The necessity of addiction treatment in time

August 5, 2015

The necessity of addiction treatment in time: Drug addiction is a curable disease

The necessity of addiction treatment in time is not an option but a must owing to the complications that may come with it if treatment is not done in time.

I want to bring to you the message of hope particularly to those who may be losing hope in their struggle with addiction. We understand the difficulties you and your family are going through in your struggle with the condition. It also concerns us as professionals from AWAREmed Health and Wellness Resource Center. This is a medical facility that was founded by one of the veteran addiction expert doctor Dalal Akoury with the primary objective of bringing hope to all addiction victims like you. Because of our great concern, we want to assure you that somebody cares and you are not alone. The good news about this problem is that it is curable meaning that you can have you life back and live it to the fullest. However for this to take effect it is important that we share with you the necessity of addiction treatment in time. Remember that just like all other health conditions, prevention would be the best so that we don’t have to get to the treatment phase. Nonetheless, because this is already with us professional treatment becomes necessary. It will therefore interest you to note that, the formation of this facility was guided by the good will doctor Dalal Akoury is having in making her contribution towards eliminating this problem from your life and that of your family. Doctor Akoury practice focuses on personalized medicine through healthy lifestyle choices that deal with primary prevention and underlying causes instead of patching up symptoms. Therefore if this introduction suits your situation, then you are at the right place and calling doctor Akoury for an appointment should be the first thing to do so that she can enroll you to the right addiction recovery program.

Now back to our topic of discussion “the necessity of addiction treatment in time, it is quite unfortunate that despite this condition being curable many people still don’t come out for help and they chose to suffer in silence. Yet some still argue that the addiction treatment does not help and that it is only the patient’s own strong will that can solve the problem of addiction. This is what I will call a terrible mistake. It is important to note that the journey for treatment of addiction is along one. Like for instance, in the first 3-5 years of addiction victims are generally inclined to deny the existence of any problem. Then after this the next phase of the process is delaying and searching for the short cuts and cheapest treatment, and then the statement that nothing helped them is followed. With all these time wasting the intensity of addiction increases meaning that there will be need of a lot of motivation on the part of loved ones for this process to be a success. Doctor Akoury says that even though motivation is necessary, it is meaningless to keep postponing treatment until the moment when motivation appears, when a person’s physical and emotional will power have been completely worn out.

The usual argument and blame game where victims defend themselves by using cases where some people’s addiction treatment were unsuccessful to declare that addiction is incurable disease is pure manipulation and shifting of responsibility on parents, doctors, government, aliens and other such institutions and individuals. The true position is that people who have recovered from their addiction will always try as soon as possible to forget the period of their lives which was associated with drugs. They often do so because they are ashamed and sorry for many mistakes they made. People just don’t want to recall that time. For man of sense it is stupid to walk around and boast to everybody that he was cured. On contrary, a drug addict with a peculiar tendency to change reasonable behavior for empty rhetoric will be arguing that treatment doesn’t help, because two or three of ten undergoing treatment failed. Therefore, the negative feedback on different drug forums and in the streets always prevails yet this is not always the case. If you want to be helped, speak to the experts and don’t listen to street garters. Your health is very important for you to take wrong information from quakes and believe them.

The necessity of addiction treatment in time: Drug addiction is a serious disease not a bad habit

Did you know that at this point of time there are still very many people who still believe that addiction is all about weak character? It is quite unfortunate that after many years of communicating with the addicts and their relatives we could still realized the following:

Despite the fact that nowadays, when information about addiction available to everybody, most of the people, oddly enough, know little about drug addiction as a disease and often underestimate its seriousness and destructiveness to the body. And in this regard, they just don’t realize how deep, diverse and the same time complex must be the treatment. Most people believe that drug addiction is rather a bad habit than an illness. But in fact, this is a very serious disease that affects all body systems – from the higher nervous activity to intracellular metabolism. That is why addiction must be considered as one of the most intractable diseases. Everyone knows that our organism is endowed with protective systems which protect us from germs, viruses and other disease-causing factors. To such protective systems can be attributed a system that produces ingenious “hormones of pleasure” – endorphins and enkephalins. The purpose of which is to protect the body from such harmful factors as stress, pain, shock. For instance, in case of injury or disease the endorphins protect the whole body and especially the nervous system from excessive pain, which in its turn may be very detrimental by itself. Sufficient level of endorphins makes a person feel good, optimistic, productive, and active during the day and provides good quality sleep during a night.

The necessity of addiction treatment in time: Drug addiction and endorphins

When we talk about endorphins we refer to any group of hormones secreted within the brain and nervous system which are tasked with a number of physiological functions. Ordinarily they are peptides that activate the body’s opiate receptors, causing an analgesic effect. Now having got that explanation, it is important to note that the external narcotics will destroy the ingenious narcotic system and thus leave the individual without its protection. It therefore means that foreign drugs displace the body’s own endorphins and gradually become an essential element of biochemical processes in nervous system. In this case the person is forced to use the drugs to maintain his health condition in a “normal” state. The nature of endorphin-enkefhalin system is such that it is not able for self-recovery. It means that without proper repair of this marred by drugs system, to defeat craving for drugs is impossible. A person with impaired endorphin system is vulnerable to stress, to situations where even the slightest provocation can cause him to resort to drugs again. We will continue the discussion of this hormone in our next article but in the meantime, treatment of addiction must be done in good time if any meaningful result is to be realized. Therefore if addiction is causing you sleepless nights, reach out for help from the experts at AWAREmed Health and Wellness Resource Center today.

The necessity of addiction treatment in time: Drug addiction is a curable disease

What Causes Neurodegenerative Changes

July 27, 2015

What Causes Neurodegenerative Changes

Neurodegeneration is a medical condition of the nerve system that generally refers to a gradual loss of neurons. It is a condition of damage to the nerve cells both in structure and functionality. Neurodegeneration changes also used to refer to the death of nerve cells. It is an age related condition of the brain. Neurodegeneration is however a blanket terminology. It involves several disorders. Alzheimer’s disease (AD), Amyotrophic Lateral Sclerosis (ALS), Corticobasal Degeneration (CBD), HIV-related cognitive impairment, and Huntington Disease (HD) are just but a few.

Alzheimer’s Disease (AD)

This is degenerative brain condition that gradually erodes memory. Alzheimer’s disease AD distorts one’s ability to think clearly. It is characterized by progressive failure to solve simple numerical problems and inability to perform simple tasks. AD is reportedly the root cause of dementia. Based on several research findings, AD accounts to close to 70 percent of all cases of the brain disease. AD is one of the neurodegenerative changes that increase exponentially with age. It is even reported the number of Americans with the AD condition stands at well over 5.1 million. For an in-depth explanation of the disease please click on www.awaremednetwork.com.

AD is a genetically inherited condition. Chances of inheriting the disease are however minimal, at a low of 5% or less. Signs of the disease often begin to show at an age, 65. However there are forms of AD that can indicate early signs at as low as age 30. Early-onset Familial Alzheimer’s Disease (EOFAD) is one such. There are genetic materials that can increase or reduce proneness of a person to the disease but do not necessarily cause it. You may call up Dr. Dalal Akoury of integrative Addiction Institute and International Organization of Integrative Cancer Physicians for incisive information on genetic composition of AD and its transmission through generations.

nerve degeneration

Naturally the first sign of Alzheimer’s Disease (AD) is loss of memory especially about recent events. Memory lapses may also occur however not profound. An example of a person suffering early signs of these neurodegenerative changes is one asking the same thing over and over, even when that same question has been properly answered in recent prior conversations. While at home they struggle to find such small items like handkerchiefs or wallets. Ever wondered why some people constantly leave foods on the cooker? AD victims are actually worse in the kitchen. Their foods always burn. The disease often progresses from mild AD, Moderate AD to advanced stages of the Neurodenerative changes of Severe Alzheimer’s Disease. Eee…very crazy, I guess many of us are victims. This is why you must sign up for this year’s August integrative addiction medicine conferences. Click on http://www.integrativeaddiction2015.com for more information.

Amyotrophic Lateral Sclerosis (ALS)

This is a degenerative brain condition that often affects the motor neurons in adults. It is one of the most common forms of neurodegenerative changes in the U.S. Amyotrophic Lateral Sclerosis (ALS) often causes a discerned loss of neurons that normally connects the brain to the muscles. It affects both the dorsal superior motor neurons and the lower inferior neurons of the spinal cord in the rest of the body. This condition is well very popular in the U.S. according to population studies, the figures stand at an astonishing 5600 patients each calendar year, with well over 15 new victims every single day. Men are reportedly 20% more prone to this type of degenerative change compared to women. You may click on www.awaremednetwork.com to further research on ALS and the other neurodegenerative changes. Dr. Akoury will be of great assistance too in understanding genetic composition and transmission of the ALS.

Basic symptom of ALS involves a feeling of weakness in the arms. Other symptoms include clumsiness, stiffness, and slowness. Muscles in the said organs often become smaller as the disease progresses. Other symptoms; cramping and twitching even though are common in much healthier people, tend to be profound when one is nursing ALS. It is for the same reasons the degenerative change is normally ignored in its primary stages. ALS does not uniformly progress from one stage to the other in every victim. The disease is however worse at an advanced stage, paralysis. There are not specific laboratory tests to ALS however low co-ordination between the fine motor neurons always serves a good one. Again, there are various professionals attending this year’s August integrative addiction medicine conference, catch some of them via the above link. The speakers are carefully selected to handle a number of subjects across a wider array of medical problems you might be interested in knowing treatment of such neurodegenerative changes.

Corticobasal Degeneration (CBD)

CBD is sometimes called Corticobasal ganglionic degeneration (CBGD). Clinically, It is similar FrontoTemporal Dementia (FTD). Just like the AD above, CBD is also characterized by loss of neurons and contraction of certain parts of the brain among them; the basal ganglia and the cerebral cortex. The disease is more often diagnosed in patients within the age brackets of 45 and 70. CBD is hardly genetically transmitted down the generations. The symptoms vary from locomotive difficulties to cognitive discrepancies. They are usually very unique. It is therefore advisable to refer suspected patients to a practitioner with good experience with the disorder. Consistent advances in scientific studies and research have led to a better understanding of CBD among other neurodegenerative changes hence improved medical care and therapeutic interventions.

NEURODEGENERATIVE changes

Frontotemporal Dementia (FTD)

This is a cluster of related neurodegenerative changes resulting from progressive deterioration of the temporary and font lobes of the human brain. In a case similar to that of AD, FTD greatly affects decision making, emotional control, speech and general behavior of the patient.

Frontotemporal dementia is a cluster of related conditions resulting from the progressive degeneration of the temporal and frontal lobes of the brain. These areas of the brain play a significant role in decision-making, behavioral control, emotion and language.

HIV-related Cognitive Impairment

Thanks to antiretroviral interventions, effects of Human Immunodeficiency Virus (HIV) on the nervous system have declined. Few cases however still exist. HIV- related impairments can be broadly categorized into Asymptomatic neurocognitive impairments, mild neurocognitive disorder, and HIV-associated dementia (HAD). The first two categories barely have any visible symptoms. However the third category, HAD has from time to time indicated severe effect on the victims both clinically and on their daily life activities. As earlier mentioned, cases of HAD are however rare. The other form of neurodegenerative change is the Huntington Disease (HD), which affects the underlying neurons of the brain. You may visit any of the above links for more information on HD and the other neurodegenerative changes. Once again click http://www.integrativeaddiction2015.com for your chance to participate in the integrative addiction medicine conference mentioned earlier.

Neurodegenerative Changes

Social skills training for the substance abusers

July 22, 2015

Social skills training for the substance abusers: Alcoholics and drug addict

Social skills training for the substance abusers is very instrumental in rehabilitating drug addicts.

The rate at which the prevalence of drug use is escalating is worrying that we can no longer keep quiet about it. The most valuable gift we can ever have is that of good health. If this virtue is under threat because of substance abuse, the all of us must pool together in finding lasting solutions. As an individual you can seek for social skills training for the substance abusers to make a difference in their lives by impacting knowledge of rehabilitation and treatment of this unhealthy condition. I know that this may not be very easy on many people since addiction is something many would not want to associate with. But the most important thing is that we lend a helping hand to drug addicts and all alcoholics. Doctor Dalal Akoury MD and founder of AWAREmed Health and Wellness Resource Center are acknowledging that one common trait of many drug addicts and alcoholics are problems interacting with others in social situations. This is known as a lack of social skills. Sometimes this difficulty is what leads an individual into addiction in the first place. And some people have been addicted to substances for such a long time that it has affected their social development. Therefore if anyone is lucking social skills, then that calls for social skills training.

When opting for social skills training for an alcoholic or drug addict then these are some of the things that you must be ready to take the following into consideration: you must be ready to learn how to interact with friends, family members and even colleagues at work. You must also know how to interact in social situations especially when drugs and alcohol will be served or present and finally you must take a firm stand in declining any offer to use drug and alcohol in other words, you must be well armed with the refusal skills. That is to say when you say NO then it must remain that way irrespective of the prevailing circumstances. Doctor Akoury says that social skills training are closely associated with behavior therapy. Behavior therapy attempts to remove unwanted behaviors and replace them with desirable behaviors. It must be noted that for desired result, social skills training may not be very effective on its own but when combined with other cognitive behavioral therapy treatments, then its effectiveness can be realized. From the professional findings, it has been established that social skills training can significantly decrease the relapse rate for alcoholics and drug addicts.

Social skills training for the substance abusers: Interpersonal relationships and substance abuse

Social skills training can teach drug and alcohol addicts how to relate with coworkers, friends, and family in a variety of social settings. Clients will learn such skills as:

Listening as well as talking; that is, two-way communication
Empathy
Understanding unspoken clues such as body language
Assertiveness, and how not to be taken advantage of

Social skills training for the substance abusers: Social settings in addiction recovery

After addiction recovery is complete, drug and alcohol addicts still face a lifetime of social settings where drugs and alcohol may be present. Social skills training can teach clients better ways to deal with these situations. Different skills that can be taught are eye contact and small talk. Some people drink or take drugs to overcome their awkwardness in social settings. Learning the art of small talk can help a recovering addict get past this awkwardness without relapsing.

The recovering addict can choose to avoid social situations where there will be alcohol or drugs. However, this is not always possible. In that case, the recovering addict can also learn skills to avoid drinking in social situations where alcohol or drugs are present. These are called refusal skills. Refusal skills training are often conducted by role-playing in group therapy. This way, patients in recovery can get experience in saying no, which makes it easier to remember when the patient is in the social situation. The following are some of the refusal skills that may be applicable to drug addict or alcoholic:

No phrases to use
Strategies to deal with peer pressure
Practice saying no at home, before the social situation
Ask friends and family to help with saying no by supporting your resolve to make your No to be No and your Yes to be Yes.

Social skills training for the substance abusers: Where to Find Social Skills Training

When you have made up your mind to get the social skills trainings, it is important to appreciate that social skills training in many cases will take place in group therapy. When you are finally there, in many instances one or two therapists will work with a group of patients in recovery to teach social skills. Clients will be taken through practices of drink refusal skills by role playing with each other. They will also practice small talk and drink refusal skills. Besides that clients in recovery can also learn these social skills in individual therapy. This is less common, as the group model is important for role playing. Finally in the explanation given above in response to the question “where to find social skills training I want to urge that do all it takes to be on top of everything that is threatening to bring your life down. This may be quite a challenge to many and therefore I want to introduce to you the best way forward that will be simpler for you. Your struggle will be no more if only you can schedule for an appointment with doctor Dalal Akoury today for a much more lasting solution. It will interest you to know that on seeing the difficulties people were going through, Dr. Akoury made a decision to create a medical center whose main objective is to transform each individual’s life through increasing awareness about health and wellness and by empowering individuals to find their own inner healing power. Dr. Akoury’s practice focuses on personalized medicine through healthy lifestyle choices that deal with primary prevention and underlying causes instead of patching up symptoms. So stop going for symptom patching and come to the place of solutions right now.

Social skills training for the substance abusers: Alcoholics and drug addict

Addiction: A Neuroplasticity Disease

July 22, 2015

Addiction: A Neuroplasticity Disease

Had an accident or stroke? Developed amnesia? Lost consciousness for some reason? Well maybe not you. You may be wondering however how a friend or neighbor is recovering from such incidences of short or long term memory losses. Well thanks to technology now we know the brain has a way to self-regenerate in its functions through a process called neuroplasticity.

Neuroplasticity and Addiction Defined

Neuroplasticity is the brain’s ability to adjust to new environments or needs by developing new nerve cells throughout the body. it is the brain’s way of recovery. neuroplasticity allows the cells to compensate for any injuries or diseases in the nerve system. It also allows the neurons reorganize themselves to perform new functions of the brain depending on changes in their working environment.

One of the most common mechanisms in neuroplasticity is axonal sprouting. This is the process whereby active axons develop new nerve endings to connect with those their links were severed. Inversely, the damaged one can also grow new nerve endings to reconnect to the active neurons. Neuroplasticity is a term derived from the words; “neuron” and “plasticity”. A neuron is a nerve cell of the brain. Plasticity on the other hand means ability to remold. The process is at times referred to as brain malleability. Other times it is simply called brain plasticity.

Addiction on the other hand is an intricate condition of the brain, usually categorized as a disease that involves reward and motivation cerebral systems structurally and chemically altered. It is a mental condition characterized by a compulsive urge to indulge in rewarding stimuli despite possible dire consequences. Addiction is both reinforcing and rewarding. It manifests itself in the form of repetitive, intrinsic behavior including; gambling, food, exercises, shopping and substance abuse.

neuroplasticity

Influence of Neuroplasticity on Addiction

At one time Aristotle said: “We are what we repeatedly do.” Even though the Greek coined the phrase in the context to advice his readers of making a habit of excellence, the great philosopher had his brain develop a pathway around his successes over time. See, that is what the brain does. It creates a path of neurons to support our habits. A weight lifter for instance develops stronger muscles as a result of repetitive action. Similarly the brain may develop a path around addiction.

Once such pathways are created, addiction takes control of the brain. Eventually the addiction becomes the only thing that matters to the addict. Once the addiction hijacks the brain’s centers of pleasure it becomes the only thing that brings the addict a sense of joy or happiness. Soon his/her brain recognizes more of the addiction and less of other socio economic aspects of life including: friends, relatives, family, responsibilities, and work among other normal forms of social interactions and activities.

Neuroplasticity on Addiction Treatment

For a long time detoxification has been used as a treatment mechanism against addiction. This is the removal of the substance of abuse from the body. Victims however fell back on to substance abuse shortly afterwards. The billion dollar question then was how this still happened sometimes way after the victim’s blood had been cleaned of the same. This was one very interesting aspect of scientific state of quandary.

It is however through neuroplasticity scientists discovered treatment of an addiction needed more than mere detoxification. The brain actually needed to be retrained back to its normal functions. It required an intensive psychotherapy among other medical interventions to remold the recovery process. Also, it required an intense psychotherapy to reconfigure the brain’s recognition of what initially seemed normal and of the person as a whole especially in terms of behavior change. The nerve cells needed to rebuild a connection along initial, rather former normal pathways.

neuroplasticity

Neuroplasticity and Drug Abstinence

The process, neuroplasticity however does not take away the addictive neuron pathways like probably in the case of severe brain damage usually by accidents. It only retrains the brain to develop new ones along the old clean pathways. It is therefore often advisable to abstain from drugs completely during recovery. This is so as to avoid reinforcing the addictive path.

It is the same case each time you reread your favorite novel. You might have read it last twenty years ago. And you could have forgotten a few characters already. However if you picked that same book today you would remember a lot more, the story would begin to unfold in your sub conscience mind even without rereading the whole story yet again. You would remember the chapters more clearly, vividly the characters, deeply their roles and or attributes without going into it a whole other time.

Relationship between neuroplasticity and addiction is not a simple support of addictive habit and recovery alone. It is an inter-disciplinary connection of varied other fields; computer technology, anthropology, and psychology among others. Want to learn more on this? This year’s August integrative addiction medicine conferences could just be the answer you are looking for. Click on: http://www.integrativeaddiction2015.com and sign up for the upcoming event where you will have a chance to meet various medical experts, and listen to speakers on the neuroplasticity and integrative addiction recovery.

Addiction: A Neuroplasticity Disease

Addressing complications of Depression and Chronic Pain

July 21, 2015

Addressing complications of Depression and Chronic Pain: What is chronic pain?

Addressing complications of Depression and Chronic Pain is something that needs to be done continuously for stability in life and health

Chronic pain can be described as any pain that lasts much longer than would be expected from the original problem or injury. Up on registering chronic pain in the body, the body is likely to respond in various ways. There are certain facts that we need to understand clearly and we are going to be relying on the expert’s opinions from the experts at AWAREmed Health and Wellness Resource Center under the able leadership of doctor Dalal Akoury. And to start us off doctor Akoury says that chronic pain may be characterized by abnormalities in brain hormone, low energy, mood disorders, muscle pain, and impaired mental and physical performance. Chronic pain worsens as neurochemical changes in your body increase your sensitivity to pain and at this point you begin to have pain in other parts of your body that do not normally hurt. Ordinarily nobody would want to be subjected to any kind of pain and that is going to be our focus under the topic of “addressing complications of depression and chronic pain.” So many questions have been raised by many of you and doctor Akoury is going to respond to them as we progress into the discussion. In the meantime you may want to schedule for an appointment with the expert (doctor Akoury) today for a one on one professional advice.

Addressing complications of depression and chronic pain: What happens with chronic pain and depression?

This is a worthy concern and for sure when you are struggling with both chronic pain and depression, you’ll definitely have plenty of company. It will interest you to note that depression is one of the most common psychological issues facing people who are suffering from chronic pain. This problem if not addressed timely can really complicates the patient’s conditions and treatment. The most worrying thing is that prevalence of these problems is escalating on a daily basis. Like for instance according to the American Pain Foundation, they have registered that about 32 million people in the U.S. alone have had pain lasting longer than one year. And about one quarter to more than half of all the population that complain to their doctors registering depression. And on average up to 65% of those depressed individuals are also complaining of pain and yet again those people whose pain limits their independence are especially likely to get depressed. These statistics are a reflection of how depression and pain are a serious threat globally. It has now become an epidemic that must be addressed from all quarters if we want to enjoy comfort in life says doctor Akoury.

Addressing complications of depression and chronic pain: Is there a cycle of depression and pain?

One would not be punished for saying that pain is a trigger of depression. In fact it has been established from various studies that pain can provoke an emotional response in everyone. Like for instance if you struggling with some pain, you may also have high anxiety, irritability, and agitation. These are very normal accompaniment feelings when you’re hurting. Even though this is so, the good news about all this process or relations is that under normal circumstances, as pain subsides, so does the stressful response. However with chronic pain, you’re likely to constantly feel tense and stressed. Nonetheless with time, the constant stress can result in different emotional problems associated with depression. Doctor Akoury says that if you are suffering from these chronic pains and depression then you are likely to experience some of the problems: Altered mood, work issues, fatigue, physical deconditioning, financial concerns, chronic anxiety, weigh gain or weight loss, anger, social sleep disturbances, isolation, legal issues, confused thinking, family stress, reduced sexual activities, fear of injury, decreased self-esteem and irritability.

Addressing complications of depression and chronic pain: Why is there an overlap between depression and chronic pain?

Scientifically some of the overlap between depression and chronic pain can be explained. It has been established scientifically that depression and chronic pain have a common denominator and that is, they both share some of the same neurotransmitters brain chemicals that act as messengers traveling between nerves. Depression and chronic pain also share some of the same nerve pathways.

Besides that it is important to note that the impact of chronic pain on an individual’s life can also contribute to depression. In fact chronic pain can exact pressure and force you to struggle with tremendous losses, such as the loss of exercise, sleep, social network, relationships, sexual relationships, even a job and income. These losses can make you feel depressed and bring a total change in your life and even to that of your loved ones. With this depression will then magnify the pain and reduces your coping skills. It therefore means that when you used to exercise and be active when you felt stressed, with chronic pain you can no longer deal with stress in this manner.

Experts while carrying out research, they compared people with chronic pain and depression to those who only suffer chronic pain. It was established from that research that those who suffer with both depression and chronic pain report: more intense pain, less control of their lives and more unhealthy coping strategies. Therefore since chronic pain and depression are so intertwined, they are often treated together. In fact, some medications can improve both chronic pain and depression. That is why you need to seek for a more professional input if any of these discussions suits your situation. You may be wondering on where to begin, we are here to help you do the right thing and with the right people. Remember that Dr. Akoury made a decision to create a medical center whose main objective is to transform each individual’s life through increasing awareness about health and wellness and by empowering individuals to find their own inner healing power. Dr. Akoury’s practice focuses on personalized medicine through healthy lifestyle choices that deal with primary prevention and underlying causes instead of patching up symptoms. This is what doctor Akoury intends to achieve if only you can schedule for an appointment with her today.

Addressing complications of Depression and Chronic Pain: What is chronic pain?

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