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Anafranil 50mg pills $153.00 Background

Anafranil 50mg pills $153.00 In 2011 I took a vacation from http://www.chronicpaindoctor.net to go work at Naval Hospital Camp Pendleton (NHCP) with Marines returning from Afghanistan. Anafranil 50mg pills $153.00 Camp Pendleton is the Marines main base an hour’s drive up I-5 from San Diego. Anafranil 50mg pills $153.00 NHCP is where the Navy implements its duty to provide the care Marines need as a result of their combat responsibilities. Anafranil 50mg pills $153.00 I took the job for 3 reasons: 1) to add to my knowledge about pain, anafranil 50mg pills $153.00 to see what the Navy had learned from a heavy concentration of pain cases about how to restore optimal functioning; 2) to treat Marines with chronic pain the “Navy way” and learn how to implement their rehab approach for chronic pain; and, anafranil 50mg pills $153.00 3) to give wounded Marines my personal “thanks” for their bravery in Afghanistan by extending to each one in pain a credentialed pain specialist’s best efforts to help restore function.

Anafranil 50mg pills $153.00 What follows are my observations extracted specifically from my experience with Marines who had diagnosable chronic pain disorders – often in combination with other combat-related disorders – and which I personally treated during 2011.

Anafranil 50mg pills $153.00 Functioning As An HMO, anafranil 50mg pills $153.00 Is NHCP Structured to Treat Chronic Pain? 

Anafranil 50mg pills $153.00 The quick answer is “No” because only if the structures are in place for a hospital to be enabled to effectively treat, anafranil 50mg pills $153.00 manage and rehabilitate chronic pain and restore function is it possible to rehabilitate chronic pain. Anafranil 50mg pills $153.00 Simply put, anafranil 50mg pills $153.00 the extent to which you ski is determined by the investment you make in developing the skill-knowledge needed to ski. Anafranil 50mg pills $153.00 Since NHCP made no investment in developing chronic pain rehab capabilities, anafranil 50mg pills $153.00 it has none to offer.

Anafranil 50mg pills $153.00 Problems of All Non-Pain Specialty Approaches to Treating Chronic Pain

Anafranil 50mg pills $153.00 The problem for those with chronic pain is that NHCP operates like any other HMO in the country and so it concentrates on offering only a narrow range of primary care services in general, anafranil 50mg pills $153.00 family and internal medicine. Anafranil 50mg pills $153.00 A few additional services in specialty medicine, anafranil 50mg pills $153.00 like Ob/Gyn and Pediatrics, anafranil 50mg pills $153.00 exist which, anafranil 50mg pills $153.00 in combination with the primary care services, anafranil 50mg pills $153.00 are available to anyone who is a beneficiary of Tricare, anafranil 50mg pills $153.00 the military’s health insurance. Anafranil 50mg pills $153.00 Medical needs that fall outside the hospital’s primary care area of practice ar simply not acknowledged and that is why they are never treated. Anafranil 50mg pills $153.00 Therefore, anafranil 50mg pills $153.00 those chronic complex disorders that do not “fit” the primary care acute care model, anafranil 50mg pills $153.00 referrals to “out-of-network” providers who are qualified to treat these disorders are rarely made. Anafranil 50mg pills $153.00 If as far as primary care providers a disorder is not acknowledged then no need exists to make a referral to someone who specializes in that disorder. Anafranil 50mg pills $153.00 Again, anafranil 50mg pills $153.00 the services needed to treat the chronic complex pain disorders that many Marines develop were never adequately treated for 18-24 months, anafranil 50mg pills $153.00 do not exist at NHCP.  The fact a Marine could be exposed to primary care or specialty care treatment at NHCP for 18-24 with no objective change in the Marine’s chronic pain condition provides evidence of the absence of qualified pain treatment at NHCP. Anafranil 50mg pills $153.00 Clearly engaging a pain patient in 18-24 months of inept, anafranil 50mg pills $153.00 failed treatment does nothing to provide stable enough pain relief, anafranil 50mg pills $153.00 restored function, anafranil 50mg pills $153.00 and a return to full-duty status, anafranil 50mg pills $153.00 all of which are the explicit duty of Navy doctors to provide wounded Marines. Anafranil 50mg pills $153.00 That the Naval Hospital at Camp Pendleton has chosen to administratively limit itself to functioning as a primary care hospital that does not offer a qualified chronic pain rehab program does not exculpate it and its doctors from its duty to treat wounded Marines according to the needs of their symptoms.

Anafranil 50mg pills $153.00 How Navy medicine manages a Marine with chronic complex pain reveals the same negligence seen in how civilian providers manage chronic complex pain – by either under treating or not treating it at all, anafranil 50mg pills $153.00 which leads to worsening of condition and a complex chain of further costly healthcare services in all pain patients. Anafranil 50mg pills $153.00 Marines are harmed further by terminating their careers without a solidly grounded differential diagnosis or proof of the failure of a demonstrably competent chronic pain rehab program. Anafranil 50mg pills $153.00 My experience in running a chronic pain rehab program is that ~70 percent of musculoskeletal pain cases could be restored to optimal functioning with that 12 months, anafranil 50mg pills $153.00 or about half the time that Marines in chronic pain are exposed to failed or inept acute approaches to chronic pain.

Anafranil 50mg pills $153.00 The Steps NHCP Uses to Evaluate Chronic Pain Complaints

Anafranil 50mg pills $153.00 The steps that Marines went through who I treated for chronic pain were as follows:

Anafranil 50mg pills $153.00 - All Marines are first evaluated by their BAS MOs (Battalion Aid Station Medical Officers), anafranil 50mg pills $153.00 family medicine residents not yet licensed to practice as independent physicians. Anafranil 50mg pills $153.00 Since BAS MOs work and live with and are deployed with the battalion, anafranil 50mg pills $153.00 they know individual Marines best and the likely conditions of their symptoms occurrence. Anafranil 50mg pills $153.00 Most complaints at the BAS level are acute and are resolved by usual care from a family medicine approach. Anafranil 50mg pills $153.00 However, anafranil 50mg pills $153.00 many Marine complaints surface once Marines are no long “in theater” where most believe they have “no time or stomach” for severe pain.  So once some Marines return to base, anafranil 50mg pills $153.00 chronic pain issues will emerge. Anafranil 50mg pills $153.00 When issues develop that require repeated visits over a period of 6-9 months to their BAS MOs for treatment to which the Marine fails to respond, anafranil 50mg pills $153.00 referral is then made further up the ladder;

Anafranil 50mg pills $153.00 - Primary care (physicians licensed in general medicine, anafranil 50mg pills $153.00 family practice or internal medicine) now evaluates the complaints  and starts a medication regimen that fits the acute care model of the primary care doctor and has nothing to do with the end objective of restoring function and a return to full-duty status.  This treatment usually shows no response within 4 weeks, anafranil 50mg pills $153.00 but it may be extended, anafranil 50mg pills $153.00 or literally forgotten, anafranil 50mg pills $153.00 for another 6-9 months. Anafranil 50mg pills $153.00 As with the BAS MO, anafranil 50mg pills $153.00 this is a similar treatment to which a Marine with an under or untreated pain disorder will fail to respond. Anafranil 50mg pills $153.00 Referral is now made to specialty medicine;

Anafranil 50mg pills $153.00 - Specialty medicine now evaluates the Marine’s complaints, anafranil 50mg pills $153.00 usually orthopedics, anafranil 50mg pills $153.00 neurology or psychiatry, anafranil 50mg pills $153.00 to rule out objective causes from the perspective of the particular specialty. Anafranil 50mg pills $153.00 More modifications to treatment are made over a period of another 9-15 months, anafranil 50mg pills $153.00 often with multiple prescription drugs to which the Marine with an inappropriately treated pain disorder will again fail to respond, anafranil 50mg pills $153.00 often with side effects that further exacerbate the pain condition and decrease his/her ability to function as a Marine.

Anafranil 50mg pills $153.00 - In several cases, anafranil 50mg pills $153.00 specialty medicine referred the Marine for evaluation by pain anesthesiologists at the Naval Medical Center at Balboa in San Diego where a competent differential diagnosis was obtained and medications to which the Marine finally began to respond well and to get some pain relief. Anafranil 50mg pills $153.00 However, anafranil 50mg pills $153.00 a solid diagnosis and some initial pain relief are not chronic pain rehabilitation by a qualified integrated interdisciplinary team where the primary responsibility of each of its members is chronic pain rehab alone. Anafranil 50mg pills $153.00 The problem was that there was no continuity of care by the pain anesthesiologists who knew how to best manage the pain; that responsibility fell back onto the BAS MO who, anafranil 50mg pills $153.00 once the prescription ended, anafranil 50mg pills $153.00 s/he might or might not renew, anafranil 50mg pills $153.00 completely change the treatment, anafranil 50mg pills $153.00 or be deployed and the Marine require transfer to a temporary BAS MO who would start this entire process all over again.

Anafranil 50mg pills $153.00 - By this time, anafranil 50mg pills $153.00 specialty medicine would usually begin to discuss preparation of the Marine’s Medical Board, anafranil 50mg pills $153.00 terminating his/her career in the Marine Corps. Anafranil 50mg pills $153.00 This without the chronic complex and disabling pain disorder ever being competently diagnosed, anafranil 50mg pills $153.00 effectively treated (and confirming the diagnosis) and having this entered in the Marine’s AHLTA medical chart to document, anafranil 50mg pills $153.00 once s/he went to request treatment from a civilian provider that the Marine was a legitimate chronic pain patient as evidenced in a credible military document by a qualified physician who treated the Marine’s pain and could attest to it if the civilian physician felt the need to do so.

Anafranil 50mg pills $153.00 With the Marine’s career ended thanks to a chronic pain disorder that the Marine has no awareness of what its causes are, anafranil 50mg pills $153.00 how to relieve the pain, anafranil 50mg pills $153.00 manage the conditions of its occurrence, anafranil 50mg pills $153.00 what to do to return to optimal functioning (allowing for regular employment), anafranil 50mg pills $153.00 and to enjoy increased quantity of life within his/her unique life situation.

Anafranil 50mg pills $153.00 The Result of “Business As Usual” At NHCP

Anafranil 50mg pills $153.00 In other words, anafranil 50mg pills $153.00 the outcome of a military medicine approach to chronic complex pain is no different from that seen in the private sector when chronic pain patients are seen by independent practitioners and left with the same disabling conditions that will lead to unending high frequency use of medical visits, anafranil 50mg pills $153.00 prescription medications, anafranil 50mg pills $153.00 diagnostic and laboratory studies, anafranil 50mg pills $153.00 the ER, anafranil 50mg pills $153.00 hospitalization and unnecessary surgery. Anafranil 50mg pills $153.00 To this must be added becoming totally disabled, anafranil 50mg pills $153.00 unemployed, anafranil 50mg pills $153.00 divorced, anafranil 50mg pills $153.00 with loss of children, anafranil 50mg pills $153.00 in medical bankruptcy, anafranil 50mg pills $153.00 living alone, anafranil 50mg pills $153.00 being highly prone to developing multiple chronic diseases, anafranil 50mg pills $153.00 intractable pain (see http://intractablepaindisease.com), anafranil 50mg pills $153.00 along with a likely addiction to alcohol and prescription or street drugs.

Anafranil 50mg pills $153.00 Finally, anafranil 50mg pills $153.00 my experience included a clear case of no leadership on the part of the psychiatrist who was in charge of the Wounded Warrior Battalion who knew I was credentialed in pain management and was bound to practice based on the ethical standards of my diplomate with the American Academy of Pain Management (AAPM) and who told me to “do less pain management and something more psychological.”  Ultimately he demanded I become credentialed in health psychology – which is not an evidence-based procedure for rehabilitating chronic complex pain – or not have my contract renewed. Anafranil 50mg pills $153.00 I chose to stick by the ethical standards of the AAPM and did leave.

Anafranil 50mg pills $153.00 Marine Myths about NHCP

Anafranil 50mg pills $153.00 NHCP knows and treats everything. Anafranil 50mg pills $153.00 No it doesn’t. Anafranil 50mg pills $153.00 NHCP only has the evidence-based skill-knowledge set for primary care – or the perspective of general, anafranil 50mg pills $153.00 family or internal medicine plus a few specialty medical services. Anafranil 50mg pills $153.00 That’s it. Anafranil 50mg pills $153.00 Marines should not expect more. Anafranil 50mg pills $153.00 For Marines with pain that has lasted more than 3 months and for whom the usual medical care offered at NHCP has done nothing to restore their ability to function, anafranil 50mg pills $153.00 NHCP lacks the MOS to treat, anafranil 50mg pills $153.00 manage or rehab a Marine’s chronic pain disorders. Anafranil 50mg pills $153.00 The likelihood is that a Med Board will be the outcome for those with chronic pain.

Anafranil 50mg pills $153.00 Specialized rehab programs for chronic pain exist at NHCP.  They do not. Anafranil 50mg pills $153.00 There are many rehab programs in hospitals around the country. Anafranil 50mg pills $153.00 The classic ones are Cardiac Rehab, anafranil 50mg pills $153.00 and Diabetes Rehab, anafranil 50mg pills $153.00 and they all have the same characteristics: an integrated interdisciplinary team who are all knowledgeable about chronic pain with the single minded objective being to: (a) restore optimal behavioral and molecular to the patient as evidenced by objective behavioral and molecular markers, anafranil 50mg pills $153.00 and (b) turning over to the patient the responsibility of self-managing the conditions of their pain’s occurrence.

Anafranil 50mg pills $153.00 If one has chronic pain, anafranil 50mg pills $153.00 one can quickly get to see a pain specialist at NHCP. Anafranil 50mg pills $153.00 Not possible. Anafranil 50mg pills $153.00 A chronic pain specialty requires special education, anafranil 50mg pills $153.00 training, anafranil 50mg pills $153.00 experience and credentialing. Anafranil 50mg pills $153.00 There are no such providers at NHCP. Anafranil 50mg pills $153.00 Pain specialists are available at Balboa but it takes a long time to go through the steps to get a referral to Balboa. Anafranil 50mg pills $153.00 And then it’s just for a “differential diagnosis” that will probably be the basis for your Med Board rather than for ongoing treatment, anafranil 50mg pills $153.00 relief of pain and restored ability to function (especially in “full-duty status”).

Anafranil 50mg pills $153.00 The Med Board process is no big deal. Anafranil 50mg pills $153.00 Not really. Anafranil 50mg pills $153.00 Most wounded Marines who I saw at Camp Pendleton ended up being “med boarded” out of the Marines – at great harm to the Marine – not because the Marine had a specific, anafranil 50mg pills $153.00 diagnosable condition that made him/her “unfitting” for duty. Anafranil 50mg pills $153.00 That their disorder rendered them “unfitting” never could be confirmed because they were never exposed to the appropriate treatment for chronic pain, anafranil 50mg pills $153.00 which when done right, anafranil 50mg pills $153.00 could have confirmed if their pain disorder really rendered them “unfit” by disappearing. Anafranil 50mg pills $153.00 Instead, anafranil 50mg pills $153.00 Marines with chronic pain were summarily “med boarded” out of the Marines because the Marine’s pain disorder did not respond to general medicine’s acute perceptions, anafranil 50mg pills $153.00 treatment and management approach to pain and your chronic pain failed to respond to their mistaken expectations.

Anafranil 50mg pills $153.00 If a provider at NHCP says I don’t have chronic pain it’s so.  Not so, anafranil 50mg pills $153.00 not today when evidence-based pain management is what we practice, anafranil 50mg pills $153.00 rather than philosophy and the unsupported use of words. Anafranil 50mg pills $153.00 Scientific pain management exposes the patient to the evidence-based treatment for the specific pain condition that is implemented by an integrated interdisciplinary team qualified in providing chronic pain rehab. Anafranil 50mg pills $153.00 If the Marine’s chronic pain responds to the qualified version of chronic pain treatment within the expected period of time, anafranil 50mg pills $153.00 there is confirmation of the pain condition and the primary care doctor’s diagnosis is therefore false. Anafranil 50mg pills $153.00 If there is no response to the chronic pain treatment, anafranil 50mg pills $153.00 there is no confirmation of the pain condition and the chronic pain specialist’s diagnosis is therefore false.

Anafranil 50mg pills $153.00 It’s easy for a neurologist to see the real causes of pain. Anafranil 50mg pills $153.00 No so. Anafranil 50mg pills $153.00 Take the case of a 20 y/o Lance Corporal “mortar man” who was on patrol in enemy territory carrying a heavy mortar barrel by wrapping both his arms around the mortar barrel and resting it over his traps as one might hold a heavy barbell prior to doing squats. Anafranil 50mg pills $153.00 As the patrol came over a rise, anafranil 50mg pills $153.00 enemy rocket fire started coming in over the Marines, anafranil 50mg pills $153.00 and the Lance Corporal started running down a hill that was inclined to the right. Anafranil 50mg pills $153.00 As he ran he stumbled on a rock and as gravity took him towards the right, anafranil 50mg pills $153.00 still with the mortar barrel over his shoulders, anafranil 50mg pills $153.00 he fell hard with all his weight. Anafranil 50mg pills $153.00 As he fell he put out his right elbow to break the fall and, anafranil 50mg pills $153.00 in so doing, anafranil 50mg pills $153.00 the barrel was forced towards the right front and tightly against his right trap which he fell against with all his weight. Anafranil 50mg pills $153.00 When he was able to get up the pain was sharp and throbbing over his right shoulder and neck. Anafranil 50mg pills $153.00 He reported to the BAS MO, anafranil 50mg pills $153.00 was given rest and mild analgesics. Anafranil 50mg pills $153.00 The pain subsided slightly but within a week he reported having “bad migraines.” He was returned to base but was unable to perform his duties due to the “bad migraines” so he was air-evac’d back to Camp Pendleton for evaluation and treatment. Anafranil 50mg pills $153.00 After a period of unsuccessful treatment by his BAS MO he was referred him for primary care evaluation and more treatment with analgesics which again did nothing to relieve his headaches. Anafranil 50mg pills $153.00 At 12 weeks post-injury the Marine was referred to a neurologist for evaluation who prescribed the standard medication for migraines to which the Marine faithfully adhered for a further 4 months; however the migraines persisted while his marriage, anafranil 50mg pills $153.00 work, anafranil 50mg pills $153.00 and social life got worse. Anafranil 50mg pills $153.00 Another 8 months went by with relief in his migraines; he also was treated with psych meds because he couldn’t stand the side effects. Anafranil 50mg pills $153.00 He couldn’t do any exercise, anafranil 50mg pills $153.00 he had no appetite and he lost 15 pounds. Anafranil 50mg pills $153.00 The neurologist told him he was going to be “med boarded” since his symptoms didn’t improve, anafranil 50mg pills $153.00 he couldn’t qualify for any of his Marine required activities, anafranil 50mg pills $153.00 and his Command was ready to support his being med boarded.

Anafranil 50mg pills $153.00 Since NHCP can provide no qualified treatments for chronic pain, anafranil 50mg pills $153.00 all his Navy doctors could say concretely was that this young Marine did not have the neurological, anafranil 50mg pills $153.00 psychiatric, anafranil 50mg pills $153.00 or orthopedic conditions they hypothesized he might have. Anafranil 50mg pills $153.00 There is no way of confirming with hard evidence of either Navy physicians’ impression of the condition or provide no qualified treatment, anafranil 50mg pills $153.00 only assertions that the condition is something that it is not – and for which there is no confirming response to treatment – rather than what it is – and for which the confirming response to treatment does exist.

Anafranil 50mg pills $153.00 CONCLUSION – THE EMPEROR HAS NO CLOTHES 

Anafranil 50mg pills $153.00 My original impression before I came to work with wounded Marines at NHCP was that Navy medicine at NHCP was at the same level of expertise that military medicine was at in their work amputees. Anafranil 50mg pills $153.00 This was not the case at NHCP on closer inspection:

Anafranil 50mg pills $153.00 - There is no qualified pain treatment at NHCP;

Anafranil 50mg pills $153.00 - There are no qualified full-time pain specialists available to Marines at NHCP;

Anafranil 50mg pills $153.00 - There are no continuing education courses on chronic pain for providers at NHCP;

Anafranil 50mg pills $153.00 - There is no integrated interdisciplinary chronic pain program at NHCP;

Anafranil 50mg pills $153.00 - Med Board diagnoses for those with chronic pain are probably in error

Anafranil 50mg pills $153.00 - Med Board diagnoses for those with chronic pain are often trivial (“neuritis” was given as a diagnosis rather than the disabling Complex Regional Pain Syndrome that it was based on a second round work-up by pain anesthesiologists at Balboa);

Anafranil 50mg pills $153.00 - There is no credentialed chronic pain specialty leadership for the Wounded Warrior Battalion.

Anafranil 50mg pills $153.00 The Marines I worked with were a wonderful group of men I got to know and appreciated enormously. Anafranil 50mg pills $153.00 They deserve a more than the “business-as-usual” primary care effort they have been given. Anafranil 50mg pills $153.00 All Marines should be returned to the high level of behavioral and molecular functioning they had shortly after finishing boot camp at their physical best. Anafranil 50mg pills $153.00 Hopefully, anafranil 50mg pills $153.00 legislators in Washington will implement the urgently needed chronic pain rehab programs these brave young Americans deserve.

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Anafranil 50mg pills $153.00 AAPM Diplomate in Pain Management

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Anafranil 50mg pills $153.00 COMPLEX PAIN – DEFINITION

Anafranil 50mg pills $153.00 This is a very special type of pain. Anafranil 50mg pills $153.00 It’s pain that …

Anafranil 50mg pills $153.00 - is not caused by cancer, anafranil 50mg pills $153.00 diagnosable tissue or structural damage and it responds poorly to all sorts of medical treatment;

Anafranil 50mg pills $153.00 - has lasted for more than a year;

Anafranil 50mg pills $153.00 - is not mild or intermittent but rather it occurs daily and the pain is moderate to severe (5+ on a 10-point scale);

Anafranil 50mg pills $153.00 - is pain that physicians you’ve seen haven’t been able to get you back to work or functioning normally again;

Anafranil 50mg pills $153.00 - all of your diagnostic tests produce “negative” findings and your physicians tell you that “you have nothing, anafranil 50mg pills $153.00” yet you continue to have moderate to severe pain and you can’t work and you can’t lead a normal life;

Anafranil 50mg pills $153.00 - is pain that the medications that have been prescribed for you for pain have not only not helped but more often than not they’ve made your pain more severe, anafranil 50mg pills $153.00 more frequent, anafranil 50mg pills $153.00 and more long-lasting;

Anafranil 50mg pills $153.00 - it’s very likely you’ve never been evaluated and treated by a doctor who was Board Certified or credentialed in pain management;

Anafranil 50mg pills $153.00 - it’s pain not caused by nerve damage as determined by a Nerve Conduction Study (NCS) and examination by a qualified neurologist;

Anafranil 50mg pills $153.00 - it’s complex pain that has led your doctors to tell you, anafranil 50mg pills $153.00 “That’s all we can do for you. Anafranil 50mg pills $153.00 Learn to live with it;”

Anafranil 50mg pills $153.00 - it’s complex pain that is becoming increasingly difficult to have carriers pay for the integrated, anafranil 50mg pills $153.00 interdisciplinary treatment that works best; and, anafranil 50mg pills $153.00

Anafranil 50mg pills $153.00 - it’s pain you had better learn to self manage because: (a) the teams of qualified doctors needed to treat it are extremely difficult to find; (b) the carriers aren’t paying for either the drugs or the effective treatment; and, anafranil 50mg pills $153.00 (c) pain patients who follow a qualified program do learn how to self-manage pretty well without physicians and much fewer of the wrong drugs.

Anafranil 50mg pills $153.00 HOW DID WE GET HERE?

Anafranil 50mg pills $153.00 We’re at this state of chaos because this is pain that fell between the cracks of conventional, anafranil 50mg pills $153.00 acute-minded, anafranil 50mg pills $153.00 acute-treated solo practice medicine. Anafranil 50mg pills $153.00 That means, anafranil 50mg pills $153.00 urgent care type medicine provided by a single doctor for as little time as possible. Anafranil 50mg pills $153.00 Why? Because that’s all that healthcare will provide. Anafranil 50mg pills $153.00 Healthcare is broke. Anafranil 50mg pills $153.00 It can’t be afforded any more. Anafranil 50mg pills $153.00 Where before it used to cost $200 a month for all medical services and medications, anafranil 50mg pills $153.00 today it’s the equivalent of a salary, anafranil 50mg pills $153.00 or a quarter or more of your take-home pay.

Anafranil 50mg pills $153.00 OUT-OF-SYNC ACUTE-MINDED MEDICINE GOT US HERE

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