#Epidemiological #status of the #MERS #coronavirus in 2019: an #update from January 1 to March 31, 2019 (Int J Gen Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Int J Gen Med. 2019 Aug 26;12:305-311. doi: 10.2147/IJGM.S215396. eCollection 2019.

Epidemiological status of the Middle East respiratory syndrome coronavirus in 2019: an update from January 1 to March 31, 2019.

Ahmadzadeh J1, Mobaraki K1.

Author information: 1 Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran.

 

Abstract

PURPOSE:

This study represents the current epidemiological status of Middle East respiratory syndrome coronavirus (MERS-CoV) worldwide in the first three months of 2019.

PATIENTS AND METHODS:

Full details of the MERS-CoV cases available and published in the disease outbreak news on the WHO website were retrieved. Related details of laboratory-confirmed MERS-CoV were extracted and analyzed by standard statistical methods.

RESULTS:

A total of 107 cases of MERS-CoV, including 18 deaths (overall case fatality rate (CFR), 16.8%; male-specific CFR was 17.5% [14/80] and female-specific CFR was 14.8% [4/27]) were reported to WHO from the National International Health Regulation Focal Points of Saudi Arabia and Oman. The overall mean age was 50±17 years and 80 patients (74.8%) were male. The average time from the onset of the symptoms to the first hospitalization was 3±3.3 days; from the first hospitalization to laboratory confirmation was 3.6±6.5 days; from the onset of symptom to death was 17.5±11.7 days; and the mean length of hospitalization for patients with MERS-CoV was 3.5±3.9 days. Males in comparison to females had a 1.5-fold increased chance (adjusted OR =1.5 [95% CI: 1.3-1.8]) of death related to MERS-CoV infection; 1.05 [95% CI: 1.1-3.3], 1.05 [95% CI: 1.2-2.8] and 1.06 [95% CI: 1.2-2.0] for those who had exposure to camels, camel milk consumption, and close contact with MERS-CoV cases, respectively. Health care workers had 2.4 fold [95% CI: 1.2-3.1] greater odds of death compared to other people.

CONCLUSION:

The knowledge obtained from this study can contribute to the development of a prevention program and early system warning against MERS-CoV infection.

© 2019 Ahmadzadeh and Mobaraki.

KEYWORDS: Middle East respiratory syndrome coronavirus; disease outbreaks; emerging infectious disease

PMID: 31692574 PMCID: PMC6716594 DOI: 10.2147/IJGM.S215396

Keywords: MERS-CoV; Worldwide.

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#Projection of #costs of #polio #eradication compared to permanent control (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Projection of costs of polio eradication compared to permanent control

Marita Zimmermann, MPH, PhD, Brittany Hagedorn, MBA, Hil Lyons, MS, PhD

The Journal of Infectious Diseases, jiz488, https://doi.org/10.1093/infdis/jiz488

Published: 30 September 2019

 

Abstract

Despite increased efforts and spending toward polio eradication, it has yet to be eliminated worldwide. We aimed to project economic costs of polio eradication compared to permanent control. We used historical Financial Resource Requirements from the Global Polio Eradication Initiative, as well as vaccination and population data from publicly available sources to project costs for routine immunization, immunization campaigns, surveillance and lab, technical assistance, social mobilization, treatment, and overhead. We found that cumulative spending for a control strategy would exceed that for an eradication strategy in 2032 (range 2027-2051). Eradication of polio would likely be cost-saving compared to permanent control.

Polio, Eradication, Costs, Permanent Control, Budget

Issue Section: Brief Report

This content is only available as a PDF.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords: Poliomyelitis; Worldwide; Global Health.

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The #threat of #carbapenem-resistant #bacteria in the #environment: #Evidence of widespread #contamination of #reservoirs at a #global scale (Environ Pollut., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Environ Pollut. 2019 Sep 9;255(Pt 1):113143. doi: 10.1016/j.envpol.2019.113143. [Epub ahead of print]

The threat of carbapenem-resistant bacteria in the environment: Evidence of widespread contamination of reservoirs at a global scale.

Mills MC1, Lee J2.

Author information: 1 College of Public Health, Division of Environmental Health Sciences, The Ohio State University, Columbus, OH, United States; Environmental Sciences Graduate Program, The Ohio State University, Columbus, OH, United States. 2 College of Public Health, Division of Environmental Health Sciences, The Ohio State University, Columbus, OH, United States; Environmental Sciences Graduate Program, The Ohio State University, Columbus, OH, United States; Department of Food Science & Technology, The Ohio State University, Columbus, OH, United States. Electronic address: lee.3598@osu.edu.

 

Abstract

Environmental reservoirs of antibiotic resistance (AR) are a growing concern that are gathering more attention as potential sources for human infection. Carbapenem-resistant Enterobacteriaceae (CRE) are extremely dangerous, as carbapenems are often drugs of last resort that are used to treat multi-drug resistant infections. Among the genes capable of conferring carbapenem resistance to bacteria, the most transferrable are those that produce carbapenemase, an enzyme that hydrolyzes carbapenems and other β-lactam antibiotics. The goal of this review was to comprehensively identify global environmental reservoirs of carbapenemase-producing genes, as well as identify potential routes of transmission to humans. The genes of interest were Klebsiella pneumoniae carbapenemase (KPC), New Delhi Metallo-β-lactamase (NDM), Oxacillinase-48-type carbapenemases (OXA-48), and Verona Integron-Mediated Metallo-β-lactamase (VIM). Carbapenemase genes have been reported in the environment on almost every continent. Hospital and municipal wastewater, drinking water, natural waterways, sediments, recreational waters, companion animals, wildlife, agricultural environments, food animals, and retail food products were identified as current reservoirs of carbapenemase-producing bacteria and genes. Humans have been recorded as carrying CRE, without recent admittance to a hospital or long-term care facility in France, Egypt, and China. CRE infections from the environment have been reported in patients in Montpellier, France and Cairo, Egypt. This review demonstrates the need for 1) comprehensive monitoring of AR not only in waterways, but also other types of environmental matrices, such as aerosol, dusts, periphyton, and surfaces in indoor environments; and 2) action to reduce the prevalence and mitigate the effects of these potentially deadly resistance genes. In order to develop an accurate quantitative model for environmental dimensions of AR, longitudinal sampling and quantification of AR genes and bacteria are needed, using a One Health approach.

Copyright © 2019 Elsevier Ltd. All rights reserved.

KEYWORDS: CRE; Carbapenemase; Environmental dimension; One health; Waterways

PMID: 31541827 DOI: 10.1016/j.envpol.2019.113143

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Environmental pollution; Worldwide.

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#Global #trends in #antimicrobial #resistance in #animals in low- and middle-income countries (Science, abstract)

[Source: Science, full page: (LINK). Abstract, edited.]

Global trends in antimicrobial resistance in animals in low- and middle-income countries

Thomas P. Van Boeckel1,2,6,*,†,  João Pires1,6,†, Reshma Silvester2, Cheng Zhao1, Julia Song3,4, Nicola G. Criscuolo1, Marius Gilbert5, Sebastian Bonhoeffer6,‡, Ramanan Laxminarayan1,2,4,‡

1 Institute for Environmental Decisions, ETH Zurich, Zurich, Switzerland. 2 Center for  Disease Dynamics, Economics and Policy, New Delhi, India. 3 Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA. 4 Princeton Environmental Institute, Princeton University, Princeton, NJ, USA. 5 Université Libre de Bruxelles (ULB), Brussels, Belgium. 6 Institute for Integrative Biology, ETH Zurich, Zurich, Switzerland.

*Corresponding author. Email: thomas.vanboeckel@env.ethz.ch

† These authors contributed equally to this work.

‡ These authors contributed equally to this work.

Science  20 Sep 2019: Vol. 365, Issue 6459, eaaw1944 / DOI: 10.1126/science.aaw1944

 

Livestock antibiotic resistance

Most antibiotic use is for livestock, and it is growing with the increase in global demand for meat. It is unclear what the increase in demand for antibiotics means for the occurrence of drug resistance in animals and risk to humans. Van Boeckel et al. describe the global burden of antimicrobial resistance in animals on the basis of systematic reviews over the past 20 years (see the Perspective by Moore). There is a clear increase in the number of resistant bacterial strains occurring in chickens and pigs. The current study provides a much-needed baseline model for low- and middle-income countries and provides a “one health” perspective to which future data can be added.

Science, this issue p. eaaw1944; see also p. 1251

 

Structured Abstract

INTRODUCTION

The global scale-up in demand for animal protein is the most notable dietary trend of our time. Since 2000, meat production has plateaued in high-income countries but has grown by 68%, 64%, and 40% in Asia, Africa, and South America, respectively. The transition to high-protein diets in low- and middle-income countries (LMICs) has been facilitated by the global expansion of intensive animal production systems in which antimicrobials are used routinely to maintain health and productivity. Globally, 73% of all antimicrobials sold on Earth are used in animals raised for food. A growing body of evidence has linked this practice with the rise of antimicrobial-resistant infections, not just in animals but also in humans. Beyond potentially serious consequences for public health, the reliance on antimicrobials to meet demand for animal protein is a likely threat to the sustainability of the livestock industry, and thus to the livelihood of farmers around the world.

RATIONALE

In LMICs, trends in antimicrobial resistance (AMR) in animals are poorly documented. In the absence of systematic surveillance systems, point prevalence surveys represent a largely untapped source of information to map trends in AMR in animals. We use geospatial models to produce global maps of AMR in LMICs and give policy-makers—or a future international panel—a baseline for monitoring AMR levels in animals and target interventions in the regions most affected by the rise of resistance.

RESULTS

We identified 901 point prevalence surveys from LMICs reporting AMR rates in animals for common indicator pathogens: Escherichia coli, Campylobacter spp., nontyphoidal Salmonella spp., and Staphylococcus aureus. From 2000 to 2018, the proportion of antimicrobial compounds with resistance higher than 50% (P50) increased from 0.15 to 0.41 in chickens and from 0.13 to 0.34 in pigs and plateaued between 0.12 and 0.23 in cattle. Global maps of AMR (available at resistancebank.org) show hotspots of resistance in northeastern India, northeastern China, northern Pakistan, Iran, eastern Turkey, the south coast of Brazil, Egypt, the Red River delta in Vietnam, and the areas surrounding Mexico City and Johannesburg. Areas where resistance is just starting to emerge are Kenya, Morocco, Uruguay, southern Brazil, central India, and southern China. Uncertainty in our predictions was greatest in the Andes, the Amazon region, West and Central Africa, the Tibetan plateau, Myanmar, and Indonesia. Dense geographical coverage of point prevalence surveys did not systematically correlate with the presence of hotspots of AMR, such as in Ethiopia, Thailand, Chhattisgarh (India), and Rio Grande do Sul (Brazil). The highest resistance rates were observed with the most commonly used classes of antimicrobials in animal production: tetracyclines, sulfonamides, and penicillins.

CONCLUSION

The portfolio of antimicrobials used to raise animals for food is rapidly getting depleted, with important consequences for animal health, farmers’ livelihoods, and potentially for human health. Regions affected by the highest levels of AMR should take immediate actions to preserve the efficacy of antimicrobials that are essential in human medicine by restricting their use in animal production. In some middle-income countries, particularly in South America, surveillance must be scaled up to match that of low-income African countries that are currently outperforming them despite more limited resources. Policy-makers coordinating the international response to AMR may consider sparing African countries from the most aggressive measures to restrict access to veterinary drugs, which may undermine livestock-based economic development and rightfully be perceived as unfair. However, in regions where resistance is starting to emerge, there is a window of opportunity to limit the rise of resistance by encouraging a transition to sustainable animal farming practices. High-income countries, where antimicrobials have been used on farms since the 1950s, should support this transition—for example, through a global fund to subsidize improvement in farm-level biosafety and biosecurity.

 

Abstract

The global scale-up in demand for animal protein is the most notable dietary trend of our time. Antimicrobial consumption in animals is threefold that of humans and has enabled large-scale animal protein production. The consequences for the development of antimicrobial resistance in animals have received comparatively less attention than in humans. We analyzed 901 point prevalence surveys of pathogens in developing countries to map resistance in animals. China and India represented the largest hotspots of resistance, with new hotspots emerging in Brazil and Kenya. From 2000 to 2018, the proportion of antimicrobials showing resistance above 50% increased from 0.15 to 0.41 in chickens and from 0.13 to 0.34 in pigs. Escalating resistance in animals is anticipated to have important consequences for animal health and, eventually, for human health.

Keywords: Antibiotics; Drugs Resistance; Worldwide; Cattle; Poultry; Pigs.

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#Variations in common #diseases, #hospital admissions, and #deaths in middle-aged #adults in 21 countries from five continents (#PURE): a prospective cohort study (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study

Prof Gilles R Dagenais, MD †, Darryl P Leong, PhD †, Sumathy Rangarajan, MSc, Fernando Lanas, PhD, Prof Patricio Lopez-Jaramillo, PhD, Prof Rajeev Gupta, PhD, Rafael Diaz, MD, Prof Alvaro Avezum, PhD, Gustavo B F Oliveira, PhD, Prof Andreas Wielgosz, PhD, Shameena R Parambath, MBBS, Prem Mony, MD, Khalid F Alhabib, MBBS, Ahmet Temizhan, MD, Noorhassim Ismail, MD, Jephat Chifamba, DPhil, Karen Yeates, MD, Rasha Khatib, PhD, Prof Omar Rahman, MD, Katarzyna Zatonska, PhD, Khawar Kazmi, MD, Prof Li Wei, PhD, Prof Jun Zhu, MD, Prof Annika Rosengren, MD, Prof K Vijayakumar, MD, Manmeet Kaur, PhD, Prof Viswanathan Mohan, MD, AfzalHussein Yusufali, MD, Prof Roya Kelishadi, MD, Prof Koon K Teo, PhD, Philip Joseph, MD, Prof Salim Yusuf, DPhil

Published: September 03, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32007-0

 

Summary

Background

To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches.

Methods

The PURE study is a prospective, population-based cohort study of individuals aged 35–70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the age-standardised and sex-standardised incidence of these events per 1000 person-years.

Findings

This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9·5 years (IQR 8·5–10·9). During follow-up, 11 307 (7·0%) participants died, 9329 (5·7%) participants had cardiovascular disease, 5151 (3·2%) participants had a cancer, 4386 (2·7%) participants had injuries requiring hospital admission, 2911 (1·8%) participants had pneumonia, and 1830 (1·1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7·1 cases per 1000 person-years) and in MICs (6·8 cases per 1000 person-years) than in HICs (4·3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13·3 deaths per 1000 person-years) were double those in MICs (6·9 deaths per 1000 person-years) and four times higher than in HICs (3·4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs ( vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0·4 in HICs, 1·3 in MICs, and 3·0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs.

Interpretation

Among adults aged 35–70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care.

Funding

Full funding sources are listed at the end of the paper (see Acknowledgments).

Keywords: Public Health; Worldwide.

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#Global #burden of #latent #MDR #tuberculosis: #trends and #estimates based on mathematical modelling (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Global burden of latent multidrug-resistant tuberculosis: trends and estimates based on mathematical modelling

Gwenan M Knight, PhD, C Finn McQuaid, PhD, Peter J Dodd, PhD †, Rein M G J Houben, PhD †

Open Access / Published: July 04, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30307-X

 

Summary

Background

To end the global tuberculosis epidemic, latent tuberculosis infection needs to be addressed. All standard treatments for latent tuberculosis contain drugs to which multidrug-resistant (MDR) Mycobacterium tuberculosis is resistant. We aimed to estimate the global burden of multidrug-resistant latent tuberculosis infection to inform tuberculosis elimination policy.

Methods

By fitting a flexible statistical model to tuberculosis drug resistance surveillance and survey data collated by WHO, we estimated national trends in the proportion of new tuberculosis cases that were caused by MDR strains. We used these data as a proxy for the proportion of new infections caused by MDR M tuberculosis and multiplied trends in annual risk of infection from previous estimates of the burden of latent tuberculosis to generate trends in the annual risk of infection with MDR M tuberculosis. These estimates were used in a cohort model to estimate changes in the global and national prevalence of latent infection with MDR M tuberculosis. We also estimated recent infection levels (ie, in 2013 and 2014) and made predictions for the future burden of MDR tuberculosis in 2035 and 2050.

Findings

19·1 million (95% uncertainty interval [UI] 16·4 million–21·7 million) people were latently infected with MDR tuberculosis in 2014—a global prevalence of 0·3% (95% UI 0·2–0·3). MDR strains accounted for 1·2% (95% UI 1·0–1·4) of the total latent tuberculosis burden overall, but for 2·9% (95% UI 2·6–3·1) of the burden among children younger than 15 years (risk ratio for those younger than 15 years vsthose aged 15 years or older 2·65 [95% UI 2·11–3·25]). Recent latent infection with MDR M tuberculosis meant that 1·9 million (95% UI 1·7 million–2·3 million) people globally were at high risk of active MDR tuberculosis in 2015.

Interpretation

We estimate that three in every 1000 people globally carry latent MDR tuberculosis infection, and prevalence is around ten times higher among those younger than 15 years. If current trends continue, the proportion of latent tuberculosis caused by MDR strains will increase, which will pose serious challenges for management of latent tuberculosis—a cornerstone of tuberculosis elimination strategies.

Funding

UK Medical Research Council, Bill & Melinda Gates Foundation, and European Research Council.

Keywords: Antibiotics; Drugs Resistance; Tuberculosis; Worldwide.

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#Global ensemble #projections reveal trophic amplification of #ocean #biomass #declines with climate change (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Global ensemble projections reveal trophic amplification of ocean biomass declines with climate change

Heike K. Lotze, Derek P. Tittensor, Andrea Bryndum-Buchholz, Tyler D. Eddy, William W. L. Cheung, Eric D. Galbraith, Manuel Barange, Nicolas Barrier, Daniele Bianchi, Julia L. Blanchard, Laurent Bopp, Matthias Büchner, Catherine M. Bulman, David A. Carozza, Villy Christensen, Marta Coll, John P. Dunne, Elizabeth A. Fulton, Simon Jennings, Miranda C. Jones, Steve Mackinson, Olivier Maury, Susa Niiranen, Ricardo Oliveros-Ramos, Tilla Roy, José A. Fernandes, Jacob Schewe, Yunne-Jai Shin, Tiago A. M. Silva, Jeroen Steenbeek, Charles A. Stock, Philippe Verley, Jan Volkholz, Nicola D. Walker, and Boris Worm

PNAS first published June 11, 2019 / DOI: https://doi.org/10.1073/pnas.1900194116

Edited by James A. Estes, University of California, Santa Cruz, CA, and approved May 22, 2019 (received for review January 5, 2019)

 

Significance

Climate change can affect the distribution and abundance of marine life, with consequences for goods and services provided to people. Because different models can lead to divergent conclusions about marine futures, we present an integrated global ocean assessment of climate change impacts using an ensemble of multiple climate and ecosystem models. It reveals that global marine animal biomass will decline under all emission scenarios, driven by increasing temperature and decreasing primary production. Notably, climate change impacts are amplified at higher food web levels compared with phytoplankton. Our ensemble projections provide the most comprehensive outlook on potential climate-driven ecological changes in the global ocean to date and can inform adaptive management and conservation of marine resources under climate change.

 

Abstract

While the physical dimensions of climate change are now routinely assessed through multimodel intercomparisons, projected impacts on the global ocean ecosystem generally rely on individual models with a specific set of assumptions. To address these single-model limitations, we present standardized ensemble projections from six global marine ecosystem models forced with two Earth system models and four emission scenarios with and without fishing. We derive average biomass trends and associated uncertainties across the marine food web. Without fishing, mean global animal biomass decreased by 5% (±4% SD) under low emissions and 17% (±11% SD) under high emissions by 2100, with an average 5% decline for every 1 °C of warming. Projected biomass declines were primarily driven by increasing temperature and decreasing primary production, and were more pronounced at higher trophic levels, a process known as trophic amplification. Fishing did not substantially alter the effects of climate change. Considerable regional variation featured strong biomass increases at high latitudes and decreases at middle to low latitudes, with good model agreement on the direction of change but variable magnitude. Uncertainties due to variations in marine ecosystem and Earth system models were similar. Ensemble projections performed well compared with empirical data, emphasizing the benefits of multimodel inference to project future outcomes. Our results indicate that global ocean animal biomass consistently declines with climate change, and that these impacts are amplified at higher trophic levels. Next steps for model development include dynamic scenarios of fishing, cumulative human impacts, and the effects of management measures on future ocean biomass trends.

climate change impacts – marine food webs – global ecosystem modeling – model intercomparison – uncertainty

Keywords: Worldwide; Climate change; Biodiversity.

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