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ACCESS Health launched its latest book Every Second Counts with an hour long session at the Jaipur Literature Festival, titled “Innovations in Healthcare”. The book describes the story of the largest emergency response providers in the world, the Emergency Management and Research Institute (EMRI). EMRI launched in 2005 in a single state in India, Andhra Pradesh. Today, it operates in seventeen Indian states and territories and serves a population of more than seven hundred million. Each day, the emergency system receives one hundred and fifty thousand calls and responds to almost twenty five thousand emergencies. The service is free to the user and costs EMRI less than $15 USD per emergency, less than one percent of what an emergency call costs in the United States.

Watch ACCESS Health Chair and President William A. Haseltine and ACCESS Health India Country Director Siddhartha Bhattacharya discuss the book and other innovations in health in the video below.

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This post was guest authored by Shefali Srinivas, Vice President, Health Lead, Asia Pacific at WE Communications. It originally appeared on LinkedIn.

SGInnovate and ACCESS Health International brought a truly fantastic group of people together to talk blockchain in healthcare earlier this week. I had a mortifying moment at the start of our discussion; I forgot what I wanted to say. Let’s just say I had blockbrain. Lesly Goh (Financial Services Industry Lead, Microsoft Asia Pacific) rescued me so gracefully, picking up my train of thought and validating the quote I eventually remembered: “AI and climate change may ruin us, but blockchain and women will save us.”

Lesly talked about permissioned blockchain, the area that is most promising for healthcare enterprises. “We need to focus on interoperability and commitment to an open source standard,” she said.

Zia Zaman (Chief Innovation Officer, MetLife Asia) said blockchain technology could make insurance more inclusive by providing different ways to extend cover to more people or cover more diverse risk pools. The hope is to reduce costs and complexity and make it simpler for people to buy insurance products at the point of care. “About as much friction as it takes to get a drink out of a vending machine,” he said.

Dr Marcus Tan (senior resident at NUH) said blockchain could be the answer to the problem of patient data that is stuck in various institutional silos. “In the blockchain model, we can give patients back the ownership of their data. Data that is reliable, immutable, and trusted.” In Singapore, the first implementations of blockchain will probably be targeted at electronic medical records.

We had an hour-long discussion with a very engaged audience and questions ranged from privacy concerns to use cases. Judging by the audience interest, we could easily have gone on for another hour.

Zia’s reminder stood out: no matter what the enterprise is, we need to think of all technology from the perspective of the end user. “It’s not about the technology itself – it is about the problems you can solve uniquely and differently for the customer. So we need to think about how deep tech impacts the industry’s customers – Does it reduce friction? Does it increase security? Does it provide other types of benefit?”

These are the questions to ask in order to keep this conversation going well into 2018. A big thank you to everyone on the panel, the organisers, and our very encouraging audience.

(Ps: You can access the full video here.)

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ACCESS Health and its partners Health News (Jian Kang Bao) organized the China Chronic Disease Management Industrial Forum late last year in Wuxi, Jiangsu Province. ACCESS Health and Health News invited guest speakers to speak about chronic disease and medical insurance and invited healthcare startup representatives and investors to present in a roadshow on chronic disease management. Chronic diseases are a growing health concern across the globe and an important priority for ACCESS Health that combines much of our work on aging, digital health, and healthcare and finance. Cross industry collaboration is essential to improving the life quality of patients with chronic diseases.

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Emergency medical response systems are a critical component of any nation’s healthcare system. Minutes and seconds can mean the difference between life or death. In our latest book, Every Second Counts, ACCESS Health Chair and President William A. Haseltine tells the story of the largest emergency services provider in the world.

The Emergency Management and Research Institute (EMRI) launched in 2005 in a single state in India, Andhra Pradesh. Today, it operates in seventeen Indian states and territories and serves a population of more than seven hundred million. Each day, the emergency system receives one hundred and fifty thousand calls and responds to almost twenty five thousand emergencies. The service is free to the user and costs EMRI less than $15 USD per emergency, less than one percent of what an emergency call costs in the United States.

“What the government of India has achieved in partnership with EMRI is nothing short of groundbreaking,” said Dr. Haseltine. “Despite limited resources, challenging infrastructure, and a substantial population spread out over one of the largest countries in the world, the government created a near universal, world class emergency system. The EMRI story proves that every government, with the right intentions and partnerships, can provide their people universal access to high quality and affordable care.”

At ACCESS Health, we believe all people no matter where they live, no matter what their age, have the right to access high quality and affordable healthcare and to lead healthy and productive lives. Every Second Counts is one in a series of books written by the organization to showcase outstanding examples of success.

In addition to being the largest emergency services provider in the world, EMRI also represents one of the largest public private partnerships. Central and state governments in India share the costs of the service but private companies do the work. Every Second Counts is an inspiring story of political leadership, private sector engagement, and public access to care. The book is an important read for policymakers, business leaders, and healthcare leaders who care about providing high quality care at an affordable cost to all those in need.

Head to Amazon.com to buy a hard copy of the book or download the PDF of the book here.

Singapore Healthcare Story and Aging with Dignity

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As part of its support for its partner, the Non-Profit Incubator, and the Bright Start Project, ACCESS Health China participated in recruitment sessions in four different colleges in Shanghai and conducted a series of online and offline training sessions for students in November. More than two hundred students joined the November training sessions. Bright Start is a nonprofit joint project with ACCESS Health China and Non-Profit Incubator, funded by J.P. Morgan Foundation. The goal of the project is to prepare students for jobs in the digital health sector.

We were grateful to be joined by Haochen Xu from the human resource department of Ping An Health Cloud Company Limited human resource department for a sharing session at Shanghai University of Medicine and Health Science. Mr. Xu spoke with medical students about the potential of a career in the digital health sector. We also invited distinguished guest speakers Ying Zhao from AstraZeneca and Lisha Ye from First Respond to participate in the online sharing events. Shu Shang from ACCESS Health China also took part. The three guest speakers shared their respective experiences and offered insightful suggestions on developing careers in digital health marketing, information technology, and administration.

The ACCESS Health China team also supported a Design Thinking workshop at Shanghai Second Polytechnic University. The challenge for the workshop was to improve the user experience of an online medical application. More than one hundred and fifty students participated in the workshop. The goal of the workshop was to let students learn design thinking and develop a deeper understanding of digital health. It was the first time for many students to use the online medical application. All students went through the process of design thinking to understand how online medical works, how to conduct user surveys with empathy, how to define problems, and how to brainstorm solutions and create draft models for testing. We appreciate the support of Ping An for using their Good Doctor mobile application as the study case for students. Students will present their solutions to the challenge in the form of a roadshow for Ping An in the coming week.

The Bright Start project started in January 2017. Since its inception, the project has organized more than thirty online and offline training events for more than sixty mentors and one thousand students. As part of the program, ACCESS Health approached thirteen companies about more than eighty positions that may be available to students. By supporting training and content for Bright Start, we are glad to be able to enable these students as they consider starting their careers in digital health.

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This post originally appeared on the Joint Learning Network blog.

Medical audit systems are crucial to improving the quality of patient care and making efficiency gains in health care systems. But many countries struggle with the complexities of establishing or strengthening their medical audit schemes.

The Joint Learning Network for Universal Health Coverage (JLN), in collaboration with South Korea’s Health Insurance Review and Assessment Service (HIRA), has been working with eight countries, including Colombia, Ghana, India, Indonesia, Kenya, Malaysia, Nigeria and the Philippines, to share expertise and best practices in designing medical audit systems. The group of practitioners and policymakers has just launched a comprehensive guide for fellow practitioners, the Toolkit for Medical Audit Systems: Practical Advice from Implementers to Implementers.

Defined as a quality improvement process with a step-by-step analysis of health care services against explicit criteria relating to quality and cost, well-designed medical audit systems can ensure effective and financially sustainable health care systems and improve patient outcomes.

When the delivered care or health outcomes fail to meet established benchmarks in a medical audit, practitioners have vital data on the changes that should be implemented at an individual, team or service level.

The Formation of the Medical Audits Collaborative
The participating JLN member countries formed a collaborative working group to address what practitioners had identified as common challenges in designing and implementing medical audits within their national health insurance programs.

Participants included technical professionals focusing on claims, quality assurance and monitoring and evaluation in national health insurance agencies; medical practitioners, professors and researchers; and policymakers from national ministries of health.

South Korea, a new member of the JLN, hosted three in-person meetings to support fellow member countries in thinking about how to design and implement medical audits to improve quality of care. South Korea has one of the most well-established and highly-functioning medical audit systems today, leading the collaborative to identify HIRA as a reference point for best practices in medical audit systems.

Throughout the in-person and virtual meetings, the collaborative discussed common challenges and exchanged experiences, defined the components of a medical audits framework within a health insurance program, and identified tangible recommendations for strengthening medical audit systems within the context of their countries.

Equipped with this collective knowledge, the participants worked collaboratively to produce a practical toolkit for their fellow practitioners on how to design, implement and strengthen medical audit systems.

The Medical Audit Systems Toolkit and Framework
Developed from the perspective of purchasers of care, such as national health insurance agencies, the Toolkit provides comprehensive recommendations for designing and implementing medical audit systems and includes best practices, country examples, and solutions to common challenges.

Results from a medical audit can guide actions and recommend changes to the individual, team, service or system levels. Practitioners can then further monitor the changes to identify improvements in the quality and efficiency of the health care system.

The Toolkit also walks the user through a medical audits framework. Essential components of a medical audit framework include:

  • Inputs: preconditions for enabling a successful medical audit system
  • Processes: the development of indicators, rules, and triggers to ensure effective medical audits and the process of conducting the audit, including onsite and offsite investigations
  • Outcomes: the overarching goals of improved quality, patient outcomes and financial elements of risk protection and sustainability

The figure below illustrates the medical audit system framework adopted by the collaborative, featuring the perspectives of policymakers, purchasers of care (such as insurers), health care providers and patients.

The collaborative also developed cross-linkages with JLN Data Analytics collaborative, which focuses on collecting indicators for provider payment mechanisms, complementing the work of the Medical Audits collaborative around the process of developing audit triggers. For example, one step in the Medical Audits toolkit requires the development of indicators for claims reviews, drawing directly from the co-produced knowledge in the Using Data Analytics to Monitor Provider Payment Systems manual.

As the technical coordinator of the collaborative, ACCESS Health International synthesized and developed the content for the toolkit based on case studies, country examples and critical insights shared by participants. The toolkit will be officially launched at an event in South Korea, hosted by HIRA, in December 2017.

Applying the Toolkit in Nigeria and the Philippines
The discussion during the in-person and online meetings have already supported member countries to take immediate steps to strengthen their respective medical audit systems. Participation in the collaborative helped the Philippines’ national health insurance agency, PhilHealth, to train its staff on data quality and the importance of data standardization. PhilHealth is currently working with a consulting firm to determine thresholds for fraud identification triggers. Meanwhile, Nigeria’s national health insurance agency launched a capacity-building program for staff working in the medical audits program.

Next Steps for Quality Health Systems
Following the launch, the JLN will work with member countries to adapt, apply and implement the toolkit. The Medical Audits collaborative plans to continue engagement through a community of practice, identify in-country champions for designing efficient medical audit systems and explore in-country dissemination opportunities. JLN member countries can also take advantage of the Joint Learning Fund to start initial learning and application of best practices in their countries. As countries increasingly have the opportunities, knowledge, and resources to improve their medical audit systems, they will move ever closer to their common goal of ensuring universal access to high-quality health care.

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ACCESS Health China organized a Modern Aging Open Day inviting mentors from Hong Kong and Mainland China to give guidance on innovative projects that are aimed at improving the quality of life and wellbeing of the elderly. It was the first time inviting mentors to participate virtually from different geographic locations. Two distinguished mentors participated in the day:

Ms. Serena Xie, Co Founder and Chief Executive Officer of YD Care

Ms Di Zheng, Senior Program Officer of Leping’s Social Innovation Research and Development Center

SOW Asia, our Open Day partner, recommended three outstanding projects from Hong Kong in the aging sector: ELDPATHY, Sit N Shower, and Acesobee. These projects focus on elderly simulation, elderly assistive devices, and platforms to help manage healthcare records. Mentors gave their comments on each project based on different opportunities and challenges specific to each field.

Open Day is a monthly Modern Aging event. It facilitates the implementation and growth of new projects that serve the needs of the elderly and provides opportunities for collaboration for mentors. Open Days also attracts startups to our community of entrepreneurs.

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ACCESS Health China recently co organized the Fourth National Innovation for the Elderly Competition. This was  the second time ACCESS Health participated in the competition. This year, ACCESS Health participated in the recruitment process for new projects, designing the training program, offering training, judging the semifinal completion, and conducting research on global trends in aging innovations. Winners from the competition will join the Shanghai Aging Innovation Alliance and will receive exclusive business development support and networking support from the alliance. Members of the Shanghai Aging Innovation Alliance automatically become members of the Modern Aging Innovator Alliance.

The National Innovation for the Elderly Competition is a yearly competition endorsed by several aging related government departments in Shanghai. The goal of the competition is to enhance the public’s awareness of innovation in the aging sector by recruiting and supporting best practices and ideas from China. Winners of the competition will receive a wide range of resources and support, including investment opportunities, media exposure, training, strategic advice, and implementation support. The competition invites senior citizens to meet with the innovators. The older participants act as end users and provide user testing feedback and comments on the innovative services and products. ACCESS Health China first co organized the event in 2016. This year the theme of the competition is Science and Technology Design on the Aging Challenges. The competition has thus far attracted more than five hundred projects. More than eighty percent of the winners successfully reached their fundraising goals.

About the Shanghai Aging Innovation Alliance

ACCESS Health China launched the Shanghai Aging Innovation Alliance in collaboration with the Shanghai Technology for the Elderly Center. Cathie Liu, program director of ACCESS Health China, serves as the deputy secretary of the alliance. Winners of the National Innovation for the Elderly Competition make up a key part of alliance membership. The alliance offers members high quality resources in the industry, access to exclusive events and networking opportunities, and media exposure through various channels. By gathering the most outstanding innovators in the aging sector, we work together to build a new ecosystem for aging innovations. The top ten winners of the competition since its inception were the first members to be invited to join the alliance.

Training Session

On November 19, 2017, ACCESS Health China, in collaboration with TusStar Shanghai, organized a training session for all semifinalists in the Fourth Innovation for the Elderly Competition. The goal of the training session was to improve the performance of the innovators in the next stage of the competition. ACCESS Health invited three mentors and ten representatives of senior citizens to offer comments and suggestions to the topics including presentation content and skills, services and products, and development strategies. It enabled the innovators to improve their efficiency in communicating with both judges and end users, as well as to have a brighter understanding of their future development.

Semifinals

On November 20, the semifinals of the Fourth National for the Elderly Competition took place at Shanghai Media Group. The semifinal was recorded and broadcast through radio channel FM 89.9 to the entire city. Linguo Li, operations director of ACCESS Health China, joined the team of judges and provided insightful comments on the projects. Due to the large number of radio listeners, the competition attracted great attention by the public on aging and innovation. It also gave the innovators remarkable exposure to the public to promote their products and ideas.

Presenting the State of Innovation in Aging and Senior Care: Trends and Lessons

The Modern Aging China team and the ACCESS Health China research team had written an industrial report of The State of Innovation in Aging and Senior Care: Trends and Lessons which was officially launched at the finals of the competition. Cathie Liu, program director of ACCESS Health China and deputy secretary of Shanghai Aging Innovation Alliance, presented the report at the finals which took place on November 28, 2017. The report reveals the challenges and solutions of the demographic shift in China and around the globe. The report introduces global trends in aging innovation in five sectors reacted to the challenges mentioned above, including health management, care and rehabilitation, independence and safety, mobility and convenience, and mental vitality and life style. In each sector, the report highlights the key facts within the sector and presents both domestic and global successful innovative models. The report also features the top ten winners of the competition in these five sectors and looks forward to the future opportunities.

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World renowned lactation expert and professor in pediatrics and nursing, Paula Meier PhD, visited Newborn Intensive Care Units (NICUs) across Telangana to help nurses and staff to implement a process of quality improvement to help them overcome the barriers to feeding NICU newborns mother’s milk. Dr. Meier heads the RUSH human milk research team in Chicago, USA that conducts translational studies that address barriers to high dose, long exposure mothers own milk (MOM) feeding for NICU infants.

Mother’s own milk is the best nutrition possible for preterm and low birthweight babies, and helps protect them against infections and other health risks that could lead to long term health problems or death. However, new mothers don’t always have the opportunity to breastfeed their babies. This is due to a wide variety of factors. Sometimes infants are not strong enough to breastfeed, sometimes mothers may need extra support to express enough breastmilk to feed their babies, and sometimes hospital staff don’t recognize that a mother may be in need of extra help or don’t know how to offer the right type of support.

Telangana’s neonatal mortality rate of 25/1000 live births is higher than neighboring southern states. For mothers delivering in public and private sector hospitals, only 37 percent breastfeed their children within the first hour and barely two thirds, 67 percent, exclusively breastfeed their children. The high rate of cesarean sections in the state (58 percent) further adds to the challenges for mothers to begin breastfeeding their babies in the first hour.

ACCESS Health International invited Dr. Meier to speak with faculty and staff in NICUs across Telangana to help them overcome barriers to breastfeeding, through a process of quality improvement. Through its Safe Care, Saving Lives program, ACCESS Health teaches hospitals how to use quality improvement methodology to identify opportunities to increase newborn survival rates – such as early and exclusive breastfeeding – and implement changes in their NICUs to make sure those opportunities are not lost.

On her visit, Dr. Meier spoke with nearly 500 faculty and staff from hospitals that are implementing quality improvement initiatives through the Safe Care, Saving Lives program.

“It has been a great pleasure to meet and interact with so many wonderful doctors, nurses, mothers and the ACCESS Health International team. I am deeply impressed with India’s commitment to breastfeeding and the acknowledgement of the value of a mother’s milk,” said Dr. Meier, Professor of Pediatrics and a Professor of Nursing at Rush University Medical Center in Chicago. “The support and expansion of donor milk banks is also very positive as it puts the necessary equipment and services needed for lactation support in reach of all mothers. However we do need to keep in mind that anything other than a mother’s own milk can never match this lifesaving medicine. In a resource constrained country we need to ensure that all available resources are used in the most effective way and in all our research we have found that mother’s own milk is a vital component in newborn care.”

Dr. Meier also spoke about health outcomes and the value that the relatively low cost of human milk feeding for very low birth weight infants brings in terms of newborn survivals. She also spoke about how governments and policymakers can take positive and concrete steps to promote breastfeeding. She shared evidence from her studies that the cost of providing mothers own milk per baby for entire NICU hospitalization is $954.08 equivalent to 62000 rupees in the United States which was a fraction of the cost for treatment of sepsis, necrotizing enterocolitis etc. Mothers own milk given to babies admitted in NICU can reduce the NICU stay of babies and bring down costs significantly. She also shared that the monetary value of every 1 ml of mother’s milk received by the baby during the first 14 days of life is worth 565 USD in decreasing NICU care costs.

Dr. Meier visited three hospitals and spoke to their faculty and staff: Niloufer Hospital, Government Modern Maternity Hospital-Petlaburz, Mahatma Gandhi Memorial Hospital Warangal. Faculty and staff from other hospitals were also invited to participate in the academic learning sessions organized during at the three hospitals. Faculty and staff from the Government Maternity Hospital-Hanamkonda, CKM Maternity Hospital, Gandhi Hospital, Government Maternity Hospital, Sultan Bazaar and members of the Warangal chapters of the Indian Academy of Paediatrics (IAP), and the Federation of Obstetrics and Gynecology all participated.

Dr. Meier ended her visit by saying, “I look forward to continuing to work with such wonderful people in a beautiful country.”

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Healthcare leaders in Telangana joined together at Niloufer Hospital to pledge their support to improve health outcomes for babies born preterm. Premature birth and low birthweight is a leading cause of infant mortality in India.

At Niloufer Hospital today, Dr. K Manohar, CEO of the Aarogyasri Health Care Trust, and Dr. Ramesh Reddy, Director Medical Education of the Government of Telangana joined the Medical Superintendent of Niloufer, Dr. Murali Krishna, and other key staff from the hospital, the Head of the Neonatal Intensive Care Unit of Fernandez Hospital, and representatives from ACCESS Health International, UNICEF, and the National Neonatology Forum to place their handprints on a white sheet to symbolize their promise to ensure that preterm babies are given access key interventions that can help ensure their survival. Two infants who were born preterm with birthweight between 700-900 grams were successfully managed at Niloufer Hospital, and present with their mothers for the event.

Telangana has become a leader in providing quality care to newborns in India. Recently, the Ministry of Health and Family Welfare has been ranked Telangana second in the country in terms of quality of care in Special Newborn Care Units. For the country overall, while there have been recent declines in maternal and neonatal mortality too many babies continue to die of complications due to premature birth. Of the 27 million babies born in India annually, approximately 13 percent (3.5 million) are born preterm and more than one quarter (7.6 million) have low birthweight. Being born prematurely or with a low birthweight significantly increases the risk of dying in the days immediately following birth.

Participants at today’s events pledged to implement a series of key interventions that can improve survival rates of preterm babies:

  • Providing antenatal corticosteroids to mothers at risk of preterm delivery that have been proven to reduce morbidity and mortality for newborns
  • Skin to skin contact, called Kangaroo Mother Care, between babies and their mothers, fathers, grandmothers or other loved ones
  • Respiratory support to help the lungs of preterm babies grow strong, including continuous positive airway pressure, caffeine, surfectants, and other tools
  • Early and exclusive breastfeeding

Dr. K Manohar, CEO of the Aarogyasri Health Care Trust assured the availability of  Aarogyasri revolving fund to be used for Quality improvement initiatives for newborns.

According to Dr Ramesh Reddy, Director Medical Education of the Government of Telangana, “Today, the maximum number of premature babies are referred to Niloufer hospital. At any given time there are 250 to 300 babies in the hospital. The state government has taken steps to provide advanced infrastructure to this hospital including level three facilities, high frequency ventilators, round the clock laboratory facilities and free supply of medicines. I believe that with Quality Improvement initiatives, a robust infrastructure, and introduction of KCR kit program, we will be able to save more premature babies. Though Telangana’s performance in terms of neonatal and maternal mortality rates is lower than most states, we look forward to higher survival rates and better ranking.”

Dr. Himabindu Singh, Head of the Department of Neonatology at Niloufer Hospital mentioned that Niloufer Hospital has been actively adopting low cost solutions to help preterm births. She mentioned that Niloufer is the only government hospital in Telangana that provides tertiary care for newborns. Further Dr Singh said that, Niloufer is the single government hospital in India with advanced services, example human milk bank and management of retinopathy of prematurity in preterm babies.

Dr Ajitkumar Sudke, Director of Quality and Process Improvement at ACCESS Health International added, “We know the interventions that can save the lives of preterm babies. The challenge now is to make sure frontline healthcare workers have the support they need to identify the main causes of newborn death in their own hospitals and to apply the proven interventions that can save newborn lives. Teaching healthcare workers about the process of quality improvement is one of the best ways to provide support.” ACCESS Health has been implementing a quality improvement program at Niloufer and other hospitals affiliated with the Aarogyasri Health Care Trust called Safe Care, Saving Lives.

Dr. Srinivas Murki, Head of Neonatal Intensive Care Unit at Fernandez Hospital both highlighted the importance of improving the quality of care for newborns and finding simple, small measures through a quality improvement process to significantly advance health outcomes for preterm babies. He shared that the reasons for preterm births included early age at marriage, early or late age at conception, high prevalence of anemia, and infections. He mentioned that implementing low cost solutions will help the state achieve the neonatal mortality reduction targets.

Other honorary guests present at the event included Dr.Srikrishna, Child Health Consultant, UNICEF Hyderabad, Dr. M Surendranath, Secretary, National Neonatology Forum, Telangana State Chapter, and Dr. Kalyan Srinivas, Associate Professor, Department of Neonatology, Niloufer Hospital.

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