Thoughts,opinions and musings of a restless nomad

Doctors on the move

February 27, 2009 Posted by Maddy , , , 18 comments
The other day I saw a white van speeding by on the next track of the CA 78 highway. It said ‘Your friendly neighborhood doctor’ (Spiderman like) or some such thing. Well, it was a surprise, and I wondered, is the work of physicians going to get distributed, close to the need, finally, with home calls etc coming back into vogue? Seeing that close on the heels of the computerization and outsourcing moves, it sounded like a great idea, actually.

Years back, when we were kids, we had a Dr-mama - Dr Balakrishnan Nair at Calicut who used to come if the patient at home was too weak or sick to move or was a small kid. Otherwise we took a horsecart (or were there noisy autos then? – I forgot) or some form of conveyance to his ‘Karunakara Nursing home' on Wynad road.

Calicut medical College records these things for posterity though I myself was recounting of the mid 1960’s. The1930s and 1940s saw the heydays of Family Practice in Kozhikode. In1930, Dr VA Raman established Ashoka Hospital - perhaps the first private hospital in the region. Meanwhile, Dr A Balakrishnan Nair in the north of the city, Dr A Narayana Sami in the central town area and Dr CK Menon to the south had laid equal and honourable claims to the patient clientele of Kozhikode, despite the lack of facilities for inpatient hospital care: recalls Dr Ramanathan and Dr Madhavan Kutty. It was only later that Karunakara Pharmacy established by Dr A Balakrishnan Nair, an alumnus of Calicut Medical College, started offering inpatient care. Dr Ramanathan adds - The general practitioner was a jack of all trades — friend, philosopher and guide. It was a hectic schedule with home visits. There were few women gynecologists. I had to attend to deliveries too, including in remote areas in Wynad.

This was the history of medical services in Kozhikode, with the medical college coming up in 1957 or so but then, I recall Dr-mama arriving at Chalappuram, asking questions about maths, homework, other relatives and their well being, the politics of the country, discussions about his children (doctors themselves) and so on. The Nair/Menon community out in Calicut was pretty well connected and inter-related, so everybody knew everybody else.

That was family practice - Do you remember those scenes from early movies, the doctor comes to the bedside, this briefcase held by a male member of the patient’s family, standing beside him with arms crossed and great respect writ on his face. The doctor asked for some water which he boiled using a small pot & spirit lamp taken out of his leather bag, to sterilize his syringe. Distilled water for injections came from those small ampoules that he broke using the mini saw ‘aram’ (just the other day I found out that they have a new tool - a plate with a hole through which the ampoule top is inserted and snapped off– though not as interesting as the original one, it is probably faster & safer). After drawing out the water, he injected it through the rubber cap of the antibiotic or whatever was in the bottle, then shook it vigorously and drew it out again with the syringe for the injection. As a child, I recall holding out my hand for one of those mini saws or ‘arams’ after the doctor’s work was finished. Later when my dad, a doctor himself came back to Palakkad after a stint in the estates, I recollect seeing the very scenes even more often, and I remember helping him now & then with cutting the head of those ampoules and lighting the spirit lamp.

After he was done, Dr-mama stopped to drink some tea and eat chips served out from the ‘bharani’ filled up recently from Maharaj’s at SM street Then, the Dr would get up to go. The ‘karanavar’ of the house (my valiachan) would stealthily go near him and slip the ‘fees’ into his hands (I have never understood this stealth – as though it was dishonourable). Dr-mama would consign it to his pockets without a look at how much it was and the leather bag would be carried by another adult male in the family to Dr-mama’s car. Sometimes he left a sample syrup or something for the ailment thus avoiding the need to go and find it in the ‘Palms’ medical shop across Karunakara Nursing home (I think it was only later that Karunakara Pharmacy came into being to supply the medicines).

From those days medicine came a long way in Calicut. Clinics came up; though there was the big medical college hospital it was 5-7 miles away in Chevayoor. Then came the primary health centers, private hospitals, specialty hospitals, the diagnostic centers…Now you even have the 5 star hospiplexes (Honestly - I made that word up just now ) – hospitals that will soon become like cinema multiplexes with all kinds of stuff – 5 star rooms, shops, hotels, in room TV entertainment, on demand movies…and what not.

Appointments were then the rule of the day since the clinics started, but I can say that to this date I have not seen a place where I have met the doctor on time. Whichever be the country the aspect that time is irrelevant is writ on the honorable doctor’s profession. Probably right, I guess, because when you are in with the doctor, at least I have always much to ask and understand. But then, sitting in the reception, being prey to all those germs floating around and sick and glum faces looking at you is not fun. Here in California, the clinic states that anybody who has a cold or flu has to wear a mask out of consideration to others. But we have a new breed these days. They are called PA’s or ‘physicians assistants’ who become kind of ‘quasi’ doctors after a two year course. They cannot be sued, I believe, so cost the clinic less, and are quite popular. The PA’s take care of mundane ailments or less complicated patients. From personal experience, I can say that they are equally good.

In England, these clinics are called surgeries. The NHS works in a completely alien fashion and you can chose to meet a nurse for small issues and a doctor’s appointment for routine check up’s can be many days away, when you call in to fix one. Meeting a specialist (unless an emergency) requires a reference and a long wait and getting a dentists appointment is even more time consuming, many months of wait actually. Private insurance can help jump the queue for surgery, otherwise it is free. UK still requires doctors & nurses to do some home visits.

Today outsourcing is the name of the game with diagnostics outsourced across continents, clinical trials are done in India (I saw a very negative Tamil film on this called E) and China, with even diagnosis getting outsourced. Thus from the days of home visits, we have transcontinental visits. The days of telemedicine are here… You could for example call the Auyurvedic specialist in Kerala and get a diagnosis and advice on what to do with hair loss. But that is not exactly what I meant by telemedicine.

Telemedicine typically involves physicians using interactive video and/or store-and-forward consultations to treat patients. Interactive video allows medical specialists to directly communicate with their patients who are in another location, using television monitors and specially adapted equipment. Store-and-Forward techniques include physicians sending pictures, x-rays, and other patient information directly to the computer of a specialist. After reviewing that information, the specialist then sends the diagnosis back to the local doctor, who treats the patients and provides follow-up care. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Well, it has come a distance from ancient days of African villages sending smoke signals to keep visitors away from a sick village!!

Interestingly, it is in India that we have already utilized advanced forms of Telemedicine since 2001. The efficacy of telemedicine has already been shown through the network established by the Indian Space Research Organization (ISRO), which has connected 22 super-specialty hospitals with 78 rural and remote hospitals across the country through its geo-stationary satellites. This network has enabled thousands of patients in remote places such as Jammu and Kashmir, Andaman and Nicobar Islands, the Lakshadweep Islands, and tribal areas of the central and northeastern regions of India to gain access to consultations with experts in super-specialty medical institutions. More details of the ISRO project can be found here.

So will computers & satellites take care of our medical needs? Will robots like Da Vinci that I wrote about earlier replace surgeons? Will nanobots (tiny nano sensors or devices placed into the blood stream) go through our bodies (also delivering minute amounts of medicine at the right time to the right place) and constantly report the health of the individual to a computer and will the computer dictate predictive & preventive maintenance as well as corrective actions to our bodies? I think all the above will happen in our life time just like many of us have already undergone laparoscopic (keyhole) surgeries.

But will all this provide the same comfort and confidence that you would get from the reassuring words of a doctor in front of you? Probably not! And so, for that reason and probably since it is a niche business by itself, some docs are getting back to visiting patients. Today you have mobile doctors in UK, USA & many countries, flying doctors in Australia etc. But will we see the reemergence of eminent Dr-Mama’s? I doubt it.

Tailnote - I cannot leave this subject without taking a dig at doctor’s infamous handwriting …

There is always a question about a doctor’s handwriting in the patients mind. He peers at it and can hardly make out the drug name (this is valid mainly back home & some other countries – here we get it off computers as a print out with the doctor checking his/her hand held device sometimes to come up with the drug names and then to input it into the key board). As he presents it to the pharmacy, the guy at the till takes one look and screams out the names to the boy who is on the ladder to search it out. Then he transcribes to you the codes e.g. 3 t.i.d. pc or t.d.s pc as ‘three tablets per day after meals’ and the such.

Why is it a scrawl on the prescription and one that only a compounder or pharmacist can understand? Apparently this bad handwriting kills over 7000 people a year due to wrong transcription by today’s pharmacists.

Well, I do not know the reasons, but the assertion that doctors have bad handwriting holds an honoured place in traditional lore. According to conventional wisdom, doctors write in a code--a self righteous chicken scratch that is decipherable only by experienced pharmacists and, with luck, by each other. A study was conducted and the results were - The handwriting of doctors (mainly related to letters & not numerals) was no less legible than that of non-doctors. Significantly lower legibility than average was associated with being an executive and being male.

Today the problem coupled with strict health & safety requirements in any countries require that the prescription is printed out or emailed to the pharmacy.

Why is it that the prescription has an Rx on the top left corner even today? What does it mean?

There are various theories about the origin of this symbol - some note its similarity to the Eye of Horus, others to the ancient symbol for Jupiter, both gods whose protection may have been sought in medical contexts. But in reality it means ‘prescription’….

The word "prescription" comes from the Latin "praescriptus" and is made up of "prae," before + "scribere," to write, so that prescription meant "to write before." This reflected the historic fact that a prescription had traditionally to be written before a drug could be prepared and then administered to a patient.

What other codes are used? Quite a few are used, Check these links for details. (One, Two)

What is QD and QOD? QD means ‘every day’, QOD means ‘every other day’ (alternate days). But OD means ‘right eye’ so imagine what happens if the Q looks like O!!!
Some cartoons on the subject
Pics - Thanks to ISRO & various sites

From the first to the last puff

February 20, 2009 Posted by Maddy , 16 comments
Once upon a time, I was a smoker, smoking a good (never more than 5-6 a day) number of cigarettes between 1974 and 1987. I had absolutely no qualms when I stopped, knowing fully well that stopping was the right thing to do. Never have I wanted to smoke since then, even when offered choice cigars at parties or when I saw exquisite lighters & pipes. My advice to those who have a habit – just kick it!!

My first puff was not from a cigarette, but a rolled up piece of paper. Wanting to emulate the macho smoker, the small kid that was me rolled up a piece of paper and lit it. As expected, the acrid smoke brought tears to the eyes and burned the throat. Then it was a longish kutti (thrown away stub) that was tried out by bro and me. Finally after a few months and after saving a few paise, it was a proper ‘Cool’ mentholated cigarette at the shop opposite Motilal School (close to Victoria College Palakkad). The benevolent owner of the shop wanted to make the quick buck from the students and would let us try out fags (cigarettes were called thus) in the back room.

Next experiments were with acrid ‘beedis’ that were much cheaper but tasted horrid. Eventually we got caught and caned, after which we were warned of dire consequences should the act be repeated. Thus we started trying ‘meetha paan’ till we got caught chewing it on the school corridor (subject of another blog).Growing up, our interests moved on to other matters till holiday time when Sreekumar, bro & me would buy a couple of Scissors from Kazhakootam - Chandavila and smoke it. All that was for the fun of it, the mystery & doing what we were not supposed to do.

At college I had a free run, trying Scissors, Wills, Gold flake, GF kings, Charminar, Charminar Gold, Charms, foreign smokes like 555, Rothman’s etc. My friend Soman was a funny guy, he got the idea of attaching a cheaper Charminar to a 555 filter and smoke it after the 555 was done with…There were Kerala Dinesh & Ganesh beedis as well on poorer days…Marco Polo the cigar which smelt heavenly, local cheroots or Churuts on an odd occasion.

I used to collect Newsweek advertisements of the Malboro man on horseback while at college. That was the man I wanted to look like, coupled with western novels from L’armor, this was the macho image that appealed. Little did we know at that time, the Malboro man’s real story

For a while there was the Capstan brand which I tried, once I tried an ‘India kings’ premium cigarette, but I always recalled Eacharan our farming supervisor smoking the ‘Passing show’ that had a filter like band at the bottom, and then there was Panama. And there were strange brands like Abdullah #7 that I have never seen.

Once I started working, it was Wills Navy cut (made for each other) mainly till I got to Bombay and we discovered the Four square brand. There I stopped smoking for a while, smoking only an occasional brown ‘Chancellor’ cigarillo or a Rothman’s after lunch. It was around 1982, that Rothmans started local manufacturing from Calcutta, I believe.
In Saudi I moved from Salem Mentholated to Dunhill to State express 555 to Benson & Hedges, then Cartier and finally Silk cut. I was a light smoker though, not more than 5 a day even in those years. I never tried the Malboro brands that used toasted tobacco. Later, I tried rolling fags using cigarette paper, that was cool, but the fags looked like joints, which were very dangerous things to have in Saudi, so stopped it quickly. Brands I would have liked to try – Camels & Gauloise…made famous in books and of course a Cuban cigar!!

Then it was pipe smoking triggered by the Sherlock Holmes books. That was cool. I purchased a pipe, the pipe cleaner etc, but it was all too difficult to keep the pipe going. Secondly I thought I looked ridiculous and too silly holding pipes, so I smoked it only at home with a sniggering better half. Fortunately there were no smoke alarms in those houses, or they’d have gone off…

Lighters – Ah! There was a time I’d have done anything to get a Ronson gas lighter that had the flint flicked when you pressed the side. I found one eventually while at Saudi. For awhile it was the love of those exquisite gas lighters like Zippo & Ronson that kept my habit going.. History of Ronson.

At that time, my elder son started getting sick (lung infections) frequently & the doctor suggested that it could be due to allergies such as cigarette smoke. I stopped smoking right then, on a fine bright summer day in 1987, and never looked back…

Meetings in Turkey were the toughest, everybody smoked out there and the rooms were full of smoke that you peered through. Sometimes it was the local brands and of course the brand camel, which smelt terrible…

I hear Malboro has come to India. So also brands like red & white, Cavenders, Tipper & white etc…Scissors I guess still rules in Kerala where the word ‘cigarette’ is synonymous with ‘scissors’ the brand. That is brand recognition for you!!!

While on the subject, it is always interesting to bring up the fabled legend that the best Cuban cigars are rolled on the inside of a virgin Cuban girls thighs – Today visitors are told jokingly by factories that they don’t do it anymore since there are no virgins around. In reality, Cigars & virgin thighs - South African cigar expert Theo Rudman addresses this hoary old legend in his on-line magazine. “It is a lovely idea,” he writes, “but alas is a legend that has persisted since the mid-forties, when a visiting journalist saw tobacco leaves being sorted and graded by women who placed the respective piles on their laps.” The visitor apparently took some imaginative journalistic license when he later wrote that Havanas were rolled on the thighs of virgins. Certainly, this story hasn’t hurt the mystique-laden marketing of Habanos. “Yes, they would stretch the leaves on their uncovered skin, but to roll a cigar on one’s leg - you cannot do that,” Borhani says with a snicker. “I challenge anyone - man or woman - to put bunched tobacco on their thigh and roll a successful cigar.”

With declining markets in the West, and 50 per cent of India's population under the age of 25, the major tobacco companies are increasingly targeting India as their new growth market. 250 million Indians use tobacco, and the market's already worth a massive $5 billion. India’s cigarette market of 105 billion sticks a year is relatively small compared to China; 82% of India’s tobacco is consumed in the form of beedis. However, the market is still attractive to multinationals, given its size (200 million smokers) and growth potential. The Big Three in India are ITC (65% of the market), Vizir Sultan Tobacco and Godfrey Philips. Philip Morris already owns 36% of Godfrey Philips, while BAT has 33% of ITC.

So there it was, a little story on smoking – Once again, anybody who is still smoking – Kick the habit, It is not worth it..
Other related references
Blog that covers a number of nostalgic ads..
John Grisham’s book – Runaway jury is a superb thriller involving the Tobacco industry.
A review on the Malboro man.
Soon Indian warnings on cigarette packs will be gory
Cig pack pics - various sites ack with thanks

Nafisa Ali

February 13, 2009 Posted by Maddy 14 comments
There are a few persons I hold in high regard, this beauty from Bengal named Nafisa Ali Sodhi happens to be one. Our earliest association (well that is one way to put it, I guess) was in my college room. She was a roommate, well actually as a wall pinup for two years, standing by the pool side in a blue string bikini. Man! Was she gorgeous (alas, the pinup was lost over the years) …Then we parted ways, though I saw her later on in the movie ‘Junoon’. I recall that in those days we had a pretty interesting magazine around, called JS. I remember an article about her in that mag…probably the pinup came from the same JS (junior statesman) too.

Then I lost touch, nowadays, we see her on TV here & there and she is of course quite popular on the net…She still looks gorgeous, the beauty with the grey hair and lots and lots of grey matter…a pretty rare combination indeed.

She acted in a Hindi movie ‘Life in a Metro’ recently, should watch it one day. We saw her (as Mary teacher) with Mamooty in ‘Big B’ a Malayalam movie. About ‘Big B’ says Nafisa Ali, "I never knew there were so many talented people in the film world, in the North every one has got the feeling that Bollywood is Indian cinema, even though almost all the talented technicians are from the South." Although she had a problem with her dialogues in Malayalam, she says, "You have very down-to- earth people, convenient schedules and you find that your work is finished within the time given. When Kamal approached me for the film, I was reluctant to say yes, but now I am glad to be here". "I have just found out that Mammooty is five years older to me," revealed a 50-year-old and glowing Nafisa Ali who played Mammooty's mother in the film, that was shot in Kochi

Her life has always been varied, mother a Catholic, father a Muslim, husband a Sikh (Pickles Sodhi) and she a pupil of Chinmayanada and one who has studied Vedanta!!! A swimming champion, Miss India, a jockey, and now a social activist working on HIV/AIDS, child welfare, cyclone victim rehab and what not. Dabbling in politics, she was also a Congress party nominee.

Just look at this - "The turning point in my life came 12 years ago, when I prayed to God for a wish – something to do with my family – and I said that if it came true, I would go to Tirupati and shave my head." Ali’s shorn head made a fashion statement – she even took part in a fashion show minus her tresses – and she took to social work in earnest.

Now she wants to race, own a Ferrari or a Lamborghini…taking up from brother Niyaz who is even more into cars, is a race driver, car magazine editor etc. Anyway she enjoys her driving.

In a discussion with Kumkum Bhandari – She says - When I was young, as a swimmer every muscle in my body was toned, my physique perfect. Now at 40, I've realized that a few kilos more or less are not everything. I've learnt to be comfortable the way I am because my friends, my family and my husband love me for who I am. In the Vedas, fitness encompasses the body, mind, soul, spiritual aspects and the relationship you have with people. If all five are in balance, I would consider a person to be fit. always strove to give my best, to win. At 19, I won the Miss India contest. I've never sought to be glamorous or fashionable, but I did feel insecure for a while when the first gray hair came. At 37, I went to Tirupati, shaved my head (to honor a wish come true), stood in front of God (Lord Venkateswara) there and said: "I'm putting my life into your hands. Guide me, I need direction." Shaving my head made me realize how vulnerable we are to our human image, to the façade we cling to. I have seen miserable souls for whom all that counts is dressing well. It's so futile. We need to shed externals and focus on who we truly are.

Much into fitness, she has a good lecture for the obese.

Video interview

Pics - google images - thanks

Remembering - Marcus Bartley

February 06, 2009 Posted by Maddy , 15 comments
Many of you would have seen Chemeen (made in 1965), if not ages ago, recently after the DVD was released. For Malayalees it is a very special movie which won a President’s gold medal, popularized music directors like Salil Chaudhary (in Kerala) and made superstars of Madhu, Sheela and Satyan. With brilliant acting and an emotional story line, Chemmen remains in the hearts and minds of Malayalis, young and old.

But who remembers the man who did bulk of the camerawork for the movie including the famous sea scene picturing the epic struggle of Satyan with a shark in the swirling waters? It was a certain genius named Marcus Bartley. For all these years I thought he was a German who strayed into South India. I did not know that he was an Anglo Indian and that he had done over 50 movies between the 1950’s and 80’s in multiple languages. Starting with ‘Swarga Seema’ in Telugu way back in 1945, he went on to become the master of black and white photography and special effects. He epitomized cinematography of that time and was an integral part of all ‘Vauhini films’ movies.

He did only one more Malayalam film after Chemmen, titled ‘Mamangam’ in 1979. Raam Aur Shyam, Saathi, Yehi hai zindagi and Zindagi Jeene ke Liye are his Hindi films. ‘Chemeen’ incidentally used a technicolour format. The cinematography was considered outstanding, especially the shots of the sea, providing the audience with a wide angle feeling about the fishing community of the story. Close up’s of characters were resorted to as and when required.

Bartley was born in 1917 and was the recipient of the gold medal at the International Film Festival held at Cannes for ‘Chemmeen’ in the year 1978 for cinematography. As a Vizag based Cinematographer, the only information about this ace came from his much talked about work in Telugu movies, namely ‘Paathal Bhairavi’ and ‘Maya bazaar’, two movies I have not seen or for that matter, may not see. But well, I decided to find a bit about Marcus and here it goes.

Ambu Rao, his protégé, says “To me calling Bartley as my guru is causing disrespect to him, the word `guru' is too small to address that man. He has a towering influence over me and what I am today is merely because of him. In those days his young mind was brimming with creative ideas and Bartley allowed Ambu to experiment with a free hand. Bartley skillfully kindled this enthusiasm, though he was harsh at times. It was an experience that I would cherish till my end." Bartley not only taught Ambu the finer points of photography but also played a very important role in shaping his individuality.

"One day as I was standing near the dollies during the shoot of a very important scene of `Maya Bazaar', the director K. V. Reddy pointed at me and asked Bartley: `who is this novice, tell him to go, this is a very important scene'. Bartley replied: `he is my assistant and it's my look-out'. He later scolded me and gave me a through dressing down on body language." Another nice article on Ambu Rao’s recollections about Bartley.

Following from the review of the movie PathalaBhairavi- Marcus Bartley was arguably the greatest cinematographer of those times. Almost all the superhits of those times were made with his hand at the camera. His specialty was the shots under the moonlight. In those days, a circle was drawn on a screen and the screen was lit to make it look like a moon. With this on the background, one cannot have other lights there. In spite of this difficulty, all the characters in such scenes had their shadows away from the moon. Apart from this, many of the transformations of elements in this movie were shown using Fade-In and Fade-Out techniques giving it a much better look and feel than the latest digital morphing which uses high technology computers. Marcus Bartley made this possible with his innovative ideas.

Adoor Gopalakrishnan, the famous film maker says - Chemmeen, Yes, the film made by Ramu Kariat in 1965 was the first Malayalam film to win the President's Gold Medal. It was an important film in many ways. It was a color film; in fact a very colorful film with impeccable photography by Marcus Bartley.

Maya bazaar - The first cinematic Maya Bazar was made in 1936 in Telugu based on the play. Later 16 films were made with the same title in different languages but K.V. Reddy's production stood out. Though there were efforts to convert this film into color, using latest technology, the idea was dropped as the legatees of the film makers feared that original charm of black and photography of Marcus Bartley would be lost. He simply created magic on screen with his imaginative photography. Full of special effects, camera tricks by the famous camera man Marcus Bartley, this movie produced 50 years ago is a visual feast!

Passionforcinema has this to add - Marcus Bartley was the top camera man those days (his work for Mayabazaar is legendary). As per the protocol adhered to by KV’s crew, only Marcus and KV will get a chance to see through the camera lens. Right from the moment he started working on the sets of Mayabazaar, Rao always wanted to see through the lens - at least once.

One fine day he gathered courage and approached KV. KV gave Ambu Rao one glance and gave a shout to Bartley. Bartley looked back and beckoned the young man. Rao ran towards the camera only to hear Bartley say “WAIT!”. He was scared by the tall giant of a man and stood still. Bartley summoned a spot boy to get a high chair. Rao was a short guy and the camera was set high - in position. Hence the high chair. Bartley then he called the lights on and Rao had his first look through the lens eye.

What was it like? Let’s hear from the man (rao) himself - “When I saw through the lens, my lifelong wish was fulfilled. It is the memorable moment of my life. It is the best moment of my life. It is the greatest moment of my life. I am blessed to see Bartley’s vision through his lens. Believe it or not, till date I have never seen the same lighting feel again. I pointed out the same to camera man Kabir during the making of Bhairawa Dweepam.

Marcus Bartley shot brilliant movies with the legendary Mitchell Camera. The Mitchell camera was originally developed by Leonard in 1917 who sold its designs to George Mitchell. The Mitchell standard went on to remain for many decades, no camera has ever been so well equipped for special effects work; it was another reason for the Mitchell's immediate popularity. 85% of all Hollywood pictures of those days were shot with a Mitchell.

Pics – Thanks to ‘The Hindu’

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