A lot more needs to be done. It seems many educational institutions are jumping on the band wagon of encouraging more testing for diabetes. But calling for more testing is not getting the job done. Unless this call is turned into action, nothing will change. And this is all to often the case. Calls go out, but no one follows through to see that doctors are doing this and often the insurance companies are discouraging them.
If these institutions would encourage their medical schools to spread the word and talk to their graduates, more good might happen. What might assist if pressure on the medical insurance industry to request doctors do this to remain on the approved list. Doubt insurance would consider, but it could save them big bucks in the long term.
In addition they would actually be doing some excellent preventative medicine and developing customer relations. What is it going to take to get everyone on board and taking action. I suspect it is a task for people in a position to call investigations and enact legislation that might force this stalemate.
Yes, why even have elected officials if they cannot act on behalf of their constituents. The Alzheimers Association has a national plan. What can't the American Diabetes Association have a national plan. Probably because it is not part of their 2011 priorities.
Many of the Type 1 people are talking about talking to their elected officials and are doing this, but it is not even on the agenda for the ADA. This is another reason those of us with Type 2 need a new organization that will advocate for 90 to 95 percent of the people with diabetes.
Using the HbA1c test as a screening test is somewhat practical, but both tests should be preformed. If getting this started requires giving up one test, then so be it. In the January 2011 issue of the American Journal of Preventive Medicine, a study reports that the A1c test can be administered in the physician's office and will identify pre-diabetes.
If they can identify more individuals with pre-diabetes in the physicians office, it will give an opportunity to stop the progression of the disease and possibly delay diabetes for many years. This would be a win for the people in terms of healthcare and even a win for the medical insurance industry with less expenses.
If you are considering being tested, learn the signs for risk for diabetes. They are high blood pressure or heart disease, being overweight or obese, or a family history of diabetes, over the age of 45, and are a woman with a past gestational diabetes, get yourself tested to determine if you have prediabetes. If you are diagnosed as having pre-diabetes, loosing as little as 10 to 15 pounds through exercise and diet will cut your chances in half of developing diabetes. This will improve your health dramatically if you treat it as serious and keep working at it.
Read the article on the study here and good luck. For those of us already with diabetes, if you can work this in with a friend that shows the above probabilities, do it politely and explain how it can help.
This article appeared on January 13, 2011. It is not a total shock that they say that nearly one-half of the people with Type 2 diabetes do not manage it. From the persons I know locally, I thought the percentage would have been nearer 60 percent.
Don't get me wrong, nearly 50 percent is horrible, and coming from the Centers for Disease Control, I can trust these numbers a lot more that my own observations. This public health initiative is between the doctors of endocrinology and two large pharmacological companies.
This may be a lofty project, but at least some of the people in a position to do so are involved. Now the problem will be if we can get them behind the screening for diabetes and pre-diabetes.
January 14, 2011
January 11, 2011
ADA Has Legislative Priorities?
Well, on January 6, 2011, the American Diabetes Association finally issued their 2011 legislative priorities. While reasonable, I see nothing innovative or challenging in their agenda. It is good to know that they continue to back federal funding for several established government agencies.
Since they don't wish to be specific in their priorities, this should not be a challenge since most of the Federal funding of this will probably be funded, but to a lesser degree than previously with the cutbacks necessary to rein in our bloated budget. I sincerely hope that this has some success.
Now to take the remaining list of priorities and my comments.
Health Reform Defense & Implementation – focus on access to quality, affordable coverage that provide people with, and at risk for, diabetes the tools necessary to manage diabetes and prevent its onset and complications
I have to wonder why this means defending the Affordable Care Act (ACA) which congress is under mandate from the people to repeal. Plus if they are participating in the legal defense, I think this would be wrong on so many levels. We do need affordable coverage and many people do need the tools to manage diabetes to prevent its onset and complications. This seems such a mild statement, that one must wonder what they expect to accomplish. ADA's track record is not even a fair rating in the past.
Prevention – focus on primary prevention of type 2 diabetes centered on prediabetes, physical activity and nutrition
If they follow through with this, this could be great. Again they fail to mention any specifics and this should always be a top priority, especially the way they expect the number of people with diabetes to increase.
Eliminating Disparities in Diabetes Prevention and Access to Care Act to address racial and ethnic disparities
This is an excellent goal, but hopefully will encompass financial disparities. Otherwise this priority will fail.
Gestational Diabetes Act to expand diagnosis, data collection and treatment
This does reflect the major change in policy and definition for gestational diabetes in the 2011 Care Guide. For this issue alone they get my praise for something positive.
Diabetes Screening and Medicaid Savings Act to provide screening and diabetes care under Medicaid
A good priority, but lacks support in encouraging the insurance industry and Medicare to provide necessary screening from children to the elderly.
Stem Cell Research
This is too broad a priority and should be limited to research for diabetes applications only.
Health Entitlement Programs including Medicare and Medicaid
Should include all, meaning not only Medicare and Medicaid, but the medical insurance industry as well.
Discrimination Issues
Time for ADA to act accordingly and end their own discrimination. The one area they listed is worthy, but does not address ADA's own discrimination.
Bills Related to Complications and Comorbidities of Diabetes
This is very general as it needs to be. What legislation will be introduced remains a mystery until introduction.
These are at best broad priorities for an organization that should also have some specific goals and priorities. I would hopefully think they could publish some specific goals and priorities.
The listed or published priorities are in and of themselves very discriminatory. No where is any mention made of doing anything for Type 1 diabetes. Only Type 2 is given a mention. It is small wonder that the number one complaint against the ADA is their discrimination against Type 1, yet at every chance they get they will take credit for something the JDRF accomplishes.
I agree with those that want to hold ADA's feet to the fire for their lack of attention to Type1 priorities. Even the monogenic diabetes classifications get no mention in their priorities. While Type 2 is about 95 percent of all diabetes, does this mean that the others deserve no mention. I don't think so! I also will not accept that the word diabetes means all types when one type, Type 2 is singled out.
Read their priorities here, a slightly expanded version here, and if interested a list of the officers here.
Since they don't wish to be specific in their priorities, this should not be a challenge since most of the Federal funding of this will probably be funded, but to a lesser degree than previously with the cutbacks necessary to rein in our bloated budget. I sincerely hope that this has some success.
Now to take the remaining list of priorities and my comments.
Health Reform Defense & Implementation – focus on access to quality, affordable coverage that provide people with, and at risk for, diabetes the tools necessary to manage diabetes and prevent its onset and complications
I have to wonder why this means defending the Affordable Care Act (ACA) which congress is under mandate from the people to repeal. Plus if they are participating in the legal defense, I think this would be wrong on so many levels. We do need affordable coverage and many people do need the tools to manage diabetes to prevent its onset and complications. This seems such a mild statement, that one must wonder what they expect to accomplish. ADA's track record is not even a fair rating in the past.
Prevention – focus on primary prevention of type 2 diabetes centered on prediabetes, physical activity and nutrition
If they follow through with this, this could be great. Again they fail to mention any specifics and this should always be a top priority, especially the way they expect the number of people with diabetes to increase.
Eliminating Disparities in Diabetes Prevention and Access to Care Act to address racial and ethnic disparities
This is an excellent goal, but hopefully will encompass financial disparities. Otherwise this priority will fail.
Gestational Diabetes Act to expand diagnosis, data collection and treatment
This does reflect the major change in policy and definition for gestational diabetes in the 2011 Care Guide. For this issue alone they get my praise for something positive.
Diabetes Screening and Medicaid Savings Act to provide screening and diabetes care under Medicaid
A good priority, but lacks support in encouraging the insurance industry and Medicare to provide necessary screening from children to the elderly.
Stem Cell Research
This is too broad a priority and should be limited to research for diabetes applications only.
Health Entitlement Programs including Medicare and Medicaid
Should include all, meaning not only Medicare and Medicaid, but the medical insurance industry as well.
Discrimination Issues
Time for ADA to act accordingly and end their own discrimination. The one area they listed is worthy, but does not address ADA's own discrimination.
Bills Related to Complications and Comorbidities of Diabetes
This is very general as it needs to be. What legislation will be introduced remains a mystery until introduction.
These are at best broad priorities for an organization that should also have some specific goals and priorities. I would hopefully think they could publish some specific goals and priorities.
The listed or published priorities are in and of themselves very discriminatory. No where is any mention made of doing anything for Type 1 diabetes. Only Type 2 is given a mention. It is small wonder that the number one complaint against the ADA is their discrimination against Type 1, yet at every chance they get they will take credit for something the JDRF accomplishes.
I agree with those that want to hold ADA's feet to the fire for their lack of attention to Type1 priorities. Even the monogenic diabetes classifications get no mention in their priorities. While Type 2 is about 95 percent of all diabetes, does this mean that the others deserve no mention. I don't think so! I also will not accept that the word diabetes means all types when one type, Type 2 is singled out.
Read their priorities here, a slightly expanded version here, and if interested a list of the officers here.
January 6, 2011
National Action Plan for Alzheimer's Disease is Law
Well it was bound to happen. President Obama signed the National Alzheimer's Project Act (NAPA) into law on January 4, 2011. This provides Alzheimer's disease with its first national plan to fight the disease. According to the author this was needed to abate the threat to bankrupt the US healthcare system.
I thought from all the press about diabetes and the rate of diabetes increase, that diabetes is what will bankrupt our healthcare system. I am happy for the Alzheimer's Association as this is a big step in finding ways to stop the spread of Alzheimer's disease and I do not want to belittle this accomplishment.
Now, if you will permit me, I need to rant about the American Diabetes Association and their lack of getting anything similar done. I don't know how we as patients are going to be able to influence the leadership of the ADA to do something similar, but I feel there is a need and it is long past time that someone lit a very hot fire under their backsides.
It seems that if they are doing any lobbying, it is very ineffective and they are spending the money in unproductive activities. It seems to me that the powers of ADA are more interested in anything other than getting the recognition on a national or even world wide basis. Otherwise, we should be seeing more activity and be reading more press about the accomplishments of the ADA.
Thank goodness, the International Diabetes Federation seems to have more interest and is working with governments around the world to put forth the need for diabetes recognition. This is a lot harder than working with one government. So to the ADA, I issue a challenge to quit being so sedentary and start accomplishing something which will bring more press to diabetes.
So before I forget it, please read the short article about the Alzheimer's plan here. Wish them well and start working on ADA to get something accomplished.
I thought from all the press about diabetes and the rate of diabetes increase, that diabetes is what will bankrupt our healthcare system. I am happy for the Alzheimer's Association as this is a big step in finding ways to stop the spread of Alzheimer's disease and I do not want to belittle this accomplishment.
Now, if you will permit me, I need to rant about the American Diabetes Association and their lack of getting anything similar done. I don't know how we as patients are going to be able to influence the leadership of the ADA to do something similar, but I feel there is a need and it is long past time that someone lit a very hot fire under their backsides.
It seems that if they are doing any lobbying, it is very ineffective and they are spending the money in unproductive activities. It seems to me that the powers of ADA are more interested in anything other than getting the recognition on a national or even world wide basis. Otherwise, we should be seeing more activity and be reading more press about the accomplishments of the ADA.
Thank goodness, the International Diabetes Federation seems to have more interest and is working with governments around the world to put forth the need for diabetes recognition. This is a lot harder than working with one government. So to the ADA, I issue a challenge to quit being so sedentary and start accomplishing something which will bring more press to diabetes.
So before I forget it, please read the short article about the Alzheimer's plan here. Wish them well and start working on ADA to get something accomplished.
January 5, 2011
Benefits Found for Colonoscopies
Bob Pedersen, a fellow Type 2 blogger first wrote about his experience of having a colonoscopy here (link is broken and site no longer exists). It was humorous and to the point. They put me under as well using an IV and a slow drip. I have had five of these and only one that was without polyps. All have been negative for cancer. The first was at age 55 and one polyp was considered by the physician as about six months precancerous.
Now a study from Germany offers strong evidence that they can prevent colorectal cancers throughout the colon. The study appears in the January 4 issue of Annals of Internal Medicine.
A colonoscopy is one of the most effective cancer screening and prevention exams. That being said, recent studies have raised issues that a colonoscopy may not be useful in detecting some colorectal cancers. However, the issue raising studies were done in Canada. Colonoscopies are the standard in Europe and the US and apparently are better used.
Most in Canada are performed by surgeons and primary care doctors and not gastroenterologists who specialize in the exam. This could be what has caused the problem with the studies.
We definitely have a need for the exam to be performed with the flexible fiberoptic scope with a video camera as the other exams are not as accurate and the fecal occult blood testing often did not see results until cancer was already in place and doing damage. Granted they were lower cost and while there was strong evidence that they were effective, there is still some serious questions about whether more cancer is prevented using the old tests.
There are some problems in the US because gastroenterologists are not required to document the thoroughness of the exam and many people to not receive information after the procedure showing a map of the colon and where the polyps were found. In Germany the quality assurance measures have been introduced nationwide.
I have had both types of exam where I received a complete report and map and then I have not received a complete report. Some standardization needs to be put in place and patients need this complete information.
Since most colorectal cancers take five to seven years to develop on polyps, I agree that the exam needs to take place at least every five years at a minimum. When polyps are found on a regular basis, then I agree that every three years should be normal as are mine. The recommendation is that people should have the exam starting at age 50 unless there are indications for earlier exams.
Do I dare ask questions of or about the gastroenterologist? Yes, everyone should ask at least two questions when the schedule is set for the exam. They are the detection rate for the person performing the colonoscopy and what documentation will be presented upon completion and will it be for the entire colon. If it not for the entire colon, then think seriously about finding another gastroenterologist.
Read about the article on the study here and here. Also view an excellent slide show on colorectal cancer overview here.
Now a study from Germany offers strong evidence that they can prevent colorectal cancers throughout the colon. The study appears in the January 4 issue of Annals of Internal Medicine.
A colonoscopy is one of the most effective cancer screening and prevention exams. That being said, recent studies have raised issues that a colonoscopy may not be useful in detecting some colorectal cancers. However, the issue raising studies were done in Canada. Colonoscopies are the standard in Europe and the US and apparently are better used.
Most in Canada are performed by surgeons and primary care doctors and not gastroenterologists who specialize in the exam. This could be what has caused the problem with the studies.
We definitely have a need for the exam to be performed with the flexible fiberoptic scope with a video camera as the other exams are not as accurate and the fecal occult blood testing often did not see results until cancer was already in place and doing damage. Granted they were lower cost and while there was strong evidence that they were effective, there is still some serious questions about whether more cancer is prevented using the old tests.
There are some problems in the US because gastroenterologists are not required to document the thoroughness of the exam and many people to not receive information after the procedure showing a map of the colon and where the polyps were found. In Germany the quality assurance measures have been introduced nationwide.
I have had both types of exam where I received a complete report and map and then I have not received a complete report. Some standardization needs to be put in place and patients need this complete information.
Since most colorectal cancers take five to seven years to develop on polyps, I agree that the exam needs to take place at least every five years at a minimum. When polyps are found on a regular basis, then I agree that every three years should be normal as are mine. The recommendation is that people should have the exam starting at age 50 unless there are indications for earlier exams.
Do I dare ask questions of or about the gastroenterologist? Yes, everyone should ask at least two questions when the schedule is set for the exam. They are the detection rate for the person performing the colonoscopy and what documentation will be presented upon completion and will it be for the entire colon. If it not for the entire colon, then think seriously about finding another gastroenterologist.
Read about the article on the study here and here. Also view an excellent slide show on colorectal cancer overview here.
January 1, 2011
CPAP Is A Carry-on for Air Travel
If you have obstructive sleep apnea and use a CPAP (or other XPAP) machines, please know that if you travel on aircraft, this equipment is allowed as a carry-on in addition to one other piece plus a personal bag such as a purse or briefcase. This is in the Department of Transportation rules which states an allowance for medical supplies and/or assistive devices.
Please do not check it as luggage. It can be damaged or lost. If you are questioned or it is deemed that it must be checked as luggage, it would be a good idea to have a print out with you to present. This can be found here.
TSA often does not know their own regulations in detail. In the above reference it does provide an email address - airconsumer@ost.dot.gov for filing complaints. There is also a site to download forms to mail in complaints.
Also it is advisable to carry a letter of medical need signed by your doctor on his letterhead paper. This has come in handy for me.
Read the reference here.
Please do not check it as luggage. It can be damaged or lost. If you are questioned or it is deemed that it must be checked as luggage, it would be a good idea to have a print out with you to present. This can be found here.
TSA often does not know their own regulations in detail. In the above reference it does provide an email address - airconsumer@ost.dot.gov for filing complaints. There is also a site to download forms to mail in complaints.
Also it is advisable to carry a letter of medical need signed by your doctor on his letterhead paper. This has come in handy for me.
Read the reference here.
December 30, 2010
Why Do We Need New Years Resolutions?
I have never seen the need. One time I tried a couple, by the end of January they were no more.
Everyone seems to think they are needed and many are blogging about how to make them achievable. Granted, most that I hear are so grandiose that it is small wonder they can't be kept. Many are totally impracticable and impossible to keep in the first place. So why even make them. This takes all the fun out of the new year and sets a pattern of failure which many people then follow for the rest of the year.
Jen Hubley, the About Today Editor at about dot com started her newsletter for December 29, 2010 stating “New Year's Resolutions: So easy to make, so hard to keep. Unless, like me, you resolve every year to stop setting unreasonable goals. Then you can start out by not making resolutions, and you're already a winner.”
Then she had to ruin her excellent start by proposing some ways to make New Year's Resolutions. Not really, but she does link to lots of types of resolutions written by others at about dot com.
Have a Happy New Year!
Everyone seems to think they are needed and many are blogging about how to make them achievable. Granted, most that I hear are so grandiose that it is small wonder they can't be kept. Many are totally impracticable and impossible to keep in the first place. So why even make them. This takes all the fun out of the new year and sets a pattern of failure which many people then follow for the rest of the year.
Jen Hubley, the About Today Editor at about dot com started her newsletter for December 29, 2010 stating “New Year's Resolutions: So easy to make, so hard to keep. Unless, like me, you resolve every year to stop setting unreasonable goals. Then you can start out by not making resolutions, and you're already a winner.”
Then she had to ruin her excellent start by proposing some ways to make New Year's Resolutions. Not really, but she does link to lots of types of resolutions written by others at about dot com.
Have a Happy New Year!
December 25, 2010
Medically Induced Diabetes
What is this you say? Why would anyone allow diabetes to be induced. It is one of the types of diabetes that is recognized by the American Diabetes Association (ADA). I feel that there is one exception that is not officially recognized by the ADA, but still exists in daily life.
I will start with the not recognized diabetes which I will emphasize is not considered by the ADA. This is when an accident happens which severely damages the pancreas making it incapable of insulin production. This does not happen that often, but there are a few individuals in this unofficial category.
The medically induced is simply called – Drug- or chemical-induced diabetes. There are apparently many drugs that can impair insulin secretion, but not cause diabetes by themselves. These drugs can start diabetes in people with insulin resistance. When this happens, the classification is difficult because the sequence or importance of the beta-cell dysfunction and insulin resistance in unknown.
Some toxins like Vacor (a rat poison) and intravenous pentamidine can destroy pancreatic beta-cells, but these are rare. There are many drugs and hormones that can affect insulin action. A list (link is broken) in table one is not all-inclusive, but includes the more commonly recognized drug-, hormone-, or toxin-induced forms of diabetes.
When I was told recently that a friend had medically induced type 2 diabetes, I had to look this up. There is only a classification of medically induced and no type associated with it. I am not going to debate this until the ADA does more clarification or assigns a type. Then there is diabetes resulting from prescription steroids.
Medically induced diabetes is still diabetes and must be treated as such. Some are treated with oral medications and the rest with insulin depending on the damage done to the pancreas. Most of the few that have accident caused diabetes are on insulin.
Read the ADA definitions here. This definitions for the above discussion are about one-third to one half way down the page.
I will start with the not recognized diabetes which I will emphasize is not considered by the ADA. This is when an accident happens which severely damages the pancreas making it incapable of insulin production. This does not happen that often, but there are a few individuals in this unofficial category.
The medically induced is simply called – Drug- or chemical-induced diabetes. There are apparently many drugs that can impair insulin secretion, but not cause diabetes by themselves. These drugs can start diabetes in people with insulin resistance. When this happens, the classification is difficult because the sequence or importance of the beta-cell dysfunction and insulin resistance in unknown.
Some toxins like Vacor (a rat poison) and intravenous pentamidine can destroy pancreatic beta-cells, but these are rare. There are many drugs and hormones that can affect insulin action. A list (link is broken) in table one is not all-inclusive, but includes the more commonly recognized drug-, hormone-, or toxin-induced forms of diabetes.
When I was told recently that a friend had medically induced type 2 diabetes, I had to look this up. There is only a classification of medically induced and no type associated with it. I am not going to debate this until the ADA does more clarification or assigns a type. Then there is diabetes resulting from prescription steroids.
Medically induced diabetes is still diabetes and must be treated as such. Some are treated with oral medications and the rest with insulin depending on the damage done to the pancreas. Most of the few that have accident caused diabetes are on insulin.
Read the ADA definitions here. This definitions for the above discussion are about one-third to one half way down the page.
December 22, 2010
Learn How to Manage Holiday Stress
Many people are telling us how to minimize the stress of the holiday season. Some are excellent, some are okay, and others almost seem to create more stress than help reduce stress. I am looking as this as a person with diabetes. What works for some may not work for all us. Stress makes management of blood glucose levels more difficult.
This article fits and includes many of the criteria for reducing stress. The most important point is not forgetting to take care of ourselves. There are many points that can be included in taking care of ourselves. These also work for minimizing depression. Learn to manage your diabetes routine and expectations to make the holidays enjoyable.
Make sure that you maintain a good sleep schedule. This means not shorting the amount of sleep and getting the eight hours needed each night. Sleep deprivation is a negative factor in managing your blood glucose levels and can make it more difficult.
Avoid overeating or loading up on carbohydrates. This will force blood glucose management out the window. Know you limits and stick to them. If you must have the extra piece of desert or extra serving of your favorite food remember to plan for some exercise before eating and some light exercise after eating to help burn the extra carbohydrates. Those of us on insulin have a much easier time, but we still need to be careful of the extra carbohydrates.
This is important – know your limits. Avoid family gatherings that include airing family issues and grievances. It is often better to miss these gatherings than feel resentful for days afterward. It is better exercising restraint beforehand than dealing with problem relatives and letting them raise your blood pressure.
Rather than staying late at gatherings, leave early when necessary to allow yourself some time unwind and relax before bed time. Allow time for taking a walk if possible or other types of exercise. Take a good hot shower or soak in the tub to wash the day's stress away. In other words, take care of yourself first and don't let little things become mountains.
Learn to budget your time and patience for the holidays to get the most enjoyment out of them for you. If you have something that reduces the stress for you, do it. You are worth it!
I cannot leave this without adding another reference that may reduce the food stress for the holidays. Even though the author does not have diabetes, he knows how to adapt for diabetes. His blog has a practical way to handle the eating stress many of us feel during the holidays. Though he probably was not thinking stress, his blog has some excellent tips. I use many of them, but never thought of them the way he presents the ideas.
Happy holidays!
This article fits and includes many of the criteria for reducing stress. The most important point is not forgetting to take care of ourselves. There are many points that can be included in taking care of ourselves. These also work for minimizing depression. Learn to manage your diabetes routine and expectations to make the holidays enjoyable.
Make sure that you maintain a good sleep schedule. This means not shorting the amount of sleep and getting the eight hours needed each night. Sleep deprivation is a negative factor in managing your blood glucose levels and can make it more difficult.
Avoid overeating or loading up on carbohydrates. This will force blood glucose management out the window. Know you limits and stick to them. If you must have the extra piece of desert or extra serving of your favorite food remember to plan for some exercise before eating and some light exercise after eating to help burn the extra carbohydrates. Those of us on insulin have a much easier time, but we still need to be careful of the extra carbohydrates.
This is important – know your limits. Avoid family gatherings that include airing family issues and grievances. It is often better to miss these gatherings than feel resentful for days afterward. It is better exercising restraint beforehand than dealing with problem relatives and letting them raise your blood pressure.
Rather than staying late at gatherings, leave early when necessary to allow yourself some time unwind and relax before bed time. Allow time for taking a walk if possible or other types of exercise. Take a good hot shower or soak in the tub to wash the day's stress away. In other words, take care of yourself first and don't let little things become mountains.
Learn to budget your time and patience for the holidays to get the most enjoyment out of them for you. If you have something that reduces the stress for you, do it. You are worth it!
I cannot leave this without adding another reference that may reduce the food stress for the holidays. Even though the author does not have diabetes, he knows how to adapt for diabetes. His blog has a practical way to handle the eating stress many of us feel during the holidays. Though he probably was not thinking stress, his blog has some excellent tips. I use many of them, but never thought of them the way he presents the ideas.
Happy holidays!
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