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Passions in Poetry

"I apologize to the dead' not the GOP"

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Denise
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25 posted 10-03-2009 11:29 AM       View Profile for Denise   Edit/Delete Message      Find Poems  View IP for Denise

Here's some straight talk from Newt Gingrich:
http://www.healthtransformation.net/cs/opeds_news?pressrelease.id=3406
Grinch
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26 posted 10-03-2009 03:05 PM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


quote:
You obviously haven't read Zeke Emanuel's writings.


I have.

I think it's an absolute travesty that certain political figures have misquoted and misrepresented his writings and demonised a well-respected opponent of euthanasia by taking parts of his well thought out writings out of context.

What's your opinion of him Denise?

Denise
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27 posted 10-03-2009 03:57 PM       View Profile for Denise   Edit/Delete Message      Find Poems  View IP for Denise

I don't agree with his philosphy of age-based medical treatment, which has already been implemented with the H1N1 vaccine. Funny that there is a scarcity requiring age restricted rationing when we have already arranged to give our 'surplus' to other countries through the U.N. I guess there is more than one understanding of a shortage, one real, due to formulation problems and delays, and the other, a manufactured shortage, because we are shipping some overseas to other countries, to presumably more age-worthy recipients.
Grinch
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28 posted 10-03-2009 04:08 PM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


quote:
I don't agree with his philosphy of age-based medical treatment


In that case Denise you'll absolutely love Emanuel - he doesn't agree with it either.

quote:
I guess there is more than one understanding of a shortage, one real, due to formulation problems and delays, and the other, a manufactured shortage, because we are shipping some overseas to other countries


That's an interesting accusation Denise. As I understand it the vaccine hasn't yet been released by the manufacturers. The first batches - 600,000 doses of the nasal spray version aren't due to be delivered until Tuesday of next week. As I understand it what you are saying is that shipments have already been sent abroad?

Is that true or simply a repeated rumour?

.
Denise
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29 posted 10-03-2009 04:21 PM       View Profile for Denise   Edit/Delete Message      Find Poems  View IP for Denise

Has Emanuel recently retracted what he said previously?

No, I didn't say that they have already been shipped, Grinch. They have been scheduled to be shipped to 3 or 4 other countries through a deal made with the U.N. Sorry I don't have a link. I heard it on the news.
Grinch
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30 posted 10-03-2009 04:46 PM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


quote:
Has Emanuel recently retracted what he said previously?


Not as far as I'm aware, he's been fairly consistent. What previous comment are you talking about?

The US manufacturers have agreed to supply a proportion of their produced vaccine to the third world, as far as I know so has every other manufacturer worldwide. The last article I read put the expected amount to be about 10% of the vaccine each manufacturer produces leaving 90% to be sold on the open market.

It seems like a good plan to me. America, along with every other developed country can purchase as much vaccine as it needs from all manufacturers worldwide but 10% is ring fenced for underdeveloped countries.


.
Denise
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31 posted 10-04-2009 09:45 AM       View Profile for Denise   Edit/Delete Message      Find Poems  View IP for Denise

I'm talking about his "Principles For Allocation Of Scarce Medical Interventions" which you can download here:
http://blog.jonolan.net/wp-content/uploads/2009/08/complete-lives.pdf
http://blog.jonolan.net/politics/complete-lives-system/

Below is an article with some highlights from the Emanuel paper:

quote:


”The system advocated by Dr. Emanuel would allocate health care based on the government’s perception of the societal worth of the patients.  Accordingly, the very young and the very old would receive less care since the former have received less societal investment and the latter have less left to contribute.

“Forstall[ing] the Concern that Disproportionate Amounts of Resources Will be Directed to Young People with Poor Prognosis”

“The Complete Lives System” would also consider the prognosis of the individual.  

Quoting Dr. Emanuel:  “A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life.  Considering prognosis forestalls the concern that disproportionately large amounts of resources will be directed to young people with poor prognosis.”

When fully implemented, Dr. Emanuel’s system, in his words, “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”

http://www.humanevents.com/article.php?id=33100

I'm all for sharing our resources with the rest of the world once everyone in this country who wants to receive it can.
Grinch
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32 posted 10-04-2009 11:31 AM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


quote:
I'm all for sharing our resources with the rest of the world once everyone in this country who wants to receive it can.


That sounds like an interesting plan Denise.

If you don't mind me saying though there's one itsy-bitsy flaw in it - the US doesn't actually have the capacity to produce enough vaccine to cover it's own population.

Far from having a surplus the US actually buys its shortfall from foreign producers. The agreement that the US has signed up to is that all manufacturers, including those in the US, reserve 10% of their production for third world countries. That means that 90% of world production is available on the open market, so you get the chance to buy enough to cover your population but the third world countries are guaranteed to have at least some once the feeding frenzy is over.

Or are you suggesting that every country keeps the vaccine it produces for their own consumption? If so what are you going to tell the 220 million Americans who won't receive the vaccine?

.
Grinch
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33 posted 10-04-2009 11:52 AM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


Newt Gingrich is wrong Denise.

The figure isn't  $45,000 it's £45,000.

He's also got the calculation slightly awry too. It isn't £45,000 per year it's £45,000 for each additional year a treatment will extend your life by. There's a big difference.

If a treatment extends your life for 10 years you can add a zero onto the £45,000 figure an allowable treatment could cost and it would still pass the NICE criteria.


I explained QALY a while back to Huan here it is in case you missed it.

quote:
Quality-Adjusted Life Year

It's a method of measuring the quality of life rated against a standard year of perfect health, which has a rating of 1.0

For instance:

If you had an incurable disease but your life expectancy could be extended by one year of full health by taking a pill your QALY would be 1.0

Under this system 0.0 would mean you were dead 0.5 would mean your quality of life was half of the norm etc. In almost all health care systems the QALY is used to calculate the benefit of any treatment.

The QALY is also used in other situations. One example being in cases where there are competing patients for a single treatment, a heart transplant perhaps. If two or more people could receive the heart their QALY figures can be used to decide who gets it.

It's also used in conjunction with an acceptable cost per year figure to allow or disallow specific treatments. In such cases the individual patients QALY is replaced by a general QALY claimed or proven for the specific treatment.

If the QALY offered by the treatment is 1.0 and the acceptable cost per year figure is $100,000 a treatment that cost $100,000 or less would be deemed acceptable.

It's used in almost all health care systems in some form or other, including those in the US.


.
Denise
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34 posted 10-04-2009 01:14 PM       View Profile for Denise   Edit/Delete Message      Find Poems  View IP for Denise

It seems we're obviously not getting enough to cover our own population even with the 90%, or we wouldn't be rationing by age or any other critera.

Yes, I read the QALY that you shared before. The problem I have with the QALY and the Complete Lives System is that a government bureaucracy is assigning a quality of life factor and/or a benefit to society in determining who gets treatment, and/or level of treatment.

Grinch
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35 posted 10-04-2009 01:47 PM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch

quote:
It seems we're obviously not getting enough to cover our own population even with the 90%,


You're not Denise, you wouldn't be if you could get the other 10% either.

The world capacity for flu vaccine is 400 million doses per year, they're trying to increase that but the production process is making that difficult. With 6.7 billion people in the world there's a fairly large difference between supply and demand, some are going to have to do without.

It's actually worse than it seems, the figures for production are per year but when it comes to a vaccine you don't want to spread delivery over a year, you want to vaccinate everyone in the shortest time possible.

So what do you do?

The most logical thing to do is vaccinate the most susceptible and key people first, nurses and doctors etc.. In the case of swine flu, as opposed to other strains, the older you are the less susceptible you are so your vaccination schedule has to take that into account.

quote:
The problem I have with the QALY and the Complete Lives System is that a government bureaucracy is assigning a quality of life factor and/or a benefit to society in determining who gets treatment, and/or level of treatment.


As opposed to a health insurance company who decide based on what supplying treatment will do to their bottom line?

Health insurance companies use the same method Denise. They just don't advertise the fact.

.

[This message has been edited by Grinch (10-04-2009 05:45 PM).]

Denise
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36 posted 10-04-2009 10:41 PM       View Profile for Denise   Edit/Delete Message      Find Poems  View IP for Denise

Who has determined that the older a person is the less susceptible they are to this particular flu? Have studies been done? Why are they less susceptible than they are to the regular flu? Are the sickly elderly with underlying health problems and compromised immune systems less susceptible than the general population?

Private insurance companies do not engage in rationing of care the way that government run heatlh care systems do, and the way that ours will if it takes over our healthcare system. If they did 85% of people who have insurance would not be happy with what they have. Even Medicare patients can currently get the treatment that they need, which will be denied them when the government implements the drastic cuts to Medicare to help pay for their 'healtcare for all' plan.
Grinch
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37 posted 10-05-2009 02:50 PM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


You've got lots of questions there Denise, questions are a good thing you should ask more of them.

Who says older people are less susceptible to this type of flu?

Statistics. With any type of flu the health experts look at who's catching it, who gets sicker and ultimately who dies as a result of it, they collate all the statistics and then work out the best way of fighting it. This particular strain is odd in that regard, normally older people contract flu to a greater degree, it makes them sicker and fatalities are almost always greater amongst the elderly. Swine Flu is different; it's the younger generations that are most at risk in every regard.

Why is that?

The truth is nobody knows, all that anyone can say is the statistics show that that's how it is.

Are older people safe then?

No, while old people are less susceptible they aren't immune, in fact if they have underlying health problems any advantage they may have in being in a low risk group (older) gets wiped out by being in a high risk group (having an underlying condition). That's why older people with underlying conditions are included in the vaccination program.

Do private insurance companies ration health care like public health care systems?

I could simply say yes to that - but it wouldn't be the whole story.

They both do it in different ways Denise, one of them, at least to my mind, far more morally preferable to the other.

.
Bob K
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38 posted 10-06-2009 02:25 AM       View Profile for Bob K   Email Bob K   Edit/Delete Message      Find Poems  View IP for Bob K



      So, with not enough vaccine to go around in this country, and with the conditions as Grinch describes them, who does Denise say should get the vaccine in this country, Denise?  And why?
Grinch
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39 posted 10-06-2009 03:36 PM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


Bob,

Isn't it a little unfair to ask Denise to make such a big decision with only half the information she needs?

There are lots very important questions that haven't been asked yet, questions that, once answered, might change the vaccination plans completely. Questions like:

How serious a threat is swine flu?

What's the predicted mortality rate based on the current data?

Are there better ways of fighting this flu strain?

How dangerous is the vaccine itself?

While we're busy making swine flu vaccine what happens to seasonal flu vaccine production?

That's not an exclusive list Bob - but it's good enough as a starting point. Once you answer the above questions though you may find that your own answers to the questions you asked Denise are somewhat different that what you might expect.

Bob K
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40 posted 10-06-2009 05:54 PM       View Profile for Bob K   Email Bob K   Edit/Delete Message      Find Poems  View IP for Bob K



Dear Grinch,

          You seem to be able to make sense to Denise where I cannot.

     She now has the information from you to understand that her initial reasoning about the distribution of doses was wrong and that she was being misled about the situation.  The United States has not produced enough vaccine for everybody in the country and has to purchase from overseas.  Even then, there will probably not be enough for the time window in which it must be distributed.  6.7 Billion People versus 400 million doses worldwide versus 300 million in the United States (I think).  

     I recall Denise was still firm on the women and children and elderly first thinking when last we spoke.  If I misrecall, I am sorry; but that is how I remember it.  That seems to assume that three out of four doses in the world will go to the United States.

     The point is, to my mind at least, that no matter what is done, there has to be some rationing of health care.

     I think that it is a mistake specifically to limit ourselves to this issue, but for now, let's do that.  I think that any distribution plan that one settles on — and I mean distribution plan here, a way of sending vaccine to distribution points when there isn't enough to go around — is in fact a rationing plan in itself.  Some places and people must get the vaccine first.  Even if the distribution plan is to be completely random about sending the vaccine out, you have made a series of decisions about the importance of some lives over other lives and the importance of having a functioning country over not having a functioning country.  Any decision has consequences, even the decision not to make a decision.

     It is fair to say that you don't like a decision — the administration's decision, for example — but then it seems that you should be willing to say what you don't like about it.  One of those things can't be that it rations health care.  The fact that the government has chosen to allow doctors to live wherever they want to live has, all by itself, rationed health care.  People who don't live in places with access to large hospitals and universities and a bustling cultural life have rationed their own access to health care.  There are all sorts of factors, governmental by action or non-action, as well as non-governmental (are you a Christian Scientist?) that ration health care access one way or another.  Some of these you will like, some you will not like.  There are ways that non-governmental forces ration health care as well.  Insurance companies are an enormous factor in this sector.  So are Drug companies, by their pricing policies.  

     If you don't like the way the government rations health care, say how.  Don't pretend that not rationing health care is an option for any government anywhere.  How would they go about it?  Simply by not telling doctors and other health care workers where to live, they are rationing access to health care.  As they would if they did tell them where to live.

     If doctors and nurses did not get first shot (pun intended) at flu vaccines, or other vaccines as well in an epidemic, 1) Vaccines would soon stop being distributed at all as folks who actually knew how to run the clinics would not be available to do the work; 2) larger numbers of the then non-vaccinated population at large would fall ill; 3) the morbidity and mortality rates overall would be much higher.  Therefore, if you don't actively seek to kill people you don't actually need to kill, the health care workers get the first vaccines off the line.

     Purely as a matter of pragmatics, how are you going to stop the medical personnel from vaccinating themselves first.  In terms of enlightened self interest, why would you even expect them not to vaccinate themselves first; and would you trust a vaccine that the health care givers didn't trust enough to use first anyway?  Wouldn't you be a little more nervous about using it?

     Anyway, a few thoughts on rationing.

Sincerely, Bob Kaven
Grinch
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41 posted 10-06-2009 06:46 PM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


quote:
The point is, to my mind at least, that no matter what is done, there has to be some rationing of health care.



You won't get any arguments about that from me Bob. I agree entirely; there has to be rationing in one form or another when it comes to health care.

With regard to swine flu vaccine though I do have a problem. I think the knee-jerk reaction to the current flu variant is the wrong way to go. Denise wants to vaccinate everyone, you want to vaccinate as many as possible based on how much vaccine we can produce and I think the answer is to vaccinate as few people as possible.

Denise
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42 posted 10-06-2009 09:20 PM       View Profile for Denise   Edit/Delete Message      Find Poems  View IP for Denise

I think the way to go is to first vaccinate the health care workers and first responders, as has always been done, to my knowledge.

Next I think that the people with underlying health problems and weakened immunity, regardless of age, should be next in line.

Then after that make it available to the general population beginning with those determined to be hardest hit by a particular flu and then work your way down for as long as the vaccine is available.

Maybe I'm wrong, but I always thought that was the way it was done in the past.

Bob K
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43 posted 10-06-2009 11:12 PM       View Profile for Bob K   Email Bob K   Edit/Delete Message      Find Poems  View IP for Bob K



Dear Denise,

          Thank you for a concise and well thought out answer.

Grinch — there's nothing wrong with being parsimonious.  This art is in understanding where the few is artful and where it is too few.  That's where statistical elegance becomes so vital.  It is beyond my skill level, so sorry, but I admire it.

Thank you both.  Sincerely, Bob Kaven
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44 posted 10-10-2009 07:25 AM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


Denise,

Your suggested vaccination plan is almost word for word the same as the plans of the UN, the UK and the US.

Personally I think it's the wrong way to go.

Swine flu vaccine and seasonal flu vaccine are two different vaccines, one vaccine doesn't work on both flu strains - it's an either\or scenario.

While the world's flu vaccine manufacturers are working flat out to make swine flu vaccine they aren't making seasonal flu vaccine. Let me say that again, it's an important point and one that people aren't being told.

The vaccine manufacturers can only produce a finite amount of flu vaccine every year and, at the moment, they're producing vaccine for swine flu that has caused the deaths of a few thousand people. While they're doing that they're not producing seasonal flu vaccine. That's a big mistake.

Seasonal flu kills half a million people a year, that's a lot of people but it's nowhere near the amount of people that it would kill without the continued worldwide vaccination programs. While the world is concentrating on the potential threat of swine flu it's ignoring the real threat of a seasonal flu pandemic left unchecked because of a lack of seasonal flu vaccine.

But swine flu has the potential to kill more people, hasn't it?

Sure, it might, statistics so far though show that it's killed only a few thousand people and that's without a comprehensive vaccination plan being in place. To become a real threat the current strain would need to mutate which raises another issue. If swine flu mutates into a more virulent form the chances are that the current vaccine would be ineffective, a new vaccine would need to be developed.

At that point we'd have no seasonal flu vaccine and no swine flu vaccine but that's only if the virus mutates into a more virulent strain. If it doesn't we'll have a vaccine against a mild flu strain and a seasonal flu pandemic.

They're building flood defences in the back yard in case it rains more than it did last year but they're forgetting that they've left the taps running in the bathroom.

.
Denise
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45 posted 10-10-2009 11:10 AM       View Profile for Denise   Edit/Delete Message      Find Poems  View IP for Denise

It seems the main difference between my suggested plan and those of the organizations is that I think it should be given to those with underlying health problems and compromised immune systems regardless of age prior to be given to other groups.

Regarding Emanuel, given his above views that I provided, do you still believe that he doesn't advocate treatment based on age?
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46 posted 10-10-2009 12:21 PM       View Profile for Local Rebel   Email Local Rebel   Edit/Delete Message      Find Poems  View IP for Local Rebel

The active nasal vaccine can't be given to people with compromised immune systems Denise.  Only the dead virus injection -- which isn't available yet -- and even then if an immune system is compromised it doesn't build up a lot of antibodies anyway -- the best way to go is 'herd' immunity -- which is to immunize those affected by the virus the most -- and those who are in close contact to one another who are likely to spread it around -- like in schools -- and that's the kids.  We had an 11 year-old girl here die just this tuesday from H1N1 -- she was absolutely fine the day before.

Where I disagree with Grinch is in the assessment that it's a mistake to put so much emphasis on this special H1N1 strain -- because we simply don't know what it's going to morph into -- this is still a very young strain -- and if it had been more virulent than it has been -- the world would be weeping already because of our inability to respond.

What I love about this issue though is it brings out all the left-wing loonies who don't believe in science, maybe when some people hear how irrational they are in their fear of vaccines maybe some righties who don't believe in climate science will realize how ridiculous they sound.  
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47 posted 10-10-2009 12:23 PM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


quote:
It seems the main difference between my suggested plan and those of the organizations is that I think it should be given to those with underlying health problems and compromised immune systems regardless of age prior to be given to other groups.


Denise, the UN. US and UK plans all contain provision for high-risk groups which includes people with underlying conditions, regardless of age. Just to prove the point I've just had my second flu vaccination reminder from my doctor who keeps insisting I should have the vaccine due to my medical history which puts me in a high risk group for both seasonal and swine flu.

quote:
Regarding Emanuel, given his above views that I provided, do you still believe that he doesn't advocate treatment based on age?


Of course he advocates treatment based on age in extreme and pandemic conditions where the resource to treat people are scarce - in exactly the same way that your vaccination plan was based on age. It's just common sense.

Govind Persad, Alan Wertheimer and  Ezekiel J Emanuel in  co-wrote  "Principles for allocation of scarce medical interventions"  to look at the best way to react to an extreme health emergency. They examined the current methods of rationing a scare resource, such as vaccine, and came up with a better alternative.

Some ignorant wing-nuts on the far right took certain sections of that white paper and quoted them out of context, presumably for political reasons. In short Denise those wing-nuts lied to you. They don't believe that you are intelligent enough to know that Denise, or resourceful enough to find the evidence to disprove it. They're hoping that you'll just repeat the lie with enough conviction to convince other people that it's true - they believe that if enough people believe it to be true it'll somehow become true.

You have all the necessary tools to prove them wrong Denise. Here's the most potent of them.

?

.
Denise
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48 posted 10-10-2009 03:07 PM       View Profile for Denise   Edit/Delete Message      Find Poems  View IP for Denise

What is the lie you speak of, Grinch, in my assertion that he advocates an age-based allocation of resources when resources are limited? Wasn't that my earlier assertion?
Grinch
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49 posted 10-10-2009 04:10 PM       View Profile for Grinch   Email Grinch   Edit/Delete Message      Find Poems  View IP for Grinch


The lie?

The lie is that there's something wrong with Emanuel's suggestions, that they are somehow inherently different from how medical shortages are already dealt with - they aren't.

Applying Emanuel's system to seasonal flu wouldn't produce a vaccination program any different from the current plan. Apply it to the swine flu pandemic and you get the same result.

The wing nuts are highlighting Emanuel's system for dealing with scarce medical resources and implying that it's a manifesto for all health care, it isn't. They throw up their hands gasp in mock horror and tell you that it isn't how they'd supply heath care.

They're lying Denise, it's exactly how they would deal with a scarce medical resource - at least it would be if they had any sense.

That's the lie Denise, and all you have to do to expose it is to ask them what their alternative plan is, but don't be too surprised if their plan looks suspiciously like Emanuel's plan or the plan you gave come to that.

.
 
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