How common is stroke in people critically ill with COVID-19?

covid

A large, year-long study has found that among people with COVID-19 who were hospitalized in an intensive care unit (ICU), 2% experienced a stroke after they were admitted to the ICU. The preliminary study released today, April 15, 2021, will be presented at the American Academy of Neurology’s 73rd Annual Meeting being held virtually April 17 to 22, 2021. The study also found that hemorrhagic stroke, a bleeding stroke, was associated with a higher risk of death among people in the ICU, but ischemic stroke, a stroke caused by a blood clot blocking an artery, was not.

“Stroke has been a known serious complication of COVID-19 with some studies reporting a higher-than-expected occurrence, especially in young people,” said study author Jonathon Fanning, M.B.B.S., Ph.D., of the University of Queensland in Brisbane, Australia, and a member of the American Academy of Neurology. “However, among the sickest of patients, those admitted to an ICU, our research found that stroke was not a common complication and that a stroke from a blood clot did not increase the risk of death.”

Researchers used an international database of COVID-19 patients in 52 countries admitted to an ICU between January 1 and December 21, 2020. They identified 2,699 people who were admitted to an ICU for management of severe COVID-19 infection. Of those, 59 had a stroke. The people had an average age of 53.

Researchers evaluated the patient data at 370 hospital ICUs and found 59 people, or 2.2%, experienced a stroke during their stay in the ICU. Of those, 19 people, or 32%, had a stroke from a clot, 27 people, or 46%, had a bleeding stroke, and 13 people, or 22%, had an unspecified stroke.

Researchers determined that people who had a bleeding stroke had up to five times greater risk of death than people without stroke. However, people who had a stroke from a clot had no increased risk of death.

Of the people with bleeding stroke, 72% died, but of those, only 15% died of stroke. Instead, multiorgan failure was the leading cause of death.

“For people with COVID-19 in intensive care, our large study found that stroke was not common, and it was infrequently the cause of death,” said Fanning. “Still, COVID-19 is a new disease and mutations have resulted in new variants, so it’s important to continue to study stroke in people with the disease. More importantly, while the proportion of those with a stroke may not be as high as we initially thought, the severity of the pandemic means the overall absolute number of patients around the world who will suffer a stroke and the ongoing implications of that for years to come, could create a major public health crisis.”

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How Not Having Enough Social Interaction Really Affects Your Health

Humans are kind of like rabbits — social creatures with individual personalities (via the House Rabbit Society). And, like bunnies, humans require social interaction. In fact, according to the researchers at the Massachusetts Institute of Technology, humans “crave” interaction. “People who are forced to be isolated crave social interactions similarly to the way a hungry person craves food,” says MIT professor Rebecca Saxe. “Our finding fits the intuitive idea that positive social interactions are a basic human need, and acute loneliness is an aversive state that motivates people to repair what is lacking, similar to hunger.”

So, what does this mean? Social relationships have a behavioral, psychosocial, and physiological influence on our health. According to the Journal of Health and Social Behavior, social isolation can result in “psychological and physical disintegration,” and sometimes death. Research also suggests that individuals who are more socially connected and have “satisfying relationships with family and friends” live longer and healthier lives (via Harvard Health Publishing).

Staying connected during a global pandemic

If you’re too uncomfortable to experience indoor dining pandemic-style, there are other ways to connect with your friends. Researchers at the University of Texas at Austin recommend calling your friends and family members in lieu of email or text. Why? Because, unlike typed communication, voice communication offers immediate answers and allows for emotional cues (i.e., tone of voice, inflection, and speed of speech).

“Over email, the message that’s received may not be the same as the message that’s sent,” Guhan Subramanian, the director of the Harvard Program on Negotiation explained to The Atlantic. This is because text-based messaging (IM, email, SMS, etc.) is missing the “back-and-forth contextualization” and tone that you’d receive via a spoken conversation.

Another way to boost your social connection in a positive way is to get active. According to a team of researchers at the University of Basel, well-being can be enhanced via movement — especially if you’re with a group of friends.

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Researchers examine how microbes in the gut process the plant-based, sulfur-containing sugar sulfoquinovose

Popeye with a whiff of rotten eggs

An international team of scientists led by microbiologists Professor Alexander Loy from the University of Vienna and Professor David Schleheck from the University of Konstanz has uncovered new metabolic capabilities of gut bacteria. For the first time, the researchers have analyzed how microbes in the gut process the plant-based, sulfur-containing sugar sulfoquinovose. Sulfoquinovose is a sulfonic acid derivative of glucose and is found in all green vegetables such as spinach and lettuce. Their study discovered that specialized bacteria cooperate in the utilization of the sulfosugar, producing hydrogen sulfide. This gas—known for its rotten egg smell—has disparate effects on human health: at low concentrations, it has an anti-inflammatory effect, while increased amounts of hydrogen sulfide in the intestine, in turn, are associated with diseases such as cancer. The study has been published in the current issue of The ISME Journal.

Diet and the gut microbiome

With the consumption of a single type of vegetable such as spinach, hundreds of chemical components enter our digestive tract. There, they are further metabolized by the gut microbiome, a unique collection of hundreds of microbial species. The gut microbiome thus plays a major role in determining how nutrition affects our health. “So far, however, the metabolic capabilities of many of these microorganisms in the microbiome are still unknown. That means we don’t know what substances they feed on and how they process them,” explains Buck Hanson, lead author of the study and a microbiologist at the Center for Microbiology and Environmental Systems Science (CMESS) at the University of Vienna. “By exploring the microbial metabolism of the sulfosugar sulfoquinovose in the gut for the first time, we have shined some light into this black box,” he adds. The study thus generates knowledge that is necessary to therapeutically target the interactions between nutrition and the microbiome in the future.

Sulfosugars from green plants and algae

Sulfoquinovose is a sulfonic acid derivative of glucose and is found as a chemical building block primarily in green vegetables such as spinach, lettuce, and in algae. From previous studies by the research group led by microbiologist David Schleheck at the University of Konstanz, it was known that other microorganisms can in principle use the sulfosugar as a nutrient. In their current study, the researchers from the Universities of Konstanz and Vienna used analyses of stool samples to determine how these processes specifically take place in the human intestine. “We have now been able to show that, unlike glucose, for example, which feeds a large number of microorganisms in the gut, sulfoquinovose stimulates the growth of very specific key organisms in the gut microbiome,” says David Schleheck. These key organisms include the bacterium of the species Eubacterium rectale, which is one of the ten most common gut microbes in healthy people. “The E. rectale bacteria ferment sulfoquinovose via a metabolic pathway that we have only recently deciphered, producing, among other things, a sulfur compound, dihydroxypropane sulfonate or DHPS for short, which in turn serves as an energy source for other intestinal bacteria such as Bilophila wadsworthia. Bilophila wadsworthia ultimately produces hydrogen sulfide from DHPS via a metabolic pathway that was also only recently discovered,” explains the microbiologist.

A question of dose: Hydrogen sulfide in the intestine

Hydrogen sulfide is produced in the intestine by our own body cells as well as by specialized microorganisms and has a variety of effects on our body. “This gas is a Janus-faced metabolic product,” explains Alexander Loy, head of the research group at the University of Vienna. “According to current knowledge, it can have a positive but also a negative effect on intestinal health.” A decisive factor, he says, is the dose: In low amounts, hydrogen sulfide can have an anti-inflammatory effect on the intestinal mucosa, among other things. Increased hydrogen sulfide production by gut microbes, on the other hand, is associated with chronic inflammatory diseases and cancer. Until now, mainly sulfate and taurine, which are found in increased amounts in the intestine as a result of a diet rich in meat or fat, were known to be sources of hydrogen sulfide for microorganisms. The discovery that sulfoquinovose from green foods such as spinach and algae also contribute to the production of the gas in the gut therefore comes as a surprise.

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A first-time look at how COVID hit every town in New Jersey

A first-time look at how COVID hit every town in New Jersey

A new report issued by the Senator Walter Rand Institute for Public Affairs at Rutgers University–Camden unmasks the broad, regional impact of COVID-19 upon New Jersey municipalities during two waves in 2020. The report, “Municipal Variations in COVID-19 Case Rates in New Jersey,” is posted here.

Rather than focus on county-level COVID case data, the Rutgers University–Camden research institute explores how municipalities truly fared during the pandemic. During the second wave (from June 30 through Dec. 13, 2020), for example, Hammonton in Atlantic County had much higher case rates (4,383/100K) than the nearby municipalities of Folsom (2,885/100K) and Mullica (1,353/100K), as well as higher rates than the county as a whole (3,237/100K).

Similarly, Camden City (4,445/100K) and Pennsauken (4,697/100K) had case rates much higher than their neighbors in Collingswood (2,329/100K), Haddon Heights (1,308/100K), and Haddonfield (1,768/100K). In northwest New Jersey, Union Township (4,808/100K), had much higher case rates than anywhere else in Hunterdon County (1,755/100K).

The new research report from Rutgers University–Camden offers a visualization of variations in COVID-19 rates across New Jersey municipalities and illustrates the reality that nearby municipalities can have COVID case rates that are very different from each and from average rates within their counties.

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How Not Working Enough Can Really Affect Your Health

Most people dream of early retirement, but surprising research has shown that shortening your career could be detrimental to your health. A study published in MedPage Today found that early retirement brings a higher risk of mortality, especially for people younger than 60 or male. Another study found that retirees with health problems lived longer when they postponed their planned retirement, according to Harvard Women’s Health Watch.

Why? The reasons vary, but largely revolve around mental health and an increased risk of suicide. Working more hours and for additional years keeps people connected socially, helps them stay physically active, and offers a creative outlet or a challenge. “Social reinforcement is every bit as powerful as money,” wrote Dr. Nigel Barber for Psychology Today. “Adulation, praise, or affection, are as potent as any drug in motivating people to work hard.”

In other words, there’s a strong chance you would miss working for the social connections as much as, if not more than, for the money.

Unemployment increases risk of suicide

The National Library of Medicine found that unemployment creates a higher risk factor for suicide, especially among women, who were three times more likely to commit suicide than their employed counterparts. That risk increases with age. According to the CDC, older Americans are also at higher risk for suicide due to loneliness and isolation.

Working less hours could also lead to boredom, which can also negatively impact your health. A report in Patient says that boredom can lead to overeating and obesity, and lack of engagement can affect your breathing, making it shallower, triggering panic attacks, and aggravating respiratory problems. Obesity can lead to heart disease, Type 2 diabetes, and gallbladder disease, according to the CDC.

If you’re tempted to work more hours now, think again. Working too much can also have a negative affect on your health, leading to higher risk of stroke, heart disease, diabetes, and abnormal heart rhythms, reports WebMD. The key is finding a healthy balance between work, family, and down time.

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The Bystander Effect Explains Why Some People Don't Help When Others Are In Danger-Here's How to Fight Against It

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The data is clear: Hate crimes against Asian Americans have skyrocketed since the pandemic began. Anti-violence organization Stop AAPI Hate reported nearly 3,800 incidents against Asian Americans and Pacific Islanders from March 2020 to February 2021, and New York City alone had an 867% increase in Asian hate crime victims in 2020 compared to the previous year.

What's most shocking? Some of these crimes have happened right in front of other people—who haven't stepped in to help. In a video that's now gone viral, a 65-year-old Asian American woman can be seen being thrown to the ground and repeatedly assaulted in full view of security guards in a building nearby. The security guards look out and clearly see what's going on, as one of them closes the door on her.

Plenty of people online have expressed shock and outrage that something like this could happen right in front of others, with no one rushing to help. But this kind of thing happens more often than you'd think. In fact, it's a social phenomenon with a name. It's called the bystander effect, and it's been well documented for decades. Here's what you need to know.

What exactly is the bystander effect?

The bystander effect is a social psychology theory that says that a person is less likely to offer help to a victim when more people are around, Todd Lucas, PhD, a social and health psychologist at Michigan State University, tells Health. "It's an irony of human behavior," he says.

The term was first coined in the 1960s by psychologists Bibb Latané and John Darley who analyzed the 1964 murder of a woman named Kitty Genovese in New York City. Genovese was stabbed to death outside of her apartment, but none of her neighbors reacted to help her, even though they were aware of what was going on.

"It's really a classic example of unhelpful behavior," Victoria Banyard, PhD, associate director for the Center on Violence Against Women and Children at the Rutgers School of Social Work, tells Health.

Why does the bystander effect happen?

There are a few possible reasons for this. One is what Lucas calls "diffusion of responsibility." Meaning, the more people there are around, the less any single person feels responsible for helping in any situation.

People are also "social creatures" and we tend to react to social cues from those around us, Banyard says. "We want to fit in and, if other people seem to think this isn't serious, we tend to react the same way," she says.

Experts say this is potentially damaging on so many levels. On a very basic—but important—level, the bystander effect increases the odds that someone will get hurt. "There may be a chance to keep something from escalating and prevent someone from being harmed if people actually intervene," Banyard says.

But the bystander effect isn't just harmful on a physical level—it's damaging on a mental level for the victim, too. "It sends a message to the victim that people don't think they're worth helping," Banyard says.

What you can do to stop the bystander effect

It's easy to think you wouldn't fall victim to the bystander effect, but it's a common social phenomenon that has impacted plenty of others. If you notice something seems off in a crowd but no one else is reacting, Lucas recommends listening to your gut. "Be confident in your values and assessment of the situation," he says. "If you think somebody needs help, recognize that might be correct. Even if no one else is acting, it may be appropriate to act."

One person taking action can create a domino effect, where others recognize that there is a problem and step in to help, too, Lucas says. "You don't need to be the person that fixes the situation entirely—you just need to be the person who starts the chain reaction," he says.

If you're a victim in a crowd and no one is helping you, Lucas recommends singling out a particular person or looking for someone who seems like they could be helpful and appealing directly to them. "You can better overcome a bystander effect that way," he says.

Even simply being aware that the bystander effect is a thing can be helpful, Banyard says. Organizations like Hollaback and Step Up also have courses you can take to learn more about the bystander effect and strategies for intervening in different situations.

And, of course, if you see someone being victimized, do your best to intervene. "Take action," Banyard says. "It's simple."

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How You Should Really Be Cleaning Your Toothbrush

Do you run your toothbrush under hot water every once in a while as a way to sanitize it? If you have, you likely know that it’s important to keep your toothbrush clean, but you might not know the best way to do it. Every time you use your brush, you slough off plaque, bacteria, and other microorganisms — it’s wise to have a hygienic routine for this utensil.

For people who have used the hot water trick, this may be a worthwhile method. Healthline explains that you can sanitize the brush by running it underneath the water both before and after use. Make sure that the water is as hot as possible — the outlet suggests ensuring that the water temperature generates steam to effectively rid your brush of germs. This can help burn off any clung-on bacteria, which is especially important since germs from your toilet can even make their way onto your bristles, Insider notes. Apparently, the moving water sends bacteria into the air which can settle directly on your toothbrush. Make sure to keep your brush far from the toilet and sanitize it often to counteract this effect. 

The way that you store your brush also can make or break its cleanliness. It should always stand in an upright position after use because air kills off most of the bacteria present on the bristles. Rather than tossing your brush in a drawer, find a holder that keeps your brush separated from anyone else’s in your household and allows it to stay vertical.

You can use hydrogen peroxide to clean your toothbrush

If you’re looking for a cleaning agent, you can likely find a viable option in your medicine cabinet. Insider suggests using hydrogen peroxide to do the dirty work by killing off germs and microorganisms — especially if your toothbrush needs a deep clean. You can also use a mouthwash that contains alcohol for a powerful rinse that will sweep any lingering particles out from the bristles.

The outlet even cites a study finding that toothbrushes soaked in 3 percent hydrogen peroxide or an alcohol-based mouthwash came out 100 percent germ-free. Simply pour enough of the liquid into a cup and soak the head of your brush for 15 minutes. Rinse with hot water and enjoy your squeaky clean bristles.

Tools that clean your brush for you are also on the market, and they usually use UV rays to do the work. Healthline explains that this technology is extremely effective in sanitizing your toothbrush — you can find an apparatus online. They do carry a hefty price tag so make sure that you’re ready to use it often to get the most out of it. 

Of course, replacing your toothbrush every three-four months is the best way to keep it free from bacteria. If you notice the bristles fanning out or just a lower quality of clean, it’s best to pick up a new one.

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Analysis: How the US Invested in the War on Terrorism at the Cost of Public Health

Here’s one big takeaway from our country’s disastrous 2020 covid response: For 20 years, we’ve lavished attention and money on fighting human terrorism and forgot that the terrorism of nature is equally deadly, deserving equal preparation.

Today, with more than 545,000 U.S. covid deaths, I hope we’ve learned the huge cost of allowing our public health structure to wither as we single-mindedly pursued the decades-long war on terror. Slowly, with no one much paying attention, here’s how it happened.

After the horror of 9/11 and the anthrax powder attacks that followed, the United States rapidly created a massive infrastructure to ferret out and combat terrorism, focusing mostly on threats from international actors. Within weeks, Congress passed the Patriot Act. It created the Department of Homeland Security and the Transportation Safety Authority, which alone has an annual budget of nearly $8 billion for, among other things, intensive screening at airports.

Even relatively remote counties were supplied with military-like equipment. As a reporter covering the 2004 election, I remember being shocked to see Humvees and soldiers in body armor at county fairs in the Midwest, though they seemed an unlikely terrorist target. In the years that followed, terrorists carrying explosives in shoes and underwear on flights resulted in more screening and attention.

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Sadly, a good part of that focus and investment came at the expense of public health. “There’s only so much money, and so if you buy more of one thing, you have to buy less of another,” former FDA Commissioner Dr. Tom Frieden noted in explaining one reason the federal government had an enormous stockpile of anthrax vaccine, but not enough ventilators when covid-19 hit.

As our defenses against international and bioterrorism hardened, our defenses against infectious diseases shrank.

Though many public health experts fretted about possible pandemics, it was hard to capture lawmakers’ attention. After all, by the late 1990s, there were drugs to combat HIV/AIDS. Flu? There were vaccines. Infectious diseases? Perceived as conquered.

That’s partly why two large sources of money established after 9/11 — the Public Health Emergency Preparedness program and the Hospital Preparedness Program — were gradually chipped away.

Federal funds for state, local and tribal public health preparedness declined from $940 million in 2002 to $675 million in 2019, according to a report by the Trust for America’s Health, a nonpartisan research group. When the 2008 recession throttled government budgets, money was diverted again from public health programs to support other services.

The Affordable Care Act established the Prevention and Public Health Fund, with promised investment reaching about $2 billion annually by 2015. But that pot was reduced by half by the Obama administration and Congress to pay for other priorities.

By the time a deadly virus arrived on our shores last year, nearly two-thirds of Americans were living in counties that spend more than twice as much on policing as they spend on nonhospital health care, which includes public health, according to an investigation by KHN and The Associated Press.

Since 2010, spending on local health departments has dropped by 18% and at least 38,000 state and local public health jobs have disappeared since the 2008 recession. When covid hit, about 75% of counties had no epidemiologist on staff to track disease.

Countries like South Korea and Taiwan orchestrated a rapid, aggressive public health response as soon as the pandemic began. Testing, contact tracing and quarantines helped control spread and death — as did good national systems for electronic health records. In South Korea, a nation of 51 million, about 1,600 people have died. In Taiwan, population 26 million, the cumulative death toll is 10. Ten.

Contact tracing and quarantining takes people — lots of them. Tracking local spread takes epidemiologists and software. Many health departments in the U.S. had been limping by for years, with a skeleton staff, relying on fax machines. And remember, those local departments often also inspect restaurants, test water and give childhood vaccines.

Yes, President Donald Trump made the U.S. response far worse with lies and denial and sidelining the government’s top medical experts. But the lack of adequate public health agencies and sufficient personnel in most of the country made targeted and rapid response most likely impossible.

The Centers for Disease Control and Prevention, the national public health agency, has been regarded as a bastion of international scientific expertise, but that doesn’t always translate into good on-the-ground public health work. (Polio was eliminated by a vaccination campaign largely organized by charitable foundations.)

The human costs exacted by the pandemic are incalculable. And it will take years to tally the full financial costs of job losses, business closures, the more than $5 trillion approved in federal aid to contain the catastrophe, money that might have been spent on longer-term investments on education and the environment.

The tragedy is that a good part of this pain could have been avoided had there been a robust and functioning public health infrastructure in early 2020. That investment would have been a bargain, compared with what has been spent in the past year alone — not to mention the financial burden well into the future.

Some experts have estimated that the nation has a deficit of 250,000 public health workers. That’s about the number of people who work at DHS, now the third-largest Cabinet-level agency. But the deficits go well beyond staffing numbers.

The CDC and local public health departments need to be equipped with the same level of sophisticated tools provided to, say, airport screeners. Even though the federal government spent $36 billion to digitize medical records, we still don’t have a uniform national digital database that can track who is getting the vaccine.

Through Operation Warp Speed and private purchases, the U.S. helped make possible amazing new vaccines, paving a path out of the pandemic. By last December the government had spent $12.4 billion on shots, and the Biden administration has purchased several hundred million more doses, hoping to vaccinate most Americans by summer.

That’s a great accomplishment. But would we be so desperate if some of that money had been spent over the past decades on public health? The pandemic is a reminder that the terrorism of nature can’t be ignored, and our public health system needs to be rebuilt and expanded.

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Researchers show how stem cell depletion leads to recurring pregnancy loss

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Depletion of a certain type of stem cell in the womb lining during pregnancy could be a significant factor behind miscarriage, according to a study released today in STEM CELLS. The study, by researchers at Warwick Medical School, University of Warwick, Coventry, England, reports on how recurrent pregnancy loss is a result of the loss of decidual precursor cells prior to conception.

“This raises the possibility that they can be harnessed to prevent pregnancy disorders,” said corresponding author Jan J. Brosens, M.D., Ph.D., professor of obstetrics and gynecology at Warwick Medical School (WMS).

The womb lining—or endometrium—is a highly regenerative tissue capable of adopting different physiological states during the reproductive years. In the second half of the menstrual cycle when progesterone levels are high, the endometrium starts remodeling intensively, heralding the start of a short window during which an embryo can implant. Pregnancy depends on this transformation, a process called decidua, as it is driven by the differentiation of endometrial stromal cells into specialized decidual cells. These cells impart the plasticity needed for tissue to accommodate an embryo’s rapid growth.

“While the magnitude of tissue remodeling required for pregnancy makes it likely that poised progenitor and highly proliferative decidual precursor cells are critical for the formation of a robust maternal-fetal interface, the underlying mechanisms behind this are unclear,” Dr. Brosens said.

The same team had recently described the presence of a discrete population of highly proliferative mesenchymal cells (hPMC) during the window of implantation. Mesenchymal stem/stromal cells can be isolated from bone marrow, adipose and other tissue sources, and can differentiate into a variety of cell types depending on the conditions of the culture they are grown in. In this latest study, the research team set out to characterize these hPMCs.

“Our findings indicate that hPMC are derived from circulating bone marrow-derived stem cells and recruited into the lining of the womb at the time of embryo implantation. These cells appear critical in pregnancy to accommodate the rapidly growing placenta.” Dr. Brosens said. “We also found that these rare but highly specialist cells are depleted in the womb lining of women with recurrent pregnancy.”

Siobhan Quenby, M.D., FRCOG, professor of obstetrics and Honorary Consultant at University Hospitals Coventry and Warwickshire and the University of Warwick, was part of the research team. “These are very exciting findings,” she said. “We have already demonstrated that we can increase these highly proliferative cells in the lining of womb before pregnancy. These new findings explain why these highly proliferative cells are so important for the prevention of miscarriage and possibly spontaneous preterm labor, two devasting pregnancy disorders that affect many women and couples all over the world.”

Dr. Jan Nolta, Editor-in-Chief of STEM CELLS, said, “this key study begins to find answers to a very concerning problem in pregnancy disorders and gives insight into understanding factors that could contribute to pregnancy loss. We are very excited to be able to publish these important results.”

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