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Indiana Violent Death Reporting
System (INVDRS)
Advisory Board MeetingSeptember 15, 2017
Rachel Kenny, MPH,
INVDRS PI & Epidemiologist
Division of Trauma and Injury Prevention
1
Email Questions: INVDRS@isdh.in.gov
INVDRS@isdh.in.gov
2
Email Questions: INVDRS@isdh.in.gov
Agenda
• Introductions
• Drug Overdose Grants Update-Jessica
Schultz
• Program Updates
• Data Presentation
– 2015-2017 Violent Death Demographics
– 2015 INVDRS Pilot Counties
3
Email Questions: INVDRS@isdh.in.gov
Introductions
4
Email Questions: INVDRS@isdh.in.gov
New INVDRS Staff
• Records Consultants
– Brittany Armstrong
– Patricia Dotson
– Anita McCormick-Peyton
• Intern-Vincent Gallagher
5
Email Questions: INVDRS@isdh.in.gov
2018 meeting dates
•1 p.m.-3 p.m. EST in Rice
Auditorium
–March 16th
– September 21st
6
Email Questions: INVDRS@isdh.in.gov
Program Updates
7
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8
Email Questions: INVDRS@isdh.in.gov
2017 Reverse Site Visit
• May 16th-May 18th
• New Orleans, LA
• Attendees: NVDRS-funded states and
CDC staff
Rachel and Ryan attended.
9
Email Questions: INVDRS@isdh.in.gov
10
11
12
2017 Safe States Annual
Meeting
• September 12-14, 2017
• Aurora, Colorado
• Strong focus in Data presentation and
violence prevention
13
Email Questions: INVDRS@isdh.in.gov
Sessions Attended
• Making your Data Work for You
• Advanced Data Analysis Approaches
• Innovative ways to Communicate Data
• Building Capacity for Systems Thinking
among Injury and Violence Preventions
• Link Data to Save Lives: Using NVDRS
to Prevent Suicide and Firearm Injury
14
Email Questions: INVDRS@isdh.in.gov
Sessions Attended
• Preventing Suicide Across the National
Spectrum
• Expanding the Scope of NVDRS
Analyses
• Addressing Firearm Violence with
Public Health Strategies
15
Email Questions: INVDRS@isdh.in.gov
Suicide in Indiana ReportReminder!
16
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11 Leading Causes of Death, Indiana, 2011-2015
17
18
Email Questions: INVDRS@isdh.in.gov
19
Email Questions: INVDRS@isdh.in.gov
20
Email Questions: INVDRS@isdh.in.gov
21
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22
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23
Email Questions: INVDRS@isdh.in.gov
24
Suicide Attempts
• For every suicide death there is on
average 25 suicide attempts
• For every youth suicide death there is
on average 100-200 youth suicide
attempts
– 14,500-29,000 Hoosier youths attempted
suicide in Indiana between 2011 and
2015 25
Email Questions: INVDRS@isdh.in.gov
26
Email Questions: INVDRS@isdh.in.gov
27
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28
Email Questions: INVDRS@isdh.in.gov
Other topics in Report
• Suicide in the U.S.
• Additional maps/geographic
distributions
• Special Populations
• Protective factors
• Risk factors
29
Email Questions: INVDRS@isdh.in.gov
Data Sources
• ISDH Mortality Reports, 2011–2015. Epidemiology
Resource Center,
• CDC WISQARS and WONDER databases
• Indiana Hospital Association, Hospital Discharge
Inpatient Data, 2011-2015.
• Indiana Hospital Association, Hospital Discharge
Outpatient/ED Data, 2011-2015.
• Indiana Youth Risk Behavior System Survey, 2011
and 2015.
30
Email Questions: INVDRS@isdh.in.gov
Report available at:
http://www.in.gov/isdh/25396.htm
31
Email Questions: INVDRS@isdh.in.gov
RECENT GRANT APPLICATIONS
32
Email Questions: INVDRS@isdh.in.gov
Grant activities
• Prescription Drug Overdose: Prevention for States – Applied for year 2 (base and supplement)
– Applied for a Program Expansion: 7/2017
• Enhanced State Surveillance of Opioids– Originally awarded but not funded, funding starts September 1
– Applied for supplement: 7/2017
• First Responder Comprehensive Addiction and Recovery Act– Applied 7/2017
33
Email Questions: INVDRS@isdh.in.gov
Prescription Drug Overdose Prevention
for States 2017 Program Expansion
Activity 1.1: Building Capacity and Infrastructure to Enhance Use of INSPECT Data
Activity 1.2: INSPECT Expansion into Electronic Health Records in High Opioid- Prescribing Facilities
Activity 2.1: Piloting of an Overdose Fatality Review
Activity 2.2: Collecting Adverse Childhood Experiences Data through the 2018 Behavioral Risk Factor Surveillance System
Activity 4.1: Overdose Rapid Response Plan to Address Overdose Clusters in Five Pilot Counties
34
Email Questions: INVDRS@isdh.in.gov
Enhanced State Opioid Overdose
Surveillance (ESOOS)
Originally applied 6/2016, funded 9/2017
1. Increase the timeliness of aggregate nonfatal opioid overdose reporting
2. Increase the timeliness of fatal opioid overdose and associated risk factor reporting
3. Disseminate surveillance findings to key stakeholders working to prevent or respond to opioid overdoses
35
Email Questions: INVDRS@isdh.in.gov
ESOOS 2017 Supplemental
1 year supplemental opportunity
Activity 1: Implement comprehensive toxicology testing
Activity 2: Linking INSPECT data to opioid-related overdose deaths during coroner investigations
36
Email Questions: INVDRS@isdh.in.gov
First Responder - Comprehensive
Addiction and Recovery Act (FR CARA)
Program will: 1) Provide resources through the Indiana Naloxone Kit
Distribution Program for First Responders in rural communities;
2) Train first responders on carrying and administering naloxone; and
3) Expand the Indiana Recovery and Peer Support Initiative for referral to appropriate treatment and recovery communities.
As of 9/14/2017, Funding Decision Pending
37
Email Questions: INVDRS@isdh.in.gov
2018 IPAC Meetings
Meetings: 10 a.m. – 12 p.m. EST
• March 16
• Spring Conference, TBD
• July 20 (webcast)
• September 21
• November 16
38
Email Questions: INVDRS@isdh.in.gov
2017 IPAC Meetings
Meetings: 10 a.m. – 12 p.m. EST
• November 17
39
Email Questions: INVDRS@isdh.in.gov
Upcoming Events
• Indiana Emergency Response Conference, Sept. 20-23
• National Traumatic Brain Injury Awareness Month
• National Suicide Prevention Week, Sept. 10-16
• Child Passenger Safety Week, Sept. 17-23
• Falls Prevention Awareness Day, Sept. 22
• National Seat Check Saturday, Sept. 23
40
Email Questions: INVDRS@isdh.in.gov
Upcoming Events• Public Safety + Public Health Opioid Conference, Sept 27
• Domestic Violence Awareness, October
• National Bullying Prevention Month, October
• 8th Annual Prescription Drug Abuse & Heroin Symposium, October 30-31
• 2017 Labor of Love Summit, Nov. 15
• 2017 Midwest Injury Prevention Alliance Summit, November 30-December 1
41
Email Questions: INVDRS@isdh.in.gov
Public Safety + Public Health
Opioid Conference
42
• September 27th from 8:30 a.m. to 4:30 p.m. at the Ritz Charles
• No registration fee required and breakfast and lunch are provided
• Learn more:
https://www.eventbrite.com/e/public-safety-public-health-opioid-conference-tickets-36838582191
Email Questions: INVDRS@isdh.in.gov
2017 Midwest Injury Prevention
Alliance Summit
43
44
2018 EMS Medical Director’s
Conference
Email Questions: INVDRS@isdh.in.gov
2017 Labor of Love Summit
45
• November 15, J.W. Marriott in downtown Indy
• More info: http://www.infantmortalitysummit-indiana.org/
Email Questions: INVDRS@isdh.in.gov
Thank you for your attention!
Jessica Schultz, MPH
Injury Prevention Epidemiologist Consultant
Email: JSchultz@isdh.in.gov
Phone: 317-617-4155
46
Email Questions: INVDRS@isdh.in.gov
Data Provider Progress
47
Email Questions: INVDRS@isdh.in.gov
Coroners
48
• 76 signed data
sharing
agreements
Questions/Comments:
Joboyle@isdh.in.gov
Connections?
• Boone
• Jefferson
• Jennings
• Knox
• Miami
• Noble
• Owen
• Posey
• Sullivan
• Switzerland
• Warren
• Warrick
• Wells
• White
49Please contact: JObyle@isdh.in.gov
Email Questions: INVDRS@isdh.in.gov
Challenges
Agencies Declining to Participate in INVDRS
• Monticello PD
• Elkhart County SD
• Goshen PD
• Elkhart PD
• Cass County SD (~5)
• Gibson County SD (~14)
• Harrison County SD (~17)
• Mishawaka PD (~42)
• Montgomery SD
• New Albany PD (~45)
• Starke County SD (~14)
• Steuben County SD (~6)
50
Email Questions: INVDRS@isdh.in.gov
Challenges
Agencies Not Yet Participating
– White County coroner and sheriff
– Jasper County SD
– Demotte PD
– St. Joseph County SD
– Osceola PD
– Salem PD
51
Email Questions: INVDRS@isdh.in.gov
Successes
• 45 Coroner DSA’s in January 2017 to
76 today
• Elkhart County Coroner is participating
and we have already received their
reports
• Indiana State Police have been
approved to participate and we are now
waiting for their records52
Email Questions: INVDRS@isdh.in.gov
Data Abstraction &
Records Collection
53
Email Questions: INVDRS@isdh.in.gov
Data Availability and
Deadlines
Data Year Death Certificate Data Complete INVDRS
Data-CDC Deadline
2015 Sept. 2016 (prelim),
January 2017 (final)
June 2017
2016 Sept. 2017 (prelim),
January 2018 (final)
June 2018
2017 Sept. 2018 (prelim),
January 2019 (final)
June 2019
Etc.
54
Email Questions: INVDRS@isdh.in.gov
2016 Records Collection
• Coroner Reports Received: 52%
• LE Reports Received: 57%
55
Email Questions: INVDRS@isdh.in.gov
Death Certificate Data
for Violent Deaths
56
Email Questions: INVDRS@isdh.in.gov
57
405
977
183
506
1036
206
0
200
400
600
800
1000
1200
Homicide Suicide Undetermined
Dea
th C
ou
nt
Manner of Death by Year
2015 2016
Email Questions: INVDRS@isdh.in.gov
58
52 101107
53 41 33 18
35 109
167172
187 163 144
1510
41 32 39 3412
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<18 18-24 25-34 35-44 45-54 55-64 >65
Perc
enta
ge o
f D
eath
s
Age Group
2015 Manner of Death by Age Group
Homicide Suicide Undetermined
Email Questions: INVDRS@isdh.in.gov
59
55 121 13584
49 32 26
33125
162172
210 162 172
26
19 38 35 45 2914
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<18 18-24 25-34 35-44 45-54 55-64 >65
Perc
enta
ge o
f D
eath
s
Age Group
2016 Manner of Death by Age Group
Homicide Suicide Undetermined
Email Questions: INVDRS@isdh.in.gov
60
Email Questions: INVDRS@isdh.in.gov
1554
669226
373
466159
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Suicide Homicide Undetermined
Perc
enta
ge o
f D
eath
s
2015-2016 Percentage of Death Manner by Gender
Male Female
Breakdown: Suicides
61
Email Questions: INVDRS@isdh.in.gov
Counties with Most Resident
Suicides: 2015- 2016
1. Marion — 276
2. Lake — 129
3. Allen — 87
4. St. Joseph — 80
5. Hamilton — 76
6. Vanderburgh — 62
7. Vigo — 52
8. Elkhart — 51
9. Porter — 50
10. Madison — 44
11. Hendricks — 43
12. Monroe — 43
13. Johnson — 37
14. Tippecanoe — 37
15. Clark — 31
62
Email Questions: INVDRS@isdh.in.gov
63
0
20
40
60
80
100
120
Dea
th C
ou
nt
Suicide Counts by Month2015 2016 2017
Email Questions: INVDRS@isdh.in.gov
64
35
109
167 172187
163144
33
125
162172
210
162172
0
50
100
150
200
250
<18 18-24 25-34 35-44 45-54 55-64 >65
Dea
th C
ou
nt
Age Group
Suicide Count by Age Group and Year2015 Suicide 2016 Suicide
Email Questions: INVDRS@isdh.in.gov
65
2.09
8.86
19.1620.17 20.71
18.11
14.49
0.00
5.00
10.00
15.00
20.00
25.00
<18 18-24 25-34 35-44 45-54 55-64 >65
Rat
e
Age Group
2015 Suicide Rate by Age Group
Email Questions: INVDRS@isdh.in.gov
Rates per 100,000.
2.5
21.6
32.6 31.834.4
27.129.4
1.7
7.15.7
8.5 7.210.1
3.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
<18 18-24 25-34 35-44 45-54 55-64 >65
Rat
e
Age Group
2015 Suicide Rate by GenderMale Female
66
Email Questions: INVDRS@isdh.in.gov
Rates per 100,000.
67
15.38
24.99
6.01
7.23
12.71
2.12
Crude Rate
Male
Female
2015 Suicide rates by race and sex White African-American
*Unstable Rate
Rates per 100,000.
Email Questions: INVDRS@isdh.in.gov
23%
1%
33%
36%
1%6%
2015-2016 Marital Status Suicide
Divorced
Married, but seperated
Married/CivilUnion/Partnership
Never Married
Unknown
Widowed
68
Email Questions: INVDRS@isdh.in.gov
3.6%
13.8%
48.4%
6.3%
15.7%
8.0%
2.2%
1.6%
0.4%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%
<= 8th Grade
9th-12th Grade
HS or GED
Associate
Some College Credit
Bachelor
Master
Doctorate
Unknown
2015-2016 Education Level Suicide
69
Email Questions: INVDRS@isdh.in.gov
Breakdown: Homicides
70
Email Questions: INVDRS@isdh.in.gov
Counties with Most
Homicides (2015-2016)
71
Email Questions: INVDRS@isdh.in.gov
1. Marion — 325
2. Lake — 133
3. Allen — 79
4. St. Joseph — 40
5. Elkhart — 25
6. Delaware — 17
7. Vanderburgh — 16
8. Warrick — 10
9. Howard — 9
10. Vigo — 9
11. LaPorte — 8
12. Madison — 8
13. Johnson — 7
14. Porter — 7
15. Hamilton — 6
0
10
20
30
40
50
60
Dea
th C
ou
nt
Homicide Counts by Month2015 2016 2017
72
Email Questions: INVDRS@isdh.in.gov
50
99 100
5239 33
18
55
121135
84
49
32 26
0
20
40
60
80
100
120
140
160
<18 18-24 25-34 35-44 45-54 55-64 >65
Dea
th C
ou
nt
Age Group
Homicides by Age Group and Year2015 2016
73
Email Questions: INVDRS@isdh.in.gov
65
189 188
105
69
49
3141
3147
3119 16 13
0
20
40
60
80
100
120
140
160
180
200
<18 18-24 25-34 35-44 45-54 55-64 >65
Dea
th C
ou
nt
Age Group
2015-2016 Homicide by Gender/AgeMale Female
74
Email Questions: INVDRS@isdh.in.gov
3.23
8.68
11.40
6.07
4.443.62
1.66
0.00
2.00
4.00
6.00
8.00
10.00
12.00
<18 18-24 25-34 35-44 45-54 55-64 >65
Rat
e
Age Group
2015 Homicide Rate by Age Group
75
Email Questions: INVDRS@isdh.in.gov
Rates per 100,000.
3.59
23.57
18.06
9.477.56 7.91
2.842.854.6 4.71
2.671.36 2.16
0.950
5
10
15
20
25
<18 18-24 25-34 35-44 45-54 55-64 >65
Rat
e
Age Group
2015 Age and Gender Homicide RateMale Female
76
Email Questions: INVDRS@isdh.in.gov
Rates per 100,000.
77
2.7 31.7
3.7 54.8
1.7 10.3
0.0 10.0 20.0 30.0 40.0 50.0 60.0
Rate per 100,000
2015 Homicide rates of White and African American
Hoosiers: A look at the disparity.
Crude Rate
Males
Females
Email Questions: INVDRS@isdh.in.gov
Rates per 100,000.
78
Email Questions: INVDRS@isdh.in.gov
12% 1%
13%
71%
3%
2015 - 2016 Marital Status of Homicide Victims
Divorced
Married, but seperated
Married/CivilUnion/Partnership
Never Married
Widowed
9.8%
28.9%
39.9%
4.1%
11.7%
3.4%
0.7%
0.1%
1.5%
<= 8th Grade
9th-12th Grade
HS or GED
Associate
Some College Credit
Bachelor
Master
Doctorate
Unknown
2015-2016 Education Level of Homicide Victims
79
Email Questions: INVDRS@isdh.in.gov
80
3.6%
13.8%
48.4%
6.3%
15.7%
8.0%
2.2%
1.6%
0.4%
9.8%
28.9%
39.9%
5.2%
11.7%
3.4%
0.7%
0.1%
1.5%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%
<= 8th Grade
9th-12th Grade
HS or GED
Associate
Some College Credit
Bachelor
Master
Doctorate
Unknown
Percentage
2015-2016 Manner of Death by Education Level
Suicide Homicide
Email Questions: INVDRS@isdh.in.gov
Child Section
81
Email Questions: INVDRS@isdh.in.gov
69
47
18
1
75
44
21
6
0
10
20
30
40
50
60
70
80
Homicide Suicide Undetermined Accident
Dea
th C
ou
nt
2015-2016 Child (<18) Deaths by Manner 2015 2016
82
Email Questions: INVDRS@isdh.in.gov
98
63
19
7
26 2820
00
20
40
60
80
100
120
Homicide Suicide Undetermined Accident
Dea
th C
ou
nt
<18 Manner of Death 2015 & 2016Male Female
83
Email Questions: INVDRS@isdh.in.gov
2
34
49
02 2
1318
3 3
82
73
0
10
20
30
40
50
60
70
80
90
Accident Undetermined Homicide Suicide
Dea
th C
ou
nt
Manner of Death by Age Group <10 10-14 15-17
84
Email Questions: INVDRS@isdh.in.gov
1.8
13.5
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0
10-14
15-17
Rate
Age
Ran
ge2015 Child Suicide Rate
85
Email Questions: INVDRS@isdh.in.gov
Rates per 100,000.
5.7
1.8
4.5
0.0 1.0 2.0 3.0 4.0 5.0 6.0
<10
10-14
15-17
Rate
Age
Ran
ge2015 Child Homicide Rate
86
Email Questions: INVDRS@isdh.in.gov
Rates per 100,000.
2015 INVDRS
Data
Data limited to Allen,
Lake, Madison, Marion,
St. Joseph, and
Vanderburgh Counties
87
Email Questions: INVDRS@isdh.in.gov
Data Quality Checks
• CDC checked our 2015 pilot county
data for potential errors, such as:
– Weapon type missing
– Poisoning as cause of death but no
substance listed as having caused the
death
– If Suspect in Homicide is an intimate
partner, ensuring the IPV circumstance is
checked88
Email Questions: INVDRS@isdh.in.gov
Data Completeness Check
• CDC will soon be sending us a report
on our data that outlines the percentage
of our cases with circumstances and
other categories.
• Our completeness comparison to grant
expectations.
89
Email Questions: INVDRS@isdh.in.gov
Data Sources
• 402 Suicides
– 389 with coroner report abstracted
– 226 with law enforcement abstracted
– 229 with both abstracted
• At least one circumstance was known
for 273 of the suicides.
90
Email Questions: INVDRS@isdh.in.gov
Data Sources
• 313 Homicides
– 313 with coroner report abstracted
– 124 with law enforcement abstracted
– 121 with both abstracted
• At least one circumstance was known
for 173 of the homicides.
91
Email Questions: INVDRS@isdh.in.gov
Limitations
• First Year of Data
• Missing LE/Coroner Reports
• Quality of LE/Coroner Reports
• Can’t speculate on more rural Indiana
counties
92
Email Questions: INVDRS@isdh.in.gov
SUICIDE CIRCUMSTANCES
93
Email Questions: INVDRS@isdh.in.gov
94
54.5
23.4
14.9
3.5
2.5
1.2
0.0 10.0 20.0 30.0 40.0 50.0 60.0
Firearm
Hanging/Strangulation/Suffocation
Poisoning
Sharp Instrument
Other
Motor Vehicle
Percentage
Weapon Type for Suicide Decedents
Email Questions: INVDRS@isdh.in.gov
95
45%
37%
16%12%
66%
55%
23%
18%
0%
10%
20%
30%
40%
50%
60%
70%
Depressed Mood MH Problem Alcohol Problem Other SubstanceAbuse
Perc
enta
geSuicide Circumstances-Mental Health and
Substance Abuse% All Suicides % of Suicides with at least 1 Circumstance
Email Questions: INVDRS@isdh.in.gov
Mental Health Diagnoses-150
• 105 Depression
• 17 Bipolar
• 8 Schizophrenia
• 6 PTSD
96
Email Questions: INVDRS@isdh.in.gov
97
14%
2%
6% 6% 5%
19%
10%
19%
6%
21%
3%
8% 9%8%
27%
15%
28%
9%
0%
5%
10%
15%
20%
25%
30%
Perc
enta
geSuicide Circumstances-Life Stressors
% All Suicides % of Suicides with at least 1 Circumstance
Email Questions: INVDRS@isdh.in.gov
98
12
38
Argument Timing BreakdownDuring Argument With 24 hours of Argument
Email Questions: INVDRS@isdh.in.gov
99
2%
19%
25%27%
31%
3%
29%
37%40%
45%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Recent Suicide History ofSuicide
Attempts
DisclosedIntent
Left a Note History ofSuicidal
Thoughts
Perc
enta
geSuicide Circumstances-Suicide Specific% All Suicides % of Suicides with at least 1 Circumstance
100
37, 48%
29, 37%
12, 15%
Disclosed Intent to Whom BreakdownCurrent or Former Partner Other Family Member Friend
Email Questions: INVDRS@isdh.in.gov
HOMICIDE CIRCUMSTANCES
101
Email Questions: INVDRS@isdh.in.gov
102
80%
6%
6%
4%4%
1%
Weapon Type for Homicide Decedents
Firearm
Blunt Instrument
Sharp Instrument
Personal Weapons
Hanging/Strangulation/Suffocation
Other
Email Questions: INVDRS@isdh.in.gov
103
13% 13%
10%
7%
6% 5%5% 4%
3% 3% 3%2%
24%23%
18%
13%
10%10%
9%8%
5%5% 5%
3%
0%
5%
10%
15%
20%
25%
Perc
enta
ge
Homicide Circumstances% All Homicides % of Homicides with at least 1 Circumstance
Email Questions: INVDRS@isdh.in.gov
Precipitated by Other Crime
Breakdown
• Burglary= 6 homicides
• Drug Trade= 6 homicides
• Robbery= 7 homicides
104
Email Questions: INVDRS@isdh.in.gov
What else would you
like to see? Activity!
105
Email Questions: indianatrauma@isdh.in.govEmail Questions: INVDRS@isdh.in.gov
2018 meeting dates
•1 p.m.-3 p.m. EST in Rice
Auditorium
–March 16th
– September 21st
106
Email Questions: INVDRS@isdh.in.gov
Call to Action
• Send interested parties to ISDH Division of Trauma and Injury Prevention
• INVDRS@isdh.in.gov
• INVDRS PI & Epidemiologist
Rachel Kenny
317-233-8197
rkenny@isdh.in.gov 107
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