Cystic Fibrosis Mortality Rates Females Health Essay

Cystic Fibrosis Mortality Rates Females Health Essay

This paper will turn to the issues females with Cystic Fibrosis face. Females are smaller of the two sexes and due to size, lung map and self-image issues they die younger. The undermentioned research is sing the female mortality rate. A University of Wisconsin survey: Gender Bias in Cystic Fibrosis Care suggests females die younger due to a hold in diagnosing. However, a survey in Respiratory and Critical Care Medicine, Effects of Gender and Age at Diagnosis on Disease Progression in Long-Term Survivors of Cystic Fibrosis concluded females are at a disadvantage in adolescence, but non as grownups. Females with CF dice younger than their male counter parts.
The followers will explicate why. Cystic Fibrosis Mortality Rates Females Health Essay.
Keywords: Cystic Fibrosis and Estrogen, Cystic Fibrosis female mortality
Cystic Fibrosis Mortality Rates in Females
Cystic Fibrosis ( CF ) affects both sexes every bit, in symptoms females have more trouble due to psychological issues connected to symptoms than their male opposite numbers ; hence, males are more accepting of the disease. Three different surveies: Gender Bias in Cystic Fibrosis Care, Gender Gap in Cystic Fibrosis Mortality, and CHEST Is There Still a Gender Gap in Cystic Fibrosis, reference that females die younger than males but the grounds are unexplained. Females with Cystic Fibrosis dice younger because they are invariably reminded of their disease, and the inability to alter the result.
A positive diagnosing of Cystic Fibrosis can be lay waste toing for the parents and households of kids affected with the disease. Both parents have to be bearers of the CF cistron to go through it on to their kids. The badness of the disease can change from individual to individual. Cystic Fibrosis is the most common deadly familial disease impacting Caucasians ” ( Simmons et al. , 1985, p. 111 ) . A sweat trial confirms the diagnosing of CF. Many parents carry huge anxiousness once they receive a positive diagnosing of CF. A much larger concern would turn to if these parents should go on holding kids.
Teenss with CF have a assortment of symptoms that affect them ; females deal with them in different ways. Get downing with the salivary secretory organs, the secernments are thicker than normal and unable to maintain the oral cavity cleansed. Sugars, salts, and nutrient atoms along with the septic secernments from the lungs cause the dentition to go grey, create pits, and cause bad breath. Malabsorption, anorexia, and failure to boom cause hapless organic structure image. Embarrassed by the olfactory property of their intestine motions, females wait to acquire place to utilize the public toilet.
A bulk of the clip these immature misss are treated as if they are ill. Alternatively of being involved in athleticss or any physical activity, parents become overprotective of the immature misss smaller and sometimes delicate organic structures. Parents think they are protecting the kid when what they are truly making is enabling them to go excessively dependent. This can hold an inauspicious consequence on the female ; she may see herself weak and unable to get by. She will maintain the CF to herself and is really selective on whom she tells.Cystic Fibrosis Mortality Rates Females Health Essay.  She depends on friends because she does non desire to worry her parents.
Female babies ‘ respiratory jobs appear to be milder with coughing and wheezing that is non every bit pronounced as males. Due to these mild symptoms, females are frequently diagnosed up to 4 months subsequently than males. Diagnosis in males is around the 8th month of babyhood, with females having a diagnosing of CF after making the twelvemonth grade. Harmonizing to a University of Wisconsin survey, Females that showed symptoms of merely coughing and wheezing were diagnosed an norm of 18 months subsequently than male childs ” ( Gender Bias in CF, ” 2002, parity. 7 ) .
One of the lone ocular parts of CF is something immature misss look at every twenty-four hours, and frequently hide. Depending on the badness of the disease, there can be clubbing of the fingers and toes. Clubbing is when the tips of the fingers or toes are enlarged and the fingernails curve downwards. When a babe is born this is one physical indicant that a babe could hold the disease.
Both males and females struggle to take a breath when their lungs become compromised with infections. However, female lungs are smaller than male lungs. Even the common cold can go life endangering. The lungs are one of the major variety meats involved in CF, and normally are the cause of decease. Because of the hapless O impregnation, patients with CF have somewhat grey shade to their tegument. The secernments are thick and green which means there is normally an infection. The lungs are susceptible to lung infections such as pneumonia, bronchiectasis, pseudomonas aeruginosa and staphylococci aureus and most hospitalizations are due to lung complications.
Cystic Fibrosis is an assault on a females ‘ smaller frame. Due to how their organic structure absorbs nutrient, vitamins, and proteins, females with CF are physically smaller than their male opposite numbers. The pancreas ‘ engagement is compromised and this leads the failure to boom. Food gets to the tummy and is unable to be digested entirely. Harmonizing to a recent survey most patients with cystic fibrosis ( 90 to 95 % ) have pancreatic insuffiency ( PI ) , have hapless weight addition, failure to boom. Patients have trouble prolonging energy because of malabsorption, and anorexia ” ( Sharma, 2010, parity. 7 ) . Keeping their intestine motions causes faecal impaction and adds to their overall negative psychological mentality. Cystic Fibrosis Mortality Rates Females Health Essay.
It is believed that the females ‘ generative system plays a critical axial rotation in her physical wellness. When females have their catamenial rhythm, it depletes Fe and can do exhaustion, crossness, and endocrine alterations. During this clip, a female with Cystic Fibrosis ‘ system is compromised and they have a greater opportunity of going ailment during this 5 to 7 twenty-four hours period. A survey suggests, The weakening lung map alterations were related to Lipo-Lutin degrees ” ( Zeitlin, 2008, p. 6 ) . Cystic Fibrosis does non impact the female reproduction variety meats. Females have the ability to go pregnant and carry a fetus full term with proper medical supervising. Unfortunately, males have a 95 % opportunity of being unfertile.
When females with CF get into their teenage old ages, they start recognizing what a annihilating terminal disease Cystic Fibrosis is. Finally, they will transport a great trade of the load of the disease with them. They will seek to do their parents experience less guilty for go throughing the disease on to them. Harmonizing to a survey, females are better able to deny the disease than males. They seem to be compliant with parents ‘ wants and demands and demo fewer unacceptable behaviours ” ( Simmons et al. , 1985, p. 119 ) .
In many respects, males are treated really otherwise than females with CF. From the clip they are diagnosed, males are encouraged to encompass the disease. They are encouraged to seek athleticss, be active, and assert themselves. There are times when they deny the disease, but they have a healthy organic structure image. Males live 3 to 5 old ages longer than females with Cystic Fibrosis.
Harmonizing to a survey in Maedica, Since the early 1970 ‘s, the figure of persons with CF aged 18 old ages or older has increased by more than 400 % . Presently in the western states 43 % of all CF patients will be older than 18 old ages, bulk of them between 18 and 30 old ages and 10 % being older than 40 old ages ” ( Ciofu, Ciofu, Davila, Alexandrescu, & A ; Rusescu, 2007, p. 316 ) .
Coping with a chronic disease and the physical alterations can do adolescents to do some hapless wellness related determinations. Teenss can arise by non taking vitamins and medicines prescribed to a hapless diet can do frequent or unscheduled hospitalizations. Surprisingly, this is a common happening with CF patients.
Due to the progresss in intervention for CF patients are populating longer.Cystic Fibrosis Mortality Rates Females Health Essay.  These interventions include aerosol-breathing interventions, chest percussion with postural drainage, bronchodilators, antibiotics, mucose dilutants, and decongestants. Promote regular exercising to better external respiration. Interesting fact, in roll uping mucose from a CF patient is the mucose offprints into beds. In the most sever instances, lung grafts have proved to be successful ; nevertheless, the patient will still expose all other CF features.
In decision, females with Cystic Fibrosis may necessitate excess attending once they understand the disease and forecast. Females need counsel adjusting to the physical and emotional challenges and restrictions this disease brings. It is really of import they live a normal life that includes dances, day of the months and holding kids. Parents need to be supportive and non surrounding. From a medical position, possibly all neonates should be tested for Cystic Fibrosis. Once a parent finds out that they are bearers, should they go on holding kids cognizing they will most likely base on balls on the Cystic Fibrosis cistron.
Abstract

The aim of this study is to analyze population-based mortality attributed to cystic fibrosis (CF) over 36 years in Spain. CF deaths were obtained from the National Statistics Institute, using codes 277.0 from the International Classification of Diseases (ICD) ninth revision (ICD9-CM) and E84 from the tenth revision (ICD10) to determine the underlying cause of death. We calculated age-specific and age-adjusted mortality rates, and time trends were assessed using joinpoint regression. The geographic analysis by district was performed by standardized mortality ratios (SMRs) and smoothed-SMRs. A total of 1002 deaths due to CF were identified (50.5% women). Age-adjusted mortality rates fell by −0.95% per year between 1981 and 2016. The average age of death from CF increased due to the annual fall in the mortality of under-25s (−3.77% males, −2.37% females) and an increase in over-75s (3.49%). We identified districts with higher than expected death risks in the south (Andalusia), the Mediterranean coast (Murcia, Valencia, Catalonia), the West (Extremadura), and the Canary Islands. In conclusion, in this study we monitored the population-based mortality attributed to CF over a long period and found geographic differences in the risk of dying from this disease. Cystic Fibrosis Mortality Rates Females Health Essay. These findings complement the information provided in other studies and registries and will be useful for health planning.

Keywords: cystic fibrosis, population-based mortality, mortality trends, geographic analysis

Cystic fibrosis (CF) is a genetic disease with autosomal recessive inheritance that affects various organ systems [1]. Its effects on the pulmonary system are some of the most important causes of morbidity and mortality [2]. It is manifested, amongst other symptoms, by pancreatic insufficiency, chronic lung disease, infertility, and an increase in electrolyte concentration in sweat. CF is diagnosed in both sexes, although male patients are reported to have longer life expectancy [3]. It is a chronic disease affecting above all children and young adults. However, the advances that have been made in the treatment in recent decades have greatly increased life expectancy and a lot of today’s patients are adults [1,4,5].

Due to its low prevalence, CF is considered a rare disease (prevalence below 5 per 10,000 in the European Union). It occurs most frequently in Europe, North America, and Australia, and prevalence is lower in East Asia and Africa [4,6]. According to a study of CF in Europe, it has a prevalence in Spain and Italy of 0.55 per 10,000 inhabitants, while the prevalence in France and Germany is slightly higher [7]. The highest rates in Europe are in the United Kingdom and Ireland with 1.37 and 2.98 per 10,000 inhabitants, respectively, while countries in Eastern Europe, such as Latvia and Lithuania, have lower rates (1.04 and 1.30 per 10,000 inhabitants, respectively) [7].

The mortality trends have been analyzed at country and large-region level (United Kingdom, Italy, Australia, Japan, Europe, North America, and South America). In general, these studies reported a decline in mortality rates over the different periods analyzed with some variations between the different geographical areas [8,9,10,11,12,13,14]. The analysis of the studies of mortality in cohorts of patients with CF based on historical records included extensive series such as those produced by the CF Foundation in the U.S., the European CF Society, and data from official registries in other countries (Sweden, Canada, Italy, France, United Kingdom, Germany) [11,15,16,17].Cystic Fibrosis Mortality Rates Females Health Essay.  In Spain, a study was conducted into mortality due to CF in children and young people under 30 years of age [18], but so far there have been no studies of spatial variability in the risk of death. Geographical analysis is particularly useful for creating hypotheses regarding exposure to environmental factors that might influence the appearance of complications in CF [19].

The methodologies applied in the available studies of mortality and survival of CF patients were based on either death certificates [8,18] or registries [16,17,20]. Studies based on patient registries, as well as indicating mortality trends, allow demographic and clinical factors to be analyzed [17,21]. However, some registries may not cover all the cases and their representativeness depends both on the number of institutions that supply them with information and the proportion of patients with CF in each institution [15]. According to the latest report on the registry of patients with CF in Spain, coverage is about 70% and there are 22 participating institutions [22]. In contrast to the studies based on patient registries, the official mortality records cover the whole population and allow us to carry out detailed analyses based on the place of residence of those who died. In this sense, the national mortality records are useful for epidemiological surveillance, as they provide data about the number of deaths directly attributed to a particular disease. They also report the total number of deaths in a region (population-based mortality) and follow a standardized methodology over time. In the specific case of rare diseases such as CF, population-based data are particularly important in order to build a series of cases that is sufficiently large as to enable a detailed temporal and geographical analysis to be performed [18,23]. In spite of the limitations of mortality studies, they continue to be a useful source of information for obtaining population-based epidemiological indicators [8,18,23].

The objective of this study is to broaden existing information about CF by means of a population-based analysis of the mortality attributed to this rare disease over a period of 36 years (1981 to 2016) and to identify the geographical variations within Spain in the risk of dying from this disease. Cystic Fibrosis Mortality Rates Females Health Essay.

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2. Materials and Methods

On the basis of the annual death records issued by the Spanish National Statistics Institute (NSI), we selected the deaths in which cystic fibrosis was cited as the underlying cause of death. We used code 277.0 from the International Classification of Diseases (ICD) ninth revision (ICD9-CM) for the period 1981–1998, and code E84 from the tenth revision (ICD10) for the period 1999–2016. For each deceased person, we considered their date of death, municipality of residence, sex, and date of birth. We also obtained the population data, broken down by sex, age, and municipality of residence.

We then calculated the specific mortality rates by age groups and sex. These were obtained for the whole study period and for each ICD period. The age-adjusted mortality rates were calculated for males, females, and both sexes. Mortality rates were expressed per 100,000 inhabitants and the European standard population was used as a reference for the adjustment. Time trends were evaluated using joinpoint regression models including two possible points of change [24]. The annual fluctuations were smoothed using the T4253H non-parametric procedure, available in SPSS 22.0 (IBM Corp, NY, USA). This procedure is based on the use of running medians to summarize overlapping segments [25].

For the geographical analysis, the municipalities were grouped into districts in order to increase the stability of the results [23]. The standardized mortality ratios (SMRs) were then calculated by district for the period 1999–2016 taking the Spanish population as a reference. On the basis of confidence intervals (CI) of 95% for each SMR, we identified the districts that showed values that were significantly higher or lower than expected compared to the total for Spain as a whole (SMR = 1.00).Cystic Fibrosis Mortality Rates Females Health Essay.  The SMRs were smoothed according to the model proposed by Besag, York, and Mollié, which takes into account the heterogeneity of each one [26]. For each district we also obtained the posterior probability (PP) value associated with each smoothed SMR. PP values of less than 0.20 indicate that the risk of death is lower than expected, while those greater than 0.80 indicate a higher than expected risk.

The statistical analyses were performed with Stata (StataCorp, College Station, TX, USA), Joinpoint (National Cancer Institute, Bethesda, MD, USA) and the INLA R 3.3.1 software package (Norwegian University of Science and Technology, Trondheim, Norway). ArcGIS software (Esri, Redlands, CA, USA) was used for cartographical representations.

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3. Results

We identified 1002 deaths in which CF was cited as the main cause of death between 1981 and 2016 in Spain. The deaths were equally balanced between sexes in that 49.5% were males (496 of those who died) and 50.5% females (506 of those who died). The average age of death for the whole 36-year period was 27.7 years old (CI 95% 26.0–29.4), although this masks important differences between the two halves of the study period. In the first half of the study period (1981–1998) the average age of death was 13.7 years (CI 95% 12.2–15.3), while in the second half (1999–2016) it was much higher at 41.1 years (CI 95% 38.8–43.8) (p < 0.001). Cystic Fibrosis Mortality Rates Females Health Essay. The average age of death increased significantly by 9.54% per year until 2003 (p < 0.001), and since then has remained unchanged. The age-specific mortality rates were highest in under-25s and over-75s, with maximums in the 0–4 years age group and the over-85s (Figure 1a). In the second half of the study period (1999–2016) there were decreases in the specific rates of child mortality and an increase in the mortality of over-75s (Figure 1b,c).

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Figure 1

Age-specific mortality rates due to cystic fibrosis in females, males, and both sexes for 5-year age groups. (a) Whole period, (b) 1981–1998, (c) 1999–2016.

In Table 1 we present the age-adjusted mortality rates for the 36-year period. Overall, we noted a slight fall over time in the number of deaths due to CF with an annual percentage change of −0.95% (p < 0.001). In males, there was a fall of −1.37% (p < 0.01), while in women the annual change was not significant (−0.47%, p = 0.249) (Figure 2a). As can be seen in Figure 2b, mortality in under-25s fell by 3.77% per year between 1981 and 2016 in males (p < 0.01), and 2.37% in females (p < 0.01). By contrast, was an increase over time in mortality due to CF of 3.49% per year amongst the over-75s (p < 0.001). By sexes, the mortality in this age bracket increased by 2.14% in males (p < 0.01) and 2.55% in females (p < 0.01) (Figure 2c). Cystic Fibrosis Mortality Rates Females Health Essay.

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Figure 2

Changes in the smoothed age-adjusted mortality rates attributed to cystic fibrosis for the period 1981–2016. (a) All ages, (b) under-25s, (c) over-75s.

Table 1

Age-adjusted mortality rate (per 100,000) attributed to cystic fibrosis from 1981 to 2016.

Both Sexes Males Females
Year Age Adjusted Mortality Rate 95% CI Age Adjusted Mortality Rate 95% CI Age Adjusted Mortality Rate 95% CI
1981 0.090 (0.064–0.126) 0.089 (0.054–0.154) 0.092 (0.055–0.147)
1982 0.083 (0.057–0.117) 0.076 (0.043–0.136) 0.089 (0.053–0.145)
1983 0.093 (0.066–0.130) 0.105 (0.063–0.174) 0.084 (0.049–0.138)
1984 0.086 (0.058–0.123) 0.087 (0.049–0.150) 0.085 (0.047–0.143)
1985 0.095 (0.066–0.132) 0.111 (0.069–0.177) 0.076 (0.042–0.129)
1986 0.078 (0.051–0.114) 0.098 (0.057–0.162) 0.056 (0.027–0.107)
1987 0.063 (0.039–0.096) 0.042 (0.018–0.091) 0.084 (0.047–0.143)
1988 0.056 (0.034–0.089) 0.060 (0.028–0.115) 0.052 (0.024–0.101)
1989 0.085 (0.057–0.123) 0.113 (0.069–0.178) 0.057 (0.027–0.109)
1990 0.058 (0.036–0.090) 0.037 (0.016–0.079) 0.079 (0.042–0.138)
1991 0.052 (0.030–0.085) 0.049 (0.022–0.098) 0.056 (0.025–0.111)
1992 0.062 (0.039–0.096) 0.075 (0.040–0.132) 0.049 (0.022–0.099)
1993 0.075 (0.047–0.113) 0.079 (0.041–0.139) 0.071 (0.034–0.131)
1994 0.058 (0.035–0.093) 0.040 (0.017–0.086) 0.077 (0.039–0.139)
1995 0.060 (0.038–0.094) 0.048 (0.021–0.098) 0.075 (0.040–0.132)
1996 0.089 (0.061–0.127) 0.108 (0.066–0.171) 0.067 (0.035–0.123)
1997 0.076 (0.050–0.114) 0.083 (0.045–0.144) 0.069 (0.036–0.126)
1998 0.057 (0.034–0.091) 0.044 (0.018–0.096) 0.069 (0.035–0.128)
1999 0.065 (0.042–0.099) 0.056 (0.028–0.107) 0.074 (0.040–0.133)
2000 0.042 (0.025–0.070) 0.045 (0.022–0.091) 0.040 (0.018–0.088)
2001 0.050 (0.030–0.082) 0.049 (0.022–0.102) 0.053 (0.026–0.105)
2002 0.038 (0.022–0.065) 0.033 (0.013–0.077) 0.041 (0.019–0.088)
2003 0.070 (0.046–0.105) 0.079 (0.043–0.137) 0.063 (0.033–0.115)
2004 0.090 (0.062–0.128) 0.077 (0.043–0.132) 0.104 (0.062–0.168)
2005 0.053 (0.033–0.082) 0.054 (0.027–0.100) 0.052 (0.026–0.098)
2006 0.030 (0.016–0.052) 0.029 (0.011–0.067) 0.029 (0.012–0.067)
2007 0.064 (0.041–0.096) 0.047 (0.023–0.090) 0.087 (0.049–0.146)
2008 0.065 (0.043–0.096) 0.074 (0.043–0.123) 0.058 (0.029–0.107)
2009 0.076 (0.052–0.109) 0.068 (0.037–0.117) 0.084 (0.049–0.138)
2010 0.072 (0.048–0.104) 0.088 (0.052–0.142) 0.053 (0.027–0.098)
2011 0.055 (0.035–0.082) 0.044 (0.022–0.082) 0.067 (0.037–0.115)
2012 0.061 (0.041–0.090) 0.056 (0.030–0.099) 0.066 (0.037–0.113)
2013 0.079 (0.054–0.113) 0.057 (0.031–0.101) 0.106 (0.064–0.167)
2014 0.063 (0.040–0.094) 0.072 (0.040–0.124) 0.053 (0.026–0.100)
2015 0.057 (0.038–0.085) 0.050 (0.027–0.090) 0.066 (0.037–0.114)
2016 0.049 (0.030–0.078) 0.054 (0.027–0.100) 0.044 (0.020–0.090)

As regards the geographic variability, Table 2 shows the districts with SMRs that were significantly different from expected for Spain over the period 1999 to 2016 (SMR = 1.00). We identified just one district (Área Metropolitana de Madrid) with a lower mortality rate due to CF than expected and 11 districts with a higher SMR than expected, most of which were located in the south of the Iberian Peninsula.Cystic Fibrosis Mortality Rates Females Health Essay.  The spatial analysis shows less geographic variability when the sexes are considered separately. In males the higher than expected mortality rate was only significant in five districts, while in females it was significant in three districts.

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Table 2

Comparison of SMR values (95% CI) among districts with significant results for the period 1999–2016, for both sexes, and for males and females separately.

District Province Location Both Sexes Males Females
Very low risk
 Área Metropolitana de Madrid Madrid C 0.658 (0.453–0.924) 0.598 (0.341–0.970)
High risk
 Brozas Cáceres W 15.462 (1.736–55.825) 30.304 (3.403–109.413)
 Alto Maestrazgo Castellón E 12.091 (1.358–43.654)
 Logrosán Cáceres W 10.474 (1.176–37.817)
 Guadix Granada S 5.468 (1.099–15.978)
 Campiña Alta Córdoba S 3.168 (1.269–6.527) 4.652 (1.499–10.856)
 Campo de Gibraltar Cádiz S 2.892 (1.245–5.698) 3.783 (1.219–8.829)
 Norte de Tenerife SC de Tenerife SW * 2.473 (1.184–4.549) 2.849 (1.040–6.200)
 Gran Canaria Las Palmas SW * 2.331 (1.423–3.600) 2.664 (1.328–4.767)
 La Vega Sevilla SW 2.201 (1.004–4.178) 2.169 (1.119–3.788)
 La Campiña Sevilla SW 1.934 (1.225–2.902) 2.816 (1.028–6.129)
 Guadalhorce Málaga S 1.798 (1.126–2.722)
 Campo de Cartagena Murcia SE 3.395 (1.240–7.390)

* Island territories (Canary and Balearic Islands); CI: confidence interval; C: Centre; E: East; N: North; NE: Northeast; NW: Northwest; S: South; SE: Southeast; SW: Southwest; W: West. Cystic Fibrosis Mortality Rates Females Health Essay.

When the information from the adjacent districts was taken into account, as reflected by the smoothed-SMRs and the PPs (Figure 3a,b), the results were consistent with a higher risk of death from CF in certain districts in Córdoba (Campiña Alta), Cádiz (Campo de Gibraltar), Sevilla (La Vega and La Campiña), Málaga (Guadalhorce), Santa Cruz de Tenerife (Norte de Tenerife), and Las Palmas (Gran Canaria). We also detected five new locations: Cantabria (Costera), Barcelona (Bages y Bajo Llobregat), Alicante (Meridional), and Badajoz (Mérida). According to Figure 4a,b, the districts with significantly higher risk for males were above all in provinces in the south, such as Córdoba (Campiña Alta), Cádiz (Campo de Gibraltar), Sevilla (La Vega), and Málaga (Centro-Sur U Guadalorce), and in certain districts in Barcelona (Bajo Llobregat) and Murcia (Campo de Cartagena). In the case of women, the geographic differences in the risk of dying were less pronounced when neighboring regions were taken into account (Figure 4c,d). Cystic Fibrosis Mortality Rates Females Health Essay.

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