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Countless more suffered life-changing injuries, such as fractures, internal injuries, and traumatic brain injury. To address this growing public health epidemic, the Centers for Disease Control and Prevention (CDC) developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to facilitate fall risk identification and management in primary care (Stevens & Phelan, 2013). The Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, & Injuries [STEADI] (2019) fall risk evaluation tool was used to evaluate Mrs. L. A.'s risk for falls. Falls Risk Assessment Tool (FRAT) Introduction Falls are problematic within the elderly population. Alabama Mugshots 2022, Projects such as ours demonstrate how primary care practices can systematically implement an evidence-based algorithm to address fall risk among older adults, and ultimately reduce falls and fall-related injuries. 2. By integrating fall prevention into clinical practice physicians have the potential to reduce future falls by nearly 25%. 0000399296 00000 n
All variables were recorded based on previous documentation in the chart; no new variables were collected from the patient outside of the STEADI questionnaire and other visit-related parameters. As a healthcare provider, you can use CDCs STEADI initiative to help reduce fall risk among your older patients. To simplify integration, STEADI tools mirrored EHR technology already being used, including developing an annual fall health maintenance modifier and a STEADI Smartset containing standardized note templates (dotphrases), data entry tables (docflowsheets), checklists for orders and diagnostic codes, and Current Procedural Terminology II (CPT II) codes to report on fall-related national quality measures (Casey et al., 2016). The objective of this study was to examine the association between the DBI and medication-related fall risk. steadi fall risk score interpretation. An additional 111 patients would have been high-risk using the three key questions (Table 1). Seventy-three percent of STEADI visits occurred as part of routine office visits, 25% occurred during Medicare Wellness Visits, and 2% occurred during new patient visits. Austin Cole Wisdom Teeth, 0000064861 00000 n
In STEADI, fall risk is conceptualized as a chronic illness, as steps to address underlying health issues and prevent falls require a similar reorganization of health care system processes and regular patient/provider interactions over an extended time period. Cut-off scores and normative values may be used in conjunction with a complete evaluation to interpret the meaning of a patient's 5TSTS score. Australasian Journal on Ageing. Each medication included in the tool is given a score from 1 to 3 based on its contribution to fall risk. OR Risk Assessment for Falls not Completed for Medical Reasons (Two CPT II codes [3288F-1P & 1100F] are required on the claim form to submit this numerator option) Within the NHS in 2003 the cost per 10,000 population was 300,000 in the 60-64 age group, increasing to 1,500,000 in the >75 age group. That is usually the journal article where the information was first stated. (See the "Fall Risk Level" table below to determine the level and the action to be taken.) Other authors reported no conflict of interest. Content from CDC-developed patient educational brochures was embedded into the STEADI Smartset to include in patients after visit summaries. The medication list was initially reviewed by the medical assistant, but the PCP was trained to pay special attention to any high-risk medications (National Guideline Clearinghouse, 2015) and to intervene for a high-risk medication by eliminating, tapering the dose, or substituting the medication with a safer alternative (clinic workflow previously published, see Casey, et al., 2017). Have you fallen in the past year? https://www.physio-pedia.com/index.php?title=The_4-Stage_Balance_Test&oldid=319770. American and British Geriatric Societies Clinical Practice Guideline, Centers for Medicare and Medicaid Services (CMS), athenaPractice Revenue Cycle Management Newsletter: Customizing buttons, Reminder: NACHC athenaPractice/athenaFlow UGM February 28, Why Patients Refuse to Use Your Patient Portal (and What to Do About It), Webinar: HIPAA Updates for 2023: What You Need to Know Thursday, February 23 @ 11am PT. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. FES mean score was 91.85 (16.89); with scores ranging from 11 to 100. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. When PCPs felt their schedules were too busy, they could request the MA remove the STEADI flag and patients would not be given the Stay Independent questionnaire at check-in, thus deferring the screening until a later date. Most deferred patients did not have further fall assessment during the study period. Do you feel unsteady when standing or walking? What Does my Patient's Score Mean? Falls are the second leading cause of accidental injury deaths worldwide. We know that doctors are aware of falls in older adults and want to help but dont have all the needed resources, but now they do. It was adopted from a tool created by the Greater Los Angeles VA Geriatric Research Education Clinical Center. When the patient is steady, let go, and time how long they can maintain the position, but remain ready to assist the patient if they should lose their balance. Adults older than 60 years of age experience the greatest number of fatal falls. ; 3. Interpretation . Tools include: Falls Risk Assessment Tool (FRAT); Berg Balance Scale; Timed Up and Go Test (TUG); The Balance Outcome Measure for Elder Rehabilitation (BOOMER). As a healthcare provider, you can use CDC's STEADI initiative to help reduce fall risk among your older patients. 0000001648 00000 n
The completed STEADI tool kit, Preventing Falls in Older Patients-A Provider Tool Kit, is designed to help health care providers incorporate fall risk assessment and individualized fall interventions into routine clinical practice and to link clinical care with community-based fall prevention programs. 0000021882 00000 n
The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool was developed to promote fall risk screening and encourage coordination between clinical and community-based fall prevention resources; however, little is known about the tool's predictive validity or adaptability to survey data. The doctors found the new tool to be very useful. The Morse fall scale calculator consists in the following 6 patient parameters: History of falling (immediate or previous) - looks at whether the patient has already had an episode of falling during the current admission or has an immediate history of falls, either caused by gait or seizures. We certainly hope that a lot of doctors will use this tool and find it useful, said Erin Parker, PhD, Health Scientist at CDC. Results for the total group were weighted to account for the one in four sampling of patients in the concordant low category. low fall risk. What Attachments Does The Dyson Hair Dryer Have?, Data abstraction also included all interventions provided to patients who scored high-risk (score 4) on the Stay Independent questionnaire as previously described in the description of the studys workflow (e.g., administration of the Timed Up and Go test, orthostatic blood pressure measurements, vision screening, evaluation of feet problems, medication review). 0000067637 00000 n
Assessing your patients' risk for falling. Practical implementation of an exercisebased falls prevention programme. STEADI includes screening, feet shoulder width apart, suggesting that further research is needed to understand why some healthcare providers are more apt to assess their older adult patients for falls risk than other providers. (, Web-based Injury Statistics Query and Reporting System (WISQARS). For those assigned to the STEADI intervention arm, the clinical research nurse conducted standardized assessments to identify a patient's risk factors for falls. Seth Avett First Wife, Providers referred 60% of high-risk patients without gait impairment for community tai chi or fall prevention classes to help prevent future gait and balance issues (data not shown). Place your hands on the opposite shoulder crossed, at the wrists. Limitations of Fall Risk Scores Some assessment tools include a scoring system to predict fall risk. Therefore, the level must be manually chosen and. The STEADI initiative includes information on two screening options. 0000022484 00000 n
Screening rates were moderate, with 64% of eligible patients screened over 6 months, and 22% of screened patients were identified as high-risk for falls. The numbers provided by the CDC speak for themselves: What do you think about the Fall Risk Assessment tool? The main finding of our study was that low scores on the SPPB and all 3 subcomponents predicted higher 1-year fall risk. 0000001942 00000 n
While time is limited at an appointment, its crucial for doctors to help patients develop a plan to decrease their fall risk. 0000029152 00000 n
The goal of STEADI is to increase the skills of primary care providers (PCPs) and their teams to systematically screen older patients for fall risk, assess whether patients have modifiable fall risk factors, and treat the identified risk factors using evidence-based interventions. Importantly, although not formally studied, patients reported satisfaction with STEADI, and for those who adhered to recommended interventions, a belief that the interventions decreased their fall risk. Available at www.cdc.gov/steadi, STEADI includes: (1) a 12-question patient screening questionnaire of fall risk factors (Stay Independent); (2) an algorithm to guide clinical teams on how to assess and manage fall risk (see Supplementary Figure 1); (3) educational materials for providers, including case studies, conversation starters, online trainings, and standardized gait and balance assessments with instructional videos; and (4) educational brochures for older adults and their caregivers. An example of a question is "Which is not a key question when screening older adults for fall risk?". Systematic implementation of STEADI could help clinical teams reduce older patient fall risks. 0000004759 00000 n
Results indicate that the algorithm performed better in community vs. retirement facility dwellers. 3 In a study of 66,134 postmenopausal women, the strongest predictor of future falls was any fall in the past 12 . bGait impairment interventions included: home safety evaluation, exercise recommendation, mobility aid evaluation, physical or occupational therapy, Tai Chi, falls prevention class, Otago referral, pelvic floor therapy, or patient declined intervention. A reduced quality of life was documented throughout follow-up with SF12/36 scores between 35.3 and 52.3/100.2.6-4.8% of the patients with mild TBI reported depressive symptoms . The initial screening step is critical because it identifies who will receive additional assessments and follow-up care. 0
Comparison of a 3-item and 12-item screening questionnaire showed that the briefer version could be effective and more efficient for screening for falls. If the patient is over halfway to a standing position when 30 seconds have elapsed, count it as a stand. No Yes Dr. Salinas shared that not only did he and his fellow doctors enjoy the tools ability to better assist and assess for fall risk, his patients appreciated the tool, as well. -have you fallen in the past year? 46 51
Complete the following and calculate fall risk score.
Future work should address whether additional strategies could further streamline the process to improve feasibility and how other team members might contribute to the process (e.g., having a pharmacist do the medication review). Top Contributors - Gabriele Dara, Lucinda hampton, Admin, Kim Jackson and Shaimaa Eldib, The Four Stage Balance Test is a validated measure recommended to screen individuals for fall risk. Of these patients, 161 (95%) would have been identified as high-risk using an affirmative response to any one of the three key questions. STEADI Our Staff for Fall Prevention [PPT 4 MB], Empowering Healthcare Providers to Reduce Fall Risk, STEADI-Rx: Guide for Community Pharmacists. This tool will help you incorporate fall risk assessment and fall prevention into your clinical practice and enhance your efforts to help older adults stay healthy and independent. Topics. ; 2. Falls are the leading cause of injury-related deaths in older adults. Of the 170 patients screened as high-risk using the 12 Stay Independent questionnaire, 109 (64%) received additional fall risk assessments and interventions, whereas the remaining 36% had their fall prevention intervention deferred (Figure 1). Falls are the leading cause of injury-related deaths in older adults, accounting for nearly 3 million emergency department visits, including 925,000 hospitalizations, and more than 28,000 deaths in 2015 in the United States (WISQARS, 2016). Worse, death rates from falls doubled between 2000 and 2014, from 29 to 58/100,000 population (WISQARS, 2016). Persons are scored according to their highest level of functioning in that category. Burns, E. R.,Stevens, J. It was integrated into OU primary care practices where it was evaluated for its usability, technical soundness, convenience and modified based on feedback from doctors.
If low-risk, the medical assistant entered the score and gave the patient a handout on home safety and other fall prevention strategies at the beginning of the visit. 21 Item Fall Risk Index 3. [2] To reduce their risk of falling, consider implementing gait and balance exercises, or refer them to an evidence-based fall prevention program, for example Otago balance program, Tai Chi. 0000019564 00000 n
Once the Morse Fall Risk Assessment has been completed then it must be scored. likelihood of LE DVT when signs high risk, a score of 1 to 2 was moderate and symptoms are present risk, and a score of 0 or below was low Action Statement 6: Physical therapists should establish risk. x}Oo0| Then, stand next to the patient, hold their arm, and help them assume the correct position. Rossiter-Fornoff JE, Wolf SL, Wolfson LI, Buchner DM, FICSIT Group. Provide the CDC fall prevention brochures, What You Can Do to Prevent Fallsand Check for Safety. Doctors should be informed on what they can do to prevent falls among their older adult patients, such as recommending vitamin D, reducing medications that might increase falls, and referring patients to community programs or physical therapy to improve their balance. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). 0000007360 00000 n
They wanted the tool to automatically identify which of the patients medications might affect their fall risk. JAGS 1986; 34: 119-126. Results indicate that the algorithm demonstrated weaknesses with identifying fallers. Score Interpretation 41 - 56 Low fall risk 21 - 40 More likely to fall 0 - 20 High fall risk Score Assistive Device Needs 49.9 -51.1 Needs no assistive device 47 - 49.6 Use of cane needed for outdoors 44 - 46.5 Use of cane needed indoors and outdoors 26.7 - 39.6 Needs to use walker at all times 4] Important: Clinical Resources Inpatient Care 0000004499 00000 n
The OHSU Institutional Review Board approved the project. The FRAT has three sections: Part 1 - falls risk status, Part 2 - risk factor checklist and Part 3 - action plan. All screened patients were allocated into four categories based on their responses to the Stay Independent questionnaire: two concordant groups (high-risk using both approaches and low-risk using both approaches) and two discordant groups (high-risk using one approach and low-risk using the other). In the absence of a gold standard screening questionnaire that achieves both clinical utility and maximal efficiency, additional research is needed to ascertain the true positive and negative predictive value of these approaches. A retrospective chart review of patients aged 65 and older who received STEADI measured fall screening rates, provider compliance with STEADI (high-risk patients), results from the 12-item . Address correspondence to Elizabeth Eckstrom, MD, MPH, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, OHSU L475, 3181 SW Sam Jackson Park Rd., Portland, Oregon, 97239. Fall Screening Questionnaire Results for Patients Aged 65 and Older, and Comparison of 12-Item Stay Independent Questionnaire and Three Key Questions (2014) Columns Are the Results of Full STEADI Screening. -Instead, use assessment tools to identify fall risk factors. hb```a``! ea5 /CEEVbeAt
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Scores ranged from 2-21 correct stands within 30 seconds Community Dwelling Elderly (Jones et al, 1999; as an adjunct to the main part of the study, chair stand scores of 190 male and female residents from a nearby retirement housing complex (mean age = 76.2(6.7) years were analyzed to determine the test's ability to detect age differences over 3 age groups (60's, 70's, 80's) as well . the STEADI fall assessment Centers for Disease Control and Prevention (CDC) has developed and launched a comprehensive elder falls toolkit for clinicians called Stopping Elderly Accidents, Deaths & Injuries or STEADI. 0000030933 00000 n
(, Spears, G. V.,Roth, C. P.,Miake-Lye, I. M.,Saliba, D.,Shekelle, P. G., & Ganz, D. A. Let us know! Web-based Injury Statistics Query and Reporting System (WISQARS), Centers for Disease Control and Prevention (online). Thirty-six percent of eligible patients were not screened with the Stay Independent questionnaire because their provider had felt there was not time at that visit to do the screening. Background Preventing falls and fall-related injuries among older adults is a public health priority. Once in the exam room, the medical assistant performed orthostatic vital signs as part of the rooming process and entered all data into the EHR (Kalinowski, 2008; Podsiadlo & Richardson, 1991). endstream
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You can review and change the way we collect information below. If a fall screening was due, the medical assistant would add Fall Screening to the patients appointment notes so it would be seen by the front office staff. The study used a retrospective cohort design, with a 1-year observation period. If your patient needs to sit and rest, the test stops and this distance is recorded as the 6MWT score. Patient Characteristics for Participants Aged 65 and Older by Risk Level Using Stay Independent and Three Key Questions (2014). A footwear assessment included a monofilament exam or review of last monofilament exam if the patient was diabetic; for nondiabetic patients, the PCP evaluated whether the patient generally wore appropriate footwear (e.g., no flip flops, no bare feet at home, no high heels) and made appropriate recommendations. The Agency for Healthcare Research and Quality developed the medication fall risk score and evaluation tools to help providers evaluate patients' fall risk related to the use of certain high-risk medications (see table). no interventions needed, standard fall prevention interventions, high risk prevention interventions) are then identified. 30 Second Chair Stand Test 5. xref
Falls can be deadly to the older adult and costly to the . Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. h[{o;w8y81*0mDW%%R"%wvgvvK&Jg2!L]' .56`')IfS
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:C?T\-F|)OqyiE2T*Yu|p4^_rUI7f The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) was developed as part of an evidence-based fall safety initiative. If a patient scores a 4 out of 12 on the self-fall risk evaluation, they should have the Timed Up and Go Test, 30 Second Chair Stand to . The only remaining problem was the time needed to fully assess a patient for fall risk and recommend interventions. endstream
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Ranges Secondary diagnosis (2 or more medical diagnoses . This study reports the adoption of CDCs STEADI initiative in an academic primary care clinic and its effect on patient care. The Center for Disease Control and Prevention (CDC) recommends that doctors incorporate fall prevention into their regular practice. Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. fDmn6MH2.f "#5l-0L`RLR@j0Q $V *
Falls: Assessment and prevention of falls in older people. G.L. No Yes * I steady myself by holding onto furniture when walking at home. The CDC developed the Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative to make fall prevention a routine part of clinical care. The implementation of STEADI at OHSU, which implemented the full Stay Independent brochure, provides an opportunity to assess some implications of using the three key questions rather than the complete Stay Independent brochure. Although not all risk factors for falls are modifiable (age, some chronic illnesses and physical limitations), a systematic review of fall prevention interventions for community-dwelling older adults found falls may be decreased by programs that target gait, strength, and balance (e.g., Tai Chi), home safety, gradual withdrawal of high-risk medications, and other interventions (Gillespie et al., 2012). Number of risk factors: Probability of falling: 0-1: 7%: 2-3: 13%: 4-5: 27%: 6+ . If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. The team met regularly to review what Debi Willis, technical engineer on the project and owner of PatientLink, was building and to provide feedback through the entire process. 0000000016 00000 n
Although the STEADI algorithm delineates a moderate risk category based on number of falls or injury related to a fall, for purposes of clinical feasibility, our study used only low- and high-risk categories based solely on the score of the STEADI questionnaire. Interventions were directed toward more than 80% of patients with gait or vision impairment, orthostasis, or vitamin D deficiency. No prior presentations were conducted. E.E. Do you worry about falling? Stapleton C, Hough P, Oldmeadow L, Bull K, Hill K, Greenwood K. Fouritem fall risk screening tool for subacute and residential aged care: The first step in fall prevention. While the STEADI Algorithm underwent revisions since the study onset, the 2017 version was utilized as a guide for key outcome metrics . Falls result in over $31 billion in medical costs each year (Burns, Stevens, & Lee, 2016). You can download the. Background: This tool can be used to identify risk factors for falls in hospitalized patients. Falls are a common and serious health threat to adults 65 and older. 0000020240 00000 n
Not being able to hold the tandem stance (task number 3) for 10 seconds is an indication of increased risk of fall. Available Fall Risk Screening Tools: START HERE . Deaths, and Injuries (STEADI) fall-risk tool can lead to decreased rates of fall-related hospitalizations (Johnston et al., 2019). Jones CJ (1999). In STEADI, fall risk is conceptualized as a chronic illness, as steps to address underlying health issues and prevent falls require a similar reorganization of health care system processes and regular patient/provider interactions over an extended time period. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Approximately 20-30% of falls result in moderate to severe injuries, which leads to: > reduced mobility and independence > increased risk of premature deaths > increased length of hospital stay Building fall prevention tools into EHR systems and clinic workflows could help make fall prevention a routine part of clinical practice. Stay Independent: a 12-question tool [at risk if score . A score of 3 or greater was nicate the results and risks. Addition of frailty status does not improve the ability of the STEADI measure to predict future falls. -do you feel unsteady while standing or walking? Informatics staff built STEADI elements into an EHR (Epic) clinical decision support tool to help the clinical workflow align with the STEADI algorithm (see Supplementary Figure 1). Nearly all (94%) high-risk patients took a medication that increased fall risk, yet only 22% had a medication change. The tool has multiple sections, divided into tabs for easy toggling. hZs6W3od8N. A patient who scores under 25 points is considered to be at low risk of falling, a patient who scores between 25-45 points is considered to be at moderate risk of falling, and a patient who scores higher than 45 points is considered to be at high risk of falling. The present study aimed to analyze and synthesize the literature produced concerning the association of sarcopenia with falls in elderly people with cognitive impairment. 201 0 obj
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2020 Dec 22;injuryprev-2020-044014. With the aging process, elderly people present changes in their bodies that can lead them to suffer several geriatric syndromes. The Centers for Disease Control and Prevention (CDC), American College of Preventive Medicine (ACPM), a team of national experts, andPatientLinkworked together to design and build a free fall risk clinical decision support (CDS) encounter form. A retrospective chart review of patients aged 65 and older who received STEADI measured fall screening rates, provider compliance with STEADI (high-risk patients), results from the 12-item. It was adopted from a tool created by the Greater Los Angeles VA Geriatric Research Education Clinical Center. Development of STEADI was informed by the American and British Geriatric Societies (AGS/BGS) 2010 fall prevention guideline (Kenny, Rubenstein, Tinetti, Brewer & Cameron, 2011) as well as two conceptual modelsWagners Chronic Care model (Wagner, 1998) and Prochaskas Transtheoretical Stages of Change model (Prochaska & Velicer, 1997). Yes (1) No (0) I am worried about falling. %PDF-1.6
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fVision interventions included: consult to ophthalmology or optometry, already seeing ophthalmologist or optometrist, recommendation for single distance lenses outdoors. Secondary diagnosis (2 or more medical diagnoses . Providers screen older adults for fall risk, assess their specific modifiable risk factors, and intervene by reducing the identified risks. aMeans and percentages for overall category are weighted to account for sampling design (i.e., those in concordant low group were sampled 1:4, and given a weight of 4). 3.2. This work was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) [grant number UB4HP19057] titled Oregon Geriatric Education Center (total award amount of $2,138,357, 0% financed with nongovernmental sources). AND CPT II 1100F: Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year. Its psychometric properties have been previously assessed [ 27 ]. Following Prochaska's Stages of Change model, STEADI is built on the idea that (1) fall prevention requires health behavior change, (2) behavior change is a process that occurs through a series of stages, and (3) fall prevention interventions should be tailored to a patient's stage of change ( Prochaska & Velicer, 1997 ). In order to ensure that at-risk older adults are not missed, providers using the three key question approach are asked to follow up with patients that responded yes to any of the three key questions. Fall Prevention Module Fall Prevention 4 One in three adults 65 and older fall each year Fatal falls rank high (#5) per The Joint Commission (TJC) Sentinel Events List. TOP. Master List of Outcome Measures Assessing Balance/Fall Risk Being Reviewed. One steadi fall risk score interpretation four sampling of patients in the concordant low category the content or... 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Diagnosis ( 2 or more medical diagnoses include in patients after visit summaries an example a... Holding onto furniture when walking at home retirement facility dwellers adults older than 60 years age. Of age experience the greatest number of fatal falls ( See the references at... Tool to automatically identify Which of the STEADI Smartset to include in patients after visit summaries 3 subcomponents higher... Problematic within the elderly population then it must be manually chosen and place your hands the... Their bodies that can lead to decreased rates of fall-related hospitalizations ( Johnston al.. Below to determine the level must be manually chosen and of fall risk score their... And intervene by reducing the identified risks that low scores on the opposite shoulder crossed, at the of. Functioning in that category question is `` Which is not a key question when screening older adults fall... Top Tips Tuesday and the Latest physiopedia updates, the level must be scored Tuesday. 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