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HomeMy WebLinkAbout021904 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 19, 2004 Board Members: Dan Titterness, Chairman - County Commissioner District # 1 Glen Huntingford - County Commissioner District #2 Patrick M. Rodgers - County Commissioner District #3 Geoffrey Masci - Port Townsend City Council Jill Buhler - Hospital Commissioner District #2 Sheila Westerman - Citizen at Large (City) Roberta Frisse!i, Vice Chairman - Citizen at Large (County) StqfMembers: Jean Baldwin, Health & Human Seroices Director Larry Fay, Environmental Health Director Julia Danskin, Nursing Seroices Director Thomas UJcke, MD, Health Officer Ex-officio David Suliivan, PUD #1 Chairman Titterness called the meeting to order at 2:30 p.m. All Board and Staff members were present. There was a quorum. APPROVAL OF AGENDA Member Masci moved to approve the agenda as submitted. Vice Chairman Frissell seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Masci moved to approve the minutes of January 15, 2004. Vice Chairman Frissell seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT - None OLD BUSINESS AND INFORMATIONAL ITEMS Bioterrorism 101: Dr. Tom Locke provided an informational report on Ricin, another bioterrorism-like agent in the news. It is not easily deliverable unless it is injected. A fact sheet was included in the agenda packet. Oral Health Access: SmileMobile. March 15-19. 2004: The Board received in its agenda packet a copy of the community flyer that went home with all children in the school districts, announcing this five-day dental clinic. The Oral Health Coalition coordinated this first-time event, which focuses on low-income children who do not have other access to dental care. The Health Department Staff would be scheduling appointments and assisting patients in filling out the necessary paperwork HEALTH BOARD MINUTES - February 19, 2004 Page: 2 before directing them to the clinic in the Health Department's parking lot. If successful, the event might be done again next year and even expanded to other areas in the County. Additional outreach might also be done in the next few weeks. Cruise Shin Waste Discharl!e - Letter from State Board of Health: Dr. Locke provided a brief history of the Board's discussion of this topic. In the packet was a letter from the State Board of Health to the Jefferson County Board of Health, acknowledging its concerns and announcing a March 10th State Board of Health briefing in Tacoma, where there would be public testimony. The Board had also received a draft of the Memorandum of Understanding (MOD) between the Coast Guard, Ecology and the Cruise Ship industry. At this meeting, Larry Fay would make a presentation on behalf of the Board. Member Masci observed that with no penalties defined in the MOU, it appears the document could be largely ignored by the cruise ship industry. He would like to empower Larry Fay to make a strong statement from a county directly impacted by this issue that the MOU does not appear to be a serious response. Member Westerman asked what authority the nonprofit North West Cruise Ship Association might have with the individual cruise lines? She also noted that at the end of the lengthy MOU is the undefined term "innocent passage," and a reference to the United Nations Convention on the Law of the Sea 1982, December 10. She suspects this might be a huge exemption. Member Buhler asked what benefit there would be under the MOU if vessels could simply go into Canadian waters to discharge? Member Masci moved to give Larry Fay additional discretion and authority in his presentation to address the matters brought forward by the Board. Member Westerman seconded the motion, which carried by a unanimous vote. Northwest Public Health Leadershiu Institute: Julia Danskin announced that in April she would be accepting an 18-month membership to the University of Washington Northwest Public Health Leadership Institute and expressed appreciation for the opportunity. NEW BUSINESS Report on City of Port Townsend Februarv 9. 2004 Work Session: Following up from last month's discussion of the Health and Human Services $100K budget shortfall, Jean Baldwin briefed the Board on the presentation she and Dr. Locke gave City Council members. In addition to explaining the local public health funding crisis, they relayed the three requests to the City for ongoing funding - Healthy Jefferson, Family Planning Services, and the Maternal Child Health Home Visiting Program. Council also received population breakdowns for these three requests, published revenues and expenses for Health and Human Services, and accountings of operating transfers. Although no resolution was forthcoming, Council members were responsive and expressed interest in further discussing how the City might participate, including a possible meeting of the Board of Health and/or the County Commissioners. HEALTH BOARD MINUTES - February 19, 2004 Page: 3 Member Masci noted that even though both he and Kees Kolffhad, during City budget discussions, raised the issue of the County's contribution, Staff may have not reflected the $24K under the assumption that the end ofthe Behavioral Risk Factor Surveillance Survey (BRFSS) meant the end of that funding. Addressing concerns about double taxation, he recognized that the County has services that are weighted toward City residents, primarily due to the location of the Health Department. While a flat contribution per program might not be accurate, there is likely a percentage in each program that could be verified. He suggested that the County and City Staff come up with a mathematical model and then a breakdown program by program. He envisions that the City would have to generate a supplemental budget and work with the County to produce a new interlocal agreement. There was instead Board support for Jean Baldwin working with City Manager, David Timmons and County Administrator, David Goldsmith before bringing the topic before the Council and the Board of Health. In response to the suggestion that the formula used pre-MVET would be appropriate, Jean Baldwin agreed to review this state formula and bring it into the discussions. Member Westerman agreed it is important to demonstrate that, historically, the City has contributed. Commissioner Huntingford observed that it is positive that the City and County have recently gotten past the argument that "City residents are part of the County too and should not have to pay more." His larger concern is finding a permanent solution and a City commitment to these health programs. Kees Kolff suggested investigating a joint City/County Health Department model of delivering services, as exists in King County. A brief discussion then ensued about a health district. Chairman Titterness confirmed the Board's support for City and County Staff working on program formulas and outlining how a health district might work. Kees Kolffrecommended there be a joint workshop with the Board of Health and City Council to look at the realities of public health funding. In response to the concern by Member Masci of the significant Staff effort involved in preparing an effective presentation, Staff said they might find assistance from resources from the State Department of Health, Hospital District, and/or the University of Washington. 2003 End-of-Year Performance Evaluation Renorts: Jean Baldwin provided background about the performance measurement model, which the Department began using in 2000. Discussion on the reports were as follows: 1. In a review of the Adruinistration report, it was noted that the number of birth certificates issued was 463 and 226 recorded births. In the same period, there were 230 deaths and 1,632 death certificates issued. 2. The Communicable Disease report reflects the increased number of children in the Child Profile system (statewide immunization bank). The Department is also seeing an increase in the number of syringe exchanges. Next month, Staff would report on prevention efforts on Hepatitis B and C. Vice Chairman Frissell said she believes the total number is deceiving, noting that the number of syringes exchanged (9,222) HEALTH BOARD MINUTES - February 19, 2004 Page: 4 divided by 365, equates to 25 people per day. 3. Under the Population and Prevention Programs, so far this year, there have been three child deaths in the community, compared to just one child death in 2003. Even though funding for Child Death Reviews was cut, Staff believes it is beneficial to continue involvement in the Child Death Review Team. The number of Peer-In presentations is going down, probably because the number of 9th grade classrooms has decreased. Health screenings are also down. 4. The Targeted Community Health Services report reflects unduplicated clients served in Family Planning has increased over the past three years, as have the number of adolescents served. The biggest jump was in the Breast and Cervical Health Program, due in large part to outreach. The Department did over-spend its budget in this program. There were several Board comments about the successful mammogram- screening event held in conjunction with the Quilcene fair and about the importance of the existing clinic to that area. In response to Staffs concern about how to continue these important programs, it was suggested that the health outreach components of Kiwanis and Rotary might be a funding resource in the community. 5. Julia Danskin stressed the importance ofthe Family Support Services' early intervention programs in helping prevent adverse experiences in adolescence and later in life. In response to a question from Member Masci about opportunities for grants to continue the Family-Nurse Partnership after the expiration of the Office of Juvenile Justice grant, Julia said Staff is writing a grant, but if it were not obtained, the Department would need to look at laying off a public health nurse. She hopes that in the future there is a more holistic healthcare system that looks at all these things together. Commissioner Rodgers pointed out the direct relationship between these programs and building the tax base to generate the revenue to pay for these programs. Jean Baldwin reviewed ongoing efforts to seek grant funding. 6. Reporting on the Drinking Water Program, Larry Fay noted that the reason for the many well inspections is to verify that wells are being constructed properly, information not reflected in the report. Asked why so many more wells were abandoned in 2003 than 2002, Mr. Fay said he would need to verify with Staff why this rate was so high last year and projected to increase in 2004. Commissioner Rogers asked if an expansion of public water systems might be the cause? Mr. Fay agreed to investigate the reason. Member Buhler asked whether well testing could be tied to real estate sales? David Sullivan reported that well testing is a voluntary program. Larry Fay said that the UDC requires some well monitoring in seawater intrusion areas, but there has been no word on how this would happen, nor where the funding would come from. While many real estate transactions have this as a contingency, since Environmental Health only does a small percentage of the sampling in the County, they would be unaware of the others. 7. Staff noted that the number of inspections and number of restaurants in the Food program are similar to what you might see in Mason or Clallam County. Larry Fay noted that staffing is pretty consistent with populations, but the numbers are fairly high. A web-based examination/class system is being investigated as a cost-setting exercise. When asked ifthe food programs have resulted in cleaner restaurants, etc., he said he would rather see a manager certification requirement implemented. 8. Solid Waste Program -The effectiveness of solid waste education would have to be HEALTH BOARD MINUTES - February 19, 2004 Page: 5 based on increases in reuse and recycling as well as reductions in both tonnages and illegal dumping, elements that are challenging to measure. The reason 100% is shown under illegal dumps is because the litter program, funded by the state, is used to clean up dump sites. 9. On-site sewage - Larry noted "the percentage of system failures less than 5 years in use," is a percentage of those system failures the Department has dealt with, not a percentage of failures of all systems. When asked why the number of complaints is dropping off substantially, Larry said he is uncertain, but it might be that Staff has caught up on long-time problems and there is separate tracking of repeated complaints in the case file. With this year's increase in enforcement and compliance, he would not be surprised to see a larger number of complaints initially and then over time, fewer. The number of days between application and initial inspection would change from 14 to 7. Staff is hopeful that through education they can reduce the number of permits delayed due to clockstoppers. He noted that roughly 90% ofthe system applications come from six designers. He said he could track the number of systems various designers have done, their percentage of applications completed with and without clockstoppers and post the information on the web site, but he noted that some designers take more challenging projects than others. He noted the number of systems repaired/upgraded not associated with a violation or building application is not increasing because Staff is identifying more at the time of sale. The workshops have and will continue to drop off with a decrease in Ecology funding. He noted that Staff conducts 250 EES a year, so the percentage requiring significant maintenance or repair only refers to that total, not all systems. There was continued discussion about the importance ofthe monitoring program. The Board felt this type of performance measurement report is helpful. 2003 Sexuallv Transmitted Disease Report - Jefferson County: Dr. Locke referred to a 2003 report, which shows an outbreak of the sexually transmitted disease, Chlamydia, locally, in the state and across the nation. The new strategy is to get all Washington State health care providers doing universal Chlamydia screening of all women in the high-risk population ages 15-24. The risk of transmission is 25% - one in four. While some cases are curable, others result in lifelong infections and some are fatal. Diagnostic methods are improving, including a urine test, but the prevalence continues to climb. Member Masci shared that just this morning he had a patient who was suffering low back pain and other symptoms of Pelvic Inflammatory Disease (PID) who had admitted being seen by two doctors and the Health Department, none of whom had urged to have her boyfriend screened. He suggested there is not enough education and outreach. He also asked if there is a prevailing practitioner model of client privacy and protection? Dr. Locke reviewed that in addition to universal screenings, physicians do contact tracing and treatment of sexual partners irrespective of what their test shows, including cases ofPID. Every sexual partner of a PID case should be treated with antibiotics because the tests are not good enough to determine the cause. He recognized this as a priority area, noting that the Health Department had held an in-service on the subject at the hospital in June. HEALTH BOARD MINUTES - February 19, 2004 Page: 6 Peninsula Svrinl!e Exchanl!e Activity Renort: Referring to the syringe exchange activity report included in the agenda packet, which shows a steady increase in participation, Dr. Locke explained that it is very common for there to be secondary exchanges - not every individual N drug user comes in and exchanges, but one in a group collects and brings them in. While this accomplishes the goal of preventing people from discarding contaminated needles and creating a public safety risk, it compromises the goal of having one-on-one contact with each N drug user and being able to encourage them to get into a treatment program. While Staff knows the number of referrals given, they do not know the number of individuals going into treatment programs as a result of this contact. In response to questions about handing out kits and whether it is too easy for users to exchange, Jean Baldwin said the concern is the spread of Hepatitis C through reuse ofthe cotton. Dr. Locke commented that the reason this item is on the agenda is to ask what other types of impacts the Department should be considering? He and the Board would like to see improvements in referrals or incentives to get individuals into treatment. Staff also noted that the total of 63 attendees means 63 visits and could be just one or two people exchanging each week for other people. In response to Board interest, Staff agreed to bring a kit and the referral information given as well as statistics on other counties' number of referrals for comparison. Clandestine Drul! Lab Ordinance - Lel!al Review and Current Draft: Larry Fay said that a legal review resulted in only minor modifications to this ordinance. Although the draft receiving review did not include language suggested by Member Buhler under Section II, Applicability, this language would be included in the version to be adopted. The Deputy Prosecutor did not propose any revisions to the ordinance regarding restitution. Initial concern about whether the authorities listed in RCW 70.05 would be broad enough for the Board to impose criminal penalties for ordinances in order to gain compliance were resolved by further research. Staff recommended scheduling a hearing date. Member Masci moved to establish a March hearing date for adoption of the Clandestine Drug Lab Ordinance. Vice Chairman Frissell seconded the motion, which carried by a unanimous vote. Member Buhler expressed the concern that a property owner who is not directly involved could still be financially liable. Mr. Fay responded that the law assigns responsibility to the property owner. A landlord also has significant liability for letting anyone inside the building after it has been posted. Melinda Bower said she has done education and training in the community with property owners at apartment complexes, etc. on this issue. Owners need to be conscious to whom they rent and learn to recognize when their tenant might be engaged in illicit activities. Avian Influenza Undate: Dr. Locke reported there is careful tracking of this virus, which is still spreading in Asia. Human transmission is rare, with only 30 documented cases -but 21 of those have died. As long as the strains are spread from animals to human, they are relatively controllable, but ifthe strains are efficiently spread from person to person, it could result in a global pandemic. ACTIVITY UPDATEIOTHER ANNOUNCEMENTS - None HEALTH BOARD MINUTES - February 19, 2004 AGENDA PLANNINGI ADJOURN Page: 7 The meeting adjourned at 4:30 p.m. The next meeting will be held on Thursday, March 18, 2004 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH ~ Dan Titterness, Chairman ., i~. ., ~:.udJ. . J / . ,~/" 1/-"". tU 'r,. / <--f"'Ci'" ~ ,/ . _..1,;:." Ro . ssell, Vice Chairman ~/1 \ (2 ( ~J-/DCLIcA ill Buhler, Member ~~ \D~-(e,v~ Sheila Weste t . I.fnn iiW,,* Ilflill/ 1/1/11// 1,/1///// j!IJ./////~// CHEMICAL EMERGENCIES FACT SHEET Facts About Ricin What ricin is . Ricin is a poison that can be made from the waste left over from processing castor beans. . It can be in the form of a powder, a mist, or a pellet, or it can be dissolved in water or weak acid. L_ It is a stable substance. For example, it is not affected muchhy extreme conditions such as very hot or very cold temperatures. Where ricin is found and how it is used . _ Castor beans are processed throughout the world to make castor oil. Ricin is part of the waste "mash" produced when castor oil is made. . Ricin has some potential medical uses, such as bone marrow transplants and cancer treatment (to kill cancer cells). How you could!>e exposed to ricin . It would take a deliberate_act to make ricin and use it to poison people. Accidental exposure to ricin is highly unlikely. . People can breathe in ricin mist or powder and be poisoned.- . Ricin can also getinto water or food and then be swallowed. . Pellets of ricin, or ricin dissolved in a liquid, can be injected into people's bodies. . Depending on the route of exposure (such as injection or inhalation), as little as 500 micrograms of ricin could be enough to kill an adult. A 500-microgram dose of ricin would be about the size of the head of a pin. A greater amount would likely be needed to kill people if the ricin were swallowed. . In 1978, Georgi Markov, a Bulgarian writer and journalist who was living in London, died after he was attacked by a man with an umbrella. The umbrella had been rigged to inject a poison ricin pellet under Markov's skin. . Some reports have indicated that ricin may have been used in the Iran-Iraq war during the 1980s and that quantities of ricin were found in Al Qaeda caves in Afghanistan. . Ricin poisoning is not contagious. It cannot be spread from person to person through casual contact. Februarr Sr 2004 bE.p~lIiIlUlT C)\P ..ilftr-YH ... ..MA....1W-mA C1tNTSNf FOR Ih&&:",_ C~()t;. AND ....1lElin'~ SA_....HIIA.Ul'RJIIUI.IlmPl.oE'" pa~el of4 Facts About Ricin (continued from previous page) How ricin works · Ricin works by getting inside the cells ofa person's body and preventing the cells from making the proteins they need. Without the p~oteins, cells die. Eventually thi~ is harmful to the whole body, _and death may occur. . Effects of ricin poisoning depend on whether ricin was inhaled, ingested, or injected. Signs and symptoms of ricin exposure · The major symptoms of ricio poisoning depend on the route of exposure and the dose received, though many organs may be affected io severe cases. · Initial symptoms ofricio poisoning by inhalation may-occur within 8 hours ofexpoSUFe. Following ingestion of ricio, ioitial symptoms typically occur in less than 6 hours. · Inhalation: Within a few hours ofinhaling significant amounts of ricin, the likely symptoms would be respiratory distress (difficulty breathing), fever, cough, nausea, and tightness in the chest. Heavy sweating may follow as well as fluid building up in the lungs (pulmonary edema). This would make breathing even more difficult, and the skin might turn blue. Excess fluid io the lungs would be diagnosed by x-ray or by listening to the chest with a stethoscope. Finally; low blond pressure and respiratory failure may occur, leading to death. In cases of known exposure to ricin, people having respiratory symptoms that started within 12 hours of inhaliog ricin should seek medical care. · Ingestion: If someone swallows a significant amount of ricio, he or she would develop vomitiog and diarrhea that may become bloody. Severe dehydration may be the result, followed by low blood pressure. Other signs or symptoms may include hallucinations, seizures, and blood in the urine. Within several days, the person's liver, spleen, and kidneys might stop working, and the person could die, · Skin and eye exposure: Ricin in the powder or mist form can cause redness and pain of the skin and the eyes. · Death from ricin poisoning could take place within 36 to 72 hours of exposure, depending on the route of exposure (inhalation, ingestion, or injection) and the dose received. If death has not occurred io 3 to 5 days, the victim usually recovers. · Showing these signs and symptoms does not necessarily mean that a person has been exposed to ricin. How ricin poisoning is treated Because no antidote exists for ricin, the most important factor is avoiding rieio exposure in the first place. If exposure cannot be avoided, the most important factor is then getting the ricio off or out of the body as quickly as possible. Ricin poisoning is treated by giviog victims supportive medical care to minimize the effects ofthe poisoning. The types of supportive medical care would depend on several factors, such as the route by which victims were poisoned (that is, whether poisoniog was by iohalation, ingestion, or skin or eye exposure). Care could include such measures as helping victims breathe, giving them intravenous fluids (fluids given through a needle inserted into a vein), giving them medications to treat conditions such as seizure and low blood pressure, flushing their stomachs with activated charcoal (if the ricio has been very recently ingested), or washing out their eyes with water if their eyes are irritated. February 5, 2004 DBP~aU..i!I"I' OP IIIRl,.'1'a AN.D' IIIVMAN .nVlCSS C~Ei_ _ Dt__ CONTRO" AND PREvE\!tTroN SARa. HlIALTH1ER. _0101.1:'" pa~e 2 o~ 4 Facts About Ricin (continued from previous page) How you can know whether you have been exposed to ricin . If we suspect that people have inhaled ricin, a potential clue would be that a large number of people who nad been close to each other suadenly developed fever, cough,-and excess fluid in their lungs.-These symptoms could be followed by severe breathing problems and possibly death. · No widely available, reliable test exists to confirm that a person has been exposed to ricin. How you can protect yourself, and what to do if you are exposed to ricin · First, get fresh air by leaving the area where the ricin was released. Moving to an area with fresh air is a - good way to reduce the possibility of death from exposure to-ricin. o If the ricin release was outside, move away from the area where the ricin was released. o If the ricin release was indoors; get out of the building. · If you are near a release of ricin, emergency coordinators may tell you to either evacuate the area or to "shelter in place" inside a building to avoid being exposed to the chemical. For more information on evacuation during a chemical emergency, see "Facts About Evacuation" at htto:/lwww.bt.cdc.gov/planning/evacuationfacts.asp. For more information on sheltering in place during a chemical emergency, see "Facts About Sheltering in Place" at htto ://www.bt.cdc.gov/Dlanning/shelteringfacts.asD. · If you think you may have been exposed to ricin, you should remove your clothing, rapidly wash your entire body with soap and water, and get medical care as quickly as possible. . Removing your clothing: o Quickly take off clothing that may have ricin on it. Any clothing that has to be pulled over the head should be cut off the body instead of pulled over the head. o rfyou are helping other people remove their clothing, try to avoid touching any contaminated areas, and remove the clothing as quickly as possible. . Washingyourself o As quickly as possible, wash any ricin from your skin with large amounts of soap and water. Washing with soap and water will help protect people from any chemicals on their bodies. o If your eyes are buming or your vision is blurred, rinse your eyes with plain water for 10 to 15 minutes. If you wear contacts, remove them and put them with the contaminated clothing. Do not put the contacts back in your eyes (even if they are not disposable contacts). If you wear eyeglasses, wash them with soap and water. You can put your eyeglasses back on after you wash them. . Disposing of your clothes: o After you have washed yourself, place your clothing inside a plastic bag. Avoid touching contaminated areas of the clothing. If you can't avoid touching contaminated areas, or you aren't sure where the contaminated areas are, wear rubber gloves, turn the bag inside out and use it to pick up the clothing, or put the clothing in the bag using tongs, tool handles, sticks, or similar objects. Anything that touches the contaminated clothing should also be placed in the bag. If you wear contacts, put them in the plastic bag, too. o Seal the bag, and then seal that bag inside another plastic bag. Disposing of your clothing in this way will help protect you and other people from any chemicals that might be on your clothes. Febru:3' Sf 2004.. DBP:411TIII.lQiT D.P' IiI_AL"I'B ...It. ~ltAIIl .")tIC_ UN...lIlRS FOR DlIIEASE: f:o\;I,tiI01. A.ND PRE:1I:ERTtoN SA_.' HlliALT81 Ell. PliEOF'1.1f" paie 3 of 4 . Facts About Ricin (continued from previous page) o When the local or state health department or emergency personnel arrive, tell them what you did with your clothes. The health department or emergency personnel will arrange for further disposal. Do not handle the plastic bags yourself. · For more infonnation abo_ut cleaning your body and dispQsing of your clothes after a ch~mical release, see "Chemical Agents: Facts About Personal Cleaning and Disposal of Contaminated Clothing" at http://www.bt.cdc.gov lolanninwoersonalcleaningfacts.aso. · If someone has ingested ricin, do not induce vomiting or give fluids to drink. · Seek medical attention right away. Dial 911 and explain what has happened. How you can get more information about ricin You can contact one of therollowing: . Regional poison control center (1-800-222-1222) . Centers for Disease Control and Prevention o Public Response Hotline (CDC) . English (888) 246-2675 . Espafiol (888) 246~2857 . TIY (866) 874-2646 o Emergency Preparedness and Response Web site (http://www.bt.cdc.gov/) o E-mail inquiries: cdcresponse@ashastd.org o Mail inquiries: Public Inquiry c/o BPRP Bioterrorism Preparedness and Response Planning Centers for Disease Control and Prevention Mailstop C-18 1600 Clifton Road Atlanta, GA 30333 . Agency for Toxic Substances1fud Disease Registry (ATSDR) (1-888-422-8737) o E-mail inquiries: atsdricialcdc.gov o Mail inquiries: Agency for Toxic Substances and Disease Registry Division of Toxicology 1600 Clifton Road NE, Mailstop E-29 Atlanta, GA 30333 This fact sheet is based on CDC's best current information. It may be updated as new information becomes available. For more Information, visit www.bt.cdc.aov or cail the CDC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Espafiol), or (866) 874-2646 (TTY). 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