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Diese Beeintrдchtigungen mьssen dabei in direktem Zusammenhang mit den akuten pharmakologischen Wirkungen der Substanz stehen cholesterol over 400 generic 10mg ezetimibe mastercard. Bis zur vollstдndigen Rehabilitierung des Kцrpers nehmen sie mit der Zeit ab cholesterol lowering food tips order ezetimibe with american express, bei aufgetretenen Gewebeschдden oder anderen Komplikationen ist jedoch auch ein Weiterbestehen mцglich cholesterol ratio 2.7 purchase ezetimibe amex. Ihre Art ist abhдngig von den pharmakologischen Eigenschaften und der Aufnahmeart der Substanz cholesterol hdl ratio canadian values order 10mg ezetimibe with visa. Das,Abhдngigkeitssyndrom" umfasst eine Gruppe von Verhaltens-, kognitiven und kцrperlichen Phдnomenen, die sich nach wiederholtem Substanzgebrauch entwickeln. Typischerweise manifestiert sich ein starkes Craving als der Wunsch, die Substanz einzunehmen. Im Verlauf wird dem Substanzgebrauch immer mehr Vorrang vor anderen Aktivitдten und Verpflichtungen gegeben. Neben einer Toleranzerhцhung kann es auch zu kцrperlichen Entzugssymptomen kommen. Bei einem,Entzugssyndrom nach absolutem oder relativem Entzug" einer psychotropen Substanz handelt es sich um mehrere Symptome aus unterschiedlichen Bereichen und mit verschiedenem Schweregrad, abhдngig von der zuletzt eingenommen Substanzart und Dosis, die ьber einen lдngeren Zeitraum konsumiert wurde. Die Beschwerden sind zeitlich begrenzt, kцnnen aber durch symptomatische Krampfanfдlle kompliziert werden. Bei einem,Entzugssyndrom mit Delir" kommt als weitere Komplikation zu dem eben beschriebenen Zustandsbild ein Delir hinzu. Im Bereich der Nikotinabhдngigkeit spielt diese Diagnose jedoch keine Rolle, so dass sie lediglich der Vollstдndigkeit wegen aufgefьhrt werden soll. Дhnlich ist es im Bereich der,psychotischen Stцrung", die eine Gruppe psychotischer Phдnomene umschreibt, die wдhrend oder nach dem Sub- Nikotinabhдngigkeit ­ Geschichte, Hintergrьnde und Grundlagen 27 stanzgebrauch auftreten, jedoch nicht durch akute Intoxikation erklдrt werden kцnnen. Halluzinationen, die meist akustisch sind, Wahrnehmungsstцrungen, Wahnideen, psychomotorische Stцrungen, sowie abnorme Affekte sind typische Symptome, die im Rahmen dieses Stцrungsbildes auftreten kцnnen. In den bei einer Nikotinabhдngigkeit ьblichen eingenommenen Dosisspannen sind derartige Phдnomene jedoch nicht zu erwarten. Auch das,amnestische Syndrom", das mit einer ausgeprдgten Beeintrдchtigung des Kurz- und Langzeitgedдchtnisses einhergeht, besitzt bei der Nikotinabhдngigkeit keine klinische Bedeutung. Das Ultrakurzzeitgedдchtnis ist bei allen Substanzen meist nicht in Mitleidenschaft gezogen. Das Kurzzeitgedдchtnis mit Stцrungen des Zeitgefьhls, des Zeitgitters und Lernschwierigkeiten ist dagegen bei Einnahme anderer psychotroper Substanzen typischerweise am stдrksten gestцrt. Die als,Restzustand und verzцgert auftretende psychotische Stцrung" umfasst alkohol- und substanzbedingte Verдnderungen der kognitiven Fдhigkeiten, des Affekts, der Persцnlichkeit oder des Verhaltens, die eine direkte Substanzeinwirkung ьberdauern. Der Beginn dieser Verдnderungen muss in unmittelbarem Zusammenhang mit dem Gebrauch der psychotropen Substanz stehen. Die beiden Kategorien,Sonstige psychische und Verhaltensstцrungen und Nicht nдher bezeichnete psychische und Verhaltensstцrung" werden nicht nдher ausgefьhrt und dienen als Restkategorien fьr Stцrungsbilder, die nicht in die bereits vorgestellten Zustandsbilder eingeteilt werden kцnnen. Beide konzentrieren sich auf eine symptomatische Beschreibung der Stцrung, die keine Auskunft ьber die Дthiopathogenese oder das Wesen der Abhдngigkeit erlaubt. Die Abgrenzung des abhдngigen Konsums vom normalen Konsum fдllt mit Hilfe der in beiden Diagnosesystemen vergleichbaren Kriterien nicht leicht, da die deskriptiven Merkmale hohe Konsummengen, situative Steigerung des Konsums, Symptome der Intoxikation und kцrperliche Schдden als Folge wiederholter Einnahme weder notwendig noch hinreichend fьr eine Abhдngigkeit sind (Balfour & Fagerstrom, 1996; Hughes, 2006). Das aktuelle Krankheitskonzept geht auЯerdem davon aus, dass die Stцrung irreversibel ist, ein kontrollierter Konsum der Substanz entsprechend zeitlebens nicht mehr mцglich sei. Die Nikotinabhдngigkeit wird auch deswegen in beiden Systemen als Krankheit bezeichnet, weil sie mit Leid, Funktionseinschrдnkungen und drohendem Tod verbunden ist. Entsprechende Korrelate des abhдngigen Verhaltens von Rauchern sind bisher jedoch nur zum Teil nachweisbar. So konnte fьr das Kriterium Kontrollverlust bisher keine neurobiologische Entsprechung gefunden werden (Hughes, 2006). Auch beim Rьckfall stellt sich die Frage, ob dieser gegen den bewussten Willen ­ quasi organisch bedingt ­ erfolgt oder ob der Betroffene eine bewusste Entscheidung zur Einnahme der Substanz trifft. In der Realitдt handelt es sich jedoch um ein Kontinuum: manche Raucher rauchen wenig, inhalieren auch fast nicht, andere rauchen mehr als 50 Zigaretten am Tag und inhalieren tief, rauchen sogar in der Nacht. Nikotinabhдngigkeit ­ Geschichte, Hintergrьnde und Grundlagen 29 AbschlieЯend bleibt zu bemerken, dass sich die Diagnose der Nikotinabhдngigkeit im alltдglichen Umgang mit Patienten schwierig gestaltet, da sich die meisten Menschen auf einem Kontinuum zwischen abhдngigem und nichtabhдngigem Verhalten einordnen lassen (Balfour & Fagerstrom, 1996). Dabei befinden sich die meisten Raucher nicht an einem der beiden Extrempole, eine klare Diagnose ist jedoch nur dort mцglich (Lewis, 1994). Geschichte des Rauchens Wie in den bisherigen Kapiteln bereits deutlich geworden ist und in den nдchsten Abschnitten, in denen auf die Folgen des Tabakkonsums eingegangen wird (s.

Several studies find that distinctive traits of adult Neandertals and modern human crania emerge very early on cholesterol in pastured eggs cheap ezetimibe 10 mg without a prescription, perhaps developing prenatally oxidized cholesterol in scrambled eggs 10 mg ezetimibe amex, and then proceed along different developmental paths (Gunz et al cholesterol ratio analysis buy ezetimibe. Areas of early differentiation include mandibular and midfacial traits normal cholesterol ratio uk ezetimibe 10mg for sale, including nasal and palatal breadth and premaxillary suture closure (later in Neandertals than in modern humans; Maureille and Braga, 2002). Cranial vault shape diverges early on as well (Minugh-Purvis, 2002), possibly relating to the pace of attainment of adult brain size, which appears to have proceeded more rapidly in Neandertals than in modern humans. Although both taxa have similar estimated neonatal brain size and appear to reach adult size at the same age, because Neandertals have large average adult brain size this means that they must achieve a larger percentage of adult brain size at any particular age during development (Ponce de Leуn et al. That interpretation comes from a comparison with recent humans, however, who have smaller average brain size than early anatomically modern humans. Early modern humans had adult brains very similar in size to Neandertals (Henneberg, 1998; Ruff et al. There are other indications that archaic human development did not differ from that of modern humans. Debate has emerged over the implications of enamel development in Neandertal and modern human anterior teeth, with the disagreement centering on whether Neandertal teeth developed more quickly than in modern humans (Ramirez Rozzi and Bermъdez de Castro, 2004; Ramirez Rozzi and Sardi, 2007) or at roughly the same rate (Guatelli-Steinberg et al. This presents problems for estimating energy needs on the basis of developmental status as indicated by the dentition. Furthermore, there is some evidence to suggest archaic/modern human parity in somatic growth rates as well. Neandertal postcranial growth falls completely within the range of recent human populations from cold climates and those that experience childhood nutritional stress (Bogin and Rios, 2003; Nelson and Thompson, 302 the Origins of Modern Humans 2002). Thus, archaic and at least some modern human populations may have shared common developmental experiences and thus potentially similar offspring energetic profiles. In fact, it may be that archaic-modern dissimilarities in dental and facial ontogeny, rather than indicating faster overall growth in archaic human juveniles, instead relate to the development of adult differences in facial anatomy, a topic to which we turn below. Effects of Energy Throughput Differences on Archaic and Modern Human Anatomy the above review strongly suggests that archaic humans expended substantially greater amounts of energy, on average, than modern humans. For example, an archaic human male of average mass (78 kg) would have needed to burn roughly 167 kcal/d more than an early modern human male of average mass (67 kg) and 338 kcal/d more than an average recent subsistence-level male (57 kg) simply to meet basal metabolic needs. Differences among females are of a lesser magnitude, although certainly not trivial. To meet basal metabolic needs, an average archaic human female (65 kg) would have needed to burn roughly 86 kcal more per day than an average early modern human female (59 kg) and roughly 209 kcal more per day than an average recent human female (49 kg). The greater energy expenditure among archaic humans would have, in turn, necessitated greater oxygen intake. When physical activity is taken into account, differences in oxygen requirements are magnified, even if activity levels for the different groups are identical. As only 31 mL of oxygen are extracted from every liter of respired air (Schmidt-Nielsen, 1984), this translates to an additional 2,245 L of air per day, or an additional 1. Given that an average adult modern human respires 6­9 L of air per minute at rest (0. Daily differences, however, reflect the average of energy expenditure peaks throughout a day, during which oxygen requirements, and thereby respiratory airflow demands, were likely much higher in archaic humans than they were in early modern people. The different respiratory airflow demands were potentially of such a magnitude that they may have been the ultimate cause of some of the primary anatomical differences between archaic and modern humans, namely large thoraces, broad noses, and prognathic faces. To investigate this possibility, we must first address the energy expenditure involved with specific activities that archaic and early modern humans were probably undertaking. Even at fairly modest activity levels, archaic humans would have required roughly 5. It is likely that during strenuous activities, archaic humans had 8 Energetics and the Origin of Modern Humans 303 substantially greater respiratory demands than modern humans, and potential inefficiencies in locomotion (see above) may have made the differences even greater. To meet their elevated respiratory demands, it is possible that archaic humans simply had a faster rate of respiration than modern humans, although this option seems unlikely. Of the half-liter of air inspired by the average adult modern human with each breath, only about 350 mL reaches the alveoli and is available for oxygen exchange (the remaining 150 mL is trapped in the respiratory dead space of the tracheobronchial tree, pharynx, nasal passages, and mouth).

Stimulants are central nervous system activators that include caffeine cholesterol score of 5.3 ezetimibe 10 mg lowest price, nicotine le cholesterol definition buy ezetimibe on line amex, amphetamines cholesterol yellow spots on eyelids buy generic ezetimibe line, and cocaine cholesterol and membrane fluidity 10 mg ezetimibe visa. Cigarette smoking decreases life expectancy more than the use of any other substance. They are sometimes used to treat depression in the elderly and terminally ill, and depression and obesity in patients who do not respond to other treatments (see Chapter 12). The most common clinically used amphetamines are dextroamphetamine (Dexedrine), methamphetamine (Desoxyn), and a related compound, methylphenidate (Ritalin). Hyperactivity and growth retardation are seen in newborns of mothers who used cocaine during pregnancy. Tactile hallucinations of bugs crawling on the skin (formication) is seen with use of cocaine ("cocaine bugs"). Sedatives are central nervous system depressants that include alcohol, barbiturates, and benzodiazepines. Traffic accidents, homicide, suicide, and rape are correlated with the concurrent use of alcohol. Child physical and sexual abuse, spouse abuse, and elder abuse are also associated with alcohol use. Thiamine deficiency resulting in Wernicke and Korsakoff syndrome (see Chapter 14) is associated with long-term use of alcohol. Fetal alcohol syndrome (including facial abnormalities, reduced height and weight, and mental retardation) is seen in the offspring of women who drink during pregnancy. It usually occurs in patients who have been drinking heavily for at least 5 years. Barbiturates are used medically as sleeping pills, sedatives, antianxiety agents (tranquilizers), anticonvulsants, and anesthetics. Frequently used and abused, barbiturates include amobarbital, pentobarbital, and secobarbital. Benzodiazepines have a high safety margin unless taken with another sedative, such as alcohol. Flumazenil (Mazicon, Romazicon), a benzodiazepine receptor antagonist, can reverse the effects of benzodiazepines in cases of overdose. Compared to medically used opioids such as morphine and methadone, abused opioids such as heroin are more potent, cross the blood-brain barrier more quickly, have a faster onset of action, and have more euphoric action. In contrast to barbiturate withdrawal, which may be fatal, death from withdrawal of opioids is rare unless a serious physical illness is present. These legal opioids can be substituted for illegal opioids, such as heroin, to prevent withdrawal symptoms. Buprenorphine, a partial opioid receptor agonist that can block both withdrawal symptoms and the euphoric action of heroin, can now be prescribed by physicians in private practice. They cause less euphoria and drowsiness, allowing people on maintenance regimens to keep their jobs and avoid the criminal activity that is necessary to maintain a costly heroin habit. Increased availability of serotonin is associated with the effects of some of these agents. The effects of use and withdrawal of hallucinogens and related agents can be found in Table 9-5. In low doses, marijuana increases appetite and relaxation, and causes conjunctival reddening. Chronic users experience lung problems associated with smoking and a decrease in motivation ("the amotivational syndrome") characterized by lack of desire to work, and increased apathy. Although illegal in the United States, at least two states permit limited medical use to treat glaucoma and cancer-treatment-related nausea and vomiting. Treatment of substance abuse ranges from abstinence and peer support groups to drugs that block physical and psychological withdrawal symptoms. Treatment of withdrawal symptoms includes immediate treatment or detoxification ("detox") and extended treatment aimed at preventing relapse ("maintenance") (Table 9-8). Questions 1 and 2 A 29-year-old man comes to the emergency department complaining of stomach cramps and diarrhea. He is sweating and has a fever, runny nose, and goose bumps on his skin, and complains of severe muscle aches. Of the following, the most likely cause of this picture is (A) alcohol use (B) alcohol withdrawal (C) heroin use (D) heroin withdrawal (E) amphetamine withdrawal View Answer 2. Which of the following drugs is, by self reports, the most frequently used in the United States?

Biodiversity also underpins ecosystem functioning cholesterol definition anatomy buy 10 mg ezetimibe overnight delivery, which provides services such as water and air puri cation cholesterol foods good and bad generic 10mg ezetimibe with amex, pest and disease control cholesterol weight purchase ezetimibe 10 mg on line, and pollination vap cholesterol test quest buy ezetimibe 10mg online. Biodiversity can also be a source of pathogens and thus have negative impacts on health. Drivers of such changes extend the causal change upstream (Driver of change loss of biodiversity reduction in health bene ts). For example, air and water pollution can lead to biodiversity loss and have direct impacts on health. Deforestation (or other land-use change or ecosystem disturbance) can lead to loss of species and habitats, and also increased disease risk for humans. In addition to the parallel e ects of the driver on biodiversity and health, there may be additional impacts of the change in biodiversity on health. For example, water pollution, in addition to harming health though loss of drinking water uality, could lead to collapse of a uatic ecosystems through eutrophication leading to sh mortality and conse uent negative e ects on nutrition. For example, use of pharmaceuticals may lead to the release of active ingredients in the environment and damage species and ecosystems. On the other hand, protected areas or hunting bans could deny access of local communities to bushmeat and other wild foods, with negative nutritional impacts. For example, establishment of protected areas may protect water supplies, with positive health bene ts. In addition to environmental determinants, social and economic determinants also influence the dynamics between biodiversity changes and human health. The inequities of how society is organized mean that the freedom to lead a flourishing life and to enjoy good health is unequally distributed between and within societies. This inequity is seen in the conditions of early childhood and schooling, the nature of employment and working conditions, the physical form of the built environment, and the quality of the natural environment in which people reside. Depending on the nature of these environments, different groups will have different experiences of material conditions, psychosocial support and behavioural options, which make them more or less vulnerable to poor health. Social stratification likewise determines differential access to and utilization of health care, with consequences for the inequitable promotion of health and wellbeing, disease prevention, and recovery from illness and survival. This unequal distribution of health-damaging experiences is not in any sense a "natural" phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements and power relationships. Population groups more reliant on biodiversity and ecosystem services, especially on provisioning services such as timber, water and food, are usually more vulnerable to biodiversity loss and those less covered by social protection mechanisms. Vulnerable groups include indigenous populations, specific groups dependent on biodiversity and ecosystem services and, for example, subsistence farmers. These inequalities affect both individual and community health either directly (whether it be in isolation or through an interaction with other determinants) or indirectly. Populations exposed to the greenest environments have been found to also have the lowest levels of health inequality related to income deprivation, suggesting that healthy physical environments can be important for reducing socioeconomic health inequalities (Mitchell and Popham 2008). Equity issues are not only important in relation to different groups within a country, but also in relation to different vulnerabilities among countries. Developing countries are more reliant on biodiversity and ecosystem services than developed ones, and their health systems are usually less prepared to protect the health of their populations, which leads to greater negative health impacts of biodiversity change. Between countries, biodiversity loss is related to income inequality (Mikkelson et al. Access to , use and management of biodiversity have different health impacts on women and men and boys and girls, determined by gender norms, roles and relations (Gutierrez-Montes et al. Social norms and values determine different gender roles and relations, which in turn, are translated into different responsibilities, obligations, benefits and rights in relation to biodiversity (Manfre and Ruben 2012). In addition to the lack of political will, and frequently weak institutional capacity and legal frameworks that fail to assess and address different gender roles, there is a lack of sex-disaggregated data on biodiversity access, use and control, which makes it very difficult to conduct a gender analysis and therefore design 32 Connecting Global Priorities: Biodiversity and Human Health adequate responses targeting specifically those most vulnerable population groups (Castaneda et al. However, it is widely accepted that many of the adverse impacts of biodiversity loss are impacting already vulnerable groups of people, specifically populations who are dependent on biodiversity and ecosystem services (forest dwellers, indigenous populations, women and girls, etc. Climate change or large-scale mining or logging projects may have negative impacts on biodiversity, and increase social and economic inequalities. A social justice perspective is, therefore, needed to address the various equity dimensions in the biodiversity and health dynamic (Walter 2003).

Weidenreich expanded this list to include other features such as presence of a metopic suture cholesterol levels diet generic ezetimibe 10mg line, small frontal sinuses myth of cholesterol in eggs buy ezetimibe 10 mg visa, high frequency of third molar agenesis lowering cholesterol food to avoid buy 10mg ezetimibe with mastercard, reduced posterior dentition zinc cholesterol levels purchase line ezetimibe, profile contour of the nasal saddle and nasal roof (low nasal profile), and rounded infraorbital margins (Weidenreich 1939, 1943). He wrote: the peculiarities of the Sinanthropus skeleton, to sum up, are neither "adaptive" nor have they any recognizable connection with special functions which could not be performed otherwise. Their transmission to Homo sapiens corroborates first the thesis that Sinanthropus is a direct ancestor of Homo sapiens, and secondly, that there is a closer relationship to Mongols-or at least to certain Mongolian groups-than to any other races, particularly to whites. This statement does not mean that modern Mongols derived exclusively from Sinanthropus nor that Sinanthropus did not give origin to other races. In any case, it is safe to say that racial groups supplied with those peculiarities have Sinanthropus in their ancestry. Had only one character been transmitted, the relationship might be questioned, but as there are twelve special features which behave in the same way the coincidence cannot be accidental. The morphological evidence for continuity that he saw convinced him that early Chinese populations made significant genetic contributions to modern populations of the region, but he recognized in addition that those earlier populations were also ancestral to populations in other regions and that ancient populations in other regions also contributed to the ancestry of modern Chinese. In other words, he recognized the importance of gene flow between populations in different regions and he represented it graphically by the diagonal lines in his drawing. In the views of modern authors who trace their intellectual inspiration back to Weidenreich, this model has been more appropriately likened to a trellis as a metaphor for the evolutionary network of reticulating populations that regularly exchange genes (Wolpoff and Caspari, 1997) or a river that branches, runs for a time as separate streams, but reunites into a single river with water from the separate streams mixing together (Wu, 1999). Importantly, Weidenreich saw human variation even in the deep past as similar in nature to what we see in the present. He recognized that there were not and never had been "pure races" (Caspari and Wolpoff, 1996) and that the pattern of human variation we see today extended back into the past. He argued that "just as mankind of today represents a morphological and 92 the Origins of Modern Humans generic unity in spite of its being divided into manifold races, so has it been during the entire time of evolution" (Weidenreich, 1940: 380). Further, he wrote that "the old theory, claiming that man evolved exclusively from one center whence he spread over the Old World each time afresh after having entered a new phase of evolution, no longer tallies with the palaeontological facts" (Weidenreich 1940: 381­382). By about 1952, however, Peking Man was universally regarded in Chinese science dissemination materials as such an ancestor" (Schmalzer, 2008: 261). By then, the half-million year time gap in the Chinese fossil record between Zhoukoudian Homo erectus and the material from Zhoukoudian Upper Cave had been filled in to some extent with new discoveries, so that human evolutionary history was more evenly represented by fossils throughout the chronological sequence (Wu, 1992). Since that time, the fossil record has continued to accumulate, with more fossils having precise geological context and as a result being better dated. Wu and Zhang (1978) summarized their views that Chinese human evolution was characterized by continuity but not by isolation from other populations. They wrote that fossil humans in China "have obvious similarity in physical features, there was definite continuity in the physical development of them," and "of course, we do not exclude the possibility of exchanging genetic material between China and neighboring regions, but the exchange played less important role" (Wu and Zhang, 1978: 39). Recent Chinese scholars working on the Chinese fossil record have also emphasized in situ evolution (Wu and Wu, 1985; Wu and Dong, 1985; Wu, 1988, 1998, 1999, 2004, 2005, 2006; Chen and Zhang, 1991; Wu and Brдuer, 1993; Wu and Poirier, 1995; Liu et al. For example, Wu and Poirier (1995) pointed to the increase in the fossil record in the late twentieth century and, based on that, identified a number of features that link the material from Zhoukoudian with modern Chinese populations. These include midsagittal elevation, flatness of the nasal saddle, orientation of the antero-lateral surface of the frontal process of the zygomatic, less protruding of the middle face, contour of the lower border of the zygomatic process of the maxilla, lower upper facial index, shovel-shaped incisors, position of the maximum breadth of the skull, roundness of the orbital margins, shape of the sutures between the frontal and nasal and maxillary bones, and lambdoidal ossicle (Wu, 1990; Wu and Poirier, 1995). These features, they maintained, are frequent in Pleistocene specimens from China but rare in specimens outside the region. In 2004, with an expanded fossil record, Wu (2004) pointed out that although some of these characters are actually primitive to the genus Homo rather than strong evidence of a connection between the Zhoukoudian material and modern Asian populations, and these features could be found in fossils from other regions, the morphological constellation seen in China is unique. The cranial features he saw were: fronto-nasal and fronto-maxillary sutures forming a horizontal curve, forward-facing antero-lateral surface of the zygomatic process (making the face flat), curved lower border of the zygomatic process of the maxilla bone, flat nasal region, obtuse zygomaxillary angle (lack of protrusion in the midface), low upper facial height, rounded infero-lateral margin of orbit, presence of a malar tuberosity, and shovel-shaped incisors (Wu, 1992). It is possible that some of these features are part of a functionally integrated system and may not be entirely independent of each other. We refer to these kinds of morphological features, in this chapter, as "regionally predominant" features. They are not necessarily unique to East Asia, as they occur in other regions as well, but occur more commonly in East Asia. Similarly, 3 A River Runs through It 93 they are not universal in East Asia, simply more common than in other regions. Wu argued that some of the "regionally predominant" features of Pleistocene humans of China that he discussed do not necessarily extend into any of the Holocene materials from East Asia.

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