Lifelong discrimination linked to high blood pressure in black people

AHA news: lifelong discrimination linked to high blood pressure in black people

Enduring a lifetime of discrimination may increase the risk of high blood pressure in Black people but not in Hispanic, Chinese or white people, a new study suggests.

Previous research has linked lifelong discrimination to the development of high blood pressure, also known as hypertension, in Black people. This new study, however, is among the first to look at multiple types of discrimination in a large multi-ethnic group over a period of time.

The study included 3,297 Black, Hispanic, Chinese and white adults from 45 to 84 years old. They did not have high blood pressure at the start of the study. Participants were asked to report experiences of lifetime and everyday discrimination.

Lifetime discrimination measures included six items, such as being denied a promotion or having life made difficult by neighbors. Everyday discrimination, meanwhile, consisted of nine items, such as being treated with less respect than others or being harassed in day-to-day life.

After nearly two decades, almost half of participants developed high blood pressure. Black participants who reported lifetime discrimination had a 35% increased risk of hypertension, even after accounting for age, income, education, body mass index, physical activity and other factors. Everyday discrimination, however, did not appear to contribute to risk for hypertension.

“Discrimination impacts the health of Black Americans and it should be recognized as a major public health problem,” said Allana T. Forde, lead author of the study published last week in the Journal of the American Heart Association. In November, the American Heart Association issued a “call to action” advisory acknowledging structural racism as “a fundamental cause of poor health and disparities in cardiovascular disease.”

“Health professionals should look beyond traditional risk factors, such as diet and physical activity, and acknowledge discrimination as another risk factor,” said Forde, a researcher at the National Institutes of Health’s National Institute on Minority Health and Health Disparities.

Surprising for researchers, she said, was that lifetime discrimination did not reach the level of statistical significance for contributing to high blood pressure among Chinese and Hispanic participants, even after accounting for being born outside the United States.

Studies in other areas of the U.S. are needed to confirm the findings, researchers said, because the new study was limited to those living in five large cities and one county. In addition, the study only assessed discrimination experiences once at the start of the study, making it unclear what impact changes in discrimination exposure might have had on hypertension development during the follow-up period.

“There is always a concern that not enough subjects were included in the study to show differences in populations or that not all relevant variables were accounted for,” said Dr. Willie Lawrence, chief of cardiology at the Research Medical Center in Kansas City, Missouri. He was not involved in the study.

When measuring decades of discrimination that leads to hypertension, other social determinants of health also must be accounted for. These include health care access, transportation options and a person’s neighborhood.

“Whether communities have sidewalks and green spaces impacts health,” Lawrence said. “If we want to make people healthier, we have to not only eliminate disparities in health care delivery, but we must also seek equity in housing, neighborhoods and education.”

Overall, the study found Black people reported the highest levels of discrimination. About 65% reported lifetime discrimination compared to 42% of Hispanic people, 40% of white people and 23% of Chinese people. Black people most often attributed the unfair treatment to race, whereas white people by far attributed it to non-racial factors such as age, sex or religion. Hispanic and Chinese people were about evenly split between feeling the discrimination was motivated by race versus other factors.

For everyday discrimination, 52% of Black people, 32% of white people, 26% of Hispanic people and 20% of Chinese people reported high levels of exposure.

“Race is complicated in America. It is not genetic,” Lawrence said. “So, I’m not ready to believe that when people of other colors are treated the way Black Americans have been treated for decades that they won’t have higher rates of high blood pressure.”

Even so, he said, “it’s an important study that adds to our belief that social factors impact health.”

Certain, however, is that Black people have higher rates of high blood pressure than other racial and ethnic groups. According to AHA statistics, about 58% of Black adults in the U.S. have the condition, which increases the risk for heart attack and stroke.

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US COVID-19 deaths hit another one-day high at over 4,300

US COVID-19 deaths hit another one-day high at over 4,300

Coronavirus deaths in the U.S. hit another one-day high at over 4,300 with the country’s attention focused largely on the fallout from the deadly uprising at the Capitol.

The nation’s overall death toll from COVID-19 has eclipsed 380,000, according to Johns Hopkins University, and is closing in fast on the number of Americans killed in World War II, or about 407,000. Confirmed infections have topped 22.8 million.

With the country simultaneously facing a political crisis and on edge over threats of more violence from far-right extremists, the U.S. recorded 4,327 deaths on Tuesday by Johns Hopkins’ count. Arizona and California have been among the hardest-hit states.

The daily figure is subject to revision, but deaths have been rising sharply over the past 2 1/2 months, and the country is now in the most lethal phase of the outbreak yet, even as the vaccine is being rolled out. New cases are running at nearly a quarter-million per day on average.

More than 9.3 million Americans have received their first shot of the vaccine, or less than 3% of the population, according to the Centers for Disease Control and Prevention. That is well short of the hundreds of millions who experts say will need to be inoculated to vanquish the outbreak.

The effort is ramping up around the country. Large-scale, drive-thru vaccination sites have opened at stadiums and other places, enabling people to get their shots through their car windows.

Also, an increasing number of states have begun offering vaccinations to the next group in line—senior citizens—with the minimum age varying from place to place at 65, 70 or 75. Up to now, health care workers and nursing home residents have been given priority in most places.

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Coronavirus infection odds twice as high among Black, Latinx hospital workers

Support staff and Black and Latinx hospital employees with and without patient care responsibilities are at highest risk for SARS-CoV-2 infection in health care settings, a Rutgers study found.

After screening 3,904 employees and clinicians at a New Jersey hospital between late April and late June for the SARS-CoV-2 virus and for lgG-antibodies to the virus, whose presence suggests past recent infection, the study, published in the journal Open Forum Infectious Diseases, found that these employees are at higher risk than previously thought.

“The risk to workers in health care settings with little or no patient contact has attracted relatively little attention to date, but our results suggest potentially high infection rates in this group,” said lead author Emily S. Barrett, an associate professor at Rutgers School of Public Health and a member of the Environmental and Occupational Health Sciences Institute. “By contrast and to our surprise, physicians, nurses and emergency medical technicians showed much lower infection rates.”

Health care workers who live in highly impacted communities may have been susceptible to becoming infected outside of the hospital during the early surge of COVID-19, according to co-lead author Daniel B. Horton, an assistant professor at Rutgers Robert Wood Johnson Medical School and a member of the Institute for Health, Health Care Policy and Aging Research.

“In the early phase of the pandemic, support staff in the hospital may also have had less access to personal protective equipment or less enforcement of safety protocols,” he said. “Going forward, as cases of COVID-19 in the hospital rise again, protecting these and all hospital workers from infection both in and out of the hospital is critical.”

In the hospital-based study, researchers found that 13 participants tested positive for the virus and 374 tested positive for the antibody, which suggests recent past infection—nearly 10 percent of those studied—and that Black and Latinx workers had two times the odds of receiving a positive test for the virus or antibody compared to white workers.

Phlebotomists had the highest proportionate rate of positive tests—nearly 1 in 4 tested—followed by those employed in maintenance/housekeeping, dining/food services and interpersonal/support roles. By comparison, positivity rates were lower among doctors (7 percent) and nurses (9 percent).

Regardless of whether the infections originated in the hospital or in the community, Barrett said, the results suggest a need to enact safety protocols for hospital employees to protect the health care workforce from future waves of infection.

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Single-day coronavirus cases in US hit record high

How is the race for a coronavirus vaccine shaping up?

Centers for Medicare & Medicaid Services Administrator Seema Verma joins ‘Fox News @ Night’ with insight.

The U.S. recorded a record-high 88,521 new coronavirus cases on Thursday, pushing October’s total to over 1.7 million illnesses. Thursday also saw an additional 971 deaths, according to data recorded by Johns Hopkins University.

The sobering, record-setting number comes amid a series of lockdown measures implemented in hotspots across the country, while still others buck the advice of public health officials urging social distancing measures and mask usage.

Dr. Anthony Fauci, the nation’s leading infectious disease expert, told the “Fox News Rundown” podcast Thursday that some coronavirus restrictions will need to remain in place even after a vaccine is proven to be safe and effective.

Once the vaccine is approved, Fauci said, it will take several months to distribute to the population, and even then there will be a percentage of people who won’t get the vaccine.

“As that process evolves, you cannot abandon public health measures because the vaccine is not going to be perfect and not everybody is going to take it,” he said.

And while the Midwest has been targeted as a hotbed of coronavirus surges, plenty of states along the East Coast are experiencing spikes in hospitalizations and new cases. Maine on Thursday set a single-day record of new cases, while Maryland and New Jersey reported hospitalization numbers not seen since the summer.

“We’re reporting 1,663 new positive cases, pushing our cumulative total to 231,331,” New Jersey Gov. Phil Murphy posted on Twitter. “These numbers are sobering. We are still in the midst of a pandemic and need everyone to take this seriously. Wear a mask. Social distance. Wash your hands.”

Reported mask use between April and June increased, according to the Centers for Disease Control and Prevention, but younger generations still had room for improvement. In the CDC survey, those aged 18-29 upped mask use from 69.6% in April to 86.1% by June. Those over 60 increased their mask use from 83.7% in April to 92.4% in June.

However, the agency reported an overall decrease in other mitigation measures that Fauci had mentioned should still be in practice. Hand- washing, social distancing and avoiding crowds had decreased in the U.S., according to the CDC.

“We are entering a very dangerous time, where numbers of cases are rising dramatically, and younger Americans are potentially getting infected but not quarantining as they do not feel very ill,” Dr. Kristin Englund, an infectious disease specialist at Cleveland Clinic, previously told Fox News. “This is the time to increase our education to the public about mask-wearing to 100%, and to pay attention to other mitigation factors… to protect our older relatives and others who are most at risk.”

As of Friday, the U.S. had tallied 8,944,934 cases of coronavirus and 228,656 deaths.

Fox News' Kayla Rivas contributed to this report.

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Genetic test identifies invasive lobular carcinomas that are at high risk of recurring

New results to be presented at the 12th European Breast Cancer Conference show that a test, which looks at the activity of 70 genes in breast cancer tissue, is possible to use in the clinic to identify patients with invasive lobular carcinoma (ILC) that is at high risk of recurring and progressing.

Adjuvant treatments, such as chemotherapy, radiation therapy or targeted therapies, are not usually offered to ILC patients after surgery as the disease is slow growing and often responds well to hormone treatment alone. So far, there has been little evidence that such treatments improve outcomes, but they can affect people’s quality of life.

However, the 70-gene signature test (commercially known as MammaPrint) identified some ILC patients whose genetic make-up puts them at high risk of the cancer recurring if they are treated with hormone therapy alone. These patients may benefit from additional adjuvant therapy.

ILC is a type of cancer that begins in the milk glands (lobules) of the breast. It becomes invasive when the cancer cells start spreading beyond the lobules and has the potential to spread to the lymph glands and other parts of the body. It affects about 10% of people with invasive breast cancer. By comparison, invasive ductal carcinoma (IDC) accounts for about 80% of breast cancers in women. It begins in the milk ducts and grows into the surrounding breast tissue, and is often treated with radiation, chemotherapy, hormone therapy or targeted therapies such as trastuzumab and T-DM1, in addition to surgery.

Dr. Otto Metzger, a medical oncologist at the Dana-Farber Cancer Institute and assistant professor at Harvard Medical School, Boston, U.S., told the conference: “The decision about whether or not to treat patients diagnosed with invasive lobular carcinoma with chemotherapy is difficult. Results from earlier research, which I carried out with Professor Christos Sotiriou while I was at the Institut Jules Bordet in Belgium, indicated that 10 to 15% of ILC cases were classified as high-risk at a genomic level. These had worse survival outcomes when compared to those classified as low-risk.”

In a statement before the conference, the principle investigator of the MINDACT trial, Professor Fatima Cardoso, Director of the Breast Unit of the Champalimaud Clinical Centre in Lisbon, Portugal, said: “In this sub-study of the MINDACT trial, we have investigated further the biology of ILC and have identified a subset of ILC patients who could potentially benefit from chemotherapy or other adjuvant treatments. Here we report for the first time the utility of the 70-gene signature test in a large group of patients with ILC in the MINDACT randomised phase III clinical trial. These results are important for clinicians to help them choose a precise treatment approach tailored to the individual patient. This work was possible due to generous support of the Breast Cancer Research Foundation.”

A total of 6,693 women with early-stage breast cancer enrolled in the international MINDACT trial. Of these, 5,313 patients were included in the current analysis: 487 women had ILC, including 255 classic cases of the disease and 232 variants, and 4,826 had IDC. The tissue samples were reviewed by a central pathology service to ensure consistency in categorising the different types and variants of cancer. The patients were followed for an average (median) of five years after diagnosis.

The 70-gene signature test classified 16.2% of ILC as high genomic risk and 39.1% of IDC as high genomic risk. By comparing classic ILC to variants of ILC, it classified 10.2% of classic ILC and 22.8% of ILC variants as high genomic risk.

The researchers found that estimates for the proportion of patients surviving without the disease recurring (disease-free survival, DFS) or without the disease spreading to other parts of the body (distant metastases-free survival, DMFS) at five years were similar for both ILCs and IDCs that had been classified as high risk by the 70-gene signature test. DFS was 87.1% for IDC and 84.6% for ILC. DMFS was 92.3% for IDC and 89.4% for ILC.

Estimates for IDCs and ILCs that the 70-gene signature test classified as low risk were also similar. DFS was 92.5% for IDC and 92% for ILC. DMFS was 96.5% for IDC and 96.6% for ILC.

Dr. Metzger said: “We found that DMFS and DFS estimates were similar for ILC and IDC classified as either low or high-risk by the 70-gene signature test. This suggests that the test has prognostic value for ILC. The incorporation of biological features defined by the 70-gene signature test in the treatment decisions for patients diagnosed with ILC should facilitate a complex decision-making process, that includes the extent of disease, other health conditions and patients’ preferences.”

Chair of EBCC12, Professor Nadia Harbeck, of the University of Munich (LMU), Germany, who was not involved with the study, commented: “The results of this study show that the 70-gene signature test may play a useful role in the clinic when doctors are considering whether their patients with invasive lobular carcinoma might benefit from treatments such as chemotherapy in addition to surgery.

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Loneliness levels high during COVID-19 lockdown

During the initial phase of COVID-19 lockdown, rates of loneliness among people in the UK were high and were associated with a number of social and health factors, according to a new study published this week in the open-access journal PLOS ONE by Jenny Groarke of Queen’s University Belfast, UK, and colleagues.

Loneliness is a significant public health issue and is associated with worse physical and mental health as well as increased mortality risk. Systematic review findings recommend that interventions addressing loneliness should focus on individuals who are socially isolated. However, researchers have lacked a comprehensive understanding of how vulnerability to loneliness might be different in the context of a pandemic.

In the new study, researchers used an online survey to collect data about UK adults during the initial phase of COVID-19 lockdown in the country, from March 23 to April 24, 2020. 1,964 eligible participants responded to the survey, answering questions about loneliness, sociodemographic factors, health, and their status in relation to COVID-19. Participants were aged 18 to 87 years old (average 37.11), were mostly white (92.7%), female (70.4%), not religious (57.5%) and the majority were employed (71.9%).

The overall prevalence of loneliness, defined as having a high score on the loneliness scale (ie., a score of 7 or higher out of 9), was over a quarter of respondents: 26.6%. In the week prior to completing the survey, 49% to 70% of respondents reported feeling isolated, left out or lacking companionship. Risk factors for loneliness were being in a younger age group (aOR: 4.67—5.31), being separated or divorced (OR: 2.29), meeting clinical criteria for depression (OR: 1.74), greater emotion regulation difficulties (OR: 1.04), and poor-quality sleep due to the COVID-19 crisis (OR: 1.30). Higher levels of social support (OR: 0.92), being married/co-habiting (OR: 0.35) and living with a greater number of adults (OR: 0.87) were protective factors.

The authors hope that these findings can inform support strategies and help to target those most vulnerable to loneliness during the pandemic.

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Analysis shows high level of SARS-CoV-2 contamination in patient toilets, staff and public areas in hosptials

A systematic review of evidence being presented at this week’s ESCMID Conference on Coronavirus Disease shows that air around patients with COVID-19, as well as patients toilets, and staff and public areas in hospitals are all show significant levels of contamination with SARS-CoV-2. The study is by Dr. Gabriel Birgand, University Hosptial Centre Nantes, France, and colleagues.

Controversy remains worldwide regarding the transmission mode of SARS-CoV-2 virus in hospital settings. In this study, the authors reviewed the current evidence on the air contamination with SARS-CoV-2 in hospital settings, the viral load and the particle size, and the factors associated to the contamination.

The authors searched the MEDLINE, Embase, Web of Science databases for original English-language articles detailing COVID-19 air contamination in hospital settings between 1 December 2019 and 21 July 2020.

The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patient. The SARS-CoV-2 RNA concentrations in copies per m3 of air were pooled and their distribution were described by hospital areas.

Among 2,034 records identified, 17 articles were deemed eligible and included in the review. Overall, 27.5% (68/247) of air sampled from close patients’ environment were positive for SARS-CoV-2 RNA, with no difference between settings (ICU: 27/97, 27.8%; non-ICU: 41/150, 27.3%). Just 1/67 (1.5%) of samples in the air less than 1 metre from the patient tested positive for SARS-CoV-2, and just 4/67 (6%) of samples 1-5 metres away. (see results in abstract and poster)

In other areas, the positivity rate was 23.8% (5/21) in patient toilets, 9.5% (20/221) in clinical areas, 12.4% (15/121) in staff areas, and 34.1% (14/41) in public areas (see table in abstract). A total of 78 viral cultures were performed, and 3 (4%) were positives (meaning the virus was viable and capable of reproduction), all from close patients’ environment (3/39, 7.7%) in non-ICU settings.

The median SARS-CoV-2 RNA concentrations were found to be 10 times higher in patient toilets than in the patients’ rooms.

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Immunization programs yield high ‘return on investment,’ saving hundreds of billions of dollars

Immunization programs offered in low- and middle-income countries provide a high “return on investment” in terms of the economic costs of diseases that are prevented and the values of lives that would have been lost, according to a new study led by scientists at the International Vaccine Access Center based at Johns Hopkins Bloomberg School of Public Health.

The researchers, who report their findings in the August issue of Health Affairs, analyzed recent data on immunization programs aimed at preventing 10 infectious diseases in 94 low- and middle-income countries. The research team generated estimates for the economic cost of illnesses and broader losses due to disability and premature death that would occur without the programs, comparing those costs to the costs of the programs themselves.

Using a model that factors in treatment costs, lost wages, and productivity losses, the researchers estimate that the costs averted by implementing these immunization programs will amount to $681.9 billion for 2011-20 and $828.5 billion for the next decade. This estimated net benefit is about 26 times the immunization programs’ costs during 2011-20, and about 20 times their costs for the next ten years, 2021-30.

A second analysis based on the imputed monetary values of lives that will be saved by the immunization programs suggested net-benefit vs. cost ratios for the two decades of more than 50 to 1.

“This analysis shows that immunization programs now have and will continue to have a high return on investment,” says study senior author Bryan Patenaude, ScD, an assistant professor in the Bloomberg School’s Department of International Health. “It also helps put immunization program investments in perspective alongside investments such as education programs and infrastructure investments that might not otherwise seem comparable.”

The new study was conducted under the auspices the Decade of Vaccine Economics project based at the Bloomberg School’s International Vaccine Access Center. DOVE’s research provides economic evidence on vaccines that can be used by organizations such as Gavi, the international public health organization that sponsors immunization programs in low- and middle-income countries worldwide.

“The goal here was to show the return on ‘investment’ in economic or monetary terms, not just in terms of health impact,” says Patenaude. “Framing health investments in economic terms can help organizations and governments compare them to other social investments in an explicit and concrete way.”

For their analysis, the researchers analyzed Gavi’s data and other available data on the costs of immunization programs in 94 low- and middle-income countries against the meningitis-causing Haemophilus influenzae type b and Neisseria meningitidis serotype A; the pneumonia-causing Streptococcus pneumoniae; hepatitis B virus; human papillomavirus; Japanese encephalitis virus; measles virus; rotavirus; rubella virus (German measles); and yellow fever virus.

In the analysis, the costs of these programs will amount to an estimated $25.2 billion for 2011-20 and $39.9 billion in 2021-30 for the 94 low- and middle-income countries. Gavi hosts immunization programs, or has done so in the recent past, in most of the countries covered by the analysis.

The researchers compared these estimated costs to the estimated economic costs of illnesses in the scenario in which there were no immunizations against these pathogens. To do this they used two models. The first was a Cost of Illness model with estimates for cost items such as treatment of disease, lost caregiver wages, and productivity loss due to disability or premature death. The COI model yielded the estimated averted costs of $681.9 billion for 2011-20 and $828.5 billion for the following decade.

The second model, a Value of Statistical Life (VSL) model, was based on the estimated value of a saved life—a calculation derived from estimates of people’s willingness to spend money to reduce their risk of death. Based on this model the averted costs will be $1.31 trillion and $2.1 trillion for the two decades, respectively.

The estimated return on investment, the ratio between the net savings obtained by the programs and their cost, was therefore, for the 2011-20 decade, 26.1 using the COI model and 51.0 using the VSL model. For the 2021-30 decade, those figures were 19.8 and 52.2, respectively.

“Obviously, regardless of the approach you take to estimate benefits, immunization programs are a great value in terms of return on investment and have significant benefits over time,” says Patenaude.

The researchers bundled the estimates for the 10 pathogens together because Gavi typically offers programs with similarly bundled immunizations. But the investigators noted that measles virus was the largest driver of estimated disease-related costs.

“With some countries transitioning away from donor support, these findings can be used to advocate for sustained immunization financing,” says Elizabeth Watts, research associate at the International Vaccine Access Center and co-first author of the study.

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These Baby High Chairs Will Give Them the Safe Boost They Need

Aside from diapers and baby formula, the other constant in your life as a parent of a baby is going to be a reliable baby high chair. Whether you’re eating at home, at a relative’s, or at a restaurant, you’re going to need something to give them a boost while keeping them safely contained so you can eat too. The best baby high chairs come in a variety of shapes, sizes, and colors that you can match to their favorite outfits or colors. Many high chairs come with different features, so it’s important to consider what’s the best option for you and your little one.

When you’re picking out a baby high chair, you’ll first want to determine where you’re going to use it most. If you’re looking for a travel-friendly version, you’ll want a compact one that’s easy to fit in the car. To avoid buying high chairs as they grow out of them, one that easily adjusts as they grow up is a must. Some high chairs even convert into a step stool, so that’s another smart thing to consider. Ahead, we’ve rounded up the best baby high chairs to meet your needs.

1. Infantino High Chair

They (and you) won’t be able to resist this darling fox baby high chair. This four-in-one baby high chair is also smart too by saving space in your home. It converts from a booster into a toddler chair with ease so it will grow with them as they outgrow their baby high chair. It’s also easy to clean and has an easy release food tray for fuss-free cleaning. You can wipe down the soft cushioning without a problem, too. With front wheels, you can reposition the chair to face however you’d like.

2. Graco Everystep High Chair

If you want a baby high chair that does more than let your little one safely sit, then this convertible option will meet your needs. This smart high chair easily converts from a high chair to a kids step stool for when they need to reach for the counter. With seven total growing stages, you can keep this high chair for years without having to replace it as they get bigger. It’s narrowed down to three stages: the infant high chair with three reclining positions, fully featured baby high chair with seven height positions and dishwasher-safe tray insert, and infant booster seat that brings them right up to the table by attaching to the table.

3. Fisher Price SpaceSaver High Chair

Whether you have tight quarters at home or travel often with baby, this compact baby high chair is going to save a ton of valuable space wherever you go. Not to mention, it has a stylish neutral design that will look great in your home. It may be smaller, but it still packs in all the features of a full size high chair. It even transforms from an infant booster to a toddler one too, so you don’t have to purchase a new one as they get older. There’s two height adjustments and three recline positions for ultimate comfort, and the machine-washable seat pad makes clean ups a breeze. The deep-dish tray prevents food from falling over the edge, too.

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