The Latest Alcohol Study and a Report on it.

Sigh – I’m sort of even pissed off that I feel the need to comment 🙂

BBC: No alcohol safe to drink, global study confirms

based on:

The Lancet: Alcohol use and burden for 195 countries…

So what’s wrong with this?
Some things in pretty random order:

This study doesn’t even seek to answer the question of whether alcohol is good or bad for you!!!, as implied by the BBC report

Yeah, that’s right. Despite what the article might be suggesting.

It’s about population health, which is quite different. It is about what “burden” alcohol might put on the health of a country/society.

So, for example, if alcohol use increases the risk I might cause someone else to be hurt in a car accident, that counts towards the statistics.

And all the statistics are worked out against this objective.

There’s a lot of violence

As with almost all the similar studies I have seen, a serious part of the negative statistics comes from an increased correlation with the results of violence:- car accidents, interpersonal violence, self-harm and increase in communicable disease.

OK. Fair enough. But this is not what people understand about “health problems” I would suggest.

What is missing?

A hard thing to do with this sort of research is to work out how the whole thing might be flawed, as opposed to examining the details of the research. In this case, the big question to ask is what is missing; and it turns out there might be quite a lot.

If the authors can take such care on the input side to include tourism and even home brewing in the consumption of alcohol figures, surely they can take care to include all the stuff on the output side?

How about other illnesses that might be affected by alcohol? Maybe ME/CFS/PVF? Does peoples’ experience of MS change? And are there other physical illnesses that should be included? But the big one…

What about mental health?

At first sight the authors look like they have tried to characterise all possible adverse or positive health-related issues that might be affected by alcohol.

It has to be that mental health has the possibility of being an important factor in the increase or reduction in the “burden” of alcohol? Mental health problems can be utterly debilitating and disabling, and surely should contribute to the “disability-adjusted life- years (DALYs)”.

For example I find no mention of “depression” or “anxiety” in the entire paper. These illnesses have enormous cost to society, and any increase or reduction in them might even swamp all the other considerations. I would love to know similar research to this around these illnesses.

It is enormously sad for me that such a paper can be peer-reviewed and published without reference to mental health; are we still in a world where the only “real” illnesses are physical? Yes, the paper mentions “self-harm”, but that just makes it worse: the pain of mental illness is seen through the lens of people hurting themselves physically, rather than the pain they are feeling.

It’s not a big number

I can’t see it in the Lancet paper, but the BBC article says:

“They found that out of 100,000 non-drinkers, 914 would develop an alcohol-related health problem such as cancer or suffer an injury.

But an extra four people would be affected if they drank one alcoholic drink a day.”

(Edit: David Spiegelhalter’s excellent Medium article tells me that it is The Lancet press office that published these figures.)

Let’s just ponder that for a moment.

Almost 1% of non-drinkers will have a problem. That’s perhaps quite a lot. Or maybe it isn’t – I don’t know; people do get cancer, beaten up or fall.

Now, if all those 100,000 people decided to drink one unit a day, an extra 0.004% of them will have a problem. That is definitely not quite a lot.

And note that it includes violence (see above).

Another way of looking at it is relative risk, which the paper is hot on.
My (ignorant!) calculations suggest for these figures it is a Relative Risk of 1.0044, which actually corresponds pretty much to what I can see in the graphs.

This might be a significant figure when aggregated for a nation (although actually I think not, especially given the error bars (see below)), but is definitely not the sort of level at which I suggest people should be making life choices!

Correlation is not causation

Maybe I have missed something in the paper and appendices, but I can’t find out where they tackle this for some things.

They seem to say they account for possible confounding stuff in the area of the abstainer because they are ill. But do they for everything?

A statistical correlation between alcohol use and self-harm, for example, seems particularly difficult. Does self-harm cause increased alcohol use? Probably not, but then that is as likely as increased alcohol use causing self-harm, in the absence of other information. I don’t see any evidence that the authors tried to filter for confounding variables around these.

And remember that violence is a serious part of many of the statistics, so this is potentially significant.

It’s not really a “new global study” – it’s a meta-study of existing research, and doesn’t contain a single new measured value

I can’t even find out whether they have discarded any of the studies as being unreliable. If not, this is the worst sort of meta-study. A proper Cochrane Collaboration review would have discarded the majority of the studies they found as not meeting the criteria for inclusion.

As I said, I can find no evidence that they discarded a single study as being unsatisfactory.

This may well be “big data” at its worst.

It’s a “Global” study – but the data is very location-dependent

Tuberculosis is a significant number in many of the graphs, and so presumably is a significant influence on the headline numbers. I have to question whether this means that any inference can made at more local level, given the variation.

India (and many African countries in particular) has a TB level orders of magnitude greater than the countries that might be trying to use these statistics to direct health care.

UK: 0.01%, US: 0.003%, India: 0.211%, China: 0.064% (UK gov figures)

They even extrapolate from the USA to the rest of the world

RTAs (Road Traffic Accidents): They say they can only get statistics for the effect of alcohol use on RTAs for the USA, and so “Because of data availability, we assumed that locations outside the USA would follow a similar pattern to what we estimated with FARS” (US Fatality Analysis Reporting System)”

Really? You might have tried to be honest, but can we assume that Saudi Arabia, Japan or Turkey have anything like the same patterns, no matter how hard you try? And the USA has an RTA death rate more than three times the UK’s – can the patterns really be assumed to be similar?

“car crash involving alcohol” becomes “drunk driver”

Deciding on whether alcohol (or speed) is a genuinely contributing factor in an RTA is notoriously difficult. The FARS data is simply reporting whether alcohol was “involved”, not whether it was a contributing factor in the death. Although the authors may have allowed for this, it is hard to tell – are there confounding variables they are ignoring?

And as far as I can see (Appendix 1, Section VIII), they simply use “Driver BAC >= 0.01” as the criteria. And the fact their terminology moves smoothly from “alcohol involvement” (which of course it might not actually be) to “drunk driver” in the figures’ captions deeply undermines their claim to objectivity, in my eyes.

There are huge error bars in almost all the figures

I think the only reason that the authors can even begin to say anything with any confidence is that they have so many studies. In effect, however, they can only do this if they consider each of the studies as separate “experiments”. But can you? Many of these papers will be using similar, possibly flawed experimental methods, and who knows?, some of them may even be re-using the same data!

This is particularly true at the low end of alcohol consumption, which is where all the attention is likely to be focussed.

The consumption scale is too coarse

Looking at the graphs, it seems that many of them only do curve fitting at integral number of units per day, and others only half. This really doesn’t give me confidence that the graph fitting they have done at the lower end is valid. There could easily be more J-curves hiding in there, or certainly other interesting things.

Figure 3 from the main paper is really strange on this. “Ischaemic heart disease” (both) are very angular, and clearly only fitting curve points at integral values. Whereas “Diabetes” (male) has a point at 0.5 which gives a very strange angle.

It doesn’t actually address costs

If this is for forming public policy (which apparently it is), then it should actually be about costs, rather than “alcohol-attributable deaths and disability-adjusted life- years (DALYs)”

Perhaps the cost of different problems is different? I know that treatment for diabetes and its related problems, such as the need for limb amputation, can be very complex and expensive to both health and social care. Given that alcohol use seem to be beneficial in reducing diabetes (good news, especially for women – possibly up to five units per day is still better than none!), maybe the reduced cost is sufficient to outweigh all the other problems. Who knows? The study makes no attempt to address this issue.

Good news?

I am guessing/hoping the authors have tried very hard to be honest, and would be able to satisfy all my concerns if they were asked. And indeed they discuss these and other limitations. But at the moment I am left with considerable unease as to the real value of these statistics, and concern they will be used to drive public policy decisions based on unreliable data.

And I have to repeat that the lack of a mental health angle is deeply worrying, We have all heard people justifying drinking on mental health grounds! Surely we need the science on this, so that assertions on the benefits of alcohol to mental health can be challenged or supported? I am left worrying that the reasons that this is missing, and that I can’t easily separate out the violence from other issues is because the authors sense or even know that the results would be other than they would like.

Mind you, I think it is quite a good paper – well-written, and it enabled me to see a lot of what they were doing!

 

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My Experience of the Privatised NHS is crap

So it seems it is often accepted as given that the patient’s experience is improved when NHS services are delivered by external contractors.
And there are all sorts of issues to do with money and stuff, which I will ignore for now.

But, having just waited more than 20 minutes on the phone to get an answer from such a contracted company, I thought I would rant about how the whole experience was worse than I get from the “normal” NHS.

My GP referred me for ENT investigation.
I ended up being invited for a consultation with someone from something labelled as “Community Outpatients”. It is not immediately obvious that this is a private company, especially given the name, but it is.
I had the consultation; some treatment was prescribed, along with a CT scan.
The CT scan was at RHCH (Winchester NHS Hospital). That was amazing:- the whole visit and scan was executed so quickly that I didn’t pay any parking charges because I was in and out in less than 30 mins., including the scan itself and walking the length of the site twice.
I then had another consultation with Community Outpatients (by telephone, in fact, but that isn’t unusual nowadays, my GP does that), and was told they were recommending I look at having surgical treatment.
So I have now been referred (you guessed it) back into the maintstream NHS to see a consultant at the RHCH.

So what has happened?
Privatised service: I will have had three consultations with three different consultants, and then an operation scheduled. And they can’t even answer the phone in a timely manner, or provide the records I need, by the way.
Non-privatised: (Typically) I would have two consultations with the same consultant and then an operation scheduled. And I can get through on the phone.

OK – not *such* a big difference, but the point is that it is different, and *worse*, not *better*.

And what really pisses me off, of course, is that my worse experience has cost the NHS *more* money. At the minimum, they have had to fund an extra consultation.
In fact, they will have also put some profit into someone’s pocket. I accept that Community Outpatients has managed some stuff, and therefore can be paid for management as well as the clinical stuff, but they are actually a big business making a chunk of profit from my taxes that are funding the NHS.

If you want to know, they are one of a number of subsidiaries of Concordia Health Holdings LLP, which is owned by two Mr Hurds from Nottingham, and which had a turnover of over £18M in 2016, with a gross profit of over £6M.

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“It’ll be alright”

And yes, I mean Brexit.

I heard this yet again the other night from a street interview on TV: we might have a bit of short term economic disruption, but it’ll be alright after that.

I mean, where does the come from? Since when did the the future of me, my children and grandchild(ren) depend on some vague conviction that “it’ll be alright”, without any decent study of the processes, and attempt to understand?

Being an old fart, I see this as part of the decline of society, and it isn’t just Brexit, of course. I have a sense that Trumpism is the same. People can’t be bothered (or don’t want to) think about and try to work out what will happen. They want something to change, and vote for something to change, and just do, confident in the ‘knowledge’ that “it’ll be alright”.

I suspect that the same is true of many of the credit bills being run up – I don’t have the money now, and I don’t know where it will come from in the future, but “it’ll be alright”. Although I have no evidence for that.

So what is going on?

Is it anti-intellectualism – we can’t trust those experts? I’m not so sure.

I have a feeling it is just that the world feels so complicated, that any attempt to actually analyse and predict just feels so hard, that it feels like it isn’t worth trying. It is much easier to believe that “it’ll be alright”, and just go with the flow.

Only, of course, the future won’t be like you want it to be just because that’s what you want.

I am reminded of when I used to play chess as a 12 year old, and why I stopped playing. It would get to the complex middle game, an hour or two in, and I would make a big mistake. I worked out that what happened was that I had been sitting looking at some difficult combination for a while, and it just got so hard, that I would just say to myself “Yeah, I think this move is OK – what could go wrong? Anyway, it’s only a game.” A few moves later I would have discovered what could go wrong, when I lost a piece, or whatever. This meant that I had to grind on for another two or three hours trying to rescue a draw, when what should have happened is that I won.

This is, I think, what is happening with Brexit and many other decisions being made – and, unfortunately it isn’t just a game.

And here’s some more from later:

In technology, the government is pathetic with this.
1. Let’s ban end-to-end encryption. But e-Commerce will die. Oh, it’ll be alright, someone will solve the problem.
2. Let’s have a backdoor in mobile devices. But it will put everyone’s data at risk. Oh, it’ll be alright, someone will solve the problem.
3. Let’s require ISPs etc. to log everything. But that puts peoples privacy and human rights at risk. Oh, it’ll be alright, someone will solve the problem.
4. Let’s require all porn sites to verify the age of uses. But all sorts of things might go wrong and are unpredictable. Oh, it’ll be alright.

And, as Steve Harris said, what about climate change, population growth, the end of high levels of employment.

I think what really pisses me off about it is the utter and outrageous irresponsibility of it all. The population elects people to spend their time understanding the consequences of actions. That is what they have to do. And so many just completely renege on the deal.

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Headline Statistics

Baby teeth removals ‘up 24% in a decade’
These bloody statistic things really piss me off.
They quote a big headline figures, and then make it difficult to work out something sensible.
For your information: allowing for the 16% increase in the UK (0-4) population over the last 10 years, I calculate an increase of 6.6% (of the order of 550 extra for the whole UK, by the way – that’s a couple of extra kids in the whole of Southampton, I think.)
And since they mention it, they clearly thought it might be relevant, but don’t bother to work it out.
Of course any figures are not nice, but 7% is a loooong way from 24%.

And it is the Royal College of Surgeons‘s fault – their press release is the offending document.
As so often happens, they create the biggest nonsense figure they can think of and then put it in the headline.
It would even have been natural to put the sensible (population-normalised) figure in the table in their Note 3, but they chose to leave it out.

Actually, there is possibly a really interesting story here.
It turns out that much of the increase is in the last 5 years or so. Could it be that in the post-2008 financial climate, people in general are not going to the dentist? Ah, you might say, but children are free. Yes, but recent reports suggest that children aren’t going to the dentist because their parents aren’t.

By the way, the same organisation’s Report on the State of Children’s Oral Health is much more sensible than the press release. It says:

However, it is not immediately clear why the number of hospital admissions for children with dental caries is increasing. One possible explanation is the similar percentage increase in the birth rates of these children, but there has not been a significant change in the level of treatment for children with dental caries in primary care. Other explanations could be that children are not being treated appropriately in primary care, or they are seeking dental treatment when the caries is already at an advanced stage so must be referred to specialist services. Alternatively, it could be that preventive measures such as moderating the consumption of sugar and/or brushing teeth are decreasing.

One final comment – in 2000, Department of Health changed its recommendation about general anaesthetic, saying that it should only be done in hospital, due to safety concerns. It is always interesting to think about what other policy changes might have contributed to statistical changes. For example, it may have taken a while for the advice to be implemented, or maybe that has contributed to a change in dentists’ behaviour, in that they are more likely to recommend extraction in a hospital than extensive other work in the surgery.
7% (of the order

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The Digital Catapult Really Screwing up Trust about Personal Data

Executive Summary

In publishing a report about how organisations need to build trust with the public about the storage and use of their Personal Data, the Digital Catapult has done almost all the classic things to undermine that trust.
And they even missed a great opportunity – the research suggests that if an organisation does screw up, and then comes clean and corrects things, it ends up with a higher level of trust than if they hadn’t screwed up in the first place.
But they didn’t.

Now read on if you wish…

Wendy tweeted about a new report:

Wendy Hall ‏@DameWendyDBE 1d1 day ago
#PDTReview has been launched today by @DigiCatapult! Get the report here: http://bit.ly/SignUpPDTReview

I though it might be interesting, so I followed to find that it was called “TRUST IN PERSONAL DATA: A UK REVIEW”. When I finally got the report, it turned out it says things like “We must build consumer trust or risk future failure” and “Building trust in the use of personal data is the responsibility of every digital stakeholder in the UK”.
However, I get ahead of myself: in order to get it, I was required to fill in a short form, giving my names, email, organisation and the organisation type (as mandatory fields).
Like many people (apparently, when I read the report), I choose to be careful about where my personal information goes. And it seemed to me that there was no reason why the Digital Catapult should need more than my email address, even if it did decide that it was not going to make the PDF available for download, but only by personal request over email.
So I tweeted:

Hugh Glaser ‏@hughglaser Jul 29
@DigiCatapult Can I get a copy of #PDTReview without giving you my Personal Data please?

So far, disappointing, but OK.
Now the screw up starts:

Digital Catapult ‏@DigiCatapult Jul 29
@hughglaser Thanks for tweet. We ask anyone wishing to download the report to fill in a few fields so we can get the report to them swiftly.

Yup, “swiftly”!
Good practice to have a prompt response, but I can recognise a classic case of making up an answer, just to get rid of me. 🙂 This is known as flimflam or flannel by support staff. Like “Your database is running slowly because it is the wrong colour, we are repainting for the next release, so it will be better.” (cf http://dilbert.com/strip/1995-11-17)
But actually, this is displaying a lack of respect – the public aren’t fools.
So now I’m hooked!

Hugh Glaser ‏@hughglaser Jul 29
@DigiCatapult Huh? Swiftly?!!! My Organisation? Why not a PDF download link? It smells like you are actually touting to get a DB of people.

Digital Catapult ‏@DigiCatapult Jul 29
@hughglaser For clarity, we are not keeping a DB unless people opt-in. Equally happy to share report with you via non sign in. Please DM.

(Opt-in: There is a tick box on the page that invites people to sign up for a Network.)
But come on! This is more flimflammed flannel. No answer to why the “swiftly”. And why am I typing if it doesn’t get kept. Again, the public aren’t fools. And don’t take me for one. I know you are keeping the data – just own up to it!

Hugh Glaser ‏@hughglaser Jul 29
@DigiCatapult Thanks, may do. But hang on: if I don’t tick the box, you don’t keep anything I type? So why ask? And it says “SIGN UP…”.

Digital Catapult ‏@DigiCatapult Jul 29
@hughglaser Thanks for your feedback Hugh. We’ve amended the page so people can fill in details if they so wish, rather than ‘sign up’.

Classic! I’m not going to fix the bug – I’ll change the documentation – any Software Engineer worth their salt recognises that one. They did change it, so the page says “FILL IN…” instead of “SIGN UP…”.
And what is this “if they so wish” – more noise words of flimflam and flannel – there is no other option I can see.

Hugh Glaser ‏@hughglaser Jul 29
@DigiCatapult Sorry to be a bear with a sore head, but I’m still not making sense of this. What does “if they so wish” mean.

Now, there does seem to be some deeper investigating in order, so I went to the page and gave it my details and got the email with the report – and very interesting reading it is too.
At the same time, I emailed:

To: info@cde.catapult.org.uk
Subject: Personal Data Request
Please can you tell me what personal details you hold about me, as specified in section 1.7 of http://www.digitalcatapultcentre.org.uk/terms/
Thank you.

Within an hour (well done!) I got a lovely response, which I won’t quote because it was in email. But in there it said that they had my name, email, business name and organisation type – exactly the same details that I was being told aren’t being kept!
This needed a private response, I think – although these are really important issues, I had no wish to cause any serious embarrassment on twitter. It was something that the Digital Catapult should get the chance to put right, so it was an email back:

Subject: Re: personal data request
Dear xxxxx,
Many thanks for your swift and detailed response.
I appreciate an organisation that can do this - on the rare occasions I have done asked others, some of them simply fail!
Unfortunately, your response tells me that the person who does your twitter feed has basically lied to me:
Digital Catapult ‏@DigiCatapult 5h5 hours ago @hughglaser For clarity, we are not keeping a DB unless people opt-in. Equally happy to share report with you via non sign in. Please DM.
OK, it may be that the data you have is not in a real “DB", but in principle you have a problem here.
I clearly have a problem with your report being used to get personal data about people.
The deep, deep irony is that it is undermining trust in exactly the way the report says should be built up.
How should we resolve this?
Is your twitter feed going to give some honest and clear answers?
Best
Hugh

In the meantime, the next day I had no response to my question on Twitter, so I asked again:

Hugh Glaser ‏@hughglaser 8h8 hours ago
@DigiCatapult What does “if they so wish” mean? Is there another option if they don’t want to?

To which there was a swift response:

Digital Catapult ‏@DigiCatapult Jul 30
@hughglaser Hi Hugh, you can now directly access the review here: http://bit.ly/1DRpjpy

That’s good!
But it isn’t really what we need by now.
Any trust I might have had in the Digital Catapult has been completely undermined.
What went wrong?
Will it go wrong again?
Should I not expect an apology?
Later, I got a response to my email. It was very nice, inviting me to join the network and asking if I wanted my details removed. But it was also rather disappointing, in that it suggested that what were effectively the lies I had been told about the Digital Catapult keeping my Personal Data were because of the limitations of 140 characters in Twitter, and that the DB issue was because it was a different, “marketing” DB.
Oh dear – more flimflam and flannel.
So…

Thanks xxxxx,
Just a quick question before I respond at more length, please:
...
I think blaming the 140 is a bit disingenuous: "For clarity, we are not keeping a DB unless people opt-in.” is pretty unequivocal.
So what is the scope and purpose of the DB that you found my data in?
Best
Hugh

I also sent a message asking what is the scope and purpose of the DB that I am in.

So, coming to an end…
I exchanged a few more email,and then had a chat on the phone.
As best I see it:
The Digital Catapult wants/needs to report to the funding body what interactions they have with companies. So they gather the sort of information above. It is disturbing, because they don’t seem to think that this is “using” the information (it’s not for marketing, in particular). In fact, I am now really rather disturbed that the Digital Catapult, which has just issued a report relating to Personal Data, have significant people who actually don’t understand Data Protection, and the related regulations. We discussed how the Terms and Conditions could be improved to reflect this situation.

I asked for an apology on Twitter for taking me for a fool (at which point it felt like the call had become distinctly frosty 🙂 Or maybe it was because I mentioned I would blog about it.)

Now it is time to leave it – maybe they have learned something!

One lesson – make sure that the person on your twitter feed is technically savvy, or at least understands when they need to get advice.

Some more lessons?
Don’t take the public fools and just fudge things with brush off messages and flimflam, and when you make a mistake, come clean as soon as possible; oh, and apologise for it.
This is serious stuff – it was worth the Digital Catapult spending money to write a report about it!
And perhaps even paying Experian money to gather data, although that isn’t clear.
And, of course, “Oh the Irony!” That this should happen about a report on Trust and Personal Data!

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New Apple Keyboard

So the new Apple keyboard has got the character engraving ever so slightly offset to the right, and maybe a bit up too.

And the engravings don’t even align along the bottom properly – keys like “J”, “G”, “6” and “2” are slightly lower than the others in the row.

How do you manage to break something like that!

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Open Data Projects that Don’t Make Their Data Open

Sounds bizarre, but it seems to be the norm.

The very people who are at the forefront of consuming Open Data, funded by my tax money, almost always fail to make the fruits of their labours available as Open Data in their turn.

Let’s see: You get some public funds to build a demonstrator that shows how great Open Data is.

So you go away and harvest all sorts of data from a variety of sources (both easy and hard), and then add lots of value by linking it together and then synthesising new values and providing new insights.

Then hopefully in some time that corresponds to the proposal timescales, you launch your wizzo site, with fancy visualisations and everything. You get the loud praise and tweets from the great and good saying how this demonstrates how great Open Data is.

Then…

I come along with a little email asking if I can please have the data (so that I can use it for sameAs.org and other stuff I have that is set up to use the Open Data food chain).

I then get the standard response: “Ah, yes, we intend to make the data public, but <fill in a reason here />, and give us just a little time.”

Following that, I usually wait a few weeks or months, and then ask again. I might get another response along the same lines. I will probably ask another 2 or 3 times over the course of the next year or so, sometimes getting a response, but then decide that the data is probably too old now to be of interest, and I am wasting my time in any case because it ain’t going to happen. (It is unlikely that the original project actually included a real plan for keeping the application up to date by refreshing the data, or that the technology is actually able to do that.)

The point that anyone working in Open Data knows is that if you don’t build in the mechanisms and technology from the start to make data open, then grafting it on at the end is hard, expensive, unreliable, and various other bad words. So why don’t people put it in the proposal, and why don’t the funders require it to be part of the projects?

And the worst thing is that sometimes you hear the people who have done these projects (that are essentially data sinks) actually complaining that they couldn’t get data they wanted for their project from some other source!

Now ain’t that hypocritical?!

I would actually prefer it, by the way, if the response to my request for the data was more along the lines of, well we built a demonstrator, and we aren’t going to make the data open. There are actually quite a few sensible reasons for doing that.

Right, I’m off to think about which of my datasets is Open… 🙂

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