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  1. Article ; Online: Empowerment.

    Van Gelder, Carin M

    Annals of emergency medicine

    2016  Volume 68, Issue 4, Page(s) 509–510

    Language English
    Publishing date 2016-10
    Publishing country United States
    Document type Editorial
    ZDB-ID 603080-4
    ISSN 1097-6760 ; 0196-0644
    ISSN (online) 1097-6760
    ISSN 0196-0644
    DOI 10.1016/j.annemergmed.2016.03.050
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: A mystery: one wound, multiple bullets.

    Lilienstein, David A / Van Gelder, Carin M

    Journal of forensic and legal medicine

    2008  Volume 15, Issue 5, Page(s) 343–345

    Abstract: This case report provides an unusual presentation of a gunshot wound (GSW) and stresses the importance of gathering complete clinical, scene and historical information, if possible. Sufficient details regarding an injured patient's mechanism of injury ( ... ...

    Abstract This case report provides an unusual presentation of a gunshot wound (GSW) and stresses the importance of gathering complete clinical, scene and historical information, if possible. Sufficient details regarding an injured patient's mechanism of injury (MOI) should be elicited by the treating physician when hemodynamic status of the patient allows. A careful physical exam is essential as are appropriate laboratory investigations and diagnostic imaging. We present a case report of a single GSW found on physical exam with multiple projectiles found on imaging studies. The history of present illness, scene findings and trial transcripts clarify the patient presentation.
    MeSH term(s) Adult ; Forensic Ballistics ; Humans ; Liver/injuries ; Liver/pathology ; Male ; Radiography, Thoracic ; Thoracic Injuries/pathology ; Wounds, Gunshot/pathology
    Language English
    Publishing date 2008-07
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 2268721-X
    ISSN 1752-928X
    ISSN 1752-928X
    DOI 10.1016/j.jflm.2007.10.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Fireground use of an emergency escape respirator.

    Cone, David C / Van Gelder, Carin M / MacMillan, Donald

    Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors

    2010  Volume 14, Issue 4, Page(s) 433–438

    Abstract: Introduction: Firefighters who become lost, disoriented, or trapped in a burning building may die after running out of air in their self-contained breathing apparatus (SCBA). An emergency escape device has been developed that attaches to the firefighter' ...

    Abstract Introduction: Firefighters who become lost, disoriented, or trapped in a burning building may die after running out of air in their self-contained breathing apparatus (SCBA). An emergency escape device has been developed that attaches to the firefighter's mask in place of the SCBA regulator. The device filters out particulate matter and a number of hazardous components of smoke (but does not provide oxygen), providing additional time to escape after the firefighter runs out of SCBA air.
    Objective: To field-test the device under realistic fire conditions to 1) ascertain whether it provides adequate protection from carbon monoxide (CO) and 2) examine firefighters' impressions of the device and its use.
    Methods: A wood-frame house was fitted with atmospheric monitors, and levels of CO, oxygen, and hydrogen cyanide were continuously recorded. After informed consent was obtained, firefighters wearing the escape device instead of their usual SCBA regulators entered the burning structure and spent 10 minutes breathing through the device. A breath CO analyzer was used to estimate (+ or - 3 ppm) each subject's carboxyhemoglobin level immediately upon exiting the building, vital signs and pulse oximetry were assessed, and each firefighter was asked for general impressions of the device.
    Results: Thirteen subjects were enrolled (all male, mean age 42.5 years, mean weight 94 kg). The mean peak CO level at the floor in the rooms where the subjects were located was 546 ppm, and ceiling CO measurements ranged from 679 ppm to the meters' maximum of 1,000 ppm, indicating substantial CO exposure. The firefighters' mean carboxyhemoglobin level was 1.15% (range 0.8%-2.1%) immediately after exit. All pulse oximetry readings were 95% or greater. No subject reported problems or concerns regarding the device, no symptoms suggestive of smoke inhalation or toxicity were reported, and all subjects expressed interest in carrying the device while on duty.
    Conclusion: The emergency escape device provides excellent protection from CO in realistic fire scenarios with substantial exposure to toxic gases, and the firefighters studied had a positive impression of the device and its use.
    MeSH term(s) Adult ; Equipment Design ; Filtration/instrumentation ; Fires ; Humans ; Male ; Middle Aged ; Occupational Exposure ; Prospective Studies ; Respiratory Protective Devices ; Safety Management
    Language English
    Publishing date 2010-10
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1461751-1
    ISSN 1545-0066 ; 1090-3127
    ISSN (online) 1545-0066
    ISSN 1090-3127
    DOI 10.3109/10903127.2010.493989
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Early cardiac catheterization laboratory activation by paramedics for patients with ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms.

    Lee, Christopher H / Van Gelder, Carin M / Cone, David C

    Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors

    2010  Volume 14, Issue 2, Page(s) 153–158

    Abstract: Background: Prompt reperfusion in ST-segment elevation myocardial infarction (STEMI) saves lives. Although studies have shown that paramedics can reliably interpret STEMI on prehospital 12-lead electrocardiograms (p12ECGs), prehospital activation of the ...

    Abstract Background: Prompt reperfusion in ST-segment elevation myocardial infarction (STEMI) saves lives. Although studies have shown that paramedics can reliably interpret STEMI on prehospital 12-lead electrocardiograms (p12ECGs), prehospital activation of the cardiac catheterization laboratory by emergency medical services (EMS) has not yet gained widespread acceptance.
    Objective: To quantify the potential reduction in time to percutaneous coronary intervention (PCI) by early prehospital activation of the cardiac catheterization laboratory in STEMI.
    Methods: This prospective, observational study enrolled all patients diagnosed with STEMI by paramedics in a mid-sized regional EMS system. Patients were enrolled if: 1) the paramedic interpreted STEMI on the p12ECG, 2) the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) score was 75% or greater, and 3) the patient was transported to either of two area PCI centers. Data recorded included the time of initial EMS "STEMI alert" from the scene, time of arrival at the emergency department (ED), and time of actual catheterization laboratory activation by the ED physician, all using synchronized clocks. The primary outcome measure was the time difference between the STEMI alert and the actual activation (i.e., potential time savings). The false-positive rate (patients incorrectly diagnosed with STEMI by paramedics) was also calculated and compared with a locally accepted false-positive rate of 10%.
    Results: Twelve patients were enrolled prior to early termination of the study. The mean and median potential time reductions were 15 and 11 minutes, respectively (range 7-29 minutes). There was one false STEMI alert (8.3% false-positive rate) for a patient with a right bundle branch block who subsequently had a non-ST-segment elevation myocardial infarction. The study was terminated when our cardiologists adopted a prehospital catheterization laboratory activation protocol based on our initial data.
    Conclusion: Important reductions in time to reperfusion seem possible by activation of the catheterization laboratory by EMS from the scene, with an acceptably low false-positive rate in this small sample. This type of clinical research can inform multidisciplinary policies and bring about meaningful clinical practice changes.
    MeSH term(s) Cardiac Catheterization ; Electrocardiography/instrumentation ; Emergency Medical Technicians ; Humans ; Myocardial Infarction/physiopathology ; Myocardial Infarction/therapy ; Observation ; Prospective Studies ; Time Factors ; United States
    Language English
    Publishing date 2010-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 1461751-1
    ISSN 1545-0066 ; 1090-3127
    ISSN (online) 1545-0066
    ISSN 1090-3127
    DOI 10.3109/10903120903537213
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Prehospital electronic patient care report systems: early experiences from emergency medical services agency leaders.

    Landman, Adam B / Lee, Christopher H / Sasson, Comilla / Van Gelder, Carin M / Curry, Leslie A

    PloS one

    2012  Volume 7, Issue 3, Page(s) e32692

    Abstract: Background: As the United States embraces electronic health records (EHRs), improved emergency medical services (EMS) information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement ... ...

    Abstract Background: As the United States embraces electronic health records (EHRs), improved emergency medical services (EMS) information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR) systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies.
    Methods: We conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP) members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes.
    Results: Twenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1) identify creative funding sources; 2) leverage regional health information organizations; and 3) build internal information technology capacity.
    Conclusion: EMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and implementation of e-PCR systems has been challenging for many. Emerging strategies from EMS agencies and others that have successfully implemented EHRs may be useful in expanding e-PCR system use and facilitating this transition for other EMS agencies.
    MeSH term(s) Data Collection ; Electronic Health Records/economics ; Electronic Health Records/legislation & jurisprudence ; Electronic Health Records/statistics & numerical data ; Emergency Medical Services/economics ; Emergency Medical Services/legislation & jurisprudence ; Emergency Medical Services/statistics & numerical data ; Hospital Information Systems ; Hospitalization ; Humans ; Motivation ; Patient Care/economics ; Patient Care/statistics & numerical data ; Time Factors
    Language English
    Publishing date 2012-03-05
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0032692
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Emergency medical services in Connecticut.

    Van Gelder, Carin M / Frantz, Robert / Bogucki, Sandy

    Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors

    2005  Volume 9, Issue 2, Page(s) 219–226

    Abstract: This article describes emergency medical services (EMS) systems in Connecticut, beginning with a historical perspective. The discussion of statewide oversight of the EMS system includes legislative and regulatory mandates as well as recent external ... ...

    Abstract This article describes emergency medical services (EMS) systems in Connecticut, beginning with a historical perspective. The discussion of statewide oversight of the EMS system includes legislative and regulatory mandates as well as recent external reviews of the system. Medical oversight of EMS care and services is provided by sponsor hospitals rather than individual medical directors. Most of the 169 cities and towns in the State maintain or contract for local EMS, and have traditionally resisted regionalization. This snapshot of the EMS system in Connecticut can serve as a reference for comparison of EMS systems in other jurisdictions.
    MeSH term(s) Allied Health Personnel/education ; Allied Health Personnel/standards ; Ambulances/organization & administration ; Connecticut ; Emergency Medical Service Communication Systems/organization & administration ; Emergency Medical Services/history ; Emergency Medical Services/organization & administration ; Emergency Medicine/organization & administration ; Financing, Government/organization & administration ; History, 20th Century ; Humans ; State Government
    Language English
    Publishing date 2005-04
    Publishing country England
    Document type Historical Article ; Journal Article ; Review
    ZDB-ID 1461751-1
    ISSN 1545-0066 ; 1090-3127
    ISSN (online) 1545-0066
    ISSN 1090-3127
    DOI 10.1080/10903120590924861
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Enzyme therapy and immune response in relation to CRIM status: the Dutch experience in classic infantile Pompe disease.

    van Gelder, Carin M / Hoogeveen-Westerveld, Marianne / Kroos, Marian A / Plug, Iris / van der Ploeg, Ans T / Reuser, Arnold J J

    Journal of inherited metabolic disease

    2014  Volume 38, Issue 2, Page(s) 305–314

    Abstract: Background: Enzyme-replacement therapy (ERT) in Pompe disease--an inherited metabolic disorder caused by acid α-glucosidase deficiency and characterized in infants by generalized muscle weakness and cardiomyopathy--can be complicated by immune responses. ...

    Abstract Background: Enzyme-replacement therapy (ERT) in Pompe disease--an inherited metabolic disorder caused by acid α-glucosidase deficiency and characterized in infants by generalized muscle weakness and cardiomyopathy--can be complicated by immune responses. Infants that do not produce any endogenous acid α-glucosidase, so-called CRIM-negative patients, reportedly develop a strong response. We report the clinical outcome of our Dutch infants in relation to their CRIM status and immune response.
    Methods: Eleven patients were genotyped and their CRIM status was determined. Antibody formation and clinical outcome were assessed for a minimum of 4 years.
    Results: ERT was commenced between 0.1 and 8.3 months of age, and patients were treated from 0.3 to 13.7 years. All patients developed antibodies. Those with a high antibody titer (above 1:31,250) had a poor response. The antibody titers varied substantially between patients and did not strictly correlate with the patients' CRIM status. Patients who started ERT beyond 2 months of age tended to develop higher titers than those who started earlier. All three CRIM-negative patients in our study succumbed by the age of 4 years seemingly unrelated to the height of their antibody titer.
    Conclusion: Antibody formation is a common response to ERT in classic infantile Pompe disease and counteracts the effect of treatment. The counteracting effect seems determined by the antibody:enzyme molecular stoichiometry. The immune response may be minimized by early start of ERT and by immune modulation, as proposed by colleagues. The CRIM-negative status itself seems associated with poor outcome.
    MeSH term(s) Age Factors ; Antibodies/blood ; Biomarkers/blood ; Cells, Cultured ; Child, Preschool ; Disease Progression ; Enzyme Replacement Therapy ; Female ; Genetic Predisposition to Disease ; Glycogen Storage Disease Type II/diagnosis ; Glycogen Storage Disease Type II/drug therapy ; Glycogen Storage Disease Type II/enzymology ; Glycogen Storage Disease Type II/immunology ; Glycogen Storage Disease Type II/mortality ; Humans ; Infant ; Infant, Newborn ; Male ; Mutation ; Netherlands ; Phenotype ; Recombinant Proteins/immunology ; Recombinant Proteins/therapeutic use ; Risk Factors ; Time Factors ; Transfection ; Treatment Outcome ; alpha-Glucosidases/deficiency ; alpha-Glucosidases/genetics ; alpha-Glucosidases/immunology ; alpha-Glucosidases/therapeutic use
    Chemical Substances Antibodies ; Biomarkers ; Recombinant Proteins ; GAA protein, human (EC 3.2.1.20) ; alpha-Glucosidases (EC 3.2.1.20)
    Language English
    Publishing date 2014-04-09
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 438341-2
    ISSN 1573-2665 ; 0141-8955
    ISSN (online) 1573-2665
    ISSN 0141-8955
    DOI 10.1007/s10545-014-9707-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Treatment options for lysosomal storage disorders: developing insights.

    van Gelder, Carin M / Vollebregt, Audrey A M / Plug, Iris / van der Ploeg, Ans T / Reuser, Arnold J J

    Expert opinion on pharmacotherapy

    2012  Volume 13, Issue 16, Page(s) 2281–2299

    Abstract: Introduction: Lysosomal storage disorders (LSDs) are clinically heterogeneous disorders that result primarily from lysosomal accumulation of macromolecules in various tissues. LSDs are always progressive, and often lead to severe symptoms and premature ... ...

    Abstract Introduction: Lysosomal storage disorders (LSDs) are clinically heterogeneous disorders that result primarily from lysosomal accumulation of macromolecules in various tissues. LSDs are always progressive, and often lead to severe symptoms and premature death. The identification of the underlying genetic and enzymatic defects has prompted the development of various treatment options.
    Areas covered: To describe the current treatment options for LSDs, the authors provide a focused overview of their pathophysiology. They discuss the current applications and challenges of enzyme-replacement therapy, stem-cell therapy, gene therapy, chaperone therapy and substrate-reduction therapy, as well as future therapeutic prospects.
    Expert opinion: Over recent decades, considerable progress has been made in the treatment of LSDs and in the outcome of patients. None of the current options are completely curative yet. They are complicated by the difficulty in efficiently targeting all affected tissues (particularly the central nervous system), in reaching sufficiently high enzyme levels in the target tissues, and by their high costs. The pathways leading from the genetic mutation to the clinical symptoms should be further elucidated, as they might prompt the development of new and ultimately curative therapies.
    MeSH term(s) Animals ; Enzyme Replacement Therapy ; Genetic Therapy ; Hematopoietic Stem Cell Transplantation ; Humans ; Lysosomal Storage Diseases/physiopathology ; Lysosomal Storage Diseases/therapy ; Molecular Chaperones/therapeutic use
    Chemical Substances Molecular Chaperones
    Language English
    Publishing date 2012-11
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2001535-5
    ISSN 1744-7666 ; 1465-6566
    ISSN (online) 1744-7666
    ISSN 1465-6566
    DOI 10.1517/14656566.2012.729039
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: An experimental model of heat storage in working firefighters.

    Van Gelder, Carin M / Pranger, L Alex / Wiesmann, William P / Stachenfeld, Nina / Bogucki, Sandy

    Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors

    2008  Volume 12, Issue 2, Page(s) 225–235

    Abstract: Objective: Develop experimental models to study uncompensable heat stress (UCHS) in working firefighters (FFs).: Methods: FFs ingested core temperature (Tc) capsules prior to performing sequential tasks in 40 degrees C and personal protective ... ...

    Abstract Objective: Develop experimental models to study uncompensable heat stress (UCHS) in working firefighters (FFs).
    Methods: FFs ingested core temperature (Tc) capsules prior to performing sequential tasks in 40 degrees C and personal protective ensemble (PPE), or 18 degrees C and no PPE. Both trials were conducted in an environmental chamber with FFs using self-contained breathing apparatus (SCBA).
    Results: FFs exercising in heat and PPE reproduced UCHS conditions. For every FF in both trials for whom the capsules worked, Tc was elevated, and Tc(max) occurred after completion of study protocol. Trials with PPE resulted in a mean maximum temperature of 38.94 degrees C (+/-0.37 degrees C); Tc(max) reached 40.4 degrees C. Without PPE, maximum Tc averaged 37.79 degrees C (+/-0.07 degrees C). Heat storage values ranged from 131 to 1205 kJ, averaging 578 kJ (+/-151.47 kJ) with PPE and 210.83 kJ (+/-21.77 kJ) without PPE.
    Conclusions: An experimental model has been developed that simulates the initial phases of an interior fire attack to study the physiology of UCHS in FF. The hot environment and PPE increase maximum Tc and heat storage over that due to the exertion required to perform the tasks and may decrease time to volitional fatigue. This model will permit controlled studies to optimize work-rest cycles, rehab conditions, and physical conditioning of FFs.
    MeSH term(s) Adolescent ; Adult ; Body Mass Index ; Employment ; Female ; Fires ; Heat Stress Disorders/etiology ; Heat Stress Disorders/physiopathology ; Humans ; Male ; Middle Aged ; Monitoring, Ambulatory/methods ; Occupational Exposure ; Task Performance and Analysis
    Language English
    Publishing date 2008-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1461751-1
    ISSN 1545-0066 ; 1090-3127
    ISSN (online) 1545-0066
    ISSN 1090-3127
    DOI 10.1080/10903120801907430
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Helmet use in Connecticut motorcycle crashes: a state without a universal helmet law.

    Landman, Adam B / Phipps, Michael S / Jawin, Kimberly / Bolton, Lauri / Van Gelder, Carin M / Kamin, Richard / Teel, Bill / Vaca, Federico E

    Connecticut medicine

    2011  Volume 75, Issue 5, Page(s) 261–268

    Abstract: Objectives: Assess the association of helmet use with motorcycle crash mortality and identify characteristics of riders who do not wear helmets in Connecticut crashes.: Methods: Police crash data for Connecticut motorcycle crashes 2001-2007 were ... ...

    Abstract Objectives: Assess the association of helmet use with motorcycle crash mortality and identify characteristics of riders who do not wear helmets in Connecticut crashes.
    Methods: Police crash data for Connecticut motorcycle crashes 2001-2007 were analyzed. Bivariate analysis and multivariable logistic regressions were performed including age, gender, seating position, road type, season, time of day, and recklessness.
    Results: Of the 9,214 crashes with helmet use data available, helmets were worn in 4072 (44.2%). Non-helmeted riders, age > or =18, riding interstate or state roads, in the evening or at night, and who were riding recklessly were associated with higher odds of fatality. Predictors of nonhelmet use included males, passengers, age <18 or 30 to 59, and riding in the summer, eveningor at night, and on U.S., state, and localroads.
    Conclusion: Current crash data affirm that helmets reduce fatal crashes in Connecticut. A set of factors help predict nonhelmeted riders to whom safety training could be targeted.
    MeSH term(s) Accidents, Traffic/legislation & jurisprudence ; Accidents, Traffic/mortality ; Accidents, Traffic/statistics & numerical data ; Adolescent ; Adult ; Age Factors ; Connecticut/epidemiology ; Craniocerebral Trauma/mortality ; Craniocerebral Trauma/prevention & control ; Female ; Head Protective Devices/utilization ; Humans ; Logistic Models ; Male ; Middle Aged ; Motorcycles/legislation & jurisprudence ; Motorcycles/statistics & numerical data ; Risk Factors ; Risk-Taking ; Sex Factors
    Language English
    Publishing date 2011-05
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 412600-2
    ISSN 0010-6178
    ISSN 0010-6178
    Database MEDical Literature Analysis and Retrieval System OnLINE

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