What No One Tells You About Terminal Cancer

What No One Tells You About Terminal Cancer

No one tells you that every time you step outside to be greeted by the sun, it will be more than just the sun just shining down on you.

In elementary school, I met a strawberry blonde named Hannah. First impression? She was a total spitfire with a constellation of freckles on her cheeks and eyes that reflected her soul – full of life. Our childhoods were bliss. We were little girls as naive as sprouts whose roots were hardly established in the garden of this world. Hannah was a 13-year-old eternal optimist, forced to grow up too fast.

Because that’s what terminal cancer does. It steals childhoods, obliterates futures, and takes away the life in a little girl’s eyes.

I embarked on the journey of our friendship unaware that I would vicariously live through a battle of life versus death and come out in the end a new person… but without the warrior beside me to tell her own tale.

One year after her original diagnosis of brain cancer, Hannah received an update of massive tumor growth – essentially, her ticket to death. And a few days later, I ventured to the hospital with not a clue of what to expect because my best friend was invincible to me. I had never heard a complaint about the treatment reeking havoc upon her body or the side effects. My hopes were high until reality struck my preteen world that day.

The exquisite pain of wanting something unobtainable usually becomes trivial as life goes on. But what if all you wanted was another day with a beating heart, a functioning brain, or the opportunity to breathe?

Everyone who has walked through a pediatric oncology unit has a different type of understanding of what it means to be alive. Cracked doors and windows reveal children of all ages in the midst of fighting for a change in fate… sterilization masks and hair that’s long gone, but still believing in magic. Even if that magic won’t provide them with a cure.

After getting the news myself, I laid beside Hannah in that hospital bed. And through her slurred speech and tainted vision – we put together a list of her wishes that evolved into a legacy of our friendship, the beauty of life, and death. That list holds an explanation for why I wore hot pink stilettos to the funeral and why the name “Hannah” will definitely be embroidered on my wedding gown.

Inevitably a month later, Hannah died in her very own bed, in her Monmouth County home.

It’s almost three years later, her 17th birthday is right around the corner, and sometimes the realization that she’s gone still hits me as if I’m a child standing in the ocean hit by an oncoming wave. Because when your best friend dies from cancer freshman year, no one tells you how it’s going to affect the rest of your life.

No one tells you that you’re going to be numb at the wake. And you’re going to have trouble finding the words for a goodbye letter to put under her casket’s pillow for eternity.

No one tells you that chances are – you’ll sob alone in the bathroom at school on what should have been her Sweet 16. And each milestone will conjure up more tears because it’s just not fair.

No one tells you that resting sunflowers on her grave every summer isn’t the same as the old adventures throughout the summer haze of your childhoods, and passing her house on your neighborhood run will never become easier.

No one tells you that time doesn’t stop for anyone because life comes and goes by the numbers. But the meaning of time is impossible to define until you’ve realized the value of each moment.

But no one tells you that you can venture on in the face of a horrible prognosis and move forward ready to empathize with others as they face tragedies of their own.

No one tells you that no matter who you meet or where you travel in the world, you will always find a piece of your friend. Whether it’s in that pair of vaguely familiar blue eyes on a stranger at Target. Or how you get a laugh out of Nutella gelato in Europe – because she was allergic to hazelnuts.

No one tells you that if you open your heart – you will gain a new family. Her mother becomes your mother and best friends become your sisters. The teachers who once taught you academics will teach you about life and the names of people in your hometown are no longer just familiar faces. Everyone has a story.

And no one tells you that every time you step outside to be greeted by the sun, it will be more than just the sun just shining down on you.

For me, it’s the personification of sunshine… the life in a little girl’s eyes… it’s forever and always, my Hannah. And not even terminal cancer ever had a shot at taking her away.

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The Effect Of Inequality On Child Nutrition: Part 2

Part two in a multipart analysis of the United States food crisis and the effect it has on children.

Section IV: Food Deserts and Produce Accessibility

Food deserts are another factor that contributes to the issue of limited healthy and cost efficient food access, specifically in low-income neighborhoods, communities of color and rural parts of the country. Food access inequality has been a systemic issue for decades in the U.S., which accounts for many of the health disparities between race and class lines. In 2009, the U.S. Department of Agriculture found that 23.5 million people lack access to a supermarket within a mile of their home. “A multistate study found that low-income census tracts had half as many supermarkets as wealthy tracts” (Treuhaft et al 2010).

It was also found that low-income zip codes tend to have 30 percent more convenience/corner and liquor stores than traditional food stores, which makes less healthy options an easier and predominant option (Treuhaft et al 2016). The issue of the food desert is also prevalent in rural areas such as Mississippi. In Mississippi, more than 70 percent of food stamp eligible households travel more than 30 miles to reach a supermarket. It is also one of the states with the highest obesity level in the country. Lack of transportation to markets with healthy food options can be another factor that deters or prevents people living in food deserts from making the trip to the supermarket.

Quality of produce also tends to be poor in cities like Detroit and New Haven in low-income communities of color when compared to more affluent or racially mixed neighborhoods. By using statistical modeling techniques that control for a variety of factors, researchers estimate that for each fast food restaurant that is removed from a neighborhood with a high density of such establishments, there would be an average of a one pound weight decrease among residents (Treuhaft et al 2016). These researchers also found that by adding a grocery store to high poverty neighborhoods, there would be an average of a three pound weight decrease (Treuhaft et al 2010).

In a study following residents in Detroit and Chicago, it was found that those who lived farther from a grocery store, but closer to a convenience stores and fast food chains, had significantly higher levels of premature death as a result of diabetes.

In an assessment of 685 urban and rural census tracts in three states, it was found that low-income neighborhoods have half as many supermarkets as the wealthiest neighborhoods. Also, it was found that there are four times as many supermarkets in predominantly white neighborhoods compared to predominantly black ones. In a collection of 28 studies regarding the specifics of food availability around the country, 21 found that “food stores in lower-income neighborhoods and communities of color are less likely to stock healthy foods, offer lower quality items and have higher prices compared to stores in higher-income or predominantly white communities while only 7 found mixed results (for example, lower quality but similar prices and selection) or no difference” (Treuhaft et al 2010).

There is evidence from countless studies that supports the connection between lack of chain or comprehensive supermarkets and serious diet-related health issues that could eventually be the cause of premature death. A child can be directly affected if their parent or caregiver suffers from health complications related to diet, as expenses for healthcare will become a greater financial burden, mobility and freedom can be restricted for those adults or premature death may leave children in a tragic situation.

Moreover, parents might prioritize their child’s health needs over their own or find it too difficult to reach stores that sell products that fulfill their health needs, unintentionally putting their entire household at greater risk. In a survey in East Harlem, New York, 40 percent of diabetic adults said that they did not follow their recommended dietary guidelines because the foods required were scarce and expensive in their neighborhood markets and shops. In a recent national study that looked at 70,000 teens, it was discovered that increased availability to chain supermarkets was associated with lower rates of teens that were obese or overweight (Treuhaft et al 2010).

In a 2009 study of Chicago’s food deserts, it was brought to light that as the distance to the closest supermarket increases relative to the distance to the nearest fringe food outlet, the Years of Potential Life Loss due to diseases like cancer, cardiovascular disease, diabetes and liver disease increases significantly in African American communities.

Section V: Routes to a Better, Hungerless America

From government funded programs, social marketing campaigns and more local initiatives, there are several routes that are and were explored to help reduce the amount of food insecure folks in the United States. There are government funded programs such as the supplemental nutrition assistance program and the previously mentioned WIC, which help the most vulnerable populations access food.

Besides these programs, there was tremendous work done under former first lady Michelle Obama to combat child obesity, but also to address general health, wellness and fitness in U.S. children. Finally, there was a rise in the popularity of community gardens around the country and more conversations surrounding the wide array of benefits that can be derived from such initiatives.

In 2009, over 50 million people in the United States reported to be living in households that were food insecure and over 1/3 of these households experienced “very low food security.” These statistics soared from their past levels in 2007 and has policy-makers concerned about the current state of hunger in America. There are programs in place around the country, such as the School Breakfast and Lunch Programs and local outreach groups that are working to combat that issue.

While 94 percent of Feeding America client households with school-age children utilize the National School Lunch Program, only 46 percent use the National School Breakfast Program. However, studies and reports from Universities of Minnesota, Harvard, Boston and Tufts claim that participation in School Breakfast Programs is shown to have a positive effect on students’ attendance, behavior and academic achievement (Kennedy et al 2001). Many of the families these programs serve are living in small spaces with large families, as there was an association found between greater food insecurity and larger low-income families.

Additionally, a large percentage of client households are unstably housed and have one or more children that are five-years-old or younger. SNAP, which is the supplemental nutrition assistance program formerly regarded as the food stamp program, is taking on the challenge of remedying the food crisis in the U.S. Paradoxically, the United States is a food-rich country, yet it struggles with high levels of food waste and hunger (Gunders 2012).

In 2016, it was reported that 50 percent of all produce in the United States is thrown away, which is equivalent to 60 million tons or $160 billion worth of produce annually being wasted (Gunders 2012). According to the Feeding America website, SNAP serves two types of clientele: “Those who can’t protect themselves and those who need a helping hand to pull themselves up.” The majority of these recipients are either children, the elderly or disabled adults. SNAP is available only to those who qualify and are at the low-income level. The recipients are given Electronic Benefit Transfer cards, which can be used temporarily for food purchases only at a rate of about $1.40 benefit per meal or $126 per person per month.

Another attempt to solve the crisis revolves around educating youth about the importance of their eating patterns and how they can take control over what they decide to consume (CDC 2017). Through making children aware of the effect food can have on their development and health, it is hoped that as they grow older, they will be more conscious individuals when it comes to diet. During former president Barack Obama's administration, Michelle Obama made it her mission to work to remedy the obesity and hunger issues facing the children of the United States.

The “Let’s Move” initiative began with a simple gesture in 2009; Michelle Obama planting the White House Kitchen Garden on the South Lawn. The action prompted a nationwide discussion regarding the current state of childhood health and nutrition, which eventually led to the conception of the “Let’s Move” campaign to promote health-conscious lifestyles for children and families all around the country. While the primary focus of “Let’s Move” was to fight childhood obesity, many of its programs also worked to improve access to healthy and nutritious foods to the children at the most risk of either going hungry or being fed processed foods with higher levels of sugar and saturated fats.

One of the achievements of Michelle Obama’s work was the first update after 15 years to the national school meal nutrition standards through the “Healthy, Hunger-Free Kids Act,” which also increased funding for the first time in 30 years (White House Archives 2017). These changes allowed more children to receive free or inexpensive meals that had become centered around whole grains and a more diverse array of fruits and vegetables. Another successful project was the “Let’s Move! Salad Bars to Schools,” which provided 3 million students with access to salad bars (White House Archives 2017).

Furthermore, the “Let’s Move! Child Care” action had child care providers around the country make a commitment to improving the quality of meals for greater nutrition, increasing opportunities for physical activity and limiting screen time in collaboration with the U.S. Department of Health and Human Services and Nemours (White House Archives 2017). In order to bolster support on local levels around the country, “Let’s Move” also created their towns and cities partnership in which 520 elected officials made a commitment to the program, thus positively affecting 1 in 4 Americans or 81 million people (White House Archives 2017).

Other initiatives that look to solve the food desert crisis include community gardens and farmers markets. There is no single solution to the complex issue of childhood hunger. However, there are feasible opportunities to make positive change for the sake of the next generation and reduce the amount of children with low to extremely low food security. Community gardens are becoming increasingly popular in urban areas of the United States.

The benefits go beyond just the access to fresh produce, as gardens can foster a sense of unity between community members and provide them with a sense of pride when they see the affect their organizing has within the community at large.

For young children, the community garden can become a safe space for play and creating connections with mentors. Gardens also can instill in children and adults a greater appreciation for their health and the choices that they have to make regarding their own diet and future. The establishment and upkeep of community gardens can help to perpetuate a mindful and health-conscious neighborhood where diabetes, hunger and obesity are less prominent. Additionally, health education and the experience of working in a garden are mutually beneficial.

It is proven that a child will learn material better through having hands-on experience to contextualize and personalize the content.

Through incorporating urban gardens into the public education system and even in day care institutions, children can form meaningful connections between what they are learning about the importance of whole foods and their own actions in the garden. Parent engagement in community gardens can also prompt a deeper level of commitment to discussions at home regarding nutrition and exercise. Furthermore, for busy working parents, the garden can become a source of friendship and aid in times of need as the garden should serve to increase feelings of mutual goals between families.

One of the most comprehensive solutions to eradicating hunger is eradicating poverty. Thus, community gardens can link both entrepreneurship and sustainable food opportunities. Urban gardens initiatives around the country have worked to provide students with leadership experience and empowerment through organized production and commerce.

An instance of such integration is Rochester Roots, which has three schoolyard gardens in the Rochester community. The teachers use the gardens in their lessons and all of the high-grade produce (90 percent at heirloom status) go back to the students and community members. Parent and child seasonal cooking classes are taught from November to May. Additionally, in July and August there are paid internships offered to low-income teenagers. “Community food projects funded by the USDA provided an estimated 2,300 jobs and incubated over 3,600 micro-businesses” (Golden 2014).

Once many of these gardeners have gained some experience planting and organizing the logistics of running the garden, they pass the operation on and have the skills and confidence to start their own business. The creation of new jobs through community gardens is just one example of how these gardens can foster positive change and growth on not just physical and social, but also economic levels.

An estimate from the United Nations Development Program claims that 15 percent of food worldwide is grown in cities. More countries, such as Cuba, are beginning to utilize urban agriculture to help resolve food shortages and are reaping the benefits. According to a report from the American Planning Association, in large cities across the U.S. such as Atlanta, Portland, Chicago and Boston, more and more land is being allocated to urban agriculture.

The rise in urban agriculture popularity benefits those involved on multiple levels. Research found that gardens and farms beautified the neighborhoods, which increases home value while also employing residents and bolstering more local pride and attachment to their community, which results in a decrease in crime and vandalization. While community gardens cannot provide people with all of the nutrients they might need, it is a proven successful strategy to increasing food security and sovereignty.

Additionally, community gardens cut household grocery costs so that those participating are not paying high prices to eat well. Research shows that people who participate or have family members that participate in community gardens “were 3.5 times more likely to consume fruits and vegetables at least 5 times per day than people without a gardening household member” (Alaimo, Packnett, Miles, & Kruger, 2008).

It was also found that youth involved in programs through community gardens that discussed choosing healthy whole foods over processed and fast food ate less of these unhealthy foods as a result of their participation (Golden 2013). Clearly, the presence of a well-run community garden program can benefit all community members in becoming healthier people and developing skills that can continue to better the community as a whole.

As long as there are programs in place that support low-income communities access quality and inexpensive produce, there is hope for the current status of child nutrition in the United States. It is critical for not only the government to aid its most vulnerable populations to receive healthy and nutritious foods, but also for the communities to work from the inside to create spaces where conscious food choices are fostered and encouraged.

The prevalence of fast food chains and highly processed foods is a challenge facing primarily low-income communities and neighborhoods of color. There is injustice in who receives quality produce and who has to travel long distances to provide their family with a healthy meal. All people deserve access to foods that will keep their body able and in good shape.

All expecting mothers and children of all communities deserve access to foods that will help their development, which will affect their functioning later in life.

The right to be able to make informed choices about diet is one that should be granted to each and every child in the country. In such a food abundant country, our food deserts are much too prominent and our children are the victims of a nutritional crisis that has feasible solutions. The work of political leaders such as Michelle Obama have made positive changes and raised awareness surrounding the current condition of food inequality in the country.

However, there is still work to be done.

Through new and reformed policy that address food deserts and nutritional standards at schools and daycares, through community garden efforts that teach and provide meaningful connections to diet, and through changing the way we think about our daily food choices, great change can be made to work to eradicate hidden hunger.

Cover Image Credit: Misawa

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Is Sugar Actually Bad For You?

A look into the science behind sugar’s effect on our bodies while trying to answer the question “Is it bad for us?”

*Warning* Lots of science words ahead! This is maybe a little dry at the beginning, but it is important to know the science!

What is sugar?

Sugar is a carbohydrate. The carbohydrate molecules are typically composed of the basic carbon, hydrogen, and oxygen. Carbohydrates are usually the main source of energy for bodies unless you are on a special diet (i.e. Keto diets). These molecules are then divided into several different types: Glucose, Sucrose, Fructose, Maltose, and Lactose. Each of these different types is found in different sources in nature.

The most important one is glucose. Glucose is the body’s preferred energy source. Our bodies process glucose from the consumption of carbohydrates like bread, pasta, and grains. The glucose is immediately processed for energy use or is stored in muscle cells and the liver as glycogen.

Fructose is processed from many fruits and vegetables naturally and is often an additive in sodas and flavored drinks. Fructose is what makes sweet things sweet. Fructose is special because our body processes this sugar differently than the others. Since fructose is not the preferred energy source like glucose, our bodies metabolize fructose as a fat and send it to our livers.

Sucrose is what we know as the white granulated powder of table sugar. This sugar is made from extracting it from various sugary sources like sugar canes and beets. Sucrose is a combination of one molecule of glucose and one molecule of fructose.

Although, there are many other types of sugars. We are just going to look at these sugars while trying to answer if sugar is bad or not.

What happens when we digest sugar?

Once the sugar enters our digestive system, about 80% of the glucose is immediately absorbed into our blood through the lining of our intestines. The sucrose is broken apart into glucose and fructose, while the fructose is sent to the liver to be processed.

Our body recognizes the consumption of glucose and triggers the pancreas to release insulin. Insulin is a hormone made in the pancreas for the absorption of glucose. Insulin is the key that starts the chain of reactions telling our cells to absorb glucose from the bloodstream.

Side Note: Diabetes is a disease when the insulin production or response is not working correctly.

When our body needs energy, it uses the glucose in the bloodstream or glycogen stored in the liver and muscles. The glucose is broken into two parts (pyruvates) and sent into the mitochondria, the powerhouse of the cell. The pyruvates are converted into Acetyl-CoA. The mitochondria then take the Acetyl-CoA through an acid cycle and the electron transport chain producing adenosine triphosphate (ATP). ATP is the source of energy for the metabolic process. The mitochondria can’t burn off all the pyruvates, so it converts them to citrate which turns into VLDL which is stored as body fat.

All of this is dependent on the amount of energy needed by the cells. If our cells do not consume a lot of energy, then the excess glucose is converted into glycogen which is stored in our muscles for future use. If we fast and our consumption of glucose is lowered, then our bodies call about the stored glycogen to be broken down into glucose for energy consumption.

Our muscles can reach a maximum storage level of glycogen. The leftover glycogen is converted into fatty acids and then triglycerides. These are stored in our bodies as adipose tissue, otherwise known as body fat.

That is the process of metabolizing of glucose. However, we know our bodies like glucose. Now, let us look at the process for fructose.

Fructose skips a lot of the beginning metabolizing processes and is sent straight to our livers to be processed. Since most of the fructose is not absorbed into the bloodstream in the intestine, a large amount of fructose can easily cause an overload inside the liver. Each liver cell’s mitochondria are overloaded with too much pyruvate. Our bodies can only do the same thing that it does with excess pyruvates like does with glucose.

It turns them into fat (VLDL). Anything not turned into VLDL is converted into free fatty acids. Free fatty acids are known to inhibit insulin stimulators in the muscles causing an increase in insulin resistance throughout the body. Insulin resistance means that the body is not able to burn sugars normally. The excess sugars will turn into fat and more fatty acids repeating the process again and again.

All these excess fats are a major cause of heart disease, fatty liver diseases, obesity, and diabetes.

A quick less scientific summarization: You eat sugar. The sugar enters your digestive tract where your body recognizes which sugar it is. Sucrose is split into glucose and fructose. Glucose is sent into the bloodstream for immediate energy consumption. Fructose is sent to the liver. Insulin is triggered off glucose consumption. Insulin tells the cells to absorb glucose for energy. Fructose does not trigger insulin since it does not need insulin to be processed. This leads to the overwhelming of liver cells causing the production of body fat and fatty acids. Fatty acids slow insulin release causing more body fat and fatty acids to be produced, restarting the chain.

What does our brain experience on sugar?

Our brain wants to be fed sugar to provide it with energy. Sugars are easily processed and metabolized by our bodies into energy. Our brain knows that sugars are easily turned into pure energy. Therefore, our brains love sugar. Our bodies will release dopamine and lower serotonin while processing sugar because it is letting us know it is happy. Dopamine is what tells our brains that whatever it is experiencing it is worth getting more. Serotonin is what tells our brains that it is content with what’s happening. This combination is what creates the sugar-high.

When you take a bite of cake, your brain recognizes it is eating something sugary. The sugar in the cake causes a release of dopamine. The dopamine goes into what is called the mesolimbic pathway. Inside our brains, the amygdala is triggered telling our bodies this is awesome, and it wants to eat the cake again. The hippocampus then is like great, let me remember everything about this experience. The nucleus accumbent responds by controlling our motor functions and tells us to take another bite of the cake. The prefrontal cortex then responds and focuses your attention on the cake. Naturally, you take another bite and repeat the entire process.

This system is how people can become addicted to drugs. Certain drugs, such as cocaine, cause a massive release of dopamine and severely lowers serotine in our bodies. This large amount of dopamine causes a euphoria, a high. While at the same time, since serotonin is lowered. The body is never content. It is this high and feeling unsatisfied that people will start increasingly craving the drugs causing them to become addicted to the substance. Sugar can be scary because it uses the exact same system. The next time you start craving that sugary treat it may be because your body is addicted to the sugar high.

Is sugar bad for you?

Most sugars are not bad for you. Glucose is not bad for you. Lactose is not bad for you. Many others are not bad for you. However, consuming a lot of fructose is bad for you.

I can tell you a ton of statistics about the terrible effects of fructose on our bodies, but I won’t. I won’t because most of those statistics are from people who were unaware the amount of sugar they were eating.

Go back and read how the digestive track metabolizes the sugars. You will notice I added the word “excess” a lot when describing the bad effects of sugar. Sugar is not the problem. Glucose, sucrose, and fructose are all found naturally in the foods. They are all healthy naturally occurring things to eat. However, we need to be aware how much sugar we are consuming.

Looking at the effects of sugar, with obesity and heart disease being the front-runners. While also taking into consideration how easy it is for our brains to become hooked on the substance. It seems to be a no-brainer why our culture’s number one killers are obesity and heart disease.

How much sugar are you consuming?

Let us look at one basic day of eating. For breakfast, you eat a bowl of cereal. You grab a coffee shop mochaccino on the way to work. For lunch, you grab a burger with a soda. For an afternoon snack, you grab an apple. For dinner, you have some spaghetti. Without even realizing it, you just ate sugar for every meal.

Cereal averages at 19.8 grams of sugar in each serving. Mochaccinos, if you get whipped cream, averages at 73.8 grams of sugar. Most sodas have more than 35 grams of sugar per serving. Store-bought spaghetti sauce averages at 8 grams of sugar per serving.

Totaled up, without eating any candy or deserts for an entire day, you just consumed 137 grams of sugar. According to the American Heart Association, the maximum amount of sugar you should consume is 37.5 grams.

Now, most of the sugars I counted in that diet was table sugar (sucrose) which is about 45% glucose and 55% fructose. However, most major food companies are adding fructose in the forms of crystalline fructose or an almost pure fructose form of corn syrup, known has high fructose corn syrup. You may have heard that name before. High fructose corn syrup is added to beverages, yogurts, baked goods, energy drinks, and many other processed foods to give them that delicious sweet flavor.

More than 80% of packaged foods have sugar added to them. This sugar is not added to only increase the flavor, but also the shelf life of products.

Something people tend to forget is the massive refinement process of sugars going on today. In one sugar cane, 50% of its weight is the juice and about 20% of the juice is sugar. A sugar cane by itself is only about 10% molecular sugar. To be able to reach the 37.5 grams of recommended sugar in a daily diet. You would need to consume 2lbs of sugar cane.

Our bodies are missing all the fiber found in the sugar cane when we consume that much sugar. Fiber slows down the digestion of sugars. We are basically mainlining straight sugar. Our bodies is forced to try and process it quickly before it caused the overload in our liver cells.

I highly recommend you lower your consumption of processed sugars, especially fructose. Since sugars are almost added to everything now a days. You will need to do a lot of very careful label reading to be able to cut out a lot of sugar in your diet.

If you don’t believe me or any of the science I have told you today. Give it a shot. Try and cut most of the sugar from your diet. You will feel terrible for the first couple days as your body goes into withdrawals from the substance. However, the result will be a healthier body and a healthier lifestyle. One meal will not make a difference. If you want to try and beat sugar while lowering your chances for heart disease and obesity, it takes a thousand meals to make a difference.

Cover Image Credit: Flickr

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