BBC 2024-02-02 00:02:25


US approves plan for strikes on Iranian targets

The US has approved plans for a series of strikes on Iranian targets in Syria and Iraq, officials have told the BBC’s US partner CBS News.

The strikes will take place over a number of days, officials said, and weather conditions will likely dictate when they are launched.

It comes after a drone attack killed three US soldiers in Jordan, close to the Syrian border, on Sunday.

The US blamed an Iranian-backed militia group for that attack.

That group, the Islamic Resistance in Iraq, is believed to contain multiple militias that have been armed, funded and trained by Iran’s Revolutionary Guards force. It has said it was responsible for Sunday’s strike.

Iran, meanwhile, has denied any role in the attack which injured 41 other US troops at the military base, known as Tower 22. Four US officials cited by Reuters have said that US intelligence believes that the drone used to attack the facility was manufactured by Iran.

At a news conference on Thursday, US Defence Secretary Lloyd Austin said the US would “not tolerate attacks on American troops”.

“We will take all necessary actions to defend the United States, our interests and our people,” he said. “We will respond where we choose, when we choose and how we choose.”

The officials who spoke to CBS News did not give an exact timeline on the potential strikes. They said the US military could launch them in bad weather, but preferred to have better visibility to reduce the risk of inadvertently hitting civilians.

President Joe Biden has been under mounting pressure from Republican lawmakers, including some of Washington’s most hawkish voices on Iran, to strike targets on Iranian soil.

But while the US has repeatedly pledged to respond to the drone attack, Mr Biden and other defence officials have said Washington is not seeking a wider war with Iran or an escalation of tensions in the region.

“That’s not what I’m looking for,” Mr Biden told reporters at the White House earlier this week.

The reportedly approved plans appear to keep the targeting to Iranian targets Syria and Iraq, rather than inside Iran.

Several Iran-backed groups have increased attacks on US and Israeli-linked entities since the beginning of the Israel-Hamas war on 7 October.

The Iran-backed Houthis in Yemen, for example, have attacked ships in the Red Sea and Gulf of Aden, prompting strikes from the US and its allies.

A US defence official told CBS that a drone was shot down overnight in the Gulf of Aden, while an unmanned sea drone was struck and destroyed in the Red Sea.

Citing unnamed sources, Reuters on Thursday reported that Iran had withdrawn senior officials from Syria following a series of Israeli airstrikes in a bid to avoid being directly drawn into a wider conflict in the region.

US officials told CNN this week that there were signs that the Iranian government was becoming increasingly concerned about the actions of its proxy groups in the region, who have launched over 160 attacks on US forces since October.

The bodies of the three US soldiers killed in the attack in Jordan are expected to be repatriated to a Delaware Air Force base on Friday. The White House has announced that President Biden will attend.

The three soldiers have been named as William Jerome Rivers, 46, Kennedy Ladon Sanders, 24, and Breonna Alexsondria Moffett, 23. All three were part of an army reserve unit based in Fort Moore, Georgia.

US sanctions Israeli settlers over West Bank violence

US President Joe Biden has approved sanctions on four Israeli settlers accused of attacking Palestinians in the occupied West Bank.

Mr Biden signed a broad executive order, saying violence in the West Bank had reached “intolerable levels”.

The sanctions block the individuals from accessing all US property, assets and the American financial system.

Violence in the West Bank has spiked since Hamas launched an unprecedented attack on Israel on 7 October.

Some 370 Palestinians have been killed in the West Bank since then, according to the UN. The majority of those have been killed by Israeli forces but at least eight of them have been killed by Israeli settlers, the UN said.

The new executive order means the US government has the power to sanction any foreign nationals who attack, intimidate or seize the property of Palestinians.

The sanctions are a first by the US administration – a rare step targeting Israelis – and comes as Mr Biden travels to the state of Michigan, which has a large Arab-American population that has been critical of his support for Israel.

The Arab American Institute, an advocacy group, earlier said that since the start of the conflict, support by Arab Americans for the Democratic Party has plummeted from 59% in 2020 to just 17%.

  • Why are Israel and Hamas fighting in Gaza?

On Thursday, a senior official in the Biden administration said the president had repeatedly raised concerns with Israel about violence by settlers.

The executive order sets out the groundwork for how the US will respond to further attacks in the West Bank, and is an escalation compared to the visa restrictions it imposed on some individuals last year.

“The situation in the West Bank – in particular high levels of extremist settler violence, forced displacement of people and villages, and property destruction – has reached intolerable levels and constitutes a serious threat to the peace, security and stability” of the region, Mr Biden said in a letter to Congress explaining his reasoning.

A senior administration official said the initial round of sanctions – targeting four people – were against “individuals that have directly perpetrated violence and those who have engaged in repeated acts of intimidation, property destruction, leading to the forced displacement of Palestinian communities”.

They said one person initiated and led a riot that led to the death of a Palestinian civilian in the town of Huwara, while another had attacked people with stones and clubs.

They added that the executive order was “non-discriminatory” and applied to both Israelis and Palestinians who direct or take part in violent acts or threats against civilians, intimidation, destroying, seizing property or terrorism.

The US Treasury named the four sanctioned Israelis as David Chai Chasdai, 29; Yinon Levi 31; Einan Tanjil, 21; and Shalom Zicherman 32. Three of them lived in West Bank settlements and one lived near the occupied region’s border, the Treasury said.

These US sanctions cannot be applied to American citizens, some of whom are thought to be involved in the violence.

State Department spokesman Matthew Miller said the US does believes the sanctions “will have an impact on these four individuals” and expects Israel to “do more to hold accountable those responsible for settler violence”.

Shortly after Mr Biden signed the executive order, Israel signalled its dissatisfaction and described the majority of West Bank settlers as “law-abiding”.

“Israel takes action against all law-breakers everywhere, and therefore there is no need for unusual measures on the issue,” a statement from Prime Minister Benjamin Netanyahu’s office said.

The response was yet another sign of a deepening public rift between the US and Israel.

The two leaders are long-term allies, but have disagreed in recent weeks about the idea of creating an independent Palestinian state. The US believes a Palestinian state alongside Israel – known as a “two-state solution” – is vital for long-term stability in the region.

Mr Netanyahu has repeatedly rejected the idea, and the White House acknowledged last month that the US and Israeli governments “clearly see things differently”.

Those comments dampened hopes in some circles that the conflict could result in Israeli and Palestinian leaders restarting diplomatic negotiations and kickstarting the dormant peace process.

Hostages freed after nine hours at US plant in Turkey

Seven workers who were held captive at a Proctor & Gamble (P&G) plant outside Istanbul have been rescued after a nine-hour ordeal, local officials said.

Turkish police rescued the group from the factory in Gebza after the suspect reportedly went for a bathroom break.

Local governor Seddar Yavuz said the hostages did not suffer any injuries.

The suspect was detained unharmed after the “meticulous” rescue operation, Mr Yavuz added.

The hostage-taker first entered the plant at about 15:00 local time (12:00 GMT), the DHA news agency reported. The hostages were released shortly before midnight local time (21:00 GMT).

Officials said the suspect wanted to draw attention to the ongoing situation in Gaza.

An image earlier emerged on social media showing the man with wires and possibly explosives taped to his chest. He appeared to be holding a hand gun.

A Palestinian flag had reportedly been painted at the entrance of the building with a sign saying “doors will be open for Gaza”.

Police officers cordoned off access to the factory and medical staff were dispatched to the scene.

Officials say a large-scale investigation into the incident is under way.

Footage from the scene during the standoff showed relatives of some hostages clustered together at a police cordon some distance from the plant.

İsmet Zihni, whose wife works at the plant, told the DHA news agency she had sent him a message saying she had been taken hostage.

However, he added he did not know “if it was her or someone else”.

Relatives of the hostages had expressed frustration at the lack of information from Turkish officials or the police.

“We have been waiting for six hours without any official making a statement,” the father of one hostage told AFP earlier.

In a statement, P&G said it was relieved no-one was harmed during the incident.

“We are grateful to the authorities and first responders who managed the situation with courage and professionalism,” the company added.

Retirement in US v Scandinavia: Wildly different

While presidential hopeful Nikki Haley proposes a rise in Americans’ retirement age, retirement differences around the world point to one thing: the age doesn’t matter.

 

Benjamin Franklin famously wrote of the certainty of two things — death and taxes. In today’s world many workers would like to add a third guarantee: an enjoyable retirement. Approaches to retirement and the rights of senior citizens vary wildly around the globe with equally disparate results when it comes to health and the overall quality of life for people leaving behind their 9 to 5.  

With many countries seeing the average age of the population on the rise, questions about how to invest in the financial, medical, and community support that older adults will need to thrive in retirement, are a hot button issue in politics. Former South Carolina Governor Nikki Haley recently raised eyebrows on the debate stage when she promised to raise the retirement age in the United States. 

While many workers would like to retire at an earlier age, evidence suggests that age may not be the most important factor for well-being among retirees. When examining the multitude of systems and approaches to retirement, we may be able to learn a thing or two from Scandinavian countries in particular. While the actual age of retirement for, say, Finnish or Danish seniors is roughly equivalent to the US, Scandinavian countries have legal and societal provisions in place to ensure their older populations can live in dignity and comfort – and they make a huge difference in the quality of life for those who have left the working world to enjoy their senior years. 

Affording Retirement in the United States and the UK

In the United States, citizens are able to begin earning a government pension at age 62. That said, an individual who retires at 62 instead of at 67, considered the age of a full pension, will receive 30% less each month than they would have if they had continued working the extra five years. The Social Security Administration calculates one’s allotted benefits by taking a multitude of factors into account: total earnings in relation to the national average wage index, age of retirement, and total credits earned before retirement are among the criteria for designation. Citizens need to earn 40 credits (one credit is equal to one quarter-year in the workforce, so 10 years of work are required) in order to be eligible for Social Security benefits. 

According to Statista, the average full-time income for an American employee is $74,738, although that number varies significantly depending on geographic location, industry, race, gender and other factors. In 2022, for example, nearly 34% of the U.S. population earned under $50,000 a year. In many cases, people who have worked for decades and paid into the Social Security system may find that their eventual monthly benefit check is not likely to cover cost-of-living expenses, despite periodic COL adjustments made by the federal government. 

For this reason, workers in the United States often rely on privatized retirement savings vehicles in the form of accounts like 401Ks or IRAs. But being able to contribute to those accounts is easier said than done, particularly in an uncertain economic environment. A recent poll from Bankrate shows that 56% of Americans think they’re behind on their retirement savings and that only a quarter of Americans contributed to a retirement account in the last year. In fact, 45% of respondents don’t believe they will have enough savings to retire comfortably. 

It’s worth noting that a 2023 Gallup poll shows that, for six in 10 US retirees, Social Security makes up the bulk of their income, but likely due to concerns about the viability of the SSA, only 34% of non-retirees believe they will be able to be supported by a government pension. Indeed, even now a Social Security pension is hardly enough to make ends meet — over one in three adults over the age of 50 have “forgone basics such as food to pay for healthcare”, according to a 2022 poll by Gallup, with women and Black adults most likely to have made sacrifices due to financial instability. 

For context, in the United Kingdom, citizens are eligible for a State Pension when they turn 66; that number will gradually rise to 67 in 2026, according to Age UK. Citizens of the UK who have contributed to National Insurance (NI) for 35 years or more will get a full State Pension, at a total of £815.4 every four weeks.

An assisted living facility in the UK can cost between an average of £600 for a residential care home) all the way to an average of £4160 for nursing care in a care home. Of the 500,000 older adults living in a care home, half of them pay their own way, and while other seniors are eligible for varying degrees of support from their local municipalities the processes for accessing this help can be difficult to navigate.

How to Retire in Scandinavia

In Scandinavian countries, however, the cost of living for retirees is largely subsidized by public grants and taxes, which ensure that the elderly are able to live comfortably. These countries have long been recognized for their progressive social policies, and this holds true for their older citizens as well. Despite having similar retirement ages to the US, the pension policies and other grants allow senior citizens to access the support they need with much less logistical friction. 

Like Americans, Swedes most commonly retire at age 65, although they are eligible for a government pension at age 62. With a base pension of $1,437.5 per month (about £1,122), retiring Swedes get a significantly higher government pension than many British and American seniors. They also benefit from a strong social safety net which supports them in other non-monetary ways. The Swedish Social Services Act of 2001 enshrined into law an individual’s right to age with dignity, stating that “the social welfare committee must…take the initiative and monitor that measures are taken to create a good social environment and good conditions for…the elderly and other groups that need special support from society.” 

A key initiative in this act regulates the cost of elder care with a maximum charge of $225.90 per month for services. By comparison, the average cost of assisted living in the United States is $4,500 per month, according to the National Council on Aging (NCOA). In addition, Swedish older adults with physical disabilities can access transportation in adapted vehicles at a tax-subsidized cost. Swedes also prioritize home health care, rather than a dormitory like model, where aides engage their patients in conversation and facilitate social activities. 

In Denmark, retirees are eligible for a statutory pension between the ages of 63 and 69, depending on their year of birth. They’re also eligible for supplements to cover things such as medicine, heating costs, dental care, and more. Health supplements, for example, may cover up to 85% of one’s expenses, depending on one’s assets. To receive a Danish State Pension, which is $2,166 (or about £1,651) one must have participated in the labour market for at least 27 hours a week for 20-25 years. 

The Danish government guarantees that all seniors who need housing accommodations will be accepted into a nursing home or assisted living facility within two months of being on the list. Retirees with no income pay an average of $217.5 to live in an assisted living facility, a cost that is automatically deducted from one’s government pension. 

Finnish seniors become eligible for a state pension at age 64 and three months, which is also the most common age at which people leave the workforce. They are eligible for three varieties of pensions: a national pension, a “guarantee” pension, and an earnings-based pension. The latter two are there to “ensure a minimum income for persons who have only a small or no earnings-related pension due to a short working life or low earnings”, according to the Finnish Centre for Pensions.  

Can you retire? If so, when?

“It’s really a balancing act when choosing when to retire,” says Sarah Bonza, a board-certified family physician who specializes in menopause and women’s hormonal health. While she doesn’t advocate for an endless career, she is mindful that retiring too early can lead to a decline in one’s physical and mental health: “During my years practicing as a family physician and providing hospice care in the United States,” she says, “I’ve observed that once you retire early, you lose your daily routine. Structure is lost, including one’s sense of purpose, which can lead to symptoms of anxiety or depression.” 

But will the younger generation of Americans even get to make that choice? According to a recent study put forth by the TIAA Institute, “Fewer than half (47%) of those not yet retired are “very” or “somewhat” confident they will reach this milestone when intended; 15% don’t plan to retire at all. Confidence is lowest among Americans ages 22-34 and Hispanics (each 37%).” With a hard to access and limited social safety net, many Americans choose to retire later (when able to retire at all) in order to maintain access to healthcare and critical income. 

A July 2023 poll by Axios and Ipsos shows that one in five Americans believe they will never be able to retire. “When it comes to how Americans finance retirement, few feel Social Security will cover most of their expenses,” according to the report. They’re probably correct, as the survey also shows that “nearly one in five retirees (19%) say that Social Security covers a quarter or less of their expenses.”

This observation is borne out by the research. A 2020 study by Dr. Markus J Haapanen of the Folkhälsan Research Center et al examined the relationship between “frailty” and early or late retirement age among male executives. The study found that both extremes were predictive of increased frailty. Dr. Jaapanen writes that “the lowest prevalence of frailty was observed in former business executives who retired at ages 66-67 years.” 

Psychiatrist Gary Small says that, overall, people are able to enjoy the benefits of retirement when they “have adequate financial resources and good health,” adding that “retirement also increases the risk for developing cognitive decline in older adults, so premature retirement could further burden society with the costs of care of a larger pool of patients with dementia.” In other words, when the social safety net is in place to provide healthcare, adequate housing, and community for our elders – not just a private savings vehicle like the US 401K – they can stay sharp and thrive in their later years.

This, too, can be tracked in research. A September study from TIAA Institute explores the connection between wealth and longevity and finds those with more finances literally live longer. “Between two cohorts turning age 65 a decade apart, disability-free life expectancy gains accrued only to the wealthy,” write the authors, adding that the bottom wealth quartile of the cohort actually experienced  disability-free life expectancy losses of 0.04-0.24 years, depending on gender. 

When considering the problem of retirement, the questions are often of timing. When is the right age to retire? When should one begin saving for retirement? Looking at the Scandinavian models, perhaps the question should be one of method. Not when, but whether the systems in place reflect the physical and emotional needs of older citizens. 

Why syphilis is rising around the world

Syphilis is one of the oldest known sexually transmitted infections. Once thought to be in decline, it is now resurging at an alarming rate.
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Syphilis has been called many names since the first record of it in the 1490s, most of them uncomplimentary – “the French disease“, “the Neapolitan disease”, “the Polish disease”.

One however has stuck: “the great imitator“. Syphilis is a master at mimicking other infections and early symptoms are easy to miss. Left untreated, the consequences can be serious.

Tushar, a 33-year-old project officer in Amsterdam, has had syphilis twice. He remembers first receiving the news via WhatsApp from his sexual partner at the time.

“They were really upset,” he says. “They blamed me which wasn’t possible because of the window period. It felt strange to be accused and it took some time to de-escalate.” Tushar got tested and treated that week. “People mistakenly think syphilis is something that cannot be cured. People don’t understand what it means to still have syphilis antibodies and not have the infection.”

In January 2024, the Centres for Disease Control and Prevent (CDC) reported that cases of syphilis had reached their highest levels in more than a decade, with more than 203,500 caess of syphilis reported in the US in 2022, a figure that is nearly double that in 2018. The cases increased by 17% between 2021 and 2022, and surged by 32% between 2020 and 2021 to reach the highest number of reported incidences in 70 years. The epidemic is also showing no signs of slowing, the Centres for Disease Control and Prevention (CDC) warned. And it has pointed to some “alarming” new trends driving this sudden spike in the disease.

Congenital syphilis – where a mother passes the infection to her child during pregnancy, often after contracting it from their partner – has risen particularly sharply, with 3,755 cases in the US in 2022, an increase of 30% compared to 2021 and more than double the number of cases in 2018. The disease can cause stillbirths, infant deaths and life-long health problems.

It has left many health experts reeling.

“Fifteen or 20 years ago we thought we were on the verge of eliminating syphilis,” says Leandro Mena, director of the CDC’s division of sexually transmitted disease prevention. “There is no doubt we are seeing increasing rates of syphilis, rates we have not seen in the past 20 years or so.”

The stigma attached to a syphilis infection still prevents many people from seeking the proper medical treatment they need (Credit: Alamy)

And it is not something just happening in the US. There were 7.1 million new cases of syphilis globally in 2020 according to World Health Organization data. In 2022, the UK saw syphilis cases reach their highest level since 1948.

The rise in cases is something sexual health practitioners working on the frontline have grown familiar with.

“When I first started sexual health nursing in 2005, it was quite rare to see primary syphilis, even in a city centre clinic,” says Jodie Crossman, co-chair of the STI Foundation in the UK, where syphilis rates jumped 8.4% between 2020 and 2021. “Now most city-based clinics will see at least two or three patients per day attending for treatment.”

The infection is caused by a bacterium called Treponema pallidum and symptoms are divided into four stages. The earliest is characterised by a painless sore at the site of contact or a rash. An intramuscular dose of penicillin is considered to be the most effective way of treating the infection. Left untreated, however, syphilis can lead to long-term neurological and cardiovascular diseases

Watching the epidemic unfold in the US from across the border in Canada is Isaac Bogoch, an infectious diseases clinician and researcher at the University of Toronto.

“This is the trend that’s being seen in multiple countries around the world,” he says. “It’s very concerning because generally, syphilis is very easy to treat, and treatment is widely available. So, a lot of this is reflective of a breakdown in public healthcare.”

Canada saw an increase of 389% for infectious syphilis, significantly higher than other STIs, between 2011 and 2019.

Doctors in Mississippi have reported congenital syphilis cases soaring by 900% over the past five years

In recent decades, most cases of syphilis are among gay, bisexual and other men who have sex with men. Some parts of the world, however, are seeing a decrease in syphilis cases among men. Rates of infectious syphilis in Canada decreased among males, for example. But at the same time there has been a rise in rates among women not just in Canada but globally, which has led to higher rates of congenital syphilis in many parts of the world. Across the Americas as a whole there were 30,000 cases of mother-to-child transmissions of syphilis in 2021, a figure that health officials describe as “unacceptably high“.

The transmission of syphilis during pregnancy to an unborn child can have devastating consequences including miscarriage, stillbirth, premature births, low birth weights and the death of a baby shortly after birth.

In the US, congenital syphilis rates are soaring. They were 3.5 times higher in 2020 compared to 2016 and increased again in 2021, resulting in 220 stillbirths and infant deaths. And the national figures appear to hide some exceptionally dramatic rises in some parts of the country – doctors in Mississippi have reported congenital syphilis cases soaring by 900% over the past five years.

The highest numbers are seen among Black American and Hispanic women.

“That does reflect the underlying inequity and racism we still have in our public health and medical infrastructure,” says Maria Sundaram, associate research scientist at the Marshfield Clinic Research Institute in Wisconsin. The most vulnerable groups of women, such as those who have lost their home or struggle with substance abuse, are also hardest hit by the disease. And many of these inequalities were exacerbated by the Covid-19 pandemic around the world.

“The consensus in the public health community is that the rise in STIs including syphilis is likely related to a disruption of STI prevention resources during the pandemic,” says Sundaram.

Disparities in access to STI testing and screening services are among what is thought to be driving the increase in syphilis cases (Credit: Getty Images)

Among the disparities that might be driving this problem are access to STI testing sites, ongoing stigma around syphilis and possible language barriers. One study in the Brazil found a link between black women who had low levels of schooling and higher rates of congenital syphilis.  In many cases women struggle to access suitable prenatal care that would provide screening for syphilis.

Another study in Kern County, California – which in 2018 made up 17% of the state’s congenital syphilis cases despite representing only 2.3% of the state’s population – identified the role of immigration status, medical insurance status and sexual or domestic violence in pregnant women seeking prenatal care. Half of the pregnant or post-partum women interviewed identified as being of Hispanic, Latino or Spanish origin.

A 2020 study of syphilis in Australia saw figures increase by nearly 90% from recorded rates in 2015. Some 4,000 cases of syphilis were identified amongst the Aboriginal and Torres Strait Islander communities which make up just 3.8% of the total Australian population. And whilst a national test and treat response plan came into play to stabilise the epidemic, experts say reducing levels to pre-outbreak figures requires a much higher level of community wide testing. Again, there have been particular problems with expectant mothers accessing prenatal screening for syphilis in parts of the country.

But whilst the cost-of-living crisis and the pandemic have impacted public healthcare resources, there have also been changes in human behaviour and attitudes towards STIs.

“In the mid-1990s, with the advent of anti-retroviral therapy for HIV there was a big change,” says Mena. “Now, thanks to the advances in the prevention and treatment of HIV infection, HIV is seen as a chronic disease. The risk of HIV infection is no longer an incentive for people to use condoms or to adopt other prevention strategies against STIs.”

A change in sexual practice is an area researchers in Japan have been studying by looking at the link between dating apps and cases of syphilis. They concluded that dating app use was “significantly associated with syphilis incidence,” linking the use of the apps to a higher incidence of unprotected casual sex.

The transmission of syphilis during pregnancy to an unborn child can have devastating consequences (Credit: Getty Images)

This is something which Sasaki Chiwawa, who writes about Japanese youth culture and sex work, also found in her conversations with sex workers. Chiwawa says more and more sex workers are not using condoms and there is no obligation on the part of customers to be tested for STIs. Should sex workers contract an infection, they tend to put it down to “bad luck,” says Chiwawa. “Most of them prioritise making money over the risk.”

For most health officials, the path to tackle syphilis is clear – we already have the drugs to combat it as penicillin still remains the best treatment despite a rising incidence of antibiotic resistance. More testing, better outreach to counter the stigma attached to the disease along with greater public awareness to encourage safer sexual practices all have a much bigger role to play.

“We are social creatures, so there should be no more shame in an STI diagnosis than catching a cold,” says Crossman. “We are trying to change the focus of STI testing from something scary and judgemental to something that is part of sexual wellbeing – an important part of having a safe and enjoyable sex life.”

But scientists have so far failed to arrive at a single theory on is why syphilis is rising faster than other STIs. There is no strong evidence to suggest that the strains in circulation have become any more virulent, says Mena. Antibiotic resistance is also not prevalent enough to explain the spikes, says Bogoch.

For his part, Tushar continues to get tested every three months.

“We should be comfortable talking about syphilis,” he says. “So called well-informed people turn to accusations as opposed to thinking about it scientifically. We are having sex – stuff happens.”

* This article was originally published on 9 July 2023, but was updated on 1 Febraury 2024 to reflect the latest figures from the CDC.

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