http://jama.ama-assn.org/cgi/content/short/292/7/852
A clinical review in JAMA discusses a new theory into the misunderstood diseases of Irritable Bowel, Chronic Fatigue, and Fibromyalgia. It also suggests how these three disorders may be connected. Irritable bowel disease can present with many different symptoms. However, bloating after eating a meal is the most common symptom. Researchers discovered that the increased gas had less to do with an intolerance to any particular kind of food and more to do with bacterial overgrown in the small intestine. Bacteria do serve a critical role in the colon or large intestine. However, the small intestine between the stomach and the colon in healthy people is a mostly sterile environment. This is achieved by the acidity of the stomach which kills most bacteria which enters in the upper GI tract. On the other end a special valve at the insertion of the small intestine to the large intestine called the iliocecal valve prevents bacteria in the colon from ascending up and overgrown in the small intestine. Well, in the case of irritable bowel that is just what happens. The symptoms of bloating come from certain disaccharide like sorbitol, lactose, lactulose, and fructose found in certain foods which are not absorbed entirely in the upper small intestine, reach the bacteria in the lower small intestine and cause the bacteria to grow and produce gas. The small bowel gets distended due to the gas causing pain and bloating. The iliocecal valve keeps the gas bottled up in small intestine from being released into the colon and then expelled as flatus. Glucose and sucrose are easily absorbed in the upper small bowel and do not cause bacterial overgrown, gas production, bloating, and abdominal pain.
So, what about the constipation, diarrhea, or a combination of the two which are common symptoms in irritable bowel. Well, these symptoms are due to what kinds of bacteria are growing in the small intestine and what gases they produce. Methane gas causes decreased paristalsis and constipation. Other gases include hydrogen, and hydrogen sulfide. Diarrhea is related to toxins released by certain bacterias which stimulate the small intestine to secrete water. In the colon, a variety of bacteria are found that all compete with one another so no one kind overgrows the others. In the small intestine it is common for one or two specific bacterial species to overgrow and cause the symptoms of irritable bowel.
So, what about fibromyalgia and chronic fatigue syndrome. It's no revelation that these mysterious disorders seem to run together. Well, researchers have discovered that fibromyalgia and chronic fatigue may be caused by the same small intestine bacterial overgrown as irritable bowel. Turns out there is a great new test to diagnose irritable bowel. Symptomatic patients can be given a dose of oral lactulose and then a breathalizer test can be taken measuring for increased methane, hydrogen, and hydrogen sulfide production. Well, it turns out that patients with irritable bowel symptoms have higher gas production than healthy individual. What was even a greater surprise was that almost 100% of individuals suffering from fibromyalgia and chronic fatigue symptoms also had positive lactulose challenge, breathalizer tests. This means that having fibromyalgia and chronic fatigue could be linked to bacterial overgrown and irritable bowel (chronic fatigue can be associated with post mononucleosis as well as other potential chronic infectious, genetic, and environmental diseases and exposures).
However, not all individuals with irritable bowel have fibromyalgia. This is due to the kind of bacteria that is overgrown in the small bowel and the individual's immune reponse to the specific bacterial strain. According to the article, bacteria as well as signs of inflammation where found in neighboring lymph nodes adjacent to the small intestine in suffers of fibromyalgia and chronic fatigue. The subsequent inflammatory reaction to the bacteria results in the characteristic body aches, pains, malaise, and fatigue.
So, what to do about it. Well no official studies have been perfomed. But the review article suggests several ideas. While symptoms persist, an irritable bowel sufferer should temporarily avoid foods that contain complex disaccharide such as lactose (dairy products), sorbitol (apple juice), and even fructose (fruit) in some cases. Suffers will need to learn which foods cause bloating, constipation, and diarrhea. Temporarily eliminating these from the diet will stop feeding the bacteria in the lower small intestine and prevent the bacterial overgrown and gas production.
Another idea it to replace bad bacteria with good bacteria. Since, bacterial overgrown is believed to be due to one or two offending stains of bacteria, adding good bacteria to the mix could help control bacterial overgrown by increasing the competition for food between good and bad bacteria. Yogurt and Cranberry juice have not been shown effective in helping to alleviate symptoms of irritable bowel due to active yogurt culture and antibiotic properties in the later. This is probably because these also contain lactose and fructose which exacerbate the condition. Several prescription and nonprescription products which contain milk bacteria (Lactobacillis acidophilis) or other mixed strains of bacteria (probiotics) may be helpful (Culturel, Bifidobacterium bifidus, fecal probiotics). Probiotic therapies have proven successful in the treatment of inflammatory bowel (Crohns disease, Ulcerative colitis, Clostridium difficile colitis, recurrent diarrhea, rota virus?).
Finally, 14 day treatment with the antibiotic Flagyl (metronitazole) is also effective at treating irritable bowel. However, doctors feel uneasy about relying on antibiotic treatment due to possible emergence of resistant basteria strains.
Saturday, August 21, 2004
Tuesday, July 27, 2004
Personal Statement Howto
FIRST STEP: The Variables
While working on a project last year, I found myself reading through a series of personal statements for applications to law, business, and medical school. To my astonishment, the letters were completely identical in structure to each other. What's more, they were indistinguishable to the personal statement I had written for medical school three years prior. And here I was thinking I had come up with some wholly unique document. Well, turns out there exists a formula to the personal statement which I will attempt to describe as well as giving some advice on how to personalize a entirely generic essay.
Writing the personal statement can be the toughest part of the application. The challenges are in being original and illustrating character without bragging. The first step is knowing yourself and seeing what makes you unique. Diversity is a hot commodity so, make sure your personal statement showcases your individuality and diverse life experience. Too often, we go through life not realizing or appreciating the people who have influenced us or experiences that shape us. So, before you begin writing your statement, think and write about these influences. What did you learn from each experience, from the people you served, and from those you worked with?
FIRST STEP: The Variable
What were the 5 experiences that helped you realize your chosen medical specialty is right for you?
Where were you?
What happened, what did you accomplish?
Who did you serve, who did you work with?
How did you feel, what did you realize?
How did the experience change you?
Who are the 5 people in your life that had the biggest influence on you?
Who is the person, what did they do?
How did you come to know them?
What is it about them that influenced you?
How did you feel, and how did they change you?
Paint a portrait of yourself using these specific examples. Hopefully, you'll have many experiences through your extracurricular activities to draw upon when writing your personal statement. Remember, its these experiences, influences and your feelings about them that will make your personal statement unique.
SECOND STEP: The Formula
The second step in creating your statement involves understanding the framework of your future masterpiece. Personal statements follow a rigid 5-7 paragraph format. Since it is recommended that your statement not exceed one page, 5-7 short paragraphs is all you'll have room for. The first paragraph contains the "catchy opening sentence" as well as the thesis statement. Most people consider the opening sentence the most difficult part of the personal statement. The goal is to highjack the readers attention. Despite what you learned in Freshman English, starting with a quote is NOT interesting. Rather, you end up communicating that you are so unimaginative you needed someone else write your opening sentence for you. If you think there is a quote that sums up your existence, consider using it in the body of your statement. The way to capture the attention of the reader is to make them FEEL an emotion. This is most appropriately done through humor, or surprise. Since the rest of your personal statement, most likely, will be trying to be warm and touching; a humorous, surprising, or odd intro will provide contrast (e.g. comic relief).
One way to accomplish this task as well as communicate how one-of-a-kind you are it to think about something you have done, seen, experienced, or know about what no one else on the planet has done, seen, experienced, or knows about; or at least no other residency applicants. Maybe you have a unique hobby or interest? Lead into your statement using an anecdote, quote, question, or engaging description based on your unique theme. Then tie your theme into your thesis. For example, I am into Amateur (HAM) radio. My callsign is KB7BXP. So, I started my personal statement with: "CQ, CQ, CQ. This is KB7BXP, calling CQ, CQ, CQ." The next step is to tie your "intro" into being a doctor, or why you want to be a [whatever]. For example, I told about the time I contacted someone from the still communist Russia and like radio, medicine allows me to "connect" with others in a unique way. Then comes the thesis statement. This is something stating that your interest in [your specialty] is rooted in or stems from several unique experiences which impacted you and several people who influenced you. Then you will go on to share a few anecdotes from your life which will illustrate who you are and why your so convinced [your specialty] is meant for you. The next 3-5 paragraphs will be the anecdotes derived from the list of events, people, etc. that you made in the FIRST STEP.
A great way to talk about your accomplishments with out bragging about them is to focus your paragraph on someone you met while you were running into burning buildings to save hundreds of helpless children. You could focus on the bravery of firefighter Joe who went into the burning building with you. Then by inference, the reader will know you must have been in the burning building as well.Finally, your concluding paragraph should make reference to your initial theme and restate your thesis. I accomplished this by writing: "The ability to communicate and connect with people all over the world makes amateur radio a rewarding hobby. As a physician, I will connect with others by . . ." I then restated my thesis by summing up again the theme of my personal statement.
SECOND STEP: The Formula
Paragraph 1: catchy intro, thesis
Paragraph 2: person/place/thing/experience 1,
Paragraph 3: person/place/thing/experience 2,
Paragraph 4: person/place/thing/ experience 3,
Paragraph 5: person/place/thing/ experience 4,
Paragraph 6: refer to intro, restate thesis.
THIRD STEP: Plug and Chug
The third and final step is to put it all together. Come up with several interesting introductions, thesis statements, and personal anecdotes. Your personal statement should be longer than a single page at this point with the goal to select the intro, and 3-5 personal anecdotes that will work the best. Solicit the advice of friends, fellow students, spouses, parents, teachers, doctors in helping you rework, develop, edit and select the best material to keep in your personal statement.Lastly, you must work on flow and continuity between paragraphs. This can be a challenge as each of your paragraphs will be talking about completely different things. One way to connect paragraphs is to briefly allude to your thesis statement to make the transition. Then don't forget to edit for spelling and grammar. Remember everything your Freshman English teacher told you about using parallel construction (not only, but also), and avoiding passive speech.
THIRD STEP: Plug and Chug
Write several interesting, odd, humorous intros
Compile 7-10 personal anecdotes
Solicit others to edit, develop, rework and weed out anecdotes
Work on flow and continuity between paragraphs
Edit for spelling and grammar
Remember, I said that most personal statements will follow this format. So, by mindlessly following the suggestions here you'll likely get a drab, boring statement. These suggestion are intended as a place to start but hopefully by the end it shouldn't be obvious that your statement is following any generic formula. Also, if you have an experience or "ah-hah" moment that is particularly profound, you should consider devoting 2-3 paragraphs or even the entire statement to it. Your statement should be in a light conversational tone. Do not include specific names as that wil be interpreted as name dropping. And finally, your statement should reflect a little of your personality. Getting a sense of your personality is the major purpose applicants are required to write personal statements in the first place. In the end, If your statement reflects who you are, it will be as unique as you are.
While working on a project last year, I found myself reading through a series of personal statements for applications to law, business, and medical school. To my astonishment, the letters were completely identical in structure to each other. What's more, they were indistinguishable to the personal statement I had written for medical school three years prior. And here I was thinking I had come up with some wholly unique document. Well, turns out there exists a formula to the personal statement which I will attempt to describe as well as giving some advice on how to personalize a entirely generic essay.
Writing the personal statement can be the toughest part of the application. The challenges are in being original and illustrating character without bragging. The first step is knowing yourself and seeing what makes you unique. Diversity is a hot commodity so, make sure your personal statement showcases your individuality and diverse life experience. Too often, we go through life not realizing or appreciating the people who have influenced us or experiences that shape us. So, before you begin writing your statement, think and write about these influences. What did you learn from each experience, from the people you served, and from those you worked with?
FIRST STEP: The Variable
What were the 5 experiences that helped you realize your chosen medical specialty is right for you?
Where were you?
What happened, what did you accomplish?
Who did you serve, who did you work with?
How did you feel, what did you realize?
How did the experience change you?
Who are the 5 people in your life that had the biggest influence on you?
Who is the person, what did they do?
How did you come to know them?
What is it about them that influenced you?
How did you feel, and how did they change you?
Paint a portrait of yourself using these specific examples. Hopefully, you'll have many experiences through your extracurricular activities to draw upon when writing your personal statement. Remember, its these experiences, influences and your feelings about them that will make your personal statement unique.
SECOND STEP: The Formula
The second step in creating your statement involves understanding the framework of your future masterpiece. Personal statements follow a rigid 5-7 paragraph format. Since it is recommended that your statement not exceed one page, 5-7 short paragraphs is all you'll have room for. The first paragraph contains the "catchy opening sentence" as well as the thesis statement. Most people consider the opening sentence the most difficult part of the personal statement. The goal is to highjack the readers attention. Despite what you learned in Freshman English, starting with a quote is NOT interesting. Rather, you end up communicating that you are so unimaginative you needed someone else write your opening sentence for you. If you think there is a quote that sums up your existence, consider using it in the body of your statement. The way to capture the attention of the reader is to make them FEEL an emotion. This is most appropriately done through humor, or surprise. Since the rest of your personal statement, most likely, will be trying to be warm and touching; a humorous, surprising, or odd intro will provide contrast (e.g. comic relief).
One way to accomplish this task as well as communicate how one-of-a-kind you are it to think about something you have done, seen, experienced, or know about what no one else on the planet has done, seen, experienced, or knows about; or at least no other residency applicants. Maybe you have a unique hobby or interest? Lead into your statement using an anecdote, quote, question, or engaging description based on your unique theme. Then tie your theme into your thesis. For example, I am into Amateur (HAM) radio. My callsign is KB7BXP. So, I started my personal statement with: "CQ, CQ, CQ. This is KB7BXP, calling CQ, CQ, CQ." The next step is to tie your "intro" into being a doctor, or why you want to be a [whatever]. For example, I told about the time I contacted someone from the still communist Russia and like radio, medicine allows me to "connect" with others in a unique way. Then comes the thesis statement. This is something stating that your interest in [your specialty] is rooted in or stems from several unique experiences which impacted you and several people who influenced you. Then you will go on to share a few anecdotes from your life which will illustrate who you are and why your so convinced [your specialty] is meant for you. The next 3-5 paragraphs will be the anecdotes derived from the list of events, people, etc. that you made in the FIRST STEP.
A great way to talk about your accomplishments with out bragging about them is to focus your paragraph on someone you met while you were running into burning buildings to save hundreds of helpless children. You could focus on the bravery of firefighter Joe who went into the burning building with you. Then by inference, the reader will know you must have been in the burning building as well.Finally, your concluding paragraph should make reference to your initial theme and restate your thesis. I accomplished this by writing: "The ability to communicate and connect with people all over the world makes amateur radio a rewarding hobby. As a physician, I will connect with others by . . ." I then restated my thesis by summing up again the theme of my personal statement.
SECOND STEP: The Formula
Paragraph 1: catchy intro, thesis
Paragraph 2: person/place/thing/experience 1,
Paragraph 3: person/place/thing/experience 2,
Paragraph 4: person/place/thing/ experience 3,
Paragraph 5: person/place/thing/ experience 4,
Paragraph 6: refer to intro, restate thesis.
THIRD STEP: Plug and Chug
The third and final step is to put it all together. Come up with several interesting introductions, thesis statements, and personal anecdotes. Your personal statement should be longer than a single page at this point with the goal to select the intro, and 3-5 personal anecdotes that will work the best. Solicit the advice of friends, fellow students, spouses, parents, teachers, doctors in helping you rework, develop, edit and select the best material to keep in your personal statement.Lastly, you must work on flow and continuity between paragraphs. This can be a challenge as each of your paragraphs will be talking about completely different things. One way to connect paragraphs is to briefly allude to your thesis statement to make the transition. Then don't forget to edit for spelling and grammar. Remember everything your Freshman English teacher told you about using parallel construction (not only, but also), and avoiding passive speech.
THIRD STEP: Plug and Chug
Write several interesting, odd, humorous intros
Compile 7-10 personal anecdotes
Solicit others to edit, develop, rework and weed out anecdotes
Work on flow and continuity between paragraphs
Edit for spelling and grammar
Remember, I said that most personal statements will follow this format. So, by mindlessly following the suggestions here you'll likely get a drab, boring statement. These suggestion are intended as a place to start but hopefully by the end it shouldn't be obvious that your statement is following any generic formula. Also, if you have an experience or "ah-hah" moment that is particularly profound, you should consider devoting 2-3 paragraphs or even the entire statement to it. Your statement should be in a light conversational tone. Do not include specific names as that wil be interpreted as name dropping. And finally, your statement should reflect a little of your personality. Getting a sense of your personality is the major purpose applicants are required to write personal statements in the first place. In the end, If your statement reflects who you are, it will be as unique as you are.
Infant Formula and Omega-3-Fatty Acids
Enfamil and Simulac have developed new infant formulas that include important omega-3-fatty acids. These essential fatty acids cannot be made by our bodies are are impotant constituents of cell membranes as well as the meylin sheath of neurons in the brain. They also naturally occur in mother's breast milk. It is amazing how erogant we can be that either by divine design or evolution, mammals have the ability to provide the perfect food for their offspring and we think we can simply replace it with some synthetic substitute.
Hundreds of studies show the benifits of breast milk versus the deficiencies of formula. Some of formula's deficiencies include an average IQ lose of 5 points, as well as increased illness, greater severity of illness, and greater incidence of allergy problems. Research is showing us that omega-3-fatty acids play an important role as anti-inflammatory agents, immune modulators and decrease the risk of many autoimmune dieases as well as decreasing the incidence of eczema and asthma. They also play an important role in nerve meylination which could have significant effects in emotional and physical development, future mental health and coordination. Many infant formulas have had omega-3-fatty acids from the beginning and only emphasize it now because it is "en vogue".
Hundreds of studies show the benifits of breast milk versus the deficiencies of formula. Some of formula's deficiencies include an average IQ lose of 5 points, as well as increased illness, greater severity of illness, and greater incidence of allergy problems. Research is showing us that omega-3-fatty acids play an important role as anti-inflammatory agents, immune modulators and decrease the risk of many autoimmune dieases as well as decreasing the incidence of eczema and asthma. They also play an important role in nerve meylination which could have significant effects in emotional and physical development, future mental health and coordination. Many infant formulas have had omega-3-fatty acids from the beginning and only emphasize it now because it is "en vogue".
Fruititarian Fallacy
Fruititarianism believes that all food should be eaten raw, organic, and all natural as God intended it. The claim being that many nutrients are lost though the cooking and preparation process. Well, there is a shred of truth to this aurgument. It is clear that the extensive food processing that is done today strips many essential vitamins and minerals from food. We would all do better by avoiding processed foods that have become such a mainstay of the American diet. However, new research presents an interesting aurgument to the "raw is right" stance.
Lycopene is a molecule found in tomatos which has been shown to decrease a man's risk of developing prostate cancer. Well, it turns out that a fresh garden tomato is NOT the best sourse of lycopene. The best source just so happens to be good old American Ketchup. This aurgument seems to be a case of extreme pendulum swinging.
The truth is that certain vitamins and minerals are made more or less bioavailable by how the food is prepared. Nutrients in raw foods have a different bioavailibility than those in food which are steamed, boiled, fried, stewed, baked, or microwaved. The truth with regard to good health is to maintain a variety. Additionally, not only did God give us fruit to eat but he also gave us fire to cook it.
Lycopene is a molecule found in tomatos which has been shown to decrease a man's risk of developing prostate cancer. Well, it turns out that a fresh garden tomato is NOT the best sourse of lycopene. The best source just so happens to be good old American Ketchup. This aurgument seems to be a case of extreme pendulum swinging.
The truth is that certain vitamins and minerals are made more or less bioavailable by how the food is prepared. Nutrients in raw foods have a different bioavailibility than those in food which are steamed, boiled, fried, stewed, baked, or microwaved. The truth with regard to good health is to maintain a variety. Additionally, not only did God give us fruit to eat but he also gave us fire to cook it.
Trans-fatty acids and Alzheimer's
Together with a genetic suceptibility, those seniors who consumed more trans-fats in their diets had a 2.5 times greater correlation of Alzheimer's disease. http://archneur.ama-assn.org/cgi/content/abstract/60/2/194
In the 1950's researchers discovered a link between saturated fat (animal fat) and heart disease. So, the food industry switched from using lard to using vegetable oil. However, vegetable oil is a liquid at room temperature and food makers needed a solid. So, scientists at Proctor & Gamble discovered the process of hydrogenation which removes some of the double bonds (kinks) in the long chain fatty acids. The resulting substance is a thick, greasy substance known as Crisco. However, some of the remaining double bonds get switched form the native cis- form to the abnormal trans- form. What this means is that the body doesn't know what to do with the trans- form.
The body is picky about what molecules. The idea of chirality (handedness) is very important principle. Aminoacids, sugars, fats, and drugs all must be in the right configuration to be recignized and used by the body. Controlling the chirality of drugs is a $90 billion dollar industry (e.g. albuterol/levalbuterol, celexa/lexapro, claritin/clarinex).
Several things determine if a carbon chain is a gas, liguid(oil), or solid(wax) at room temperature. 1. length (e.g. propane[3C] = gas; octane[8C]= liquid; palmitate[16C]= wax). 2. functional groups (i.e. ethanol[2C+OH]= liguid). 3. double bonds (i.e. polyunsaturated fat[16C]= liquid). So, overal chain length helps the molecules stick together better at room temperture. Thus, long carbon chains are solid and short carbon chains are gases. However, functional groups like an alcohol can make chains stick together better. For example, ethanol[2C+OH] is a liquid at room temperature instead of a gas like propane[3C] and methane[1C]. An alcohol[OH] group is related to water[H2O] which is very cohesive. Double bonds on the other hand make long carbon chains not stick together as well at room temperature. A double bond makes a kink in the carbon chain which prevents them from stacking well together. This is what makes vegetable oil[14C] a liquid instead of wax at room temperature. Vegetable oil is polyunsaturated (multiple double bonds).
A study was reported in the annals of neurology which followed a cohort of elderly people in the Chicago area. They had these seniors record a few times a year what they ate during the day. It so happened that certain seniors in the study went on to develop Alzheimer's disease. Then with the help of a new USDA data base the researchers were able to make correlations between diet and risk of developing the disease. Well, there was only one very strong corellation and it was trans-fats. So, together with a genetic suceptibility, those seniors who consumed more trans-fats in their diets had a 2.5 times greater correlation of Alzheimer's disease. http://archneur.ama-assn.org/cgi/content/abstract/60/2/194
Proctor & Gamble is currently selling off and devesting itself of all its food processing and production business.
In the 1950's researchers discovered a link between saturated fat (animal fat) and heart disease. So, the food industry switched from using lard to using vegetable oil. However, vegetable oil is a liquid at room temperature and food makers needed a solid. So, scientists at Proctor & Gamble discovered the process of hydrogenation which removes some of the double bonds (kinks) in the long chain fatty acids. The resulting substance is a thick, greasy substance known as Crisco. However, some of the remaining double bonds get switched form the native cis- form to the abnormal trans- form. What this means is that the body doesn't know what to do with the trans- form.
The body is picky about what molecules. The idea of chirality (handedness) is very important principle. Aminoacids, sugars, fats, and drugs all must be in the right configuration to be recignized and used by the body. Controlling the chirality of drugs is a $90 billion dollar industry (e.g. albuterol/levalbuterol, celexa/lexapro, claritin/clarinex).
Several things determine if a carbon chain is a gas, liguid(oil), or solid(wax) at room temperature. 1. length (e.g. propane[3C] = gas; octane[8C]= liquid; palmitate[16C]= wax). 2. functional groups (i.e. ethanol[2C+OH]= liguid). 3. double bonds (i.e. polyunsaturated fat[16C]= liquid). So, overal chain length helps the molecules stick together better at room temperture. Thus, long carbon chains are solid and short carbon chains are gases. However, functional groups like an alcohol can make chains stick together better. For example, ethanol[2C+OH] is a liquid at room temperature instead of a gas like propane[3C] and methane[1C]. An alcohol[OH] group is related to water[H2O] which is very cohesive. Double bonds on the other hand make long carbon chains not stick together as well at room temperature. A double bond makes a kink in the carbon chain which prevents them from stacking well together. This is what makes vegetable oil[14C] a liquid instead of wax at room temperature. Vegetable oil is polyunsaturated (multiple double bonds).
A study was reported in the annals of neurology which followed a cohort of elderly people in the Chicago area. They had these seniors record a few times a year what they ate during the day. It so happened that certain seniors in the study went on to develop Alzheimer's disease. Then with the help of a new USDA data base the researchers were able to make correlations between diet and risk of developing the disease. Well, there was only one very strong corellation and it was trans-fats. So, together with a genetic suceptibility, those seniors who consumed more trans-fats in their diets had a 2.5 times greater correlation of Alzheimer's disease. http://archneur.ama-assn.org/cgi/content/abstract/60/2/194
Proctor & Gamble is currently selling off and devesting itself of all its food processing and production business.
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