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Posts published in “Schmidt”

Ticketed

schmidt

I keep seeing patients and trying my best. I sometimes wonder if it’s the right thing to keep doing. I’m sure there are younger, smarter, more agile providers out there who could be doing this work. But whenever our clinic tries to hire someone, it can be 6-12 months before we get a bite and sometimes, we don’t land them.

I enjoy seeing the patients. I know they sometimes don’t enjoy seeing me. That makes the work a bit harder. But I have never thought my job was to provide customer service. That’s a big part of the job, but it’s not the whole job. I had some very long and arduous training that instilled in me the sense of a higher purpose. I was trained to serve health, not to just give the customer whatever they wanted. Prescribing antibiotics to every child with a cold might make the worried mother feel better, like she was doing her best so she could then go off to work, leave the kid at daycare, she’d done her best, might make the customer happy. But it did not serve the child, the community.

When I first started practicing primary care in 1989, the most common prescription in the United States was Amoxicillin. It was commonly prescribed for children with colds. Many children with colds have the yellow snot draining out of their noses back up into their middle ears. Ah, an ear infection! We can treat that!

Amox 250/5ml I tsp tid for 10 days.

The kid gets better, and we glorious physicians get credit. But I had read the study that showed ¾ of middle ear infections get better in 2 weeks whether they are prescribed antibiotics or not. But then, we get no credit, do we? And it takes a while to convince the working mom her kid just needs some care, not drugs. And I need to see 25 patients a day to make my exorbitant salary. I can see why Amoxicillin was popular.

Ten years later the most popular drug was Oxycontin. You know how that turned out.

So, I work at this clinic a few days a week and I try to teach my fellow providers and the patients I see how to be healthy in the lives we live and the work we do. Two weeks back I came out to my frosty pickup and found a parking ticket. I had not gone home for lunch. I had brought a sandwich, thinking the noon drive home was wasteful. But the $25 ticket hurt.

I get to the clinic at 7AM and leave at 6PM. My lunch is from 1-2. We have a three-hour parking limit downtown. I guess the drive home made the parking enforcement people happy. The ticket irked me.

I tried another spot last week. Under the snow I scraped off in the dark was another ticket. This week I have decided to walk to work. It’s only about a mile.

My new knee is fine but the old left hip hurts. I don’t want to fall on the ice and snow. Send me your prayers.

If we want good healthcare in this country, we need to be thinking about just what that means. Do we want whatever we want whenever we want it? A patient’s partner last week called me an ignorant old man because I wouldn’t order all the wasteful blood tests his partner requested. “You need to get with it old man!” he glared at me. The ticket felt worse.

I know medicine. I do my best to practice that way. I can’t say I know the body politic. I wish we would have this discussion.

 

Turkey

schmidt

Ben Franklin, that wise and immoderate soul of our founding fathers, might have quietly argued that the American Wild Turkey should have been our national bird. Some say this is a myth. But it’s worth considering. We should question the images we revere.

A huge white-headed raptor emblazons all the official seals and political paraphernalia. It suggests we are fierce and invincible. Maybe not.

I’ll bet any of you who have worked a calving yard on the Snake River canyon might have a different image. Cows drop their calves, then the afterbirths. The eagles linger and when the opportunity avails, they swoop down for the carrion. Some can’t quite manage the take-off. A tumbling national bird with a muddy, bloody placenta in its talons is not a noble image. But maybe it suits our current condition.

Wild turkeys don’t swoop down on anything except a safe landing spot. That seems pretty wise to me. Maybe you’re a swooper.

There will be no changing the decisions of men directed to pick our national emblem 200 years ago. That barn door is flapping. But it’s worth consideration just what symbol we find inspiring.

The wily wild turkey is a vegetarian. It gobbles and struts only when procreation and defense demand. Mostly it is a wise and silent bird. We should all aspire so.

I don’t aspire to steal rotting fish from crows or pilfer placentas. Maybe you do. We should talk.

I reflect on this as I prepare to roast my outdoor bird. It is a domestic, white meat bird, not the wild kind. Martha does one in the oven, but I fire up the charcoal. It’s not a competition, though we sometimes pretend it to be so. We should all be more aware that competition should be friendly. Winning isn’t everything. Competition should bring the best out of both of us.

Having a good meal with family and loved ones is close to everything. But really, everything is everything. You knew that.

I won’t give you a list of what I’m thankful for on this Thanksgiving Day. I would hope yours is long and heartfelt. Mine is short and dear. It’s not a competition.

Ben Franklin might have been thinking of the many European royal and military eagle crests. Roman legions conquered lands and Russians tsars enslaved serfs under such emblems. He probably wouldn’t have been surprised by the Third Reich emblem that some are fond of today. He probably thought such actions were not befitting the republic he was working to craft. This was a new land. Opportunity needs inspiration and symbols are just the ticket. The American Bald Eagle carried the day. The American Wild Turkey did not inspire. Maybe it should.

Once I rode in the back seat along the Clearwater River after a fishing trip with some friends. I looked across to the far bank. I could see the head and elbows of a mostly submerged eagle as it desperately struggled to the shallows. I’m sure it’s talons entrapped too big a fish.

I’m not sharing these images because I despise this country. I love it here. I hope you do too. We have a wonderful opportunity. We have swooped down and taken much. I hope we have not taken more than we can handle. The shallow water is near.

As I roast that domestic white meat bird on store bought charcoal, stuffed with wild rice and nuts, I will give thanks for the family I love. I will give thanks for this land I live on and among. I give thanks that we can talk about the important things we share. Blessings to all.

 

Fog

schmidt

Our little town, Moscow, Idaho has been dark and cold for the last few days. The national news spotlight feels like a black hole directed at us, sucking all our light away. The icy fog that has hung over us hides our distant view that so often comforts in this beautiful place.

Bad things happened here. Yet we must go on. We need some light. But this is a very dark time of year.

I have no answers, no moral drum to beat. I know the people working to bring justice and I trust they are doing their best. I also know that some answers, some knowledge might ease our uncertainty, and our fear in the face of this tragedy. But I respect their judgement. They have a very hard job right now. The investigation, apprehension and bringing to justice of the perpetrator of this violent deed is their paramount task. We should respect this priority.

The community unease, the nervousness we feel, is palpable and immediate to each one of us. But our fears are not the prime focus of their efforts right now, nor should they be. We want to feel safe. Don’t we all? But these tragedies remind us of our fragile claims to comfort, warmth and safety.

One of my first coroner calls came on a rainy November Friday afternoon. A man was shot and killed. I worked all weekend to arrange an autopsy and recover the deadly bullet. The police asked me to remain quiet about the investigation, since they had a suspect and thought with some hard evidence, they could get a confession. They did. Monday morning, I got an angry call from our local newspaper editor. Why hadn’t I informed the public? I felt just fine telling him I felt no need. They got the story Monday morning of a murder and an arrest. It can be comforting when justice is swift.

But it isn’t always.

Our town, indeed, the nation seems to be very impatient right now. We want the election results soon as the polls close. I can understand that. The internet has made us all two-year-olds. But patience is a virtue we should all practice. And now is as good a time as any to start.

I could share some more coroner stories, or wax on about election results, but it’s really not the time.

I built up a fire out here in my writing room. It was quite cold since I have been avoiding this task for some time. It crackles and pops behind me and an occasional car will drive by. When I went out to get the wood for the stove, I watched the pickup I didn’t recognize as it went down the hill. It kept going, but I imagined it stopping and the driver tossing something over the steep embankment to the north. I am more vigilant than I have been. Fear should prompt vigilance. Vigilance can keep one alive.

The comfort of the warming fire eases my fears and my aching bones.

But vigilance is a worthwhile practice, right up there with patience.

I have heard the families of our victims decry the rumors on social media. I admit to such supposition. I even postulated theories when I first heard the horrible news. I was wrong. I was not patient.

Healthy communities can balance their fears and work toward justice. Vigilance should not breed vigilantes.

Patience should not promote passivity.

I would hope for such virtues for your communities. And I would hope that you would not need violent tragedies to inspire such virtues. Hold us in your prayers.

 

Tired

schmidt

I have been watching the online ads and the debates and I have come to a question about Idaho’s senior US Senator. Why does Mike Crapo look so tired?

He has had a long political career. Thirty-eight years in elected office. He has dutifully climbed the ladder of Idaho Republican politics. First the Idaho state senate, then Congress, when a seat opened up. Then, the US Senate, when a seat opened up. He has been one of our US Senators since 1998. And he’ll be our Senator for six more years, maybe. Unless he’s too tired.

I can sure understand why he might be tired. I’m a couple years younger than him and the gymnastics he does would exhaust me.

His ads declare how opposed he is to Joe Biden. He might as well be wearing the t-shirt “Lets Go Branden”. But that would throw him into the MAGA camp. He’s walking the balance beam many Republicans are. And it’s hard. I get that.

Imagine how the current US Supreme Court weighs on him. Conservative Republicans have for years decried an “activist” court. But now they got one, through the contortions of a Republican Senate that he did the dance with, and now that court is picking cases to correct all the wrongs of previous activist courts, through its activism. That must weigh on those tired shoulders.

Imagine watching the subprime meltdown of 2007 from his seat on the Senate Finance Committee. All those people losing their homes and no Wall Street moguls going to jail, but instead voting for their bonuses. It must have been a real burden.

Imagine when he had a President a couple years back in his own party he has little respect for yet pulls all the political levers. His Senate seatmate Jim Risch was much more outspoken about his fealty to the mogul cum president. Mike was much farther back in the ass-licking line. But he stayed in line. And still is, unlike his fellow Mormon Senator, Utah’s Mitt Romney. Maybe Mitt’s example weighs on Mike. It would me. When I see courage in others that I know I should have, I don’t sleep well. I hope Mike is getting good sleep.

Mormons respect authority. At least, so I have observed. That must become tiresome when their honest and personal sense of morality is offended. I don’t have such constraints. I don’t respect authority. That too, can be tiresome.

Imagine sitting as a juror in two impeachment trials in the US Senate on a President’s actions that both clearly met the standard of crime. I believe Mike listened (while Jim Risch slept) to the damning testimony. I believe Mike had strong feelings about our former President’s actions. And I believe Mike decided to vote with his party. It is very tiresome to frame all one’s decisions in terms of a partisan slant. Especially when one is as bright as this man is.

Yeah, I’ve been worn down by such decisions. Democrats can be crazy too.

So that brings us to the basic question. Why is this tired man asking us for another six years as Idaho’s senior US Senator? Is he expecting to be Chairman of the Senate Finance Committee when the Republicans claim the congress after November 8th? Does he have some vision for cleaning up our financial swamp? Does his belly burn to strengthen this trickle-down ship? Jeez, I wish he’d said that in his ads. He just looked tired.

I’ve seen this game played before in this lopsided state. Republican incumbents run for office, get reelected easily, then resign so their crony in the Governors office can appoint the next anointed public servant. I’m not predicting, just posing here. He looks tired. I don’t think we Idahoans know what the high mucky mucks have discussed over steaks in Boise.

 

Grumpy

schmidt

I have dealt with some grumpy old men. Some scowled, some barked. Some just glared and wouldn’t talk. I hope I don’t get grumpy. I hope I haven’t.

I have some grandchildren. Not as many as others, but I’m not in a race. I don’t want to have their memories of me as grumpy. So, I need to be careful about how I grow old.

The pains of aging can wear us down. Aching joints, creaking bones don’t make for a rosy countenance. But they are what we bear, us old folks. Let us not burden others with our pains. A rosy countenance goes a long way.

Folly is, most times, in the eyes of the beholder. Rarely does it come to a full community consensus. The stupid decisions of the next generation will not be made wiser with a scowl or frown. So, I need to practice a smile while I listen to my neighbor’s advice. It gets harder when we talk about politics, but it would serve me well to practice.

Old age doesn’t guarantee wisdom. Keep that in mind.

And crooked, chipped, even missing teeth are no excuse to hide a smile.

The happiest man I knew had a bald head and a missing front upper tooth he showed when he regularly beamed. I asked him about it. He laughed and grinned as he told me about unhooking a log chain over a load. He flipped it to see if it was loose and the hook came right over and caught his front chopper.

Friends help. They really do. To have friends you have to be a friend.

That means keeping in touch. That means getting down off the ladder or out from under the car to have a conversation. You might have to cross over the road. It means you care when you show an interest. Friends care.
Healthy habits keep us oldsters happier. It’s a good example for the grandkids to let them know you eat healthy things on a regular schedule.

They don’t need to know about your bowel habits.

Interest and engagement in your community, things beyond cleaning your gutters or changing the oil, also keep you healthy. You don’t have to scowl to make your point. Smile when you testify before the city council about their stupid plan for sewage treatment. They, and you and your grandchildren will listen more intently and will be more likely to hear your words. Who knows, maybe they’ll come to know your thoughts.

Some of the grumpy folks I’ve come to know have just adopted their demeanor as a default. Like the mustache or the hair color, old habits die hard. If you find yourself grumpy, try a change. If you are a quiet, reserved grumpy person, maybe you need to speak up. If you are a loudmouth grump, maybe you should try being quiet.

Some folks take pride in their grumpiness. It suits them. For some reason, like the mustache or the hair color, it’s just what they have always done. Then, it’s on the rest of us to decide if we want to deal with them. Grumpy makes it hard. Maybe they want it to be hard.

But I want my grandkids to know me. I want them to have some memories of me that don’t involve a scowl or frown. I’ll work on it.

I’ve focused on grumpy old men because that’s what I fear becoming. My daughters would call me sexist, so, let me expand this conversation to women. I’ve known grumpy women too, young, and old. It’s not a male specialty, though, for some reason, we are the icon. Maybe it’s because women live longer. Happy people live longer. Come on you guys, let’s learn something in our old age.

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Questions

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As the November election approaches, we should be draining our hoses and shutting off the outside water. It’s going to be getting cold.

Wise people prepare for problems and try to avoid them. Our Republic faces a hard winter. Elections are where we should prepare.

I pay a lot of attention to local elections because I think that’s what’s most important. So, I was very encouraged when a woman I have known for a long time threw her ring in the hat. I respect her integrity, her industry, and her character. She is running for the position of County Clerk. The clerk, honestly, runs the courthouse. Commissioners think they do, but they are wrong. The clerk manages the courts and elections. It is probably much more important than the county coroner, though that is painful for me to admit.

So, when I looked at this woman’s positions online, I was a bit surprised. She said very many good things about how she would run the office, improve transparency and the workplace. I believe she could well do just that.

She’s a wonderful person.

But when the Idaho Republican Party asked her to identify two instances of election fraud in the 2020 election, she gave two examples straight out of 2000 Mules. I trust her, so I Googled some more.

Do search engines just give you the answers they think you want? Of course. So, I reGoogled. I double and ghost Googled.

The evidence supporting these examples is poor. It has in fact, been rejected by judges, and Republican US Attorneys. But she believes it to be true.

We have had many profiles of candidates for legislature and county offices in our local papers. I have yet to see a reporter ask or the editor print an answer to the question of just who believes in “The Big Lie”. Why isn’t this an important electoral question?

Polls show us 70% or more of Republicans believe this. That the results of the 2020 Presidential election are fraudulent, and that we all now suffer under the executive authority of a chief executive whose position is a fraud. Why isn’t such a belief an open question that should be answered and discussed? Why is this topic avoided?

The supposition of a representative democracy is that we can elect people to represent us to enact laws that will govern us. If the elections are judged fraudulent, so is the assumption of representation. The strong man wins, and we the people lose.

This question sits right in the Republican Party’s lap. Do they, many I consider friends, endorse the idea that our elections are fraudulent? Our past President beat this drum long before his loss in November 2020. It seems many have embraced this. Such an embrace puts our Republic at risk.

If elections become meaningless, we will be ruled by the strong man, or woman.

Lots of folks believe silly things. I have relatives that don’t believe we landed on the moon. I had a brother-in-law that believed in the world domination of the Jewish Banker cabal, I think is what he called it. I would just poke the campfire when he went off like that at elk camp. His odd beliefs could go up with the embers. I was not troubled.

But I need to decide how to vote for the person who will be the clerk of our elections. I need to decide how to vote for the legislators who will write laws about how we can vote. I need to know if such people have faith in our representative democracy.

If they don’t, which strong man are they going to line up behind? Is that the right question now? It should not be. We, the people, are wiser.

 

No on 102

schmidt

There will be an Idaho Constitutional Amendment on the ballot in the November election. You should vote NO.

This proposed amendment comes from the Idaho Legislature. They want the State Constitution to say they can call themselves into session whenever they can muster enough of their own colleagues to sign a petition. The way the Idaho Constitution currently reads, only the governor can call a special session. The governor must specify one specific issue for the legislature to address. The proposed amendment has that restriction also, “one specific purpose”.

Why shouldn’t the Idaho legislature have the same authority many other states have? Thirty-six other states have such a provision, with various requirements for just how many need to agree to make the call. So, this would be putting Idaho on par with Alaska, Hawaii, Utah and 33 others. Their states haven’t melted down. We wouldn’t either. But I’m sorry, our legislature’s history makes me nervous.

Do you remember the last time the Idaho legislature asked us voters to change our Constitution? A few years back, the legislature wanted us to approve an amendment to our Constitution to enshrine their authority to review, approve or reject administrative rules. The legislature was already doing this, as the laws they had passed decreed. But they were nervous. The separation of powers gets blurred when the legislature passes a law, the administration writes rules to enforce these laws, then the legislature gets to review and approve or reject these rules.

The first time the legislature proposed the “Rules” amendment, it failed. But then some legislators got some Farm Bureau and Freedom Foundation money to support it and they ran it again two years later. This time, for some mysterious reason, we voters approved it. I guess we wised up.

But look at the record since we gave the legislature constitutional authority to review rules. NOT ONCE, since that amendment passed has the legislature done their job to review, approve or reject rules.

I know some of the Idaho legislature leadership and I don’t consider them immature. But this behavior reminds me of a two-year-old. They throw a tantrum about a toy their older brother has. But when the brother shares the toy, they have no interest in it.

So maybe, if we approve the amendment, given our legislature’s pediatric behavior, they will never exercise it? I’m asking us voters to be the grown-ups in this state. Vote No.

The Idaho legislature has constitutionally fixed dates to convene every year, with no fixed date to adjourn. Giving them the flexibility of calling themselves into session is like nagging the teenager playing his video games. “Have you done your homework?” They will not knuckle down to the serious tasks before them. Certainly not if they can consider doing it “later”.

One of my daughters had a bad habit of expressing her anger by storming off to her room and slamming the door. We asked her politely. Then we warned her. Finally, I took her bedroom door off. A week later I replaced it. Within a day, she slammed it again. That door stayed off until she moved out. It still sags some.

If we vote this amendment down, like we should, expect it to come back in two years with more money behind it. Maybe the lobbying groups can persuade us voters to be wiser with their dark money. Legislative leaders will welcome it.

The separation of powers is a fundamental principle of this republic.

Legislators represent us, write laws that serve our common good, and the Executive branch enforces those laws. Our legislature already has its finger in the enforcement role, through rules review. Don’t give them another finger to put where it doesn’t belong. Vote NO on SJR 102.

 

Coroner

schmidt

In a month we will all be heading to the polls to support our representative democracy. We will cast our ballots and elect the officials that will work for our common good.

You’ll vote for a US Senator, maybe, and you’ll for sure vote for a US Representative. Down below these lofty congressional positions you’ll decide on a State Senator, then a State Representative. Next, you’ll consider who should be one of your county commissioners. Maybe there will be two on your ballot. Below the county commissioners on the ballot comes the sheriff, though some might argue that position should be higher.

Do you even know these folks? Wait, it gets even more obscure.

The County Assessor might be up for election, and maybe the County Treasurer. County. But before you get to vote for cemetery district commissioner, or highway district commissioner, or library district commish, the County Coroner will need your attention.

This was my induction to representative politics. I got appointed to be a county coroner early in my years in Moscow, Idaho, then ran for reelection three times. I went to the candidate forums, though I raised no money and spent none on campaign signs. I was “unaffiliated” with any political party since I thought such affiliation served no purpose, and the duties had no political impact I could see.

But the duties did serve the common good. Deaths should be investigated. And that is the duty of the county coroner: to investigate accidental, unexplained, unattended, suicidal, or homicidal deaths. There are some more minor duties, but that’s the gist.

Does this endeavor serve you? Does it matter that your coroner decides Mr. Flitty died from a heart attack? That’s a natural death. But it might matter to his widow since his life insurance pays double if it was an accident. And he was splitting firewood. Can’t we just call it an accident?

In my fifteen years I was on both sides of that dispute. A widow wanting one decision, an insurance company wanting another. No one thinks of a coroner needing much integrity, but I think that’s why the King of England established the position. The King wanted his taxes paid, and the possessions of the deceased needed to be accurately catalogued. Now days, it’s the manner and cause of death that needs determination, not the assets. Isn’t that more a public health question than a monetary one?

So, should this even be a public position we vote on? Why isn’t death investigated by a qualified appointed professional whose performance and integrity are ensured by the elected official that chooses them, like a chief of police?

Many states have this model. Oregon and Utah use medical examiners. Idaho has county coroners. One of those little “other duties” I mentioned above for Idaho Coroners is that they assume the duties of the Sheriff should they become unable to perform their duties. So, I’m arguing here that the coroner should get moved up on the ballot, above the sheriff. That won’t happen.

There have been many calls to change this system, but nothing much has happened. There is inertia when death is involved. But maybe Idaho has some small momentum.

Governor Little found some money in that huge surplus a year or so back to support a center in Pocatello to perform autopsies for county coroners in that corner of the state. Most rural counties have to pay big money to urban centers for such services. Montana has a much better system. But this is moving from the voting booth to big policy changes. I apologize.

Vote for the coroner you know. May their integrity and industry serve our common good. We may all need such service.

 

Comrade Moyle

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I wasn’t all that opposed to the “payback” law imposed on Idaho state-sponsored medical students. House Majority Leader Mike Moyle proposed this law that had been rumored for years. It passed this last session. Now Idaho state sponsored medical school graduates (University of Utah and WWAMI) will need to work for four years within our borders to repay our state the investment taxpayers have made.

I remember my second year as a WAMI student in Seattle. Nowadays, Idaho WWAMIs (with the addition of Wyoming to the consortium we have an extra “W”) do almost all their training in Idaho. But back in my day we had to go to Seattle for our second year.

I asked the Medical School librarian to help me answer the question: What is the best way to train healthcare providers to serve a rural population? This was before Google. I thought I knew the answer. Move to a “mid-level” model, that is quickly train nurse practitioners and physician assistants. But her search responses came up with a lot of citations about Cuba. I read them. It was fascinating.

After Castro took power, he wanted to bring health care to “the masses”. With total state control, he could design any system he wanted. His advisors liked the “doctor” model. He instituted a system that cranked out physicians. Today, the communist Cuban health care system scores better than ours in many measurements of public health.

I got an opportunity in the late Clinton presidency to visit Cuba. I got to look at their issues. I spent a day with a young resident in a Havana suburb as he staffed a community clinic. He saw every patient on his list who wanted an appointment. He listened to their everyday complaints and offered what little he had to comfort their suffering.

If he found a problem that he could not comprehend from his four years of medical training, he scheduled an appointment with a consultant. He went with the patient to visit the consultant. He watched the consultant and learned how that specialist considered this problem.

At the end of the day, I asked the young man his aspirations. He told me he wanted to go into plastic surgery and hoped to have a lucrative practice someday, probably in Brazil.

So, Comrade Moyle may be onto something. Having medical school graduates come back to Idaho might motivate them to go out and make the most money they can. Trickle down tells us that will enrich us all, right? I can just see Mike and Fidel sharing a cigar. Except Fidel is dead, and I doubt Representative Moyle smokes cigars, though I don’t really know.

I learned something else on that Cuba trip. I heard the head of the Cuban medical education system asked just how he had accomplished the incredible turnaround in Cuban public health. How had the proliferation of doctors he had engineered in this still poor country made such strides? His answer was telling.

“You look at the doctors and think our medical training deserves credit. But you must look further. Back in the 1950’s when our infant mortality was worse than Africa, and our maternal mortality was horrible, the average education of an expectant mother was second grade. Most were illiterate. Now days, when our infant mortality and maternal mortality is better than the United States, the average level of education for expectant mothers is high school or better. None are illiterate. We have greatly improved our education, and that has improved our health.”

So, I don’t know if Comrade Moyle was actually thinking of the communist Cuban system when he proposed indentured servitude for medical graduates. But if what he wants is a healthier Idaho, he should be thinking about a better education system.

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