Posted by: keherenf | January 9, 2009

New Year’s Goals

For many Americans, New Year’s goals/ resolutions involve losing weight, saving money….seemingly all things that deal with bettering oneself. Unfortunately, these resolutions seem to be fairly ineffective as our waistlines are increasing almost as quickly as our debt clock is running….ok, well maybe there isn’t anything that runs as fast as the debt clock….but either way, this year may be the year to take the focus of your own problems and think globally.

For 2009, I would encourage you all to give some thoughts to the following: The Millennium Development Goals.

The MDG’s are as follows:


The United Nation’s website explains:

“The Millennium Development Goals (MDGs) are eight goals to be achieved by 2015 that respond to the world’s main development challenges. The MDGs are drawn from the actions and targets contained in the Millennium Declaration that was adopted by 189 nations-and signed by 147 heads of state and governments during the UN Millennium Summit in September 2000.”

These 8 goals break down into 21 quantifiable targets measured by 60 indicators. In just passing the half way mark from 2000 to 2015, there have been mixed levels of success. Some indicators have been met by some countries, while the same indicators have actually become worse in others. Here are just some of the current results of how well the MDGs are being met:




Progress towards the MDG target on basic sanitation, by region (1990 and 2004)


For a snapshot of the progression of all of the goals, click here.

From what I have read, there is still a lot to be done for all Millennium Developmental Goals to be achieved. But you can do your part in helping! Please “Stand Up and Take Action” against poverty by doing just one of these many ideas.

There are zillions of direct and indirect ways to contribute to those who are suffering from the consequences of extreme poverty. If you need an idea of where to start, let me know and I’ll give you some ideas!

Until then, try using the stress many of you likely face to focus your energy on something positive for someone else. Then maybe you will actually accomplish some of your New Years’ Resolutions along the way!

Posted by: keherenf | January 4, 2009

A New Start for a New Year!

To those who continue to read my blog (and I can see who you are!),

First of all, my apologies for the extended absence on my writings. Since April I battled an illness, moved, started a new position in a large corporation, got engaged…..and……..realized how much I miss public health. But, you never realize what you miss until it’s gone, right?

Second, thanks for the continued comments and support. It’s getting the comments and questions that lets me know what I write is helping others out that provides the continual inspiration for my involvement with public health…

And finally….happy new year to all. 2008 was an interesting one for me, I can’t wait to see what 2009 brings.

So, now I am back and will be picking up where I left off.

Any requests? I’ll write about those first.

With love,


Posted by: keherenf | April 4, 2008

A Lesson Before Dying


A Lesson Before Dying by Ernest Gaines tells the story of two men who both learn a lesson before one of them is sent to the electric chair. Set in Louisiana in the late 1940s, a black man named Jefferson happens to be at the wrong place at the wrong time…a liquor store where a robbery occurs and two black men and one white man are killed. The only one left standing, the all white jury is quick to sentence him to death by the electric chair. To make matters worse, the defense attorney keeps calling him a “hog” to try and persuade the jury that he should not be killed because he is not human, a repetitive name that infiltrates and corrupts poor Jefferson’s psyche.

After the sentence is passed, Jefferson’s godmother asks the local schoolteacher, Grant Wiggins, if he can visit Jefferson in jail and persuade him that he is truly a man before he dies. An interesting character, Wiggins does not feel that his visits will have any effect on the condemned man. But, at the persuasion of both the godmother, his aunt Lou, and his girlfriend Vivian, Wiggins continues to go to the jail cell.

His initial visits are ill met. Jefferson keeps repeating that he has no thoughts or feelings because he is a hog. At his lowest point, he eats food off the floor the way a hog would eat slop out of a trough. Right before he feels like he should give up all hope, Grant and Jefferson end up making a connection which slowly changes how Jefferson feels about himself. Grant brings him a radio and a journal, and instructs Jefferson to write down any thoughts that come to mind.

After Jefferson is killed, the deputy visits Grant to deliver the journal which Jefferson kept. He told him that above all else, Grant should know that Jefferson’s last words were to tell his godmother that he walked like a man, which he did. He held his head high and walked with grace and honor, a presence so noticeable that even the witnesses remarked how he stood well above the crowd. Thus, he fulfilled his lesson before dying: he could walk to his end as a man.

For those who have ever taught someone, you know that you will probably learn much more than you can teach. Any child I have tutored has taught me more about compassion and life than I could ever teach them about math or writing. Likewise, this book portrays Grant’s own lessons learned before Jefferson’s death. He recognizes the injustices of the entire race-based legal system, but learns it is something that must be accepted. Furthermore, he realizes that love above all else is the most important thing, as confirmed through his growing public affection for a black woman who had been ostracized from her community. Gaines also seems to suggest that love and humanity trump religion as he continuously portrays Grant’s efforts to help Jefferson as far more successful than the local priest.

This novel is a well-written time piece which shows not only the racial tensions of the time, but also discusses the roles of friendship, love, family, death, religion, race, and education in society at this time. A fairly quick read and easy writing style, I would recommend this book to anyone who desired to watch the development of two great men in a society which tried to constrain them.

Similar books: Of Mice and Men by John Steinbeck


For those who are insured and very ill, the hospital is where one would go to seek intensive health care. However, despite the great help hospitals can provide for the ill, they can also provide a host of devastating infections that collectively contribute to the fourth leading cause of death in the United States- hospital acquired infections. Of these infections, over half are attributed to MRSA (methicillin resistant Staphylococcus aureus), commonly known as “staph”.

How does this happen? There is more than one answer. The bacteria itself has become multi-drug resistant because of an abuse of antibiotics. Antibiotics can be prescribed for things like colds or viruses, which should never be treated with antibiotics. People also misuse them by not taking them the correct way, which is until the medication is completely gone. Instead, some will take the medication until they feel better, which leaves only the strongest (and most antibiotic resistant) bacteria left in the body. This bacteria can then multiply, creating a strong, drug-resistant strain of bacteria.

In addition, patients in the hospital usually have compromised immune systems, which make them more susceptible to staph infections.

Pathology: Staph bacteria lives on about one third of the population. However, in about half of these people the infection is not active, making them carriers of the bacteria. The nature of the bacteria itself is scary in the medical community because it is resistant to most antibiotics. Essentially, it is a “super bacteria” which has evolved to be resistant to most forms of antibiotics, making it very difficult to treat. For the ill or elderly, staph can result in serious skin infections and tissue infections, or a terrible form of pneumonia.

Because of its highly contagious nature, MRSA can be spread by health practitioners hands, bed rails, remote controls, bedside telephones…anything that an infected patient touches can spread MRSA.

Symptoms: Staph infections usually begin as little bumps or boils which turn into deep, pus-filled abscesses that ultimately require surgical draining. These abscesses can quickly travel into the heart, lungs, and other vital organs in the body.

Treatment: Currently, the only form of treatment is antibiotics. However, since MRSA is resistant to so many types of antibiotics, doctors must prescribe the strongest kind, including vancomycin. Unfortunately, there are several cases of MRSA that are resistant to even the strongest antibiotics, which leaves no successful treatment.


Morbidity (# of individuals affected): Over 100,000 life-threatening deaths are reported by the CDC

Mortality (# of deaths): It is estimated that about 20,000 deaths in the hospital are from MRSA…this is higher than the annual number of death from AIDS

Statistics (from newly published CDC Study):

  • While most MRSA infections could be traced to a hospital stay or some other health care exposure, about 15% of invasive infections occurred in people with no health care risk
  • Two-thirds of the 85% of MRSA infections that could be traced to hospital stays or other health care exposures occurred among people who were no longer hospitalized
  • People over age 65 were 4 times more likely than the general population to get an MRSA infection. Incidence rates among blacks were twice that of the general population, and rates were lowest among children over the age of 4 and teens

Prevention: As this is becoming an increasing Public Health concern, advisories have been made to try and enhance infection control to the highest level possible. This includes sterilizing hospital equipment, hospital beds, and health care professionals washing their hands after any contact with patients.
For More Information:

Mayo Clinic


Posted by: keherenf | March 20, 2008



From a human perspective, depression is really unfortunate and can be crippling. From a public health and economic perspective, depression is equally crippling in the loss of productivity and quality of life that results from this condition. According to the World Health Organization, depression is the #1 cause of disability and the #4 contributor to global disease, projected to reach #2 within the next ten years. The more I researched not only the medical but the economical impact of this condition, I realized it was important to try and inform as many people about it as possible.

Pathology: Although there are many possible causes of depression, the commonly accepted biological model is that it results from an imbalance of chemicals in the brain. The following may also contribute to the development of depression:

  • genetics (family history)
  • traumatic event
  • physical conditions (AIDS, cancer, etc or the medications used to treat these conditions)
  • having another psychological disorder at the same time (schizophrenia,  anxiety disorde, substance abuse, etc)

Types: Within the “Major depressive disorders” includes dysthymia, seasonal affective disorder, postpartum depression, and bipolar disorder. For the purposes of this article, I will write about general depression.


  • constant feelings of sadness or “the blues”
  • increased irritability
  • loss of energy
  • constant tiredness
  • decreased interest in usual activities
  • change in appetite, either increase or decrease
  • change in sleeping patterns: increase or decrease, waking up too early
  • feeling slower than usual
  • restlessness
  • inability to concentrate
  • suicidal thoughts, thoughts of worthlessness

Treatment: The first step is to see a doctor, who through questioning and various medical tests can rule out other conditions that can mimic depression (like a thyroid disorder). After being diagnosed with depression, the physician will refer the individual to a mental health professional which can then determine the appropriate course of treatment. The most common treatments are psychotherapy and/or medication depending on the severity of the depression and what they underlying causes are.

The most common type of medication are SSRI’s (Selective serotonin reuptake inhibitors) . To see how these work in the brain, watch this video by the Mayo Clinic.

**Important things to remember**

  • If you or someone you know is feeling suicidal, seek professional help immediately
  • If you or someone you know is suffering from clinical profession, seek professional help as soon as possible
  • If you or someone you know is beginning treatment for depression, know that it may take weeks or even months until full results are seen. Hang in there!
  • There is nothing to be embarrassed about if you are diagnosed with depression, or any other mental illness for that matter. It is an illness…just like strep throat or a cold…something that you would never voluntarily choose and cannot control.


Mortality (# of deaths): Depression is strongly linked to suicide, which takes over 850,000 lives a year

Morbidity (# affected): At least 121 million people worldwide

Epidemiology: Depression does not affect one race or gender more than the other, although it may be diagnosed more frequently in areas that have better access to health care.

Public Health Aspect: I have already mentioned how disabling depression is for the world. Unlike a virus like HIV which is much harder to treat medically, depression can be very well managed with primary care. Antidepressant medication, psychotherapy, or a combination of the two can alleviate or eradicate depression in up to 80% of individuals with just basic primary care. However, less than 25% of the world’s population has access to the primary care needed to treat depression. In addition, lack of treatment has been associated with societal stigmas about suffering from depression. If we could only broaden the education of the nature and treatment of depression, I feel that there could be great improvement not only on an individual scale but a global scale as the burden of this disease is lightened.

For More Information:


National Institute of Mental Health 

Posted by: keherenf | March 14, 2008

STD testing


While checking out the latest news about Obama and Clinton, I came across a headlining story from CNN: 1 in 4 girls currently have at least one STD. As I read the article and thought about other literature on the topic that I have read, I feel it is without question that many people are still greatly misinformed about how STD’s are transmitted, and how you can prevent them.

Although I have already written previous articles about STD’s, I feel it is necessary to write one article only on testing. This blog lets me look at the search terms people use to read these articles, and ‘std’ is nearly always the biggest one, so I think it is worthwhile to explain how STD testing works so anyone who reads this can make better decisions in this area.

First of all, it is really important to stress that there are different types of STD testing, and it requires a combination of these methods to be fully tested. In addition, most of the time you will not be given all of these tests unless you specifically ask for them, as the healthcare professional has no idea what types of STD’s you would like to be screened for. Never assume that you are getting fully tested unless you specifically ask for the blood, urine, and Pap test, all which should be for the purpose of screening for STD’s. The following describe the different types of STD testing and what each test screens for:

1. Blood test: In a blood test, the health practitioner will remove a sample of blood from the arm and send it to the lab for analysis. The results usually come back within a few days. By checking the blood, you can be screened for the following STD’s:

  • HIV
  • Syphilis
  • Hepatitis

2. Urine Test: The urine test is a simple test. The health practitioner will give you a sterile cup and instruct you to urinate a small amount into it. This will be sent to a lab, which should be able to provide results within a few days. The urine test can screen for:

  • Gonorrhea
  • Chlamydia

3. The Pap Smear (for women): Interestingly enough, the CDC recommends this as one of the most important STD tests for women. In a Pap Smear, the health practitioner will use a small device which scrapes some cells of the cervix for testing. These cells will be sent to the lab, which should give results within a few days.

The reason that this test is the most highly recommended for women is that it is the only test which screens for HPV (human papillomavirus), an epidemic that is greatly affecting sexually active women everywhere. By receiving a Pap test, the doctor will be able to look for precancerous cell changes, something that the woman would otherwise not know about.

In addition, the Pap test allows the practitioner to visually scan for herpes outbreaks and genital warts, which can often be internal and therefore unknown to the infected person.

4. STD’s for which there is no test: Because of the nature of some of the viral STD’s, there are some which cannot be tested for, especially if visual symptoms are not present. These include HPV (especially for men) and genital herpes. In addition, sometimes a full round of STD testing can come back negative only because the infection is new. For example, someone can have HIV but still test negative for the first few months because it has not completely infiltrated the body yet.


Some important things to remember:

  • If you are going to start having sexual relations with a new partner, have both you and your partner get fully tested before any sexual activity.
  • If you are sexually active, get tested.
  • Many STD’s do not have any symptoms…do not think that just because you do not feel like you do not have an STD means that you do not have one.
  • Any type of sexual activity has some risks, as condoms can not prevent all STD’s and not every STD can be tested for. Make sure that you are willing to accept that risk.
  • Ideally, you should be able to trust that your partner will not contract an STD from someone else while you are having sexual relations with them.
  • If you have ANY doubts, go get tested!

Sex can be a good thing if practiced safely. Should you read this and have any questions at all, feel free to send me a message and I will do my best to help you. Good luck and be safe!

Posted by: keherenf | March 8, 2008

Hunter Syndrome

Although I try to cover diseases that affect a large amount of people, I will always write about any personal requests I receive. Yesterday I received one for a very rare genetic disease called Hunter Syndrome.

In order to understand this syndrome, it is necessary to have a basic understanding of what an enzyme is. Imagine a key and a lock. Each lock can only work successfully with one particular key…even if there was only one slight difference, the key would not work. An enzyme is the key and the lock is a cell in the body. The enzyme is designated to one particular type of cell, and when they interlock, they are able to perform the chemical reaction that they are designed for.

Pathology: Hunter Syndrome occurs when the enzyme designed to break down complex sugar molecules called glycosaminoglycans or mucopolysaccharides either do not work or do not exist. Because the enzyme is not present to break down these complex molecules, they begin to build up in different cells and tissues, creating a toxic effect.

This syndrome is a genetic disorder which is linked to the X chromosome. Because it is linked to the X, nearly all individuals affected by this syndrome are male. Females typically tend to only be carriers.



Child Onset:

  • mental retardation
  • hyperactivity
  • aggressiveness
  • ivory colored skin lesions on the back, arms, and thighs
  • skeletal changes
  • visual impairment
  • growth delays
  • compromised cardiac (heart) functioning

Adult Onset:

  • Mild or no mental deficiency


  • Coarse facial features
  • Large head
  • Stiff joints
  • Extra hair
  • Deafness
  • Enlargement of internal organs
  • Carpal tunnel syndrome

Treatment: There is currently only one treatment that is FDA approved for Hunter Syndrome. The medication is called Elaprase, and it is given through an IV. This treatment replaces the enzymes that do not work adequately, which would theoretically reduce the toxic buildup of the complex molecules.

Prognosis: If the Syndrome develops at an early age, the current life expectancy is between 10-20 years. If it develops at an older age or in a much milder form, the current life expectancy is between 20-70 years.

Epidemiology: Every ethnic group gets equally diagnosed with Hunter Syndrome, with a slightly higher incidence in Jewish populations living in Israel.

Mortality (# of deaths): The more severe type of Hunter Syndrome always leads to death.

Morbidity (# of incidences): Anywhere between 1 in 65,000 births to 1 in every 132,000 births.

For More Information:

Mayo Clinic

National Institute of Health

Rare Diseases


Posted by: keherenf | March 5, 2008



When looking at the CDC’s top 20 most requested disorders, I was somewhat surprised to find Autism toward the top. However, after conducting more research I discovered that the rates of autism have drastically increased over the decades, while scientists still cannot pinpoint what causes the disease, let alone how to prevent it or cure it.

“Autism” is one of the most common diagnoses in what are called “Autistic Spectrum Disorders” (ASD’s). ASD’s include Rett’s Syndrome, Asperger Syndrome, and Childhood Disintegrative Disorder, with Autism being the most severe. Although the incidences of ASDs are on the rise, the long-term prognosis is good if therapy is started early.

Pathology: Although there are different theories for how children develop autism, there is currently no one theory that is widely agreed upon in the medical community. There does seem to be a strong genetic link…(if one identical twin has autism, the other twin has a 75% chance of developing it), but the environment seems to be a strong factor as well. Studies have shown that people with autism have abnormal areas of their brains, as well as an imbalance of certain neurotransmitters. However, not much more is known as to how or why autism develops.

Symptoms/ Warning Signs: People afflicted with autism tend to have the following three characteristics: impaired social functioning, impaired communication (verbal and nonverbal), and repetitive behaviors. However, the severity of each of these may vary widely on a person to person basis. These problems can usually be seen anywhere from 1-3 years of age as children with autism begin to severely lag behind a normal child development time line.


Diagnosis: Because Autism may vary so widely from one individual to the next, receiving a diagnosis of autism is a fairly long process that may include multiple physicians. The process usually begins with a series of questions from the general practitioner, who may then refer the patient to a psychologist, psychiatrist, neurologist, or other specialists to develop one agreed-upon diagnosis.

Treatment: Treatments differ based upon how the patient is affected by autism. Some of the treatments may include medication, as well as behavioral, educational, and language therapy. Depending on the severity of the autism and how effective treatments are, people with autism can lead a normal, functional life, and the long-term prognosis can be very good.

Epidemiology: Autism occurs in every socioeconomic and ethnic group, but it affects males four times more than females.

Morbidity: About 1 in 150 young children in America are currently diagnosed with autism.

Mortality: Autism itself does not lead to death.

For More Information:

CDC (Center for Disease Control)

National Institute of Neurological Disorders

Autism Research Institute

National Institute of Mental Health

Posted by: keherenf | February 24, 2008

Looking to Step up your Healthy Lifestyle? Try


I’ll be the first one to tell you I’m not into most trends or fads when it comes to fitness or nutrition. I think that eating healthy and working out is the greatest key to success, and anything outside of that I feel is tailored to personal compatibility. As such, I have worked out doing fairly similar routines for years now. I love endurance sports…especially running. Sometimes I will switch up running with weight lifting or the occasional cardio class. But, my body has not really changed since my body stopped being challenged.

Sound familiar? This all changed when I was exposed to Although anything you would ever want to know about crossfit is thoroughly answered on its website, the main gist is that one should eat well (which they explain) and combine heavy weightlifting, gymnastics, and hard cardio workouts to become the greatest athlete one can be.

The best way to start is to explore the site..find out what crossfit is all about. It is not a gimmick, it is more a way of life which so far seems to provide the steps for success. It does not cost money either. Look around, find out the beliefs behind the workouts and the nutrition.

Then, check out the WOD (workout of the day). These WOD’s have become so exciting that my friends and I check it every night until it is posted. They believe in 3 days of working out with 1 day of rest, so the WOD follows that on/off formula while incorporating the gymnastics, cardio, and heavy weightlifting they believe in.

Do you see a term on the WOD that you do not know about? Well, they also have every move on video. You can check out some uber in- shape people utilize the right form for each exercise so you can ensure that you do it correctly yourself. The competitions between the strongest people are pretty entertaining to watch.

When I was first introduced by my best friend, I took a mild interest in it. But, as he became more excited about it, I had to try it out for myself. I have been completely turned onto it ever since. I have restarted drinking protein drinks, which I have not done since I was in top shape. I too anxiously await for the newest WOD posting. And most importantly, I am sore. All the time. There are workouts in which I push myself so much that I have to stop and bend over just to catch some air, but for someone who’s body has not felt challenged in awhile, it feels really good. I can tell that I am utilizing areas of my body which I had not been doing before, and I am excited to see where crossfit takes me.

If you want to know more, check out Crossfit itself or my best friend’s blog. They both have great information on what Crossfit can do for you. It’s free, it’s fun, check it out!

Posted by: keherenf | February 23, 2008


If you live an America, all you probably need to do is look around and you will discover that our nation has a high prevalence of obesity. In fact, according to the CDC, 33% of our nation was considered obese in 2004…that is 1 out of every 3 people. The national cost, (both directly from obesity itself and indirectly from diseases resulting from obesity) related to obesity is over $120 billion according to the National Institute of Health…that’s over 10% of our health care costs! This figure does not even include the statistics on loss of productivity as a result from missed work days, etc. It is clear that obesity is a huge issue in our country, and it is time that something be done about it.

What is obesity? Obesity is not the five pounds you want to lose to fit better in your jeans if you are at a healthy weight. The terms “overweight” and “obesity” are determined by a Body Mass Index (BMI) chart. You can calculate your BMI here to get a general idea of your Body Mass Index (keep in mind that if you have a lot of muscle, your data may be slightly incorrect). A BMI of 25.0-29.9 is considered “overweight”, while a BMI of 30.0 or above is considered “obese”.

How does someone become overweight/obese? The CDC actually has a great summary of the various factors that contribute to carrying excess amounts of weight. There is the simple theory, which is of course if you put in more calories then you give out, you will gain weight. While this is true, I feel it is important to take other things into account, such as education linked to socioeconomic status, availability of resources, etc.All one has to do is look at the demographics of who are overweight and obese to get a good sense of the economic disparity that greatly contributes to this epidemic.


Who becomes overweight/obese? Anyone can become overweight or obese, but there are clear trends based on the demographic statistics released by the U.S. Government. People who live in poverty, or are minorities, or are the least educated (all of which typically goes hand in hand) are the most likely to become overweight or obese. I picked out the following charts to better show the discrepancies:



These statistics show me that obesity is not just because of genetics, but because of a clear link between poverty and lack of education and minorities. This further cements my belief that we cannot adequately change health without addressing economics and education as well.

What are the possible effects from obesity? There are many. Health wise, carrying excessive amounts of weight for a long period of time can result in the following diseases:

  • hypertension (high blood pressure)
  • high cholesterol
  • type-2 insulin resistant diabetes
  • heart disease
  • stroke
  • arthritis
  • sleep apnea (temporary choking while sleeping)
  • respiratory problems
  • various cancers
  • gallbladder disease

The body was not designed to carry so much weight, and so it will eventually start breaking down over time. But this is only on a micro-level. Obesity on a macro, national level has some scary statistics as well:

  • I have already stated that obesity-related medical costs are over $120 billion. Of this $120 billion, about 1/2 is covered through taxpayers money through the government-funded program Medicare.
  • This amounts to about $180 out of pocket costs for every American, every year.
  • Productivity loss amounts to just under $4 billion a year

What is the Public Health concern? These statistics keep increasing, and if nothing changes the impact will be even worse. Because it is so greatly linked to education and socioeconomic status, there is hopefully a way that we can reduce this problem. In fact, it is one of the CDC’s goals to reduce obesity to 15% of the population by 2010, although no data has been released to show whether or not that goal is close to being met.

What Can I do to Help…

Myself?: If you are at a healthy weight, maintain it. If you are overweight, start losing. The simplest way to do this is to start exercising and incorporate a healthier diet. If you are so overweight that you cannot lose it on your own, seek help from a physician. They may prescribe certain medications or lifestyle modifications to help you. In drastic cases, they may also suggest certain surgeries like banding or gastric bypass.

My children?: Childhood obesity is just as much of a problem as adult obesity. Over 15% of American children are considered obese. If your child is overweight, start changing their lifestyle right now. Obesity from an early age can have even worse consequences in the future, so it is important to start as soon as possible. Children should have at least 60 minutes of physical activity every day. Do not rely on school programs to fulfill this, as often many schools do not have adequate P.E. programs. Also, monitor your child’s sugar and fat intake by packing them school lunches and making meals with plenty of fruits and vegetables. In addition, try to limit the amount of television your kids watch daily.

My country? I feel the best way to alleviate this problem is through education. If you are so compelled, find a school, neighborhood, library, doctor’s office, etc who already has a nutrition/obesity program and offer your help. If you do not have the time to do this…start with your family! Promoting healthy living habits is within the home can lead to healthier people in future generations.


For More Information:


Obesity in America

National Institute of Health

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