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Kazi DS, Katznelson E, Liu CL, Al-Roub NM, Chaudhary RS, Young DE, McNichol M, Mickley LJ, Kramer DB, Cascio WE, Bernstein AS, Rice MB. Climate Change and Cardiovascular Health: A Systematic Review. JAMA Cardiol 2024:2820068. [PMID: 38865135 DOI: 10.1001/jamacardio.2024.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Importance Climate change may increase the risk of adverse cardiovascular outcomes by causing direct physiologic changes, psychological distress, and disruption of health-related infrastructure. Yet, the association between numerous climate change-related environmental stressors and the incidence of adverse cardiovascular events has not been systematically reviewed. Objective To review the current evidence on the association between climate change-related environmental stressors and adverse cardiovascular outcomes. Evidence Review PubMed, Embase, Web of Science, and Cochrane Library were searched to identify peer-reviewed publications from January 1, 1970, through November 15, 2023, that evaluated associations between environmental exposures and cardiovascular mortality, acute cardiovascular events, and related health care utilization. Studies that examined only nonwildfire-sourced particulate air pollution were excluded. Two investigators independently screened 20 798 articles and selected 2564 for full-text review. Study quality was assessed using the Navigation Guide framework. Findings were qualitatively synthesized as substantial differences in study design precluded quantitative meta-analysis. Findings Of 492 observational studies that met inclusion criteria, 182 examined extreme temperature, 210 ground-level ozone, 45 wildfire smoke, and 63 extreme weather events, such as hurricanes, dust storms, and droughts. These studies presented findings from 30 high-income countries, 17 middle-income countries, and 1 low-income country. The strength of evidence was rated as sufficient for extreme temperature; ground-level ozone; tropical storms, hurricanes, and cyclones; and dust storms. Evidence was limited for wildfire smoke and inadequate for drought and mudslides. Exposure to extreme temperature was associated with increased cardiovascular mortality and morbidity, but the magnitude varied with temperature and duration of exposure. Ground-level ozone amplified the risk associated with higher temperatures and vice versa. Extreme weather events, such as hurricanes, were associated with increased cardiovascular risk that persisted for many months after the initial event. Some studies noted a small increase in cardiovascular mortality, out-of-hospital cardiac arrests, and hospitalizations for ischemic heart disease after exposure to wildfire smoke, while others found no association. Older adults, racial and ethnic minoritized populations, and lower-wealth communities were disproportionately affected. Conclusions and Relevance Several environmental stressors that are predicted to increase in frequency and intensity with climate change are associated with increased cardiovascular risk, but data on outcomes in low-income countries are lacking. Urgent action is needed to mitigate climate change-associated cardiovascular risk, particularly in vulnerable populations.
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Affiliation(s)
- Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ethan Katznelson
- Department of Cardiology, Weill Cornell Medical Center, New York, New York
| | - Chia-Liang Liu
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nora M Al-Roub
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Richard S Chaudhary
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Diane E Young
- Knowledge Services, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Megan McNichol
- Knowledge Services, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Loretta J Mickley
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Wayne E Cascio
- US Environmental Protection Agency, Durham, North Carolina
| | - Aaron S Bernstein
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Center for Climate, Health, and Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Mary B Rice
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Yang X, Wang J, Zhang G, Yu Z. Spatiotemporal distribution and lag effect of extreme temperature exposure on mortality of residents in Jiangsu, China. Heliyon 2024; 10:e30538. [PMID: 38765142 PMCID: PMC11098786 DOI: 10.1016/j.heliyon.2024.e30538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
Background With the ever-increasing occurrence of extreme weather events as a result of global climate change, the impact of extreme temperatures on human health has become a critical area of concern. Specifically, it is imperative to investigate the impact of extreme weather conditions on the health of residents. Methods In this study, we analyze the daily death data from 13 prefecture-level cities in Jiangsu Province from January 2014 to September 2022, using the distributed lag nonlinear model (DLNM) to comprehensively account for factors such as relative humidity, atmospheric pressure, air pollutants, and other factors to evaluate the lag and cumulative effects of extreme low temperature and high temperature on the death of residents across different age groups. Additionally, we utilize the Geographical Detector to analyze the effects of various meteorological and environmental factors on the distribution of resident death in Jiangsu Province. This provides valuable insights that can guide health authorities in decision-making and in the protection of residents. Results The experimental results indicate that both extreme low and high temperatures increase the mortality of residents. We observe that the impact of extreme low temperatures has a delayed effect, peaking after 3-5 days and lasting up to 11-21 days. In contrast, the impact of extreme high temperature is greatest on the first day, and lasts only 2-4 days. Conclusion Both extreme high and low temperatures increase the mortality of residents, with the former being more transient and stronger and the latter being more persistent and slower. Furthermore, residents over 75 years of age are more vulnerable to the effects of extreme temperatures. Finally, we note that the spatial distribution of resident deaths is most closely associated consistent with the spatial distribution of daily mean temperature, and there is significant spatial heterogeneity in deaths among residents in Jiangsu Province.
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Affiliation(s)
- Xu Yang
- Key Laboratory of Virtual Geographic Environment (Nanjing Normal University), Ministry of Education, Nanjing, Jiangsu, 210023, China
- Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application, Nanjing, Jiangsu, 210023, China
| | - Junshu Wang
- Key Laboratory of Virtual Geographic Environment (Nanjing Normal University), Ministry of Education, Nanjing, Jiangsu, 210023, China
- Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application, Nanjing, Jiangsu, 210023, China
| | - Guoming Zhang
- Health Information Center of Jiangsu Province, Nanjing, Jiangsu, 210008, China
| | - Zhaoyuan Yu
- Key Laboratory of Virtual Geographic Environment (Nanjing Normal University), Ministry of Education, Nanjing, Jiangsu, 210023, China
- Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application, Nanjing, Jiangsu, 210023, China
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Fang J, Song J, Wu R, Xie Y, Xu X, Zeng Y, Zhu Y, Wang T, Yuan N, Xu H, Song X, Zhang Q, Xu B, Huang W. Association between ambient temperature and childhood respiratory hospital visits in Beijing, China: a time-series study (2013-2017). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:29445-29454. [PMID: 33555475 DOI: 10.1007/s11356-021-12817-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
Little is known on the potential impact of temperature on respiratory morbidity, especially for children whose respiratory system can be more vulnerable to climate changes. In this time-series study, Poisson generalized additive models combined with distributed lag nonlinear models were used to assess the associations between ambient temperature and childhood respiratory morbidity. The impacts of extreme cold and hot temperatures were calculated as cumulative relative risks (cum.RRs) at the 1st and 99th temperature percentiles relative to the minimum morbidity temperature percentile. Attributable fractions of respiratory morbidity due to cold or heat were calculated for temperatures below or above the minimum morbidity temperature. Effect modifications by air pollution, age, and sex were assessed in stratified analyses. A total of 877,793 respiratory hospital visits of children under 14 years old between 2013 and 2017 were collected from Beijing Children's Hospital. Overall, we observed J-shaped associations with greater respiratory morbidity risks for exposure to lower temperatures, and higher fraction of all-cause respiratory hospital visits was caused by cold (33.1%) than by heat (0.9%). Relative to the minimum morbidity temperature (25 °C, except for rhinitis, which is 31 °C), the cum.RRs for extreme cold temperature (-6 °C) were 2.64 (95%CI: 1.51-4.61) for all-cause respiratory hospital visits, 2.73 (95%CI: 1.44-5.18) for upper respiratory infection, 2.76 (95%CI: 1.56-4.89) for bronchitis, 2.12 (95%CI: 1.30-3.47) for pneumonia, 2.06 (95%CI: 1.27-3.34) for rhinitis, and 4.02 (95%CI: 2.14-7.55) for asthma, whereas the associations between extreme hot temperature (29 °C) and respiratory hospital visits were not significant. The impacts of extreme cold temperature on asthma hospital visits were greater at higher levels of ozone (O3) exposure (> 50th percentile). Our findings suggest significantly increased childhood respiratory morbidity risks at extreme cold temperature, and the impact of extreme cold temperature on asthma hospital visits can be enhanced under higher level exposure to O3.
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Affiliation(s)
- Jiakun Fang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Jing Song
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Rongshan Wu
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
- State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing, China
| | - Yunfei Xie
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Xin Xu
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yueping Zeng
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yutong Zhu
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Tong Wang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Ningman Yuan
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Hongbing Xu
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Xiaoming Song
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Qinghong Zhang
- Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, Beijing, China
| | - Baoping Xu
- Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Wei Huang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China.
- Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China.
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Wang Z, Zhou Y, Zhang Y, Huang X, Duan X, Chen D, Ou Y, Tang L, Liu S, Hu W, Liao C, Zheng Y, Wang L, Xie M, Zheng J, Liu S, Luo M, Wu F, Deng Z, Tian H, Peng J, Yang H, Xiao S, Wang X, Zhong N, Ran P. Association of change in air quality with hospital admission for acute exacerbation of chronic obstructive pulmonary disease in Guangdong, China: A province-wide ecological study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 208:111590. [PMID: 33396113 DOI: 10.1016/j.ecoenv.2020.111590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
AIMS To assess possible effect of air quality improvements, we investigated the temporal change in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) associated with pollutant concentrations. METHODS We collected daily concentrations of particulate matter (i.e., PM2.5, PM10 and PMcoarse), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), and admissions for AECOPD for 21 cities in Guangdong from 2013 to 2017. We examined the association of air pollution with AECOPD admissions using two-stage time-series analysis, and estimated the annual attributable fractions, numbers, and direct hospitalization costs of AECOPD admissions with principal component analysis. RESULTS From 2013-2017, mean daily concentrations of SO2, PM10 and PM2.5 declined by nearly 40%, 30%, and 26% respectively. As the average daily 8 h O3 concentration increased considerably, the number of days exceeding WHO target (i.e.,100 μg/m³) increased from 103 in 2015-152 in 2017. For each interquartile range increase in pollutant concentration, the relative risks of AECOPD admission at lag 0-3 were 1.093 (95% CI 1.06-1.13) for PM2.5, 1.092 (95% CI 1.08-1.11) for O3, and 1.092 (95% CI 1.05-1.14) for SO2. Attributable fractions of AECOPD admission advanced by air pollution declined from 9.5% in 2013 to 4.9% in 2016, then increased to 6.0% in 2017. A similar declining trend was observed for direct AECOPD hospitalization costs. CONCLUSION Declined attributable hospital admissions for AECOPD may be associated with the reduction in concentrations of PM2.5, PM10 and SO2 in Guangdong, while O3 has emerged as an important risk factor. Summarizes the main finding of the work: Reduction in PM may result in declined attributable hospitalizations for AECOPD, while O3 has emerged as an important risk factor following an intervention.
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Affiliation(s)
- Zihui Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yumin Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yongbo Zhang
- Department of Environmental Protection of Guangdong Province, Guangdong Provincial Academy of Environmental Science, Guangzhou, China
| | - Xiaoliang Huang
- Department of Health of Guangdong Province, Government Affairs Service Center of Health Commission of Guangdong Province, Guangzhou, China
| | - Xianzhong Duan
- Department of Environmental Protection of Guangdong Province, Department of Ecology and Environment of Guangdong Province, Guangzhou, China
| | - Duohong Chen
- Department of Environmental Protection of Guangdong Province, Guangdong Environmental Monitoring Center, Key Laboratory of Regional Air Quality Monitoring, Ministry of Environmental Protection, Guangzhou, China
| | - Yubo Ou
- Department of Environmental Protection of Guangdong Province, Guangdong Environmental Monitoring Center, Key Laboratory of Regional Air Quality Monitoring, Ministry of Environmental Protection, Guangzhou, China
| | - Longhui Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Shiliang Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China; Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada
| | - Wei Hu
- Department of Health of Guangdong Province, Government Affairs Service Center of Health Commission of Guangdong Province, Guangzhou, China
| | - Chenghao Liao
- Department of Environmental Protection of Guangdong Province, Guangdong Provincial Academy of Environmental Science, Guangzhou, China
| | - Yijia Zheng
- Department of Environmental Protection of Guangdong Province, Guangdong Provincial Academy of Environmental Science, Guangzhou, China
| | - Long Wang
- Department of Environmental Protection of Guangdong Province, Guangdong Provincial Academy of Environmental Science, Guangzhou, China
| | - Min Xie
- Department of Environmental Protection of Guangdong Province, Guangdong Environmental Monitoring Center, Key Laboratory of Regional Air Quality Monitoring, Ministry of Environmental Protection, Guangzhou, China
| | - Jinzhen Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Sha Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Ming Luo
- School of Geography and Planning, Sun Yat Sen University, Guangzhou, China
| | - Fan Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Zhishan Deng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Heshen Tian
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Jieqi Peng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Huajing Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Shan Xiao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Xinwang Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
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The Impact of Non-optimum Ambient Temperature on Years of Life Lost: A Multi-county Observational Study in Hunan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082699. [PMID: 32295256 PMCID: PMC7215980 DOI: 10.3390/ijerph17082699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 12/27/2022]
Abstract
The ambient temperature–health relationship is of growing interest as the climate changes. Previous studies have examined the association between ambient temperature and mortality or morbidity, however, there is little literature available on the ambient temperature effects on year of life lost (YLL). Thus, we aimed to quantify the YLL attributable to non-optimum ambient temperature. We obtained data from 1 January 2013 to 31 December 2017 of 70 counties in Hunan, China. In order to combine the effects of each county, we used YLL rate as a health outcome indicator. The YLL rate was equal to the total YLL divided by the population of each county, and multiplied by 100,000. We estimated the associations between ambient temperature and YLL with a distributed lag non-linear model (DNLM) in a single county, and then pooled them in a multivariate meta-regression. The daily mean YLL rates were 22.62 y/(p·100,000), 10.14 y/(p·100,000) and 2.33 y/(p·100,000) within the study period for non-accidental, cardiovascular, and respiratory disease death. Ambient temperature was responsible for advancing a substantial fraction of YLL, with attributable fractions of 10.73% (4.36–17.09%) and 16.44% (9.09–23.79%) for non-accidental and cardiovascular disease death, respectively. However, the ambient temperature effect was not significantly for respiratory disease death, corresponding to 5.47% (−2.65–13.60%). Most of the YLL burden was caused by a cold temperature than the optimum temperature, with an overall estimate of 10.27% (4.52–16.03%) and 15.94% (8.82–23.05%) for non-accidental and cardiovascular disease death, respectively. Cold and heat temperature-related YLLs were higher in the elderly and females than the young and males. Extreme cold temperature had an effect on all age groups in different kinds of disease-caused death. This study highlights that general preventative measures could be important for moderate temperatures, whereas quick and effective measures should be provided for extreme temperatures.
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