.k12.al.us

    Association President
    Catherine Davis
    email: catdavis@mindspring.com

    State Department of Education, Health Services Specialist
    Martha Holloway, RN, BSN, MHSA
    email: mholloway@alsde.edu




    QUOTE=seabreezern]I am the only one who does my job. There are people who help out with the medications. They each had to go to a class for this and all of the other nurses I talked with who held their classes did so with no problem. I had to do a self study because these people had other classes to attend to. There are no aids that assist me. Ocassionally I will have someone who can put a band-aid on but that is it. I am now having to check one school with over 300 kids every week for headlice. Last week I also had to check another school with 2oo + by myself in one day. I had to buy my own laptop, there is no phone this year because I dont use my own, and I have lost my office for the last 3 years. I was sharing a classroom with a teacher earlier this year. I fought to get an office and then my boss who was put over my position gives me excessive amounts of grief. That is a story in itself. I already spent money on a care plan book for myself and so I only have 150.00 or left for medical supplies. This also includes any paper or other supplies I might need. I am so worn out and tired of feeling like a failure. I have no support. My boss isnt a nurse and has made it clear that special ed is her main priority. She has been nasty more than once and has called me Pussycat in a ***** meaning way as well. With state coming in I am nervous enough and knowing that I have all of these care plans and other things left to do is not helping. I think it is time for me to move one...One person cant do an efficient job dealing with that many kids or schools. Last year I had 7 schools, but because of finances the 7th school closed down.....Anyway don't mean to be negative but I am at my wits end. Thanks again I will try your idea with the Journal of School Nursing. I am in Conecuh County which is a rural area in lower Alabama. Have a good day. Look forward to hearing back from you.
    [/QUOTE]
  7. by   bergren
    If you are providing nursing care that is a listed as related service on an IEP, then the district is collecting federal funds for your time, but it is reimbursed only an average of 18% of th actual amount of time devoted to the services.

    The recommended nurse to student ratio is 1:750 well students, 1:225 special education and 1:125 medically fragile (http://www.nasn.org/positions/2004pscaseload.htm ; http://www.healthypeople.gov/Documen...#_Toc490550856 See 7-4 for school nurse ratio) . In some states it is less. Massachusetts has a nurse in every school, average 1:250, and mhas a maximum allowable 1:750.
    Alabama Ala. Code 16-22-16. The ratio of pupils to school nurses is prescribed, starting at one per school system (1999-2000) to one school nurse per 7,000 pupils (2000-01) and reducing the ratio by 500 pupils per year down to 2,000 pupils (2010-11 and thereafter). The requirement is contingent on funding in the Education Trust Fund annual budget act.
    Utah actually has one school nurse for every 6,330 students--the worst ratio in the country.

    Below is Vermont's ratios.

    SCHOOL QUALITY STANDARDS

    Adopted by the Vermont Legislature and Vermont Department of Education

    January 1999

    2120.8.1.3 Support Services

    2120.8.1.3.3 Health Services

    Health services, including health appraisal, counseling, communicable disease control, emergency and first aid care, shall be made available, in collaboration with parents and community health resources, to students in each school. These health services shall be delivered in accordance with the school district's written policies and procedures, and with requirements of state law relative to vision and hearing screening, immunization and child abuse reporting.

    Each school shall engage the services of a person licensed as a school nurse and shall specify in writing his or her duties. There shall be no more than 500 students per school nurse. Schools with fewer than 500 students shall employ a nurse in at least an approximate proportion of the number of students to 500. The school shall strive to meet staffing ratios for Comprehensive School Health Services set forth in Vermont School Nurses' Association's "Guidelines for Establishing Safe School Nurse to Student Population Ratios." There shall be adequate equipment and space for delivery of confidential health services.

    Guidelines For Establishing Safe School Nurse to Student Population Ratios

    These guidelines apply to student populations in one building. Students with special needs often require a great deal of the school nurse's time to assess, plan, implement and evaluate their care. Student population numbers listed below need to reflect this by accommodating for the intensity level of the special needs students in a given population. Students who fit into an "at risk" category need to be counted as 3 students. Students who are moderately physically or emotionally challenged should be counted as 10 students (KSNO, 1994). Students with severe/complicated medical, physical, or mental challenges should be counted as 20.

    "At risk" students may be characterized by any one or more of the following indicators:

    1. A high rate of absenteeism from school - ten days or more;
    2. Failure to achieve grade level standards;
    3. Failure in two or more subjects or courses of study;
    4. Behind in credits to graduate;
    5. Retention at grade level one or more times;
    6. Below grade level for students of the same age;
    7. Pregnancy or parenthood or both;
    8. Repeated commission of disciplinary infraction;
    9. Member of a house hold that is at or below the poverty level using criteria for free and reduced lunch program;
    10. Limited English proficiency;
    11. Identified victim of physical, sexual, or emotional abuse and/or neglect;
    12. Health or substance abuse problems;
    13. Attempted suicide;
    14. Identified as medically fragile or has special health needs;
    15. Identified with an I.E.P. for Special Education, as 504, as gifted or with speech problems.
    (KNSO,1994)
    Additional factors to consider when establishing safe school nurse to student population ratios are:

    1. The number of buildings the nurse covers - The travel time and the fact that the nurse is not always present to carry out such things as first aid and medication administration limits the coverage that she/he can provide. Ratios need to be lowered in these situations. For example, the minimum school health services ratio of 1/750 needs to be lowered to 1/500 students in a maximum of five buildings, each of which is accessible within 30minutes (Vermont Standard of Practices: School Health Services, 1995).

    2. The staffing patterns - the use of unlicensed and licensed personnel such as secretaries and licensed practical nurses to cover the health office in the nurse's absence or to augment health services. The delegation of nursing tasks to these persons requires training and monitoring by the school nurse. Adequate time must be available for these functions.

    3. The amount of time and responsibility the nurse takes for health education. Coordination, planning and lesson preparation can require large amounts of time away from other school nursing tasks. The more the nurse is involved with health education the lower the ratios must be to allow for proper follow through in the area of health services.

    Adopted 1/14/98 by: The School Nurse Advisory Board to the Vermont Department of Education and the Vermont State School Nurse's Association Adopted 12/16/98 by: Vermont's Legislative Committee on Administrative Rules as part of the School Quality Standards



    Quote from bergren
    You state that you boss only cares about special education. If the reimbursement is like most other states, they could be paying your salary out fo the special education direct and indirect services you provide to the children. You should try to find out how muych revenue you are bringing in. Also, try to get the PTA and or some local businesses to donate some of the supplies you need. You are serving triple the nubmer of studnets the national association and CDC recommends.

    "I am now having to check one school with over 300 kids every week for headlice. Last week I also had to check another school with 200+ by myself in one day." School wide headchecks are not recommended by the NASN, AAP, and the Harvard School of Public Health.

    I cannot conceive of how you can do your job without a phone. How would they contact you in the event of an emergency? How do parents call? How can you call providers and how do they call you back?

    Alabama Association of School Nurses
    www.aasn.org
    3060 Mobile Highway
    Montgomery, AL 36108

    NASN Director
    Carol Austin, RN, BSN
    email: caustin@scs.k12.al.us

    Association President
    Catherine Davis
    email: catdavis@mindspring.com

    State Department of Education, Health Services Specialist
    Martha Holloway, RN, BSN, MHSA
    email: mholloway@alsde.edu




    QUOTE=seabreezern]I am the only one who does my job. There are people who help out with the medications. They each had to go to a class for this and all of the other nurses I talked with who held their classes did so with no problem. I had to do a self study because these people had other classes to attend to. There are no aids that assist me. Ocassionally I will have someone who can put a band-aid on but that is it. I am now having to check one school with over 300 kids every week for headlice. Last week I also had to check another school with 2oo + by myself in one day. I had to buy my own laptop, there is no phone this year because I dont use my own, and I have lost my office for the last 3 years. I was sharing a classroom with a teacher earlier this year. I fought to get an office and then my boss who was put over my position gives me excessive amounts of grief. That is a story in itself. I already spent money on a care plan book for myself and so I only have 150.00 or left for medical supplies. This also includes any paper or other supplies I might need. I am so worn out and tired of feeling like a failure. I have no support. My boss isnt a nurse and has made it clear that special ed is her main priority. She has been nasty more than once and has called me Pussycat in a ***** meaning way as well. With state coming in I am nervous enough and knowing that I have all of these care plans and other things left to do is not helping. I think it is time for me to move one...One person cant do an efficient job dealing with that many kids or schools. Last year I had 7 schools, but because of finances the 7th school closed down.....Anyway don't mean to be negative but I am at my wits end. Thanks again I will try your idea with the Journal of School Nursing. I am in Conecuh County which is a rural area in lower Alabama. Have a good day. Look forward to hearing back from you.
    [/QUOTE]
  8. by   bergren
    Some regs specific to Alabama: http://www.nasbe.org/HealthySchools/States/Alabama.html

    Quote from bergren
    If you are providing nursing care that is a listed as related service on an IEP, then the district is collecting federal funds for your time, but it is reimbursed only an average of 18% of th actual amount of time devoted to the services.

    The recommended nurse to student ratio is 1:750 well students, 1:225 special education and 1:125 medically fragile (http://www.nasn.org/positions/2004pscaseload.htm ; http://www.healthypeople.gov/Documen...#_Toc490550856 See 7-4 for school nurse ratio) . In some states it is less. Massachusetts has a nurse in every school, average 1:250, and mhas a maximum allowable 1:750.
    Alabama Ala. Code 16-22-16. The ratio of pupils to school nurses is prescribed, starting at one per school system (1999-2000) to one school nurse per 7,000 pupils (2000-01) and reducing the ratio by 500 pupils per year down to 2,000 pupils (2010-11 and thereafter). The requirement is contingent on funding in the Education Trust Fund annual budget act.
    Utah actually has one school nurse for every 6,330 students--the worst ratio in the country.

    Below is Vermont's ratios.

    SCHOOL QUALITY STANDARDS

    Adopted by the Vermont Legislature and Vermont Department of Education

    January 1999

    2120.8.1.3 Support Services

    2120.8.1.3.3 Health Services

    Health services, including health appraisal, counseling, communicable disease control, emergency and first aid care, shall be made available, in collaboration with parents and community health resources, to students in each school. These health services shall be delivered in accordance with the school district's written policies and procedures, and with requirements of state law relative to vision and hearing screening, immunization and child abuse reporting.

    Each school shall engage the services of a person licensed as a school nurse and shall specify in writing his or her duties. There shall be no more than 500 students per school nurse. Schools with fewer than 500 students shall employ a nurse in at least an approximate proportion of the number of students to 500. The school shall strive to meet staffing ratios for Comprehensive School Health Services set forth in Vermont School Nurses' Association's "Guidelines for Establishing Safe School Nurse to Student Population Ratios." There shall be adequate equipment and space for delivery of confidential health services.

    Guidelines For Establishing Safe School Nurse to Student Population Ratios

    These guidelines apply to student populations in one building. Students with special needs often require a great deal of the school nurse's time to assess, plan, implement and evaluate their care. Student population numbers listed below need to reflect this by accommodating for the intensity level of the special needs students in a given population. Students who fit into an "at risk" category need to be counted as 3 students. Students who are moderately physically or emotionally challenged should be counted as 10 students (KSNO, 1994). Students with severe/complicated medical, physical, or mental challenges should be counted as 20.

    "At risk" students may be characterized by any one or more of the following indicators:

    1. A high rate of absenteeism from school - ten days or more;
    2. Failure to achieve grade level standards;
    3. Failure in two or more subjects or courses of study;
    4. Behind in credits to graduate;
    5. Retention at grade level one or more times;
    6. Below grade level for students of the same age;
    7. Pregnancy or parenthood or both;
    8. Repeated commission of disciplinary infraction;
    9. Member of a house hold that is at or below the poverty level using criteria for free and reduced lunch program;
    10. Limited English proficiency;
    11. Identified victim of physical, sexual, or emotional abuse and/or neglect;
    12. Health or substance abuse problems;
    13. Attempted suicide;
    14. Identified as medically fragile or has special health needs;
    15. Identified with an I.E.P. for Special Education, as 504, as gifted or with speech problems.
    (KNSO,1994)
    Additional factors to consider when establishing safe school nurse to student population ratios are:

    1. The number of buildings the nurse covers - The travel time and the fact that the nurse is not always present to carry out such things as first aid and medication administration limits the coverage that she/he can provide. Ratios need to be lowered in these situations. For example, the minimum school health services ratio of 1/750 needs to be lowered to 1/500 students in a maximum of five buildings, each of which is accessible within 30minutes (Vermont Standard of Practices: School Health Services, 1995).

    2. The staffing patterns - the use of unlicensed and licensed personnel such as secretaries and licensed practical nurses to cover the health office in the nurse's absence or to augment health services. The delegation of nursing tasks to these persons requires training and monitoring by the school nurse. Adequate time must be available for these functions.

    3. The amount of time and responsibility the nurse takes for health education. Coordination, planning and lesson preparation can require large amounts of time away from other school nursing tasks. The more the nurse is involved with health education the lower the ratios must be to allow for proper follow through in the area of health services.

    Adopted 1/14/98 by: The School Nurse Advisory Board to the Vermont Department of Education and the Vermont State School Nurse's Association Adopted 12/16/98 by: Vermont's Legislative Committee on Administrative Rules as part of the School Quality Standards


    [/QUOTE]
  9. by   seabreezern
    Unfortunately I am in a school system in Alabama.. Things have progressively gotten worse over time....I am doing my best at this job, but I feel it is time to move one. It has been a good lesson, but the situation of the county and the job is not going to change anytime soon. I am not the only one who is feeling the brunt of not having resources. I guess that is just life. I have to fix what I can in this situation and not worry about what I can't. My budget was 350.00 last year and this year as I stated is 275.00. You can only work with what you have. I appreciate you taking the time to listen. I guess maybe I needed that more right now than a solution to this ongoing problem. I will usually let myself mope a while and do the self pity thing, but then after a day or two I bounce back and look at the positive.. I am surrounded by children (excluding most teenagers) :chuckle who enjoy me for what I do and that in the end sometimes over rides any of the negative...Thanks again and have a great day.

    Quote from bergren
    [/QUOTE]
  10. by   bergren
    "I appreciate you taking the time to listen. I guess maybe I needed that more right now than a solution to this ongoing problem. " I hear you. I do not think I could be happy in the job, not so much for the workload, but the unsupportive supervisor. It is hard enough, but when you do not have the support, it is not worth it. Good luck.
  11. by   crich
    Quote from seabreezern
    Hello and hope all are well. I am a school nurse for 6 schools and 2000 kids. Worn out right now. State coming in 3 weeks and desperately trying to finish everything. I have care plans to do on the chronically ill students but also emergency care plans as well. Having trouble finding a website that would help with the emergency ones...I also have a boss who is mainly over special education and got handed my job title. She has no idea what I do..Is nt a nurse and doesn't care anything about what I do....Have been doing this for 31/2 years now.....Basically am having to face the fact that one person can't do it all and it is okay....I don't know what do you do with no support and no resources. i have 275.00 in a budget to help with 6 schools, had to buy my own computer, dont have a phone and my office is in the back of a classroom. Anyone has any ideas, please let me know.

    I am in Tennessee. We have some basic IHPs for diabetes, asthma, heart, allergic reaction and a few others, that can be individualized with md and parent input. Your situation sounds ridiculous. One thing that you may want to do is get a copy of your school health laws. i'm sure someone at your school has them. Check with your Superintendent and if that is a problem because of your boss, call your Al. School Nurse Association or maybe State of Alabama health office. They can probably get you a copy. If you have laws that back up you and your student's needs, then if you make a formal request in writing, with the laws to back you up. This will make your boss liable and may make him and the Superindent (send him a cc of request) think again.

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