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1.
MEDICC Rev ; 23(2): 9, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1411606

ABSTRACT

The effects and implications of COVID-19 are global, comprehensive and long-term. The pandemic has exposed inequities, the fragility of economic and political systems, and in many cases, skewed priorities. Population health, not to mention planetary health, is suffering as a result. Nevertheless, the global health crisis in which we are embroiled has provided opportunities for effective collaboration, scientific innovation and real dialog around health and equity. Dr Amaylid Arteaga-García, director of Cuba's National Clinical Trials Coordinating Center (CENCEC), emphasized these opportunities when discussing Cuba's clinical trials in times of COVID-19. Founded in 1991 in response to the groundbreaking research emerging from the country's biopharmaceutical sector-including the first safe, effective vaccine against serogroup B meningococcal disease, VA-MENGOC-BC in 1989 and a recombinant vaccine against hepatitis B, Heberbiovac in 1990-CENCEC now coordinates some 100 clinical trials annually, many of them multi-site trials involving thousands of volunteers. Little did Dr Arteaga García know what problems lurked when she became CENCEC director in 2019. In February 2020, Cuba implemented its National COVID-19 Prevention & Control Plan. This included a scientific Innovation Committee tasked with evaluating promising projects, products and research that might be used in the health system to control and treat COVID-19. This approach taps into two of Cuba's strengths: biotechnology and primary health care. Given the volume and complexity of COVID-19 clinical trials, Dr Arteaga.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Clinical Trials as Topic , Communicable Disease Control/organization & administration , Cuba/epidemiology , Humans , Pandemics , SARS-CoV-2
2.
MEDICC Rev ; 23(3-4): 65-73, 2021.
Article in English | MEDLINE | ID: covidwho-1399829

ABSTRACT

INTRODUCTION: One year after WHO declared COVID-19 a pandemic, we found it useful to carry out a diagnosis of the situation in Latin America. OBJECTIVE: Examine the prevailing epidemiological panorama in mid-March 2021 in 16 countries in Latin America and the performance, over time, in the two countries with the best responses to their respective epidemics. METHODS: Using morbidity and mortality data, we compared the relative performance of each country under review and identified the two countries with the most successful responses to the pandemic. We used five indicators to analyze the course of each country's performance during the pandemic throughout 2020: prevalence of active cases per million population; cumulative incidence rate in 7 days per 100,000 population; positivity rate over a 7-day period; percentage of recovered patients and crude mortality rate per 1,000,000 population. RESULTS: According to the performance indicators, Cuba was ranked highest, followed by Uruguay. Although figures remained within acceptable margins, both nations experienced notable setbacks in the first weeks of 2021, especially sharp in Uruguay. CONCLUSIONS: Any characterization of the situation is condemned to be short-lived due to the emergence of mutational variants; however, this analysis identified favorable sociodemographic characteristics in both nations, and in their health systems, which may offer possible explanations for the results we obtained.


Subject(s)
COVID-19 , Epidemics , Cuba/epidemiology , Humans , Latin America , SARS-CoV-2 , Uruguay/epidemiology
3.
Diabetes Metab Syndr ; 15(5): 102245, 2021.
Article in English | MEDLINE | ID: covidwho-1356197

ABSTRACT

AIMS: It is important to have valid and reliable measures to determine the psychological impact of COVID-19 in patients with diabetes; however, few instruments have been developed and validated for this population. Therefore, the aim of this study was to validate the Scale of Worry for Contagion of COVID-19 (PRE-COVID-19) in a sample of patients with diabetes mellitus (DM). MATERIALS AND METHODS: A total of 219 patients (66.2% female, mean age 58.5 SD = 18.2) participated, selected through non-probabilistic sampling. The PRE-COVID-19 and the Generalized Anxiety Disorder Scale-2 were applied. Reliability analysis was performed for internal consistency, structural equation modeling and item response theory modeling. RESULTS: The results show that a unidimensional 5-item model presents satisfactory goodness-of-fit indices and excellent reliability values. Likewise, convergent validity between the PRE-COVID-19 and a measure of anxiety is evident. All items present adequate discrimination parameters, allowing for discerning between those patients with critical concern about COVID-19 contagion from those with severe concern. CONCLUSION: It is concluded that the PRE-COVID-19 is an instrument with adequate psychometric properties to measure concern about COVID-19 infection and the emotional impact in patients with DM.


Subject(s)
COVID-19/psychology , Diabetes Mellitus, Type 2/psychology , Psychometrics/methods , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety/diagnosis , Anxiety/epidemiology , Anxiety/etiology , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Anxiety Disorders/etiology , COVID-19/epidemiology , Cuba/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Psychometrics/standards , Surveys and Questionnaires , Young Adult
5.
Methods ; 195: 15-22, 2021 11.
Article in English | MEDLINE | ID: covidwho-1243244

ABSTRACT

Epidemic control may be hampered when the percentage of asymptomatic cases is high. Seeking remedies for this problem, test positivity was explored between the first 60 to 90 epidemic days in six countries that reported their first COVID-19 case between February and March 2020: Argentina, Bolivia, Chile, Cuba, Mexico, and Uruguay. Test positivity (TP) is the percentage of test-positive individuals reported on a given day out of all individuals tested the same day. To generate both country-specific and multi-country information, this study was implemented in two stages. First, the epidemiologic data of the country infected last (Uruguay) were analyzed. If at least one TP-related analysis yielded a statistically significant relationship, later assessments would investigate the six countries. The Uruguayan data indicated (i) a positive correlation between daily TP and daily new cases (r = 0.75); (ii) a negative correlation between TP and the number of tests conducted per million inhabitants (TPMI, r = -0.66); and (iii) three temporal stages, which differed from one another in both TP and TPMI medians (p < 0.01) and, together, revealed a negative relationship between TPMI and TP. No significant relationship was found between TP and the number of active or recovered patients. The six countries showed a positive correlation between TP and the number of deaths/million inhabitants (DMI, r = 0.65, p < 0.01). With one exception -a country where isolation was not pursued-, all countries showed a negative correlation between TP and TPMI (r = 0.74). The temporal analysis of country-specific policies revealed four patterns, characterized by: (1) low TPMI and high DMI, (2) high TPMI and low DMI; (3) an intermediate pattern, and (4) high TPMI and high DMI. Findings support the hypothesis that test positivity may guide epidemiologic policy-making, provided that policy-related factors are considered and high-resolution geographical data are utilized.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19 Testing/methods , COVID-19 Testing/standards , COVID-19/diagnosis , COVID-19/epidemiology , Argentina/epidemiology , Bolivia/epidemiology , COVID-19/prevention & control , COVID-19 Testing/trends , Chile/epidemiology , Cuba/epidemiology , Epidemics/prevention & control , Humans , Mexico/epidemiology , Mortality/trends , Uruguay/epidemiology
6.
MEDICC Rev ; 23(2): 12, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1224449

ABSTRACT

Cuba has five COVID-19 vaccines in clinical trials and is on track to receive emergency use authorization from the country's regulatory agency to begin mass vaccination with two of those candidates: Abdala and SOBERANA 02. Results from phase 1 and 2 trials of these vaccines, the first developed and produced in Latin America, have been encouraging, both in terms of safety and immunogenicity. The ongoing phase 3 trials will continue to look at safety, together with efficacy; parallel intervention studies involving over a million people in Havana will begin generating data on effectiveness. Coordination between Cuba's biotechnology sector and its public health system-particularly throughout the different levels of primary care-to control and treat COVID-19 is a cornerstone of the Cuban strategy and one that could serve as a blueprint for future pandemics. Another Cuban product, itolizumab, is showing positive results mitigating cytokine release syndrome (CRS) in COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Developed in collaboration with Biocon (India), itolizumab is administered under an expanded access program to treat vulnerable populations in Cuba. Marshaling complementary capacities of dozens of institutions belonging to BioCubaFarma-the country's biotech conglomerate-and developing therapies, vaccines and medical technologies together, is another cornerstone of Cuba's strategy to combat COVID-19 and improve population health. The Molecular Immunology Center (CIM) is a key player in this strategy. Founded in 1992, CIM is a powerhouse in monoclonal antibody research and production, with 6 registered products and 22 in the pipeline. Known for several novel therapeutic cancer treatments, CIM has over two decades' experience producing complex recombinant proteins in mammalian cells on an industrial scale. Once Cuba's Innovation Committee (convened in January 2020 as part of the National COVID-19 Prevention & Control Plan) determined Cuban researchers would pursue protein subunit vaccine candidates, they turned to CIM to produce the required receptor-binding domain (RBD) of the SARS-CoV-2 spike protein, among other responsibilities. CIM's General Director, Dr Eduardo Ojito-Magaz, is a chemical engineer and holds a master's degree in biotechnology. He spoke with MEDICC Review just days before 1.7 million Havana residents began participating in the country's largest intervention study with the COVID-19 vaccines his center helped make possible.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Pneumonia, Viral/prevention & control , Antibodies, Monoclonal , Biomedical Research , Biotechnology , COVID-19/epidemiology , Cuba/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2
8.
MEDICC Rev ; 23(2): 15, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1224444

ABSTRACT

INTRODUCTION: COVID-19 is caused by the novel coronavirus SARS-CoV-2 and was declared a pandemic on March 11, 2020, the same day that the first cases in Cuba were diagnosed. In Cuba, all confirmed cases of COVID-19 were hospitalized from this point forward. OBJECTIVE: Characterize the first patients diagnosed with COVID-19 in Cuba. INTRODUCTION: METHODS We carried out a descriptive, cross-sectional study of 415 suspected cases of COVID-19 admitted to the Pedro Kourí Tropical Medicine Institute in Havana, Cuba, from March 11, 2020 through April 10, 2020. (In Cuba, all patients suspected of being COVID-19-positive were admitted to hospitals or isolation centers for observation and treatment.) Of these 415 individuals, 63 (15.2%) tested positive for SARS-CoV-2. Information was obtained from the Institute's databases as well as a standardized interview form for cases confirmed or suspected as infected with the novel coronavirus. We considered the following variables: age, sex, occupation at the time of interview, national origin, personal health history, time elapsed between symptom onset and hospital admission, signs and symptoms, diagnosis and status at discharge. We based our analysis on frequency distributions and double-entry contingency tables. RESULTS: The mean age was 50 years (range: 16-94 years). The 45-54 age group represented the largest share of cases (25.4%; 16/63); persons aged ≥65 years were 20.6% (13/63); there were more men than women (55.6% vs. 44.4%). Cubans represented 52.4% (33/63) of patients while 47.6% (30/63) were from 14 countries where COVID-19 had already been identified. All foreigners and Cubans who arrived from abroad were considered imported cases (54.0%; 34/63). Health personnel (10 doctors and 1 nurse) represented 17.5% (11/63) of cases. Cough (50.8%), fever (46.0%), sore throat (22.2%) and headache (19.0%) were the most frequently reported symptoms. Asymptomatic patients represented 25.4% (16/63) of cases. Hypertension was the most frequently associated chronic disease (28.6%), followed by asthma (25.0%) and diabetes (17.9%). Patients who were admitted to hospital ≥3 days after symptom onset represented 66.7% (42/63) of cases. Mean hospital stay was 13.7 days (range: 1-27 days). Factors associated with a higher risk of contracting the disease included occupation as a healthcare worker (OR: 1.85; 95%, CI: 0.88-3.87) and aged ≥65 years (OR: 1.68; 95% CI: 0.85-3.34). Five individuals died, for a fatality rate of 7.9% (three foreigners and two Cubans; four men and one woman). Four of these patients were infected outside of Cuba and one was identified as a contact of a confirmed case. All patients who died had significant comorbidities (diabetes, asthma and hypertension). Age of deceased patients ranged from 54 to 87 years. CONCLUSION: The first patients diagnosed with COVID-19 in Cuba were admitted to the Pedro Kourí Tropical Medicine Institute in Havana. They share characteristics with those reported by other countries: more men than women were affected, and comorbidities including hypertension, diabetes and asthma were all important risk factors, as was age ≥65 years. More than half of all cases were imported, and autochthonous patients were all contacts of confirmed cases.


Subject(s)
COVID-19/epidemiology , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Cuba/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , SARS-CoV-2
9.
MEDICC Rev ; 23(2): 55, 2021 04.
Article in English | MEDLINE | ID: covidwho-1224443

ABSTRACT

Cuba implemented policies mandating social distancing on March 11, 2020, which were still in place at the time of this study. During such periods of isolation, people with psychoactive substance-related disorders and other addictions may be tempted to reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices they have abused. This can mean relapses and setbacks for patients undergoing treatment. A multidisciplinary team of health professionals specializing in addiction at the Center for Academic Development in Drug Addiction, in Havana, Cuba, cares for people with these disorders and followed their evolution during the initial period of COVID-19 social isolation. With the aim of characterizing strategies employed by patients undergoing treatment for substance abuse and addictions, we conducted a qualitative study from April 2020 through May 2020, using a convenience sample of 37 patients (all students) who had been progressing towards recovery from addictive behaviors when face-to-face encounters were suspended due to COVID-19 restrictions. Contact was maintained through information and communication technologies. The research used telepsychology and focused on understanding patient life experiences. Patients were interviewed using a semi-structured survey, which was then transcribed and coded thematically using a grounded-theory approach. We found that patients' ability to cope successfully with challenges presented by COVID-19 were influenced by: 1) the individual's own methods for maintaining self-control (commitment to studies, projects, and work with therapists) that aided them in their goals concerning abstinence; 2) difficulties faced in addressing specific events and situations (doubts, uncertainties, disagreements, isolation and time use); 3) perpetuation and revivification of myths related to substances and addictive activities (exacerbation of supposed benefits of tobacco, alcohol, marijuana, overuse of social networks); and 4) tendencies toward irrationality and lack of emotional control (fear, sadness, anger, constant worry and self-imposed demands). Our findings suggest that despite the potential negative psychological impact of preventive social isolation during the COVID-19 pandemic, individual coping mechanisms developed by these patients, aiming at improved self-control, allowed most to avoid setbacks that could have affected their recovery. Nevertheless, patients faced challenges to their recovery that were compounded by difficulties in specific situations, myths related to substances and addictive activities, and tendencies toward irrationality or lack of emotional control.


Subject(s)
Adaptation, Psychological , Behavior, Addictive/psychology , COVID-19/psychology , Substance-Related Disorders/psychology , Adult , Behavior, Addictive/epidemiology , Behavior, Addictive/rehabilitation , COVID-19/epidemiology , Cuba/epidemiology , Female , Grounded Theory , Humans , Male , Pandemics , Qualitative Research , SARS-CoV-2 , Substance-Related Disorders/epidemiology , Substance-Related Disorders/rehabilitation
11.
MEDICC Rev ; 23(2): 4-5, 2021 04.
Article in English | MEDLINE | ID: covidwho-1224441
14.
MEDICC Rev ; 23(1): 12-17, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1111039

ABSTRACT

Three fourths of the 175 staff at Cuba's National Medical Genetics Center (CNGM) are women. And women constitute 90% of the research team working on the Center's largest current project-unlocking the biological secrets of COVID-19 in the Cuban population. They are identifying particularly vulnerable groups and geographies, reviewing therapies applied and long-term sequelae of the disease, and contributing to ongoing vaccine research and trials. Their results are critical to determining effective preventive and treatment strategies as the country moves into the next phases of epidemic control. The national study is the first and only one of its kind in Latin America. Then the first COVID-19 cases were diagnosed in Cuba on March 11, 2020, the Center's role in epidemiological surveillance was activated, based on its experience with the Zika threat in 2015. This involved mobilizing the National Genetics Network anchored in primary healthcare facilities, comprised of 452 genetics counselors, nurses and clinical geneticists, supported by technicians, epidemiologists and family doctors. The Network's role would become key to the ensuing research. As the magnitude of the pandemic became clearer, CNGM investigators approached the Ministry of Public Health and government leaders with a broad-ranging proposal to study biological factors that would help explain differences in vulnerability, symptoms, immune response and severity of the disease, as well as its profile in different Cuban subpopulations. After approval, the studies got underway in June, encompassing Cubans who had been infected through June 11, 2020, and were by now convalescing. The nine main research lines were defined, and principal investigators went to work developing the instruments needed and training personnel across the island on their use. While final results are still being analyzed, CNGM Director Dr Beatriz Marcheco and four lead researchers talked with MEDICC Review about the scope of their work and some of the most intriguing preliminary findings.


Subject(s)
COVID-19/genetics , Genetics, Medical , National Health Programs/organization & administration , SARS-CoV-2/genetics , COVID-19/epidemiology , Communicable Disease Control , Cuba/epidemiology , Female , Humans , Male , Organizational Objectives , Pandemics , Population Surveillance
16.
Medwave ; 21(1): e8111, 2021 Feb 09.
Article in Spanish | MEDLINE | ID: covidwho-1094328

ABSTRACT

COVID-19 to date has caused hundreds of thousands of deaths in the world, becoming one of the worst pandemics in history. It all started in the People's Republic of China and quickly spread to the rest of the world. In this article, we seek to characterize the epidemiological situation of COVID-19 in Cuba during the first 80 days. For this article, we used observation and both quantitative and qualitative methods to collect data. We relied on statistical methodologies to validate the research. The study covered the days between March 11 and May 29, 2020. We analyzed the daily reports published by the Cuban Ministry of Public Health, this ministry's official website, and Cubadebate. Until May 29, the fifteen provinces of our country and the special municipality of Isla de la Juventud had confirmed positive cases, while the epicenter of the epidemic was the province of Havana. The coronavirus pandemic is a considerable challenge for the whole of Cuban society. A free health system, an inclusive social regime, and extensive experience in fine-tuning policies were some of Cuba's main strengths in facing the negative impact of the COVID-19 pandemic.


En la actualidad, una terrible pandemia está azotando a la humanidad. Se trata de COVID-19, que ha causado cientos de miles de fallecimientos en el mundo. Todo comenzó en la República Popular de China y rápidamente se extendió al resto del mundo. En este artículo buscamos caracterizar la situación epidemiológica de COVID-19 en Cuba durante los primeros 80 días. Para la realización del manuscrito, nos apoyamos en la técnica de la observación, en los métodos cuantitativos y cualitativos que garantizaron la obtención de los datos, y en metodologías estadísticas que probaron la validez del proceso investigativo. El estudio abarcó los días entre el 11 de marzo y el 29 de mayo de 2020. Analizamos los partes diarios publicados por el Ministerio de Salud Pública de Cuba, el sitio web oficial de este ministerio y Cubadebate. Hasta el 29 de mayo, fecha de conclusión del presente estudio, las quince provincias de nuestro país y el municipio especial Isla de la Juventud, habían confirmado casos positivos, siendo el epicentro de la epidemia la provincia de La Habana. La pandemia de coronavirus constituye un enorme reto para toda la sociedad cubana. Poseer un sistema de salud gratuito, una política social inclusiva y una amplia experiencia para enfrentar políticas de ajuste, constituyó una de las principales fortalezas de Cuba para enfrentar el impacto negativo de la pandemia de COVID-19.


Subject(s)
COVID-19/epidemiology , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Cuba/epidemiology , Female , Humans , Male , Middle Aged , Time Factors
17.
MEDICC Rev ; 22(4): 4-5, 2020 10.
Article in English | MEDLINE | ID: covidwho-1008292

ABSTRACT

We are all fatigued, frazzled. Many of us have lost too many and too much, and still more will suffer long-term physical and mental effects. A strange geography has cropped into our lexicon: states, provinces and entire countries mapped by their rates of COVID-19, telling us how dangerous it is to go outside, go to work or school. It is also the geography of health care, leadership and policies that aim to protect people fi rst-or not-the willingness to embrace the simply brilliant and brilliantly simple lessons of public health.


Subject(s)
COVID-19/epidemiology , Cuba/epidemiology , Global Health , Humans , Pandemics , SARS-CoV-2
18.
MEDICC Rev ; 22(4): 10-15, 2020 10.
Article in English | MEDLINE | ID: covidwho-995471

ABSTRACT

On August 13, 2020, Cuba's national regulatory agency, the Center for Quality Control of Medicines, Equipment and Medical Devices (CECMED), authorized clinical trials for SOBERANA 01-Cuba's fi rst vaccine candidate and the fi rst from Latin America and the Caribbean. On August 24, parallel Phase I/II double blind, randomized, controlled clinical trials were launched at clinical sites in Havana to evaluate the vaccine's safety and immunogenicity. Analysis of results and development of different formulations are currently under way and Phase III clinical trials are planned for early 2021. At the time of writing, a second vaccine candidate, SOBERANA 02, was in late-stage development and preparing to begin separate trials this fall.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , COVID-19/epidemiology , Cuba/epidemiology , Double-Blind Method , Humans , Pandemics , Randomized Controlled Trials as Topic , SARS-CoV-2
19.
J Interferon Cytokine Res ; 40(12): 578-588, 2020 12.
Article in English | MEDLINE | ID: covidwho-990531

ABSTRACT

A previous report on 814 patients who were coronavirus disease 2019 (COVID-19) positive provided preliminary therapeutic efficacy evidence with interferon-α2b (IFN-α2b) in Cuba, from March 11 to April 14, 2020. This study re-evaluates the effectiveness of IFN-α2b during the period from March 11 to June 17, 2020. Patients received a combination of oral antivirals (lopinavir/ritonavir and chloroquine) with intramuscular or subcutaneous administration of IFN-α2b. The primary endpoint was the proportion of patients discharged from the hospital; the secondary endpoint was the case fatality rate, and several outcomes related to time variables were also evaluated. From March 11 to June 17, 2,295 patients had been confirmed to be severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive in Cuba, 2,165 were treated with Heberon® Alpha R, and 130 received the approved protocol without IFN. The proportion of fully recovered patients was higher in the IFN-treated compared with the non-IFN-treated group. Prior IFN treatment decreases the likelihood of intensive care and increases the survival after severe or critical diseases. Benefits of IFN were significantly supported by time variables analyzed. This second report confirmed our preliminary evidence about the therapeutic effectiveness of IFN-α2b in SARS-CoV-2 infection and postulated Heberon Alpha R as the main component within antiviral drugs used in the Cuban protocol COVID-19.


Subject(s)
COVID-19/therapy , Interferon alpha-2/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Chloroquine/administration & dosage , Comorbidity , Critical Care , Cuba/epidemiology , Drug Therapy, Combination , Female , Humans , Infant , Infant, Newborn , Kaplan-Meier Estimate , Lopinavir/administration & dosage , Male , Middle Aged , Retrospective Studies , Ritonavir/administration & dosage , Treatment Outcome , Young Adult
20.
MEDICC Rev ; 22(4): 83-84, 2020 10.
Article in English | MEDLINE | ID: covidwho-979282

ABSTRACT

COVID-19 has dominated the conversation this year. Following the fi rst outbreaks in December 2019, it became clear that older adults were predisposed to greater disease severity and death. What occurred in nursing homes across Europe and the Americas was brutal-as much for the older adults themselves as for their families. Many didn't even get to say goodbye.


Subject(s)
Aged/psychology , COVID-19/epidemiology , COVID-19/psychology , Healthy Lifestyle , Age Factors , Cuba/epidemiology , Humans , Nursing Homes , Pandemics , SARS-CoV-2
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