Dismantling Barriers to Health, One Word at a Time

Emergency Room

Emergency Room (Photo credit: Mark Coggins)

I recently read an article about Deisy Garcia, a woman who filed a police report saying her husband had assaulted her and that she feared for her life. That report, filled out in Spanish, sat untranslated – and without follow up – for months until she and her two children were murdered.

No human being should be denied protection from bodily harm due to language barriers and cultural incompetence. Deisy Garcia’s death could have been prevented had she been given the protection she sought.  Her health, well-being, and ultimately her life was taken from her, and this could have been prevented. Prevention is power.

Deisy’s situation reminds me of how many non-English-speaking people who seek emergency treatment at hospitals are often left in precarious, harmful, or life-threatening situations. Consider the following cases:

  • A 7-year-old girl with an ear infection whose mother was told by a poorly trained interpreter to put the oral antibiotic in her daughter’s ears.
  • A 2-year-old who fell off her tricycle was taken from her mother by social workers because a doctor misinterpreted the Spanish words “Se pego” to mean “I hit her” rather than “She hit herself.”
  • An 18-year-old who said he was “intoxicate”, which can mean nauseated, spent 36 hours being treated for a drug overdose before doctors realized he had a brain aneurysm.

As I reflect on the events that led to the death of Deisy and the cases mentioned above, I am reminded that language barriers can be deadly and life-changing. Ensuring that language barriers do not exist between a police officer and a domestic violence survivor is equally as important as ensuring that these barriers do not exist between a patient and a provider.

There is a need for more culturally competent practices on the part of police departments, medical facilities, and other facilities that serve the public. Minorities are entitled to the same protections as the majority population, including access to preventive measures attributed to health and wellness.

Under Title VI of the Civil Rights Act of 1964, the denial or delay of medical care because of language barriers is discrimination. Any medical facility that receives Medicaid or Medicare must provide language assistance to patients with limited English proficiency.

This past year, the federal government released an enhanced version of the National Standards for Culturally and Linguistically Competent Services (CLAS Standards). This blueprint for cultural/linguistic competence has been expanded beyond traditional hospitals and health care centers to include human service providers. This is a great start; however, more work remains to be done.

How can we as a society work together to ensure that patients with limited English proficiency are not discriminated against when seeking medical care?

Please comment below.


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Rx: 1 Inhaler + Heat…Supporting Preventative Health


Pharmacy Rx symbol

Pharmacy Rx symbol (Photo credit: Wikipedia)

“I’m sorry,” is all the doctor could say at that point. The patient would have to have surgery–an amputation…all because he didn’t have access to medical care before diabetes took over.

According to the Center for Disease Control, African Americans, Hispanic/Latino Americans, American Indians, Asian Americans, and Pacific Islander Americans are at higher risk for type 2 diabetes than the rest of U.S. population. These racial and ethnic minority groups are more likely to develop type 2 diabetes due to poverty, lack of access to health care, and cultural factors that result in barriers to preventive and diabetes management care.

Hundreds of thousands of minorities are stricken not only with diabetes, but with asthma, chronic fatigue syndrome, fibromyalgia –ailments that could at times have been easily prevented with access to something as simple as a healthy living environment or access to more nutritious food.

Rebecca Onie speaks about these health care gaps in her TedTalk, titled ‘What if our healthcare system kept us healthy?’ She proposes altering health care’s focus from searching for “cures,” to advancing preventive solutions-solutions that could save lives of people in need.

Rebecca’s story starts when she becomes an Intern at the housing unit of Greater Boston Housing Hospital. After working here for many months, she realized that by the time many minority families in Boston made it to the hospital, four bus rides later, “they were already in crisis.”

Rebecca began asking doctors in Boston Medical Center this simple question: “If you had unlimited resources what’s the one thing you would give your patients?” The answers, she said, were always similar. Doctors explained that every day they were prescribing medications, antibiotics for ear infections, but the real problem was that the patient was living with 12 others in a small apartment at home…with no food. The doctor didn’t have any help or “even know where the nearest food clinic is.”

As a sophomore at Harvard College, Rebecca used this information to start a system of her own called Health Leads. In the clinics where Health Leads operates, “instead of asking patients what they need to get healthy, they ask the patient what was needed to be healthy.” For instance, the patient with asthma might be given an inhaler script, as well as a “script” for a volunteer to give the patient’s utility provider a call. The volunteer can then work with the utilities company to formulate a payment plan for the patient.  Fewer inhalers are needed in the future, leading to a true path to health.

Once we start concentrating on preventive health, we will not have to worry as much about problems like antibiotic resistance, medications like insulin for diabetics, or spend so much of our money on disability funds or Band-Aid solutions for those with chronic illness.

Rebecca ends her talk stating, “I believe that at the end of the day when we measure our health care it will not be by the diseases cured, but by the diseases prevented, it will not be by the excellence of our technologies or the sophistication of our specialists, but by how rarely we needed them, and most of all I believe that when we measure our health care it will not by what the system was, but by what chose it to be.”

As we consider the theme for Minority Health Month, “Prevention is Power: Taking Action for Health Equity,” it makes sense to consider innovative new approaches for preventive care. What do you think about Rebecca’s approach with Health Leads? Could a system like this be more widely used? What other ideas do you have that might help to bridge the gap of “cures” to preventive care?

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Commemorating National Minority Health Month


April is National Minority Health Month, an opportunity to raise awareness about health disparities affecting racial and ethnic minority groups in the U.S. The WellPower blog team is committed to raising these issues to public consciousness, and writing about the ways that social determinants like education, housing, and jobs affect health.

Throughout April, we will be blogging about issues that are aligned with this year’s Minority Health Month theme; Prevention is Power: Taking Action for Health Equity. This brings to mind the old saying that ‘an ounce of prevention is worth a pound of cure.’ Although there are many benefits to preventing negative health outcomes, preventive care is vastly underutilized in the U.S. – particularly among racial and ethnic minorities.

Some of the reasons why population groups are not receiving preventive care:

  • Lack of access to health care services due to transportation issues, the inability to take time off of work, or the money to pay for non-essential visits.
  • Language barriers between the patient and the provider and/or the need for more culturally competent practices on the part of the medical facility.
  • Lack of health insurance. Although the Affordable Care Act has expanded health insurance to millions of Americans, many states have not expanded Medicaid, making it impossible for low-income individuals and families to purchase insurance.

Stay tuned to WellPower throughout the month of April to learn more about this issue. Additional resources can be found on the Office of Minority Health website at: http://minorityhealth.hhs.gov/nmhm14/.

We’d love to hear from you! You are invited to comment on our posts on the WellPower website and via Twitter at @WellPowerBlog #NMHM14.

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After Soldiers Protect Us, Who Protects Them?

This piece by Stephanie Moore is re-posted from the Eyes Wide Open Blog: http://eyeswideopen.org/soldiers-protect-us-protects/


I recently read a disturbing article in the Baltimore Sun that quoted a Veterans Administration report that there is an average of 22 suicides a day by veterans. 22 a day. Where are we as a nation if we cannot help and support those who risk their lives to protect us?

The website, Veterans and PTSD shares these  statistics from a major study done by the RAND Corporation (full pdf of study), the Congressional Research Service, the Veterans Administration, and the US Surgeon General.[i]

  • at least 20% of the over 2.3 million American veterans of Iraq and Afghanistan  have PTSD (Post Traumatic Stress Disorder) and/or Depression.
  • 50% of those with PTSD do not seek treatment
  • out of the half that seek treatment, only half of them get “minimally adequate” treatment (RAND study)
  • 19% of veterans may have traumatic brain injury (TBI)
  • 7% of veterans have both post-traumatic stress disorder and traumatic brain injury
  • rates of post-traumatic stress are greater for these wars than prior conflicts
  • more active duty personnel die by their own hand than combat in 2012 (New York Times)

Where suicide is often seen as a sensitive and private family matter, it can come to the forefront like in yesterday’s shooting in Fort Hood.   As the nation turned on the news, it felt like déjà vu. As we learn more of the attack, I expect we will be learning of many distinctions that separate it from its earlier horrific assault. Where the first attack was claimed as an act of terrorism, this incident will be raising the issue of Post Traumatic Stress Disorder (PTSD) and traumatic brain injuries (TBI).  The shooter served 4 months in Iraq (non-combat) in 2011 and was undergoing diagnostic procedures for post-traumatic stress disorder, suffered from depression and had self reported a traumatic brain injury. He killed 3 people and wounded 16 before taking his own life.  Perhaps we won’t ever know if his military service impacted his decision to harm others and eventually himself, but it should at least ask the question, if it did, how can we help the next veteran?

If you are a veteran or know of a veteran who needs help, please contact the Veteran Crisis Line at 1-800-273-8255


[i] http://www.veteransandptsd.com/PTSD-statistics.html


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The Shriver Peaceworker Fellows Program Gives Back to Baltimore

“Peace Corps Volunteers, stay as you are—be servants of peace; work at home as you have worked abroad—humbly, persistently, intelligently. Serve your neighborhoods. Serve your cities. Serve the poor. Join others who serve. Serve…Serve…Serve…that’s the end. That is the challenge. For in the end it will be the servants who save us all.”    

- Sargent Shriver, Peace Corps First Director

Kennedy and Johnson greeting Peace Corps volun...

Kennedy and Johnson greeting Peace Corps volunteers, 1962 (Photo credit: Wikipedia)


The WellPower Blog is committed to creating a healthier nation by lifting up community involvement, including drawing attention to local organizations striving to end health disparities in Baltimore.  As such, we are highlighting the Shriver Peaceworker Fellows Program as described by Assistant Director, Meghann Shutt:

Serving in the Peace Corps is a life changing experience for most people.  Returned Peace Corps Volunteers (RPCVs) often speak of a life-long orientation to service as a result of that experience.  In fact, when the Peace Corps was originally introduced by John F. Kennedy and Sargent Shriver (the agency’s first director and for whom our program is named), they spoke widely of the need for a critical mass of internationally trained men and women who would return from the Peace Corps to build a better America.

Personally speaking, as a Peace Corps volunteer, I found myself very engaged in my work in a rural village in Southern Kyrgyzstan, but I was often thinking about changes needed in Baltimore City, my own hometown.  I initially went abroad thinking I wanted to do international development work for a career and discovered that the politics of working internationally changed my mind.  

If I was going to work that hard at community development, I wanted the fruits of those efforts to go to Baltimore.  This city reminds me of a developing country in so many ways, and the skills I built as a Peace Corps volunteer have been unbelievably helpful working on various community efforts here in Baltimore City.  For some of our Peaceworker Fellows, they had similar experiences.  Others came to the realization that in order to be more effective agents of change, they needed specialized graduate degrees.  Still others came back looking for opportunities to work and serve at the same time.  All of these things bring applicants to the Shriver Peaceworker program, and most fellows are not native to Baltimore.

The Shriver Peaceworker Fellows Program is a graduate level service-learning program housed at UMBC for returned Peace Corps volunteers (RPCVs).  The program is highly competitive and seeks to recruit dynamic change leaders to work, study and live in Baltimore. The fellowship combines:

What are current fellows doing now?

Now more than ever, we see the need for professionals who understand the rich and nuanced world of local international and immigrant communities, cultural differences and how to build on that diversity rather than see it as a threat.  The Peaceworker Program builds a community of returned Peace Corps volunteers who are interested in transforming this Peace Corps experience into social change leaderships either here or abroad.

Whatever their reasons for coming, one of the secondary aims of the Shriver Peaceworker Fellow’s Program is to attract these leaders to Baltimore and keep them here.  And it’s working!  Some Peaceworker alumni continue their commitment to international development in agencies and organizations like USAID, Peace Corps and Catholic Relief Services.

Still, many more Peaceworker alumni are currently serving and leading in local government agencies like the Maryland Department of Natural Resources, Baltimore City Council President’s Office, Mayor’s Office of Economic Development and Baltimore City Public Schools, as well as nonprofits, philanthropic organizations and companies focused on social change including the Annie E. Casey Foundation, Friends of Patterson Park and Campaign Consultation.

RPCVs, including Campaign Consultation’s own Michelle Bond, Julia Krieger and Megan Wall, are continuing to make changes in Baltimore long after their Peace Corps experiences ended. This is a sign that our approach of investing in people and creating meaningful community around social change is working.

WellPower Blog is pleased to showcase the Shriver Peaceworker Fellows Program, which exemplifies lifting up community involvement and collective action to create a healthier city – and nation.

Click here to find out more.


 “The benefits of the Peace Corps will not be limited to the countries in which it serves. Our own young men and women will be enriched by the experience of living and working in foreign lands. They will have acquired new skills and experience which will aid them in their future careers and add to our own country’s supply of trained personnel and teachers. They will return better able to assume the responsibilities of American citizenship and with greater understanding of our global responsibilities.”

- John F. Kennedy, Message to Congress March 1, 1961


logo (Photo credit: Wikipedia)



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Denying Vaccines: Personal Choice or Public Health Threat?

Last year, 187 Americans contracted the measles, and in 2014 there have already been over 70 cases confirmed across the country. This is a disease which can be easily prevented through immunizations; which was thought to be eradicated in the U.S. in 2000.

As a mother-to-be, I was nervous to learn that children are not able to receive the measles, mumps and rubella (MMR) vaccine until age one – thus making babies and toddlers particularly susceptible to the disease during an outbreak. Of the twenty current measles cases in New York, about half have been identified in children – seven of whom were too young to be vaccinated, and two of whom were not vaccinated following the wishes of their parents.


Keep babies measles-free! (Photo credit: bess grant)

The resurgence of measles has caused public backlash towards “anti-vaxxers,” adults who have decided not to vaccinate their children due to personal beliefs and/or the unproven theory lauded by celebrity Jenny McCarthy that immunizations can lead to autism. A pediatrician writing under the pseudonym Russell Saunders authored a much-reposted and re-tweeted article decrying, “Vaccine-deniers are responsible to the resurgence of once-eliminated illnesses. Their movement is responsible for sickening people. They are to blame for the word ‘outbreak’ appearing in headlines from coast to coast.”

There is something to be said for a person’s right to choose whether or not to receive medical treatment. In my recent blog post, “The New Life Support Debate,” I argued that patients should be able to decide whether to accept or reject medical attention. It seems somewhat hypocritical to believe that patients have the right to deny care in some circumstances but not others.

However, in the case of the anti-vaxxers, their decision does not just affect themselves but can lead to a measles outbreak among children and babies who are too young to receive the proper immunization. And, the possible results of contracting measles are blindness, loss of hearing, pneumonia or death.

Thus begging the question – if one person’s decision to not immunize themselves or their child results in a public health catastrophe, is it still considered a “personal choice?” And, if not, where do we draw the line in requiring people to embrace preventive measures that will keep the greater public safe and healthy?

Please comment below and let us know your thoughts.

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The Health and Life Outcomes of De Facto Segregation

A photo of the Baltimore National Aquarium tak...

A photo of the Baltimore National Aquarium taken July 3, 2010 (Photo credit: Wikipedia)

My maternal family’s roots have been planted in Baltimore for many generations.  I grew up believing that Baltimore is at the center of the universe and my love for this city reflects my reverence for my hometown’s unique attributes.

Despite the crack epidemic hitting the city pretty hard, making drug pushers and addicts a mainstay of my commute to school, the abandoned row houses leaving a blight on the landscape, and gentrification which led to the demolition of public housing units, I still love Baltimore.  So, why don’t you live here one may wonder.

The short answer:  My daughter.  I moved to a county that is home to one of the best public school systems in this nation.  I wanted to give her opportunities that I didn’t have – diverse experiences, abundant resources, and nonexistent barriers to learning.

The elementary, middle, and high schools that I attended in Baltimore were predominantly Black and poor.  My parents did not have a say in the schools I attended due to all students being required to attend schools within specific district zones.  To me, it felt like reverse bussing, in the sense that we weren’t being sent to schools to integrate them, but rather were being forced to attend racially homogeneous schools that were overcrowded and underfunded.  When I look back and reflect on what I know now, I realize that de facto segregation in schools was occurring in my community – and plenty of others – in the 1990s.

I suppose that’s why I busted my butt in school.  Besides being a perfectionist when it came to my academics, I also aced my way through school, in hopes that my 4.0 GPA would gain me access to the college of my choice – away from my beloved Baltimore.

The neighborhood of my youth also lacked in diversity. I was surrounded by walking statistics, consisting of high school dropouts, teenage parents, and struggling families.  I guess we overcompensated for what we lacked with our overindulgence in dreams and overambitious plans for something better, someplace different.

We did not have access to gardens with fresh fruits and vegetables.  If you were brave enough to trek the drug needle riddled path and made it to the one grocery store in the neighborhood, you’d find that there was a meager selection of healthy food options.  Yet, there were plenty of fast food chains that made it easy for kids to scrape together change to pay for a meal saturated in fat and oil.  We had access to an abundance of liquor stores but not one recreational center.

I did not know then what I know now – that where I lived affected my educational and life opportunities, and had a tremendous impact on my health and well-being.  In other words, housing-related racial and educational inequalities are social determinants of health.   And there’s a map for that.

The U.S. Department of Housing and Urban Development (HUD) is using a new interactive data map of race, class, and opportunity that it hopes will help integrate housing nationwide.  Read this article to learn more about ‘opportunity metrics.’

How did where you grew up affect your education, life, and health?  Please comment below.

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A Custody Battle that Nearly Took Justina’s Life


Hospital (Photo credit: morrissey)

Earlier this year, in her New Life Support Debate blog post, Julia shared the plight of a pregnant woman who was forced to stay on life support in order to keep her baby alive, a decision that would cost the family additional pain, and rendered her baby so unhealthy that he eventually died. The story that I will comment on does by no means depict the same circumstances, but it mirrors similar concerns of those outlined in post: The New Life Support Debate.

This month, 15-year-old Justina will be returning to the care of Tufts Medical Center after being held in a psychiatric ward for more than a year against her parent’s will. Before being admitted, Justina was under the care of Dr. Mark Korson, Chief of Metabolism at Tufts University, and being treated for mitochondrial disease.

But when Justina’s parents brought her to Boston Children’s Hospital after a complicated case of the flu, a doctor assessed Justina’s symptoms and brought in a psychologist, concluding that her medical problems, including her difficulty of eating and walking, were brought on by a psychiatric disease known as somatoform disorder, in which people are believed to be imagining their illnesses.

Boston Hospital attempted to have Justina’s parents declare that they would no longer continue their daughter’s medical treatment, and that it was medical abuse. Her parents, disagreed with the hospital’s diagnosis of their daughter having an imagined illness, so they refused to sign off on the hospital’s declaration.

When the parents disagreed with the physician at Boston Children’s Hospital, the hospital called the Department of Children and Families (DCF). Four days later the DCF and a judge took custody of the child, placing her in a mental institute. Her father was issued a gag order and was prohibited from speaking about the custody battle of his child. West Hartford psychologist Dean Hokanson, a psychologist that worked with Justina for five years, said, “They (the parents) were actually being accused of being too active in pursuing health care matters for their child.”

Meanwhile in the psychiatric ward, Justina’s medical treatment, including her pain medications were discontinued and replaced with psychiatric drugs. Her health rapidly deteriorated. A year later Justina’s father nervously broke his gag order, and began speaking out about his daughter in attempts to have his daughter get medical treatment she so clearly needed.

DCF has dropped the complaint against Justina’s father for having broken the gag order by publically speaking about concerns for his daughter. Justina’s parents Lou and Linda say “Justina is barely recognizable as her health has deteriorated so badly.” As a result of her father speaking out about his daughter’s plight, Justina has now been put back into the hands of doctors at Tufts where they will resume treating her for her mitochondrial disease.

Thankfully, Justina is receiving treatment again, but it must have been extremely painful for her parents to see their daughter go through so much pain, all the while battling legal custody of their daughter…a fight that still lives on.

What are your thoughts about the situation that Justina and her family encountered? Please comment below and let us know.

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Increasing the Federal Minimum Wage: A Meaningful Investment

Raise the Minimum Wage

Raise the Minimum Wage (Photo credit: CT Senate Democrats)

There’s a lot of talk about increasing the federal minimum wage from $7.25 to $10.10 by 2016 – including its impact:

  • Approximately 16.5 million low-wage workers would directly benefit from the proposed increase
  • Roughly 900,000 people living below the poverty line would move above the poverty threshold
  • Both low-and-middle-income families’ incomes are projected to rise, 2.8% for the poorest families to .4% for middle-income families
  • Employment would be reduced by about 500,000, or .3% of total employment
  • Wealthy families with an average income of $180,000 can expect a .4%, or $700, reduction

In addition, Kaye Gooch aptly describes the current “Inequality Boom” as it relates to this endeavor in her Eyes Wide Open blog post.

While the pros and cons of increasing the federal minimum wage continue to be weighed, I know there is a “blame the victim mentality,” as explored by Julia Krieger in her Poverty Brain Drain blog post.  Those who do not truly understand poverty wonder, “Why can’t they just pull themselves up ‘by their bootstraps’ to create a better life for themselves and their families?” or some version of that question/statement.

Hearing this, I am reminded of How Poverty Taxes the Brain, a scientific study proving that those living in poverty don’t have the mental bandwidth to exalt themselves financially.  Specifically, this study asserts that “… poverty imposes such a massive cognitive load on the poor that they have little bandwidth left over to do many of the things that might lift them out of poverty – like go to night school or search for a new job.”  The reality of poverty actually makes it harder to execute fundamental life skills.

Knowing how I feel when overwhelmed with tasks and responsibilities – I can understand where it’s impossible for people living in poverty to thrive; they are simply doing everything they can to survive.

With this in mind – wouldn’t the benefits of increasing the federal minimum wage extend beyond …  increasing low-and-moderate income families’ incomes and advancing 900,000 people above the poverty lineand begin to make a meaningful difference in peoples’ lives?  Investing in people so that they can spend their hard-earned energy being better mothers and fathers, and spouses and partners, and friends and community members?  So they can thrive within Well-communities rather than simply surviving?

What do you think?

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The War on Tobacco

The No Smoking sign, designed by one of the me...

The No Smoking sign, designed by one of the members of AIGA (Photo credit: Wikipedia)

If you’ve been following the WellPower blog this month, you know that we’ve been focusing on tobacco use as a health issue, and debating the implications of raising the smoking age to 21. Aside from the controversy surrounding the legal age of smoking, I think one thing that we can all agree on is how effective anti-tobacco education and awareness programs have become over the past two decades.

The ‘Truth’ anti-tobacco campaign has had a big impact: evaluations show that 90% of youth aged 12-17 felt that these advertisements were convincing, and they resonate so deeply that 75% could accurately describe one or more ‘Truth’ ads when asked. From 2000 to 2002, cigarette smoking among high school students fell by more than one million, due in part to this campaign.

…Compare these outcomes with those of the unsuccessful ‘War on Drugs’ campaign in the 1980’s.

Since the early 2000’s, momentum has grown. According to the American Nonsmokers’ Rights Foundation, over 80% of Americans live in states, commonwealths or localities with smoking bans in workplaces, restaurants and/or bars as of January 2, 2014.

Some communities have taken these smoking bans one step further to encompass outdoor spaces. Last week, Baltimore County announced that smoking will be banned in the county’s parks. This bill, supported by the American Cancer Society Cancer Action Network, focused on alleviating tobacco use in areas where children gather.

Another big piece of news that came out this month was the decision by the CVS pharmacy chain to stop selling cigarettes and other tobacco products by October 1st of 2014. This is significant, as it reflects CVS’s values

as a company. President Obama has applauded CVS’s landmark resolution, stating, “As one of the largest retailers and pharmacies in America, CVS Caremark sets a powerful example.”

CVS estimates that it will take an annual loss of $2 billion from tobacco shoppers once tobacco is removed from stores. However, I would bet that this decision could convince many shoppers who are opposed to the tobacco industry to patronize CVS over other pharmacies.

It remains to be seen whether this business decision will pay off financially as well as ethically. If CVS can make a business case for removing tobacco products, other companies may follow suit… prompting yet another big win for the war on tobacco.

Is there another smoking-related topic that you would like for us to explore in the future? Let us know by commenting below.

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