TIME Disease

A Major Ebola Outbreak in the U.S. or Europe Is Unlikely, Says WHO

The statement comes as the U.S. moves quickly to contain the disease after the reporting of a third case

The World Health Organization (WHO) has said a widespread outbreak of the Ebola virus, which has killed thousands in the West African countries of Guinea, Sierra Leone and Liberia, will probably not be replicated in the U.S. or Europe thanks to the advanced health care systems in the West.

Christopher Dye, the director of strategy for the WHO, told the BBC that the potential spread of Ebola in the West was a matter “for very serious concern,” but added that an epidemic was improbable.

“We’re confident that in North America and Western Europe, where health systems are very strong, that we’re unlikely to see a major outbreak in any of those places,” Dye said.

The U.S., meanwhile, is dealing with its third Ebola case as Amber Vinson, a nurse who treated the country’s first patient who died earlier this month, was diagnosed with the disease.

It was revealed on Wednesday that Vinson was cleared to get on a plane by a Centers for Disease Control and Prevention official just a few days prior, despite having a mild temperature. Officials are attempting to track down and monitor her 131 fellow passengers.

U.S. President Barack Obama, who canceled two consecutive campaign events in order to take firmer action on Ebola, echoed the WHO view in a statement. “The dangers of a serious outbreak are extraordinarily low,” he said, “but we are taking this very seriously at the highest levels of government.”

[BBC]

TIME Exercise/Fitness

The Drug-Free Way to Fight Depression

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Exercising throughout adulthood can help to keep depression at bay Jupiterimages—Getty Images

A 50-year study shows that physical activity may help fight the disease

Exercise can do a lot of physical good, from making hearts healthy to keeping weight down—and now there’s strong new evidence that it can give a mental boost as well.

In a study appearing in JAMA Psychiatry, researchers from the UK and Canada found that people who were more physically active throughout most of their adult years experienced fewer depressive symptoms than those who were less active. That finding is familiar, but these results are extremely affirming because they involved both a large number of same-aged people—11,000, who were born the same week in March 1958—and a long period of time—50 years.

The volunteers answered questions about how many times they exercised a week on average at four points during the study: when they were 23, 33, 42 and 50 years old. They also took standardized tests that measured depressive symptoms such as depressed mood, fatigue, irritability and anxiety.

At every stage, those who reported more physical activity also had fewer depressive symptoms. What’s more, those who became more active between the recordings also showed fewer signs of depression. That means someone who exercised more each week at 42 than they did at 33 also benefited from having fewer depressive symptoms at 42. In fact, getting more physically active at any age—going from never working out to working out three times a week—lowered the chances of depression by 19% five years later.

The results add to previous studies that found similar associations between exercise and lower depression rates among younger and older people, but this study shows that the connection exists throughout adulthood.

Understanding the link could help doctors better treat both obesity and depression; with some people, depression could be a barrier to becoming physically active, while with others, being overweight could feed into cycle of depression. “Our study suggests that practitioners helping patients to recover from depression might address activity within their treatment plan for lifestyle factors,” the authors write.

TIME Health Care

The Price of Staying Alive For the Next 3 Hours

Stayin' alive—and cheap at the price
Stayin' alive—and cheap at the price ZU_09; Getty Images

A new study suggests a little spending now can buy you a lot of time later

How much do you reckon you’d pay not to be dead three hours from now? That probably depends. If you’re 25 and healthy, a whole lot. If you’re 95 and sickly, maybe not so much. But for people in one part of the world—the former East Germany—the cost has been figured out, and it’s surprisingly cheap: three hours of life will set you back (or your government, really) just one euro, or a little below a buck-thirty at current exchange rates.

That’s the conclusion of a new study out of Germany’s Max Planck Institute, and it says a lot about the power of a little bit of money now to save a lot of suffering later—with implications for all manner of public health challenges, including the current Ebola crisis.

The new findings are a result of one of the greatest, real-time longitudinal studies ever conducted, one that began the moment the Berlin Wall fell, on Nov. 9 1989. Before that year, there were two Germanys not just politically, but epidemiologically. Life expectancy in the western half of the country was 76 years; in the poorer, sicker east, it was 73.5. But after unification began, social spending in the East began rising, from the equivalent of €2,100 per person per year to €5,100 by the year 2000. In that same period, the difference in lifespan across the old divide went in the opposite direction, shrinking from 2.5 years to just one year as the east Germans gained more time. Crunch those numbers and you get the three extra hours of extra life per person per euro per year.

“Without the pension payments of citizens in east and west converging to equivalent levels,” said Max Planck demographer Tobias Vogt in a statement, “the gap in life expectancy could not have been closed.” Increased public spending, Vogt adds, is often framed as an unfortunate knock-on effect of longer life. “But in contrast,” he says, “our analysis shows that public spending can also be seen as an investment in longer life.”

The idea that generous, tactical spending now can be both a money-saver and lifesaver is one that health policy experts tirelessly make—and that people in charge of approving the budgets too often ignore. Bill Gates often makes the point that $1 billion spent to eradicate polio over the next few years will save $50 billion over the next 20 years, not just because there will no longer be any cases of the disease to treat, but because the global vaccination programs which are necessary just to contain the virus can be stopped altogether when that virus is no more.

As TIME reported in September, British inventor Marc Koska made a splash at the TEDMed conference in Washington DC when he unveiled his K1 syringe—an auto-destruct needle that locks after it’s used just once and breaks if too much force is used to pull the plunger back out. That prevents needle re-use—and that in turn not only reduces blood-borne pathogens from being spread, it does so at a saving. According to the World Health Organization (WHO), $1 spent on K1 syringes saves $14.57 in health care costs down the line—or $280 for a $20 order of the shots.

All across the health care spectrum, such leveraging is possible. Critics of the Affordable Care Act have slammed the law for the cost of the preventative services it provides, and while it’s way too early to determine exactly how successful the law will be, the encouraging stabilization in the growth of health costs suggests that something, at least, is working.

Global health officials are making a similar, though more urgent, preventative argument concerning the Ebola epidemic in West Africa. Americans are rightly jumpy over the few cases that have landed on our shores, but the 1,000 new infections per week that are occurring in the hot-spot nations of Liberia, Guinea and Sierra Leone make our concerns look small. Frighteningly, according to the WHO’s newest projections, that figure will explode to 10,000 cases per week by December if the resources are not deployed to contain the epidemic fast.

“We either stop Ebola now,” WHO’s Anthony Banbury said in a stark presentation to the U.N. Security Council on Sept. 14, “or we face an entirely unprecedented situation for which we do not have a plan.”

Suiting up and wading into the Ebola infection zone is a decidedly bigger and scarier deal than spending an extra euro on public health or an extra dollar for a new syringe. But the larger idea of intervention today preventing far larger suffering tomorrow remains one of medicine’s enduring truths. We lose sight of it at our peril.

TIME health

How Lessons From the AIDS Crisis Can Help Us Beat Ebola

Health officials counsel guests on the p
Health officials counsel guests on the prevention of HIV/AIDS transmission at the Argungu fishing festival in Kebbi State, northwestern Nigeria on March 13, 2008. Hundreds of fishermen from different parts of Nigeria and neighbouring West African countries have started arriving in Argungu fishing Town to participate in the fishing festival. AFP PHOTO / PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images) PIUS UTOMI EKPEI—AFP/Getty Images

Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, D.C.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster

Without urgent action, Ebola could become “the world’s next AIDS,” said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC). HIV/AIDS has killed some 36 million people since the epidemic began, and another 35 million are living with the virus. Is history really about to repeat itself?

It doesn’t have to, if we have the wisdom to learn from past experiences. The tools we need immediately are swift international action, strong leadership, respect for science and broad-based compassion. But once we contain Ebola – and we will – we need new resource commitments and global health strategies to bring the next deadly epidemic under control much more quickly.

We’ve already done some things right. President Obama traveled to CDC headquarters in Atlanta, a rare presidential action, to detail an aggressive offensive against Ebola that includes sending troops and supplies to build health care facilities in Africa. Contrast that with the response to AIDS under President Reagan, who did not mention the epidemic publicly until 1987, six years after people started dying from it. This time around, we’re seeing leadership at the top.

Health officials have also put out a unified message about how Ebola can be transmitted – only through direct contact with bodily fluids. That, too, stands in welcome contrast with HIV, where irresponsible rumors quickly took hold and people worried about sharing toilets seats and touching doorknobs. The importance of educating health care workers and keeping them safe represents a commonality between Ebola and HIV, and must be among our highest priorities. Following the science is the only way we’re going to stop this thing.

Another lesson from HIV is that adequate resources can transform disease outcomes. The President’s Emergency Plan for AIDS Relief (PEPFAR), a $15 billion, five-year commitment under President George W. Bush saved millions of lives around the world. But by contrast, even though the CDC is attacking Ebola with the largest global response in its history, the effort doesn’t come close to having the budget necessary to do all the field work needed to really beat back Ebola. Bipartisan funding support is crucial to enable public health officials to act aggressively.

One lesson that has not been well learned is that we stigmatize people at our own peril. During the AIDS epidemic, we saw an American teenager, Ryan White, expelled from school after he contracted HIV through a blood transfusion. In Dallas, where the first known Ebola victim in the U.S. has died, we hear reports that people of African origin have been turned away from restaurants and parents are pulling their children out of school. Cries to ban flights from Ebola-affected countries — an ineffective strategy reminiscent of the 22-year ban on the entry of HIV-positive people into the U.S. — are growing louder.

Experience tells us that when we are driven by fear, we tend to push infected people underground, further from the reach of the health-care system and perhaps closer to harming others. There was a time when many people assumed every gay man could spread AIDS; now some are suspicious that anyone from West Africa could harbor a deadly virus. Acting on ignorance is the best way to disrupt an optimal public health response.

We should look to other infectious diseases for lessons as well. After severe acute respiratory syndrome (SARS) surfaced in China in 2002 and spread to more than 30 countries in just a few months, an aggressive, well-coordinated global response averted a potential catastrophe. We saw how much could be done when political and cultural differences were set aside in favor of cooperation. SARS also spurred the World Health Organization (WHO) to update its International Health Regulations for the first time in 35 years, and prompted many countries to strengthen their surveillance and response infrastructure, including establishing new national public health agencies.

But glaring gaps remain in the health care and public health systems of many nations, despite years of warnings from almost anyone who has taken a careful look at them. With a population of 4 million, Liberia has only 250 doctors left in the country. That’s more than just Liberia’s problem, because if we can’t contain the Ebola epidemic there, we’re at much higher risk here. And within our own borders, we have a public health system that the Institute of Medicine termed “neglected” back in 2002. That assessment was largely unchanged a decade later when the IOM said that “public health is not funded commensurate with its mission” in the U.S.

The international community dragged its feet far too long on Ebola, and as a result, the virus still has the upper hand, outpacing the steps finally being taken to defeat it. Sierra Leone has just 304 beds for Ebola patients and needs almost 1,500 right now; by next week, it will need more. When it comes to control and prevention, speed is paramount. With the epidemic doubling every three weeks, the actions we take today will have a much greater impact than if we take those actions a month from now.

When we finally subdue this epidemic, we also need to shed our complacency towards the infectious diseases that plague us still, and the new ones likely to arrive with little warning. In a globalized world, they remain an immense threat. Almost 50,000 new HIV infections occur in the United States every year, as do 2 million worldwide. Influenza kills thousands of people annually, and more virulent strains can be much more dire. Yet we shrug most of this off, rarely paying attention until blaring headlines announce an impending cataclysm.

To get ahead of the curve, we need a renewed commitment to research and action, and enough resources to put more public health boots on the ground, both at home and abroad. Greater support for the Global Health Security Agenda, designed to close gaps in the world’s ability to quell infectious disease, should be a priority. The agenda, launched earlier this year, is a partnership involving the U.S. government, WHO, other international agencies and some 30 partner countries.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster, and then stepping in to prevent it from getting even worse. We can’t afford to keep repeating that pattern, and squandering blood and treasure in the process.

Ebola is a humanitarian crisis, but it does not belong to West Africa alone. We are all in this together.

 

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Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, DC. She served from 2009 to 2013 as Chief Public Health Counsel with the Committee on Energy and Commerce in the U.S. House of Representatives. Ms. Katz was the lead Democratic committee staff on the public health components of the health reform initiative passed by the House of Representatives in November 2009. Prior to her work with the Committee, Ms. Katz was the Walter G. Ross Professor of Health Policy of the School of Public Health and Health Services at The George Washington University. She served as the dean of the school from 2003 to 2008. This article also appears in the Aspen Journal of ideas.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

Why Protective Gear Is Sometimes Not Enough in the Fight Against Ebola

Health workers receive assistance with putting on their protective gear before entering the high-risk zone at the Bong County Ebola Treatment Unit near Gbarnga in rural Bong County, Liberia, Oct. 5, 2014.
Health workers receive assistance with putting on their protective gear before entering the high-risk zone at the Bong County Ebola Treatment Unit near Gbarnga in rural Bong County, Liberia, Oct. 5, 2014. Daniel Berehulak—The New York Times/Redux

Human error can endanger even the most experienced health care workers in the fight against Ebola

When it comes to Ebola, the full-body Personal Protective Equipment [PPE] suit is probably the best way to prevent infection. But a PPE can also be one of the easiest ways to get Ebola. A PPE is usually made up of a full-body, impermeable suit with a hood, rubber boots covered by Tyvek booties, multiple pairs of surgical gloves, a surgical mask over the nose and mouth, a plastic bib, goggles, a plastic apron and a lot of duct tape. There is a reason why they are nicknamed moon suits: worn properly, they shouldn’t show an inch of skin. Putting them on right requires two people and about 10 minutes. Taking them off, in even the best of circumstances, is a clumsy, arduous process with multiple opportunities to make a lethal mistake.

It is not yet clear how, exactly, two health care workers at a Dallas hospital tending Thomas Eric Duncan, the first man to be diagnosed with Ebola in the United States, caught the disease, but health authorities are looking closely at the protective measures used at the hospital, and whether or not they were sufficient. Meanwhile, in Spain, where a nurse, Teresa Romero Ramos, is being treated for Ebola that she caught from a patient recently returned from Sierra Leone, officials are questioning whether or not she wore her PPE properly. On a Spanish television program quoted by the New York Times, Madrid’s regional health minister, Javier Rodríguez, questioned the need for extensive training on using the PPEs. “You don’t need a master’s degree to explain to someone how you should put on or take off” a protective suit, he said.

Maybe not, but no matter how experienced and qualified you are in putting on and taking off a PPE there is always room for error. I recently spent two weeks in Monrovia, Liberia, reporting on Ebola, and climbing into, and out of, PPEs on a regular basis, and I am still not sure I ever got it right. I was trained by the best, too: the Red Cross Dead Body Management teams, the guys responsible for picking up deceased Ebola victims and transporting them to the crematorium for safe disposal. An Ebola patient is at his most infective in the hours and days after death, when the virus swarms the skin and bodily fluids.

When the Dead Body Management team workers finish zipping a corpse into a double-sealed body bag they undergo an extensive decontamination process that best resembles a military drill in its precision and attention to detail. Each worker is paired with a sanitizer, a man wearing a backpack sprayer filled with a chlorine and water solution. The process is initiated with a good dousing of chlorine solution and a vigorous washing of the gloved hands. The worker removes his goggles, which are sprayed thoroughly and then discarded. His hands are sprayed again. Then the hood goes down, and the zipper is sprayed, as are the hands for another time. He unzips, and his hands are sprayed yet again. Then he has to shrug out of the suit without allowing any of the external surfaces to come into contact with his hands or the clothing underneath. And so it goes, layer after layer until the worker is left standing in boots, medical scrubs, and the last pair of gloves. Again he is liberally sprayed down with the chlorine solution, at which point he has to jigger off his gloves in a way that ensures that the surface does not come into contact with the skin.

Each organization, be it the Red Cross or Médecins Sans Frontières [MSF], has a similar ritual, even if small details vary. Still, mistakes are made. Even MSF, which has spearheaded the Ebola response in west Africa since day one, and probably knows more than any other organization about how to prevent infection, has seen two international health workers sickened with the disease. A United Nations medical worker infected in Liberia and transported to Germany for care died on Oct. 13. A doctor working for an Italian medical charity contracted Ebola last month, and is still receiving treatment in Germany.

The gear works, but the possibility of human error is still high, especially when working in a high-stress environment, when fatigue and fear stalk every move. PPEs can also provide a dangerously false sense of security. When they are not put on right, or if they are taken off incorrectly, they may as well not be there at all.

If you are lucky the droplet of sweat dropping into your eye as you remove your goggles without bending over first didn’t pass over some Ebola-contaminated material on your hood. I met one health care worker who thinks he caught Ebola when a young patient vomited on him, and the vomit passed through a chink in his Tyvek armor, where his suit didn’t entirely zip up over his mask. Both he and the patient survived. Which is why having the right kind of protection is only the beginning. There needs to be training, and it has to be drilled in daily. There needs to be a buddy system, in which one health care worker is always watching the other, to ensure that the protective gear is on correctly, and that it is taken off correctly. But there will always be mistakes. Ebola will get through. The important thing is to be ready when it does.

TIME Cancer

Can Low-T Therapy Promote Prostate Cancer?

lab rat
Getty Images

New rat research raises health questions for researcher

“Low T” therapy is a fast-growing trend for men who want to jack up testosterone—which declines naturally with age but which can also be clinically low in some people—and the testosterone therapy industry is predicted to reach $5 billion by 2017. The long-term safety effects of supplementing with the hormone is still in question, however—especially in light of a study earlier this year that found double the heart attack risk in certain men after starting testosterone treatments. Other research suggested there was no meaningful increase in heart risk, adding to the confusion. But a new rat study published in the journal Endocrinology raises some alarming questions about the increasingly popular drugs.

Maarten Bosland, PhD, study author and professor of pathology at the University of Illinois at Chicago’s College of Medicine, devised an animal model to test the tumor-promoting effects of testosterone in rats. He exposed a group of rats to a carcinogen, which would put them at risk of developing cancer. He also gave some of the rats testosterone, but no carcinogen. In a third group, he administered both the carcinogen and the testosterone. Then, he measured tumor growth among the two groups.

None of the rats developed prostate cancer when they were just exposed to the carcinogen, but 10-18% of them did when they were just given testosterone. When the rats were exposed to the carcinogen and then given testosterone—even at very low doses—50-71% developed prostate cancer. “I was totally amazed about how strong testosterone can work to promote the formation of prostate cancer in these animals,” he says.

Of course, an animal model can’t determine what will happen in men, but Bosland thinks a similar effect is possible. “Absent of having solid human studies, we won’t be able to say that—it’s just an extra warning signal,” he says. “But I think it’s a clear indication that there is risk.”

TIME Diet/Nutrition

Why Health Officials Are Concerned About Energy Drinks

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WendellandCarolyn—Getty Images

New report advocates for more regulation

The energy drink market is booming, but that’s not necessarily a good thing when it comes to public health, says the World Health Organization’s regional office for Europe.

In a new report in the journal Frontiers in Public Health, João Breda, who works in the division of noncommunicable diseases at WHO Europe, and his colleagues reviewed data on the health risks of energy drinks and the current policies that regulate them. They concluded that health concerns from the scientific and medical community are valid, and that consuming high levels of caffeine very quickly can cause negative health effects or “caffeine intoxication.” Those effects can include nausea, high blood pressure and heart palpitations. Some deaths have even been linked to energy drink consumption, like that of a 16-year-old girl who went into cardiac arrest after drinking the beverages, but none have been definitively proven.

MORE: What’s In Your Energy Drink?

WHO is especially concerned about what happens when people mix energy drinks and alcohol. “The consumption of high amounts of caffeine contained within energy drinks reduces drowsiness without diminishing the effects of alcohol resulting in a state of ‘wide-awake- drunkenness,’ keeping the individual awake longer with the opportunity to continue drinking,” the authors write in the journal. (A small study in July suggests the same thing: people who drank spirits mixed with energy drinks had a greater desire to keep drinking than those sipping regular mixed drinks.)

Sleep-starved college students aren’t the only ones guzzling energy drinks. The WHO report cites estimates that energy drinks make up 43% of caffeine exposure in children.

In Europe, some countries are taking energy drink regulation very seriously: Sweden has banned the sale of energy drinks to kids. In the U.S., energy drink regulation is incredibly weak, and depending on how an energy drink makes it to market, it may not even have to disclose how much caffeine it contains. The WHO report recommends that policymakers adopt more measures to get a tighter grip on the industry, including establishing an upper limit for caffeine content, enforcing labeling and marketing standards, regulating the sale of energy drinks to kids, training healthcare workers about the risks and even screening patients with a history of diet issues and substance abuse for dangerous energy drink consumption. They also call for more research on how energy drinks affect us. “From a review of the literature, it would appear that concerns in the scientific community and among the public regarding the potential adverse health effects of the increased consumption of energy drinks are broadly valid,” they write—a finding that warrants further research, policy and caution.

TIME ebola

CDC to Send Dallas Healthcare Worker Infected with Ebola to Special Hospital

CDC Atlanta Ebola
Exterior of the Center for Disease Control (CDC) headquarters in Atlanta on Oct. 13, 2014. Jessica McGowan—Getty Images

Officials are weighing the possibility in the wake of failures in Dallas, but there is only room for 19 patients

Thomas Eric Duncan, the first Ebola case diagnosed in the U.S., was a warning to hospitals that a patient infected with the deadly virus could walk into their emergency room at any time. Hospitals from New York City to Seattle are now running Ebola drills, testing their staffs to ensure they are prepared to diagnose the disease without putting healthcare workers at risk of contracting it.

“Every hospital in the country needs to be ready to diagnose Ebola,” Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention (CDC), said at a news conference on Tuesday.

The question is whether every hospital is equipped to care for a patient who tests positive for the disease, which has killed nearly 4,500 people in West Africa. During this outbreak, the most deadly since the disease was first discovered in 1976, the mortality rate is about 70%, according to statistics compiled by the World Health Organization. Health care workers are at particular risk for infection, which is transmitted through contact with a symptomatic patient’s bodily fluids, like blood or vomit.

Those risks have been born out in Texas Health Presbyterian Hospital in Dallas, where Duncan was admitted on Sept. 28 and died on Oct. 8. Early Wednesday, the hospital said a second healthcare worker who administered care to Duncan had tested positive for the disease. The hospital’s stumbles have prompted critics to question whether the additional infections were avoidable—and whether future patients should be cared for at specialized hospitals with the expertise and facilities to treat Ebola cases.

Frieden said Tuesday that the second healthcare worker would be transported to Emory University Hospital in Atlanta, which has a specialized isolation unit for treating diseases like Ebola and has successfully cared for patients with the virus in the past.

Some doctors say moving future Ebola patients to specialized hospitals makes sense. “Given some of the complexities, patients who have this disease are probably best cared for by those who have experience caring for it, and whose healthcare workers are highly trained and drilled in self-protection,” says Dr. Gabe Kelen, the director of the Johns Hopkins Office of Critical Event Preparedness and Response. “It’s not appropriate to think that each and every hospital in the country could bring the resources, the intense training for the healthcare workers that is required.”

There are four hospitals in the U.S. with special isolation units designed to contain biohazards like Ebola. In addition to Emory, they are the National Institutes of Health Clinical Center, in Bethesda, Md., a hospital at the University of Nebraska in Omaha and St. Patrick Hospital in Missoula, Mt. The facilities in Atlanta and Omaha have successfully treated Americans infected with Ebola overseas without any healthcare workers contracting the virus.

Though transporting future cases to these facilities may be prudent, they have limited beds: only 19 between them, according to CNN. Exclusively using specialized hospitals to treat Ebola is only an option so long as the number of cases in the U.S. remains extremely low.

A CDC spokesman said the agency may announce further measures for Ebola on Wednesday.

-Additional reporting by Zeke J. Miller

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