Mirror Athlete Blog Articles

June 23, 2010

Epidemiology Provides Ill-Health Prevention & Centurion Wisdom

    In a nut shell, epidemiology is the study of illness and disease affecting a population’s health.  It is also an applied science specific to the incidence of disease in populations as opposed to the individual.  I believe basic knowledge of this highly specialized job can provide individuals with a better understanding in prevention of disease and relative-timely medical referrals for ill-health conditions.  My point is if we could learn how to use specific data to our advantage in seeking to identify and treat our ill-health, we would be much more successful at alleviating pain-illness and maintaining better overall health and happiness.  This does not mean you need a degree in epidemiology to apply a common sense approach to find resolve to a specific ill-health problem.  What it does mean, by understanding how science identifies and treats epidemics in populations; the basic principles of this knowledge can provide the individual a better ill-health troubleshooting skill set that many centurions use to improve upon quality living experiences as they age!

     The work of epidemiologists includes researching risk factors in environment that cause illness and disease, clinical identification/study of illness agent, data collection, etc., of infected people and treatment of environmental out breaks on population.  What most don’t understand, epidemiologists rely on a vast array of disciplines in order to “best” identify an ill-health outbreak.  In order to understand how ill-health is disseminated on a population requires an understanding and mastery by these experts; and those specialized in the fields of biology, sociology, mathematics, statistics, anthropology, psychology and policy (research policy and bureaucracy impact data results and interpretation).  So the “one cause-one effect” to illness and death rarely is a single contributor of ill-health on a population.   Instead, multiple factors, circumstances and opportunity within environment typically lead to an epidemic that would create the lethal agent outbreak impacting an entire population.  If pain alleviation and ill-health prevention wisdom is the result of knowing how to apply some of this basic knowledge; than living to be a healthy centurion is a “more likely than not” goal scenario, is it not?

     With a broad range of potential bio-agents and psychosocial cause factors, ill-health agents can attack the physical mind-body from many internal and external cause fronts.  Understand that each one of us is a 3-part being that requires a healthy environment which caters to the mind, body and spirit.  Also recall, the internal biological neural highways, mind-body (psychosomatic) connection can depress the body’s physical biology and spirit.  The same is true of body-spirit pain which can depress the bio-mind making any part of being sick through the psychosomatic connection.  We are a 360 degree feedback “being” mechanism.  In other words, to make it simple, we all have the ability to think ourselves into ill-health conditions when our internal and external environments depress us through infection worsening a condition for example.  We do not become ill due to only biological external environmental agents!  And when our “being” is depressed, we are more susceptible to illness and disease agents from multiple environmental cause agents!

     Now let’s look at one example where epidemiologists have used their specialized data collection techniques to determine agent cause, treat and save lives in populations, than use this as a model to apply to self. 

     Before water and food sanitation practices evolved many people got extremely sick from the cholera bacteria.  This bacterium dispersed within a population from feces, or other effluents (vomit, diarrhea, etc.) that contaminated their living space; water and food sources, etc.    Cholera would not only be in the water source but would then spread to coastal water ways for example and attach itself to shellfish contaminating those whose diet in part was dependent on them.  Through consumption of shellfish the bacteria would continue its assault on distant coastal populations.   This chain of events could then infect local and distant water/food supplies, dwellings, etc., which infected the body, mind and spirit of individuals, also families in multiple communities.

     By “collecting data points” from various near and distant infected social-cultural environments, people, animals, soil samples, water, food, etc., scientist where able to find the common contributing denominator(s) to an epidemic that wiped out huge populations in the past before the Cholera bacteria agent was identified.  Once this agent was identified, preventative sanitation and treatment practices were put into effect and outbreaks in civilized populations became nonexistent.  Today these specialists collect data and provide consumers and other interest groups risk data and advisement on poor diet, smoking (second hand smoke), sewage-sanitation systems/practices, food preparation/storage, various environmental impact studies, toxic product identification, pandemic containment advisement etc., and the list goes on.

     So what can you as an individual take away from this wisdom to apply to self?  After all most of us aren’t statistical analysts that have participated in illness and disease epidemic studies.  Regardless, there are lessons to be learned and tools that can be used on self, much like the epidemiologist approach in discovery to rid a population of ill-health environmental conditions.  So the basic skill set you can improve upon when seeking relative and timely treatment to ill-health signs and symptoms will require you to provide historical and daily data to a treating physician, or specialist.    Regardless of whether an illness is acute (infrequent occurrence), or chronic (frequent-consistent occurrence), you must learn to track specific data much like the epidemiologist seeks the cause and effect in finding an ill-health agent afflicting a population.  By learning how to target the cause agent a likely solution can be applied to the internal/external threat before it causes further damage to being.  What kind of data you ask?

     You must begin collecting data on your daily habits, time/day of pain, and frequency of event, duration, signs-symptoms, products/food you consume; identify risky behaviors-habits and things that cause stress in your life.  Now you are collecting data that can be shared with those of specific medical knowledge disciplines.  Remember a “one cause-one effect” that creates illness in a population is seldom the case.  That is, the Cholera a bacterium was born and spread from multiple cause agent carriers; starting through poor sanitation practices.  This infected people, food, rodents and water; impacted social activities, wellbeing (quarantined/death) which impacted social/family dynamics in local and distant communities for years thereafter.   So where did science start looking first for this culprit?  Good question, a process of elimination through data collection and other scientific means of the times.  The same is basically true when any patient has complex illness and pain symptoms.  By collecting data on your daily habits, signs and symptoms you are providing biological, psychological, diet, physical, statistical and social environmental information that will provide a more likely inference on the cause agent(s) origin to your discomfort and ill-health.

     Below are 12 data points of interest you can track for self to share with a physician before consultations; much like an epidemiologist would collect to increase probability of targeting harmful agents by sharing collected data with other specialists to rid a population of a likely cause agent.  You too must also do some homework by providing suspected cause agent data to your physician for the best treatment outcome. 

     Information and Data Cause Agent Source Example/Ideals for the individual:  1) Use the Internet to research your symptoms/treatment solutions and visit chat rooms-forums to learn more about suspected illness and disease.  2)  If diagnosed with substantiated illness-disease buy self-help books from experts, or visit your local library for successful treatment solutions/ideals.  3) Talk to parents, siblings and blood relatives to see if there is a genetic ill-health connection, cause and what was the treatment… Did the illness worsen, or improve with treatment?  4) Are your symptoms caused from poor diet?  5) Do you engage in unhealthy habits, i.e., smoking, drinking, poor diet?  6) Are you active, or do you live a sedentary lifestyle?  7)  Do you socialize, practice spiritualism, or are you a recluse?  8)  Do you encounter daily environmental/product toxins at work/home hobbies, living area etc.?  9)  Are you involved in a stressful relationship, job and/or family?   10)  Do you take prescription medications, if so what kind & how long?  11) Are you generally depressed?  If so, do you understand why?  12) Have you had a past injury, allergy, infection that remains problematic, untreated, causes pain and/or depression?

     A process of environmental cause agent elimination can benefit your ill-health quest by collecting these daily data points and plotting them on a graph for example.  Simply list your data point suspicions horizontally.  Next list each column by the day with a 3 category code in bold: Worse, No Change, or Better.  This way you begin to plot data where status change of condition can easily be noted and shared with your treating physician(s).

     By becoming knowledgeable of symptoms caused per unique environment, one can begin the process of removing potential cause agent sources out of the equation that may be impacting, or depressing the mind, body and spirit.  For example, if you suspect something in your diet is the source of your problem; remove the potential suspect source agent for a couple of weeks to see if this improves your condition(s) plot and code the data points daily.  This can easily be done in between consultations which can be shared with treating physician(s).  Note: Do not put off seeing a physician before you start this process.  Instead, seek medical attention as soon as possible if you feel you have a serious medical condition and chart your medical condition suspicion study simultaneously.

     There are many other ways an ill-health cause agent can catch you off guard.  But this data collection insight will provide a starting point of suspected agent(s) data when consulting with physicians and specialists.  Then again, this is important why?  Because all too often we seek medical attention without providing valuable historical, recent signs/symptoms data during the physician consult.  This my friend’s leads all too often to untimely and non relative treatment!

     You don’t have to have the expertise of an epidemiologist, but only understand the importance of data collection to share with your physicians to better analyze your ill-health conditions.  Because in too many cases, we the patient depend too heavily on our doctors to fix, or treat us with a prescription and follow up based on if our signs and symptoms have not improved.  This all-too-often quick results treatment removes signs and symptoms temporarily.  But it does not address the underlying environmental and habitual cause agents of our ill-health.  As you’ve seen, we are much more complicated beings that require a multidiscipline approach to treat and keep us healthy.  And in order to determine ill health causal relationships, requires us to also be honest with ourselves by identifying our bad habits, risky behaviors and environmental stressors while taking preventative action to keep our 3-part being healthy.  To do otherwise not only risk your good health but also can impact a whole lot of other people.

     And through preventative knowledge and timely self advocacy action much pain and suffering in one’s life and family can be mitigated.  Many centurion benefits are possible through understanding the epidemiologist’s wisdom of data collection in sharing with various disciplines to rule out the “one cause, one effect” causing illness.  If a one cause, one effect is substantiated through medical exam than one knows what one must do to get well.  But for a good majority of patients, medical exams “do not” substantiate symptom(s), nor do they correlate well with conventional medical treatment.  Often non-substantiated cases of illness, pain, or just feeling bad are treated subjectively as opposed to objectively for lack of medical findings and then prescribed pharmaceuticals.  Here lies the problem for many that accept the conventional outpatient consultation protocol.  Without self advocacy for relative and timely treatment, data collection-sharing skill sets during physician consultation; insidious illness and disease agents can go unchecked for years.

     If you want to experience healthy life benefits, such as quality living conditions, personal comfort, happiness and other quality life experiences with family as you age, there is much to be learned and applied from an epidemiologist wisdom.  For the individual and centurion this skill set wisdom is invaluable as a prevention and problem solving tool that you can put to use immediately.  This wisdom teaches us to take accountability in keeping our 3-part being healthy by collecting, sharing data, while identifying-advocating for timely and relative treatment when working with our physicians for the “best possible health outcome!”

Author:  Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET2010 Copyright.  All rights reserved, Mirror Athlete Publishing @: www.mirrorathlete.com,  Sign up for your Free eNewsletter.

Your swimming pool needs and wants can be purchased at Online Sports!

May 24, 2010

“Recreational Water Parks, Spas and Pools Unhealthy?

Leisurely public pools, water parks and spa tub use are not without its health risk sanitization challenges for those that enjoy the use.  There are many potential risks that a public swim center may pose for the frequent and infrequent user.  And there are also specific challenges for the maintenance personnel that are responsible for an outdoor versus an indoor spa/pool/water park/swimming center.  Since our skin is the largest organ capable of absorbing environmental impurities; all should be aware that improper water sanitization practices can foster unhealthy microorganism growth and chemical absorption health risks.

 Most public pool facilities treat water with Chlorine to kill impurities that would otherwise be unhealthy for the user.  Chlorine is also easily absorbed through our skin as well as the air born emitted chloroform through our respiratory system.  This fact should cause great concern for those that spend a lot of time in the water “especially” in hot tubes.  The skins pores dilate acting more as a sponge when submersed in hot water.  Chloroform release and lung absorption is also compounded through the respiratory blood exchange.   Below I list all potential risks swimmers should be aware in order to reduce health risks when using public swim facilities.

 Public Water Use Transmits Impurities and Potential Health Risks

1)  Fecal contamination released, or washed off of bathers and/or outdoor pool wildlife fecal matter.  2)  There is also non fecal shedding off the body such as, saliva, mucous, vomit and skin.  3)  Infected users can contaminate hot/cold environment with potential pathogenic viral, or fungi organisms.  4) Opportunistic bacteria from users of the aquatic facilities can adapt and survive as amoebae in both hot/cold environments.  5) Indoor spas and pools ventilation systems can be contaminated and transmit pollutants and microorganisms.  6) Wet surfaces of use areas have high potential of unsanitary microorganisms.   (7) Outdoor facilities are challenged with wildlife droppings and other environmental microorganism sanitation issues.  (8) Diarrhea-causing a gastrointestinal illness that chlorine doesn’t always kill is Cryptosporidiosis parasites.  9)  Too much chlorine absorbed, or chloroform inhaled, or consumed can cause illness and disease.

 High Chlorine Use and Exposure Awareness Facts

 “Chlorine treated water’s air born Chloroform can cause allergic symptom from skin rash, irritation to eyes, sinuses, throat, skin and lungs to intestinal symptoms, arthritis and headaches.  Chlorine also weakens the immune system, dries the scalp and hair and creates worse dandruff.  Chlorine studies through animal research found too much chlorinated water consumption causes genetic mutations, initiates cancer and causes liver cancer in laboratory animals.  Canadian researchers found Chloroform risk to be 70-240 times higher in the air within indoor pools than outdoor pools.  After an hour of swimming in a chlorinated pool, chloroform concentrations in the swimmers blood ranged from 100-1,093ppb.”

 Minimize Microorganism & High Chlorine Exposure Risk

 Shower before use; avoid swallowing water, report fecal matter release.

  1. Pool disinfectants burn skin, irritate respiratory; report and avoid use.
  2. If you note much particulate matter, or cloudy water report and avoid use.
  3. Wear eye goggles when in pool and thongs when walking on spa surfaces.
  4. Inquire on maintenance practices: Chemical, filtration & ventilation.
  5. Consult with your physician if swimming benefits outweigh risks.
  6. If you have diarrhea don’t enter spa/pools until 2 weeks after it ends.
  7. If shut down for sanitation cleanup… Inquire on how the microorganisms were killed, e.g., extra chlorine, ultraviolet radiation, or ozone treatment.
  8. If the pool smells heavy of chlorination, don’t go in.

Note:  There are pools that don’t use chlorination: Ultraviolet-ozone and salt.

  Each impurity health concern has the potential to cause a variety of respiratory, dermal or central nervous system infection or diseases.  And in order to reduce risk requires one to become knowledgeable about personal health risk, water treatment/sanitation practices as well as facilities promoting patron hygiene sanitation before use.  The practice of proper chemical use includes, but not limited to, creating and maintaining a neutral ph to provide a non-toxic/microorganism environment while simultaneously maintaining proper water/air filtration and pump system upkeep.  Indoor pools that use chlorine need to ensure ventilation systems have proper filter change out air make up that promotes chloroform exchange out to atmosphere while adequately receiving fresh air makeup.  Without proactive maintenance practices and public swimming use ill-health awareness; you and your children are at greater risk of contracting an infectious illness, or disease.   Stay safe by applying this knowledge and have fun with family in the water this year.

 References

http://www.freedrinkingwater.com/water_health/health1/1-public-health-hazards-public-swimming-pools.htm

http://www.webmd.com/news/20070726/cdc-warns-of-swimming-pool-health-risk

http://www.orthomolecular.org/library/jom/2000/articles/2000-v15n02-p089.shtml

 Author:  Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET2010 Copyright.  All rights reserved, Mirror Athlete Publishing @: www.mirrorathlete.com,  Sign up for your Free eNewsletter.

August 21, 2009

MRSA Killer Bug?

MRSA (Methicillin Resistant Staphylococcus Aureus) is often referred to as a killer, or super bug that is resistant to many antibiotics.  This bacterial bug is most appropriately referred to as a super bug because of Oxacillin-Resistant Staphylococcus Aureus (ORSA).  This is a MRSA strain that is resistant to many types of antibiotics, to include penicillin’s and cephalosporins.  This bug is of great concern to those who need surgery, or nursing care services where the patient age 65 and older are four times more prone to contracting MRSA.  The term killer bug stems from the fact that in 2005, “More than 18,000 Deaths and 94,000 life-threatening cases occurred.   The bug frequently enters the body in a sterile health care facility or hospitals where patients are in a weakened immune state.  Most bacterial spread occurs due to unsterile dialysis, catheters, or surgical procedures (Medical cleanliness standards have greatly improved since 2005).  This does not mean a healthy individual cannot obtain this bug.  Patients can be exposed to a Community Associated (CA)-MRSA infection.  CA infections are common among homosexuals, athletes, prisoners and soldiers.

Since MRSA bacterium is often found in the noses and skin of healthy people, we are all susceptible during a weakened immune state to activate the MRSA bacteria.  In most cases, this activation is prominent after surgeries, can form around malignancies as boils and abscesses to include other pus-type lesions.  Most that contract MRSA are not considered infected; instead the organism is colonized on the skin, in the nose, or throat without infection.  However, if one also has fever like symptoms then they would be considered infectious.  One should not fear MRSA, or methincillin-sensitive S type (difficult to treat with anti-biotic) as a general threat to the public.  MRSA does not typically present a threat to health care providers, or family members that provide the care unless they are suffering from debilitating disease.  One should not be discouraged from social contact.
 
Recommendations, If Diagnosed with MRSA, or Require a Medical Procedure
1.        Inquire how often staff is required to wash hands (before & after MRSA patient handling, or procedures).  Frequent cleanliness practice prevents spread of MRSA.
2.      Patients room doors should remain closed, records clearly labeled where regularly damp dusting occurs, and nursed in wards not placed with non-infected patients.
3.      Treatment – Antibiotics through the nose and special bathing procedures to ensure there is no possibility of spreading the bug in a facility, or home care facility. 
4.      After patient discharge it is very important the medical facility disinfects the room and clothes bagged for special treatment so the next patient is not exposed to MRSA.
5.      Ensure your physician and care handlers refer to past MRSA susceptibility, separation and isolate immediately should you require future hospitalization, or medical care.

References,
Association of Medical Microbiologists, worldwide Internet………………http://www.amm.co.uk/files/factsabout/fa_mrsa.html
Centers for Disease Control and Prevention………………………………………http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html
Wikipedia, http://en.wikipedia.org/wiki/MRSA
Web MD, http://www.webmd.com/news/20071016/more-us-deaths-from-mrsa-than-aids

Author:  Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2009 Copyright, All rights reserved.  Mirror Athlete Enterprises Publishing @: www.mirrorathlete.com, Sign up for your free eNewsletter.

April 25, 2008

Candida and What to Do About it

    Some think or suspect the Candida fungus is responsible for what ails them.  Since Candida resides in us all, it is not impossible to believe this particular fungus could get out of hand.  Candida is a yeast fungus that normally is present on the skin and in the mucous membranes of the mouth, intestinal tract, and vagina, and that may become pathogenic, especially C. albicans, the causative agent of thrush (fungal infecti0n of the mouth or throat).  Infection caused by the fungus Candida albicans, is manifested by white, slightly raised patches on the mucous membrane of the tongue, mouth, and throat. The mucous membrane beneath the patches is usually raw and bleeding.  Candida overtakes your guts probiotics (read “Intestinal Bacteria & Nutrient Absorption?” at our home site), outnumbering the helpful bacteria as its food source.  Candida albicans then runs rampant within the stomach and small intestines.  When the fungus becomes present in the large intestines… This is a sign your system is fighting a battle it can’t win unless something changes. This is because your guts bacterial environment has become septic with the fungus.  With long-term infection the fungus actually sets up a root system penetrating the intestinal and mucosal lining of our guts.  Other harmful materials then are easily absorbed by this deep rooted system resulting in an immunological reaction, where the yeast syndrome impacts the entire body’s system.

 Health problems associated with this fungus – It is recognized, this deep rooted fungi system can introduce insidious pathogens in the body creating a condition where serious disease can thrive, e.g., “1) Acne or psoriasis 2) Allergies 3) Diabetes 4) Digestive disorders… Weight gain, gas, bloating, colitis (read “IBS Irritable Bowel Syndrome” at our home site) 5) Ear infections 6) Emotional upsets and depression 6) Energy imbalances or insomnia 7) Hormonal problems 8) Hyperactivity, Attention Deficit Disorder (ADD) 9) Hypoglycemia 10) Hypothyroidism 11) Lung problems 12) Obesity 13) Pollen allergies 14) Reproductive Organ Disorders 15) Sensitivities to foods, chemicals, and/or molds 16) Susceptibility to viruses, bacteria, and other infections 17) Thyroid.   Some practitioners believe that Candida overgrowth can lead to onset of chronic illnesses: Chronic fatigue symptom (CFS), fibromyalgia, Epstein-Barr virus, lupus, multiple sclerosis (MS), Alzheimer’s, Crohn’s disease, arthritis, cancer, and autism (reference, puristat com).  Once you are identified with Candida, it can take up to 7 months to remove it through proper diet.

Avoid the following foods that promote Candia thriving in the body:  All sugars, baked goods, breads, refined flour, alcohol, vinegars, pickled vegetable, dried fruits, cheeses, mushrooms.  Candida depends on sugar to survive.  Cut off the food source and you’ll starve-kill the fungus.  Also check food labels for fructose, glucose, lactose, maltose, mannitol, sorbitol and sucrose.  Avoid honey, maple syrup and molasses.  Remove processed and packaged foods from your diet (high in sugars).

Foods to consume to rid yourself of Candida:  Eat plenty of fresh fruits and veggies, whole grains, nuts and seeds, eggs, yogurt, meats, poultry, fish, oils (flaxseed, olive, sesame, and sunflower), butter, lemon, etc.  See our health store for purity products, fish oils, etc.

Author:  Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2008  Copyright.  All rights reserved, Mirror Athlete Publishing, www.mirrorathlete.com, Sign up for your Free eNewsletter.

February 15, 2008

How to Deal with Irritable Bowel Syndrome

 Irritable Bowel Syndrome (IBS) creates much discomfort for those that experience the symptoms causing havoc within the large intestine (colon).  The symptoms include, bloating, gas, cramps in the abdomen with pain, constipation and diarrhea.  IBS presents itself to 1 out of every 5 adults and is more prominently exhibited in women starting as early as 20 years of age.  Although IBS creates a great deal of discomfort, it is not a serious health risk (does not lead to intestinal bleeding or cancer).  Common pharmaceuticals prescribed for diarrhea (Lotronex) and for constipation (Zelnorm) to include over the counter medication, which can have serious side effects.

What causes IBS?  No one knows for sure, there is not one identifiable organic factor.  Through clinical case studies and research, scientific consensus agrees the following various factors bring about IBS symptoms:  Individuals with sensitive and reactive colons, immune system, reproductive hormones, diet, stress and emotions can strongly influence the colon.  Since the colons reactive triggers are piped to the brain and are partly controlled by the autonomic nervous system, much like the heart and the lungs; the colon responds to stress (emotions and food intake stimuli) much like the heart and lungs (e.g., being freighted, fast heart beat and breathing, etc.).  The colon reacts the same way by contracting too little, or too much, by removing too little water through the intestinal lining (diarrhea), or too much water (constipation).  Both conditions cause cramping, boating and gas felt within the stomach.  IBS “IS NOT” considered a disease.  Natural Cure Recommendations Below,

 Recommendations:  IBS has no cures. You must manage what creates & triggers the symptoms!”
1    Keep a journal of the foods you eat, when you eat and how much (target IBS triggers).  See a physician, or naturopathic physician to present this information to.
2    Reduce large meal intake, which can cause cramping, and diarrhea (smaller meals and more frequent meals), slow eating down, and stop chewing gum, both results in too much gas (air). 
3    Check risks warnings on medicines prescribed. Ask your doctor about questionable medications.  Seek professional medical advisement and ask about natural cure management.
4    Remove chocolate, caffeine, milk products and alcohol from diet.   Try removing one at a time to determine if symptoms improve.  Log this information in your daily journal.
5    Remove stress, conflict and other emotional upsetting factors from your lifestyle.
6    Drink 6-8 glasses of water/day, especially for diarrhea.  Don’t drink carbonated drinks.
7    Consume low fat & higher in carbohydrates, such as pasta, rice and “whole grain breads & cereals” (unless you have “celiac disease.”  This disease mimics IBS… If you are diagnosed with this, your body can’t digest gluten (wheat, rye, barley, etc.,) a blood test can rule out if you have celiac disease).
8    Increase fruits and vegetable consumption within your diet and, or see line #9.
9    Supplement your diet with a quality absorbable min & vit’s (See our natural products).
10   Supplement your diet with an autoimmune quality product (See our natural products).
11   Supplement your diet with flora (Good intestinal bacteria) (See our natural products).
12   Supplement your diet with natural menopausal products (See our natural products).
 

Author:  Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET2008 Copyright.  All rights reserved, Mirror Athlete Publishing @: www.mirrorathlete.com Sign up for your Free eNewsletter.

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