He Fell Ill on a Cruise. Before He Boarded the Rescue Boat, They Handed Him the Bill.

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Vincent Wasney and his fiancée, Sarah Eberlein, had never visited the ocean. They’d never even been on a plane. But when they bought their first home in Saginaw, Michigan, in 2018, their real estate agent gifted them tickets for a Royal Caribbean cruise.

After two years of delays due to the coronavirus pandemic, they set sail in December 2022.

The couple chose a cruise destined for the Bahamas in part because it included a trip to CocoCay, a private island accessible to Royal Caribbean passengers that featured a water park, balloon rides, and an excursion swimming with pigs.

It was on that day on CocoCay when Wasney, 31, started feeling off, he said.

The next morning, as the couple made plans in their cabin for the last full day of the trip, Wasney made a pained noise. Eberlein saw him having a seizure in bed, with blood coming out of his mouth from biting his tongue. She opened their door to find help and happened upon another guest, who roused his wife, an emergency room physician.

Wasney was able to climb into a wheelchair brought by the ship’s medical crew to take him down to the medical facility, where he was given anticonvulsants and fluids and monitored before being released.

Wasney had had seizures in the past, starting about 10 years ago, but it had been a while since his last one. Imaging back then showed no tumors, and doctors concluded he was likely epileptic, he said. He took medicine initially, but after two years without another seizure, he said, his doctors took him off the medicine to avoid liver damage.

Wasney had a second seizure on the ship a few hours later, back in his cabin. This time he stopped breathing, and Eberlein remembered his lips being so purple, they almost looked black. Again, she ran to find help but, in her haste, locked herself out. By the time the ship’s medical team got into the cabin, Wasney was breathing again but had broken blood vessels along his chest and neck that he later said resembled tiger stripes.

Wasney was in the ship’s medical center when he had a third seizure — a grand mal, which typically causes a loss of consciousness and violent muscle contractions. By then, the ship was close enough to port that Wasney could be evacuated by rescue boat. He was put on a stretcher to be lowered by ropes off the side of the ship, with Eberlein climbing down a rope ladder to join him.

But before they disembarked, the bill came.

The Patient: Vincent Wasney, 31, who was uninsured at the time.

Medical Services: General and enhanced observation, a blood test, anticonvulsant medicine, and a fee for services performed outside the medical facility.

Service Provider: Independence of the Seas Medical Center, the on-ship medical facility on the cruise ship operated by Royal Caribbean International.

Total Bill: $2,500.22.

What Gives: As part of Royal Caribbean’s guest terms, cruise passengers “agree to pay in full” all expenses incurred on board by the end of the cruise, including those related to medical care. In addition, Royal Caribbean does not accept “land-based” health insurance plans.

Wasney said he was surprised to learn that, along with other charges like wireless internet, Royal Caribbean required he pay his medical bills before exiting the ship — even though he was being evacuated urgently.

“Are we being held hostage at this point?” Eberlein remembered asking. “Because, obviously, if he’s had three seizures in 10 hours, it’s an issue.”

Wasney said he has little memory of being on the ship after his first seizure — seizures often leave victims groggy and disoriented for a few hours afterward.

But he certainly remembers being shown a bill, the bulk of which was the $2,500.22 in medical charges, while waiting for the rescue boat.

Still groggy, Wasney recalled saying he couldn’t afford that and a cruise employee responding: “How much can you pay?”

They drained their bank accounts, including money saved for their next house payment, and maxed out Wasney’s credit card but were still about $1,000 short, he said.

Ultimately, they were allowed to leave the ship. He later learned his card was overdrafted to cover the shortfall, he said.

Royal Caribbean International did not respond to multiple inquiries from KFF Health News.

Once on land, in Florida, Wasney was taken by ambulance to the emergency room at Broward Health Medical Center in Fort Lauderdale, where he incurred thousands of dollars more in medical expenses.

He still isn’t entirely sure what caused the seizures.

On the ship he was told it could have been extreme dehydration — and he said he does remember being extra thirsty on CocoCay. He also has mused whether trying escargot for the first time the night before could have played a role. Eberlein’s mother is convinced the episode was connected to swimming with pigs, he said. And not to be discounted, Eberlein accidentally broke a pocket mirror three days before their trip.

Wasney, who works in a stone shop, was uninsured when they set sail. He said that one month before they embarked on their voyage, he finally felt he could afford the health plan offered through his employer and signed up, but the plan didn’t start until January 2023, after their return.

They also lacked travel insurance. As inexperienced travelers, Wasney said, they thought it was for lost luggage and canceled trips, not unexpected medical expenses. And because the cruise was a gift, they were never prompted to buy coverage, which often happens when tickets are purchased.

The Resolution: Wasney said the couple returned to Saginaw with essentially no money in their bank account, several thousand dollars of medical debt, and no idea how they would cover their mortgage payment. Because he was uninsured at the time of the cruise, Wasney did not try to collect reimbursement for the cruise bill from his new health plan when his coverage began weeks later.

The couple set up payment plans to cover the medical bills for Wasney’s care after leaving the ship: one each with two doctors he saw at Broward Health, who billed separately from the hospital, and one with the ambulance company. He also made payments on a bill with Broward Health itself. Those plans do not charge interest.

But Broward Health said Wasney missed two payments to the hospital, and that bill was ultimately sent to collections.

In a statement, Broward Health spokesperson Nina Levine said Wasney’s bill was reduced by 73% because he was uninsured.

“We do everything in our power to provide the best care with the least financial impact, but also cannot stress enough the importance of taking advantage of private and Affordable Care Act health insurance plans, as well as travel insurance, to lower risks associated with unplanned medical issues,” she said.

The couple was able to make their house payment with $2,690 they raised through a GoFundMe campaign that Wasney set up. Wasney said a lot of that help came from family as well as friends he met playing disc golf, a sport he picked up during the pandemic.

“A bunch of people came through for us,” Wasney said, still moved to tears by the generosity. “But there’s still the hospital bill.”

The Takeaway: Billing practices differ by cruise line, but Joe Scott, chair of the cruise ship medicine section of the American College of Emergency Physicians, said medical charges are typically added to a cruise passenger’s onboard account, which must be paid before leaving the ship. Individuals can then submit receipts to their insurers for possible reimbursement.

More from Bill of the Month

More from the series

He recommended that those planning to take a cruise purchase travel insurance that specifically covers their trips. “This will facilitate reimbursement if they do incur charges and potentially cover a costly medical evacuation if needed,” Scott said.

Royal Caribbean suggests that passengers who receive onboard care submit their paid bills to their health insurer for possible reimbursement. Many health plans do not cover medical services received on cruise ships, however. Medicare will sometimes cover medically necessary health care services on cruise ships, but not if the ship is more than six hours away from a U.S. port.

Travel insurance can be designed to address lots of out-of-town mishaps, like lost baggage or even transportation and lodging for a loved one to visit if a traveler is hospitalized.

Travel medical insurance, as well as plans that offer “emergency evacuation and repatriation,” are two types that can specifically assist with medical emergencies. Such plans can be purchased individually. Credit cards may offer travel medical insurance among their benefits, as well.

But travel insurance plans come with limitations. For instance, they may not cover care associated with preexisting conditions or what the plans consider “risky” activities, such as rock climbing. Some plans also require that travelers file first with their primary health insurance before seeking reimbursement from travel insurance.

As with other insurance, be sure to read the fine print and understand how reimbursement works.

Wasney said that’s what they plan to do before their next Royal Caribbean cruise. They’d like to go back to the Bahamas on basically the same trip, he said — there’s a lot about CocoCay they didn’t get to explore.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

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  • A Fresh Take On Hypothyroidism

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The Three Rs To Boost Thyroid-Related Energy Levels

    This is Dr. Izabella Wentz. She’s a doctor of pharmacology, and after her own diagnosis with Hashimoto’s thyroiditis, she has taken it up as her personal goal to educate others on managing hypothyroidism.

    Dr. Wentz is also trained in functional medicine through The Institute for Functional Medicine, Kalish Functional Medicine, and the American Academy of Anti-Aging Medicine. She is a Fellow of the American Society of Consultant Pharmacists, and holds certifications in Medication Therapy Management as well as Advanced Diabetes Care through the American Pharmacists Association. In 2013, she received the Excellence in Innovation Award from the Illinois Pharmacists Association.

    Dr. Wentz’s mission

    Dr. Wentz was disenchanted by the general medical response to hypothyroidism in three main ways. She tells us:

    • Thyroid patients are not diagnosed appropriately.
      • For this, she criticises over-reliance on TSH tests that aren’t a reliable marker of thyroid function, especially if you have Hashimoto’s.
    • Patients should be better optimized on their medications.
      • For this, she criticizes many prescribed drugs that are actually pro-drugs*, that don’t get converted adequately if you have an underactive thyroid.
    • Lifestyle interventions are often ignored by mainstream medicine.
      • Medicines are great; they truly are. But medicating without adjusting lifestyle can be like painting over the cracks in a crumbling building.

    *a “pro-drug” is what it’s called when the drug we take is not the actual drug the body needs, but is a precursor that will get converted to that actual drug we need, inside our body—usually by the liver, but not always. An example in this case is T4, which by definition is a pro-drug and won’t always get correctly converted to the T3 that a thyroid patient needs.

    Well that does indeed sound worthy of criticism. But what does she advise instead?

    First, she recommends a different diagnostic tool

    Instead of (or at least, in addition to) TSH tests, she advises to ask for TPO tests (thyroid peroxidase), and a test for Tg antibodies (thyroglobulin). She says these are elevated for many years before a change in TSH is seen.

    Next, identify the root cause and triggers

    These can differ from person to person, but in countries that add iodine to salt, that’s often a big factor. And while gluten may or may not be a factor, there’s a strong correlation between celiac disease and Hashimoto’s disease, so it is worth checking too. Same goes for lactose.

    By “checking”, here we mean testing eliminating it and seeing whether it makes a difference to energy levels—this can be slow, though, so give it time! It is best to do this under the guidance of a specialist if you can, of course.

    Next, get to work on repairing your insides.

    Remember we said “this can be slow”? It’s because your insides won’t necessarily bounce back immediately from whatever they’ve been suffering from for what’s likely many years. But, better late than never, and the time will pass anyway, so might as well get going on it.

    For this, she recommends a gut-healthy diet with specific dietary interventions for hypothyroidism. Rather than repeat ourselves unduly here, we’ll link to a couple of previous articles of ours, as her recommendations match these:

    She also recommends regular blood testing to see if you need supplementary TSH, TPO antibodies, and T3 and T4 hormones—as well as vitamin B12.

    Short version

    After diagnosis, she recommends the three Rs:

    • Remove the causes and triggers of your hypothyroidism, so far as possible
    • Repair the damage caused to your body, especially your gut
    • Replace the thyroid hormones and related things in which your body has become deficient

    Learn more

    If you’d like to learn more about this, she offers a resource page, with resources ranging from on-screen information, to books you can get, to links to hook you up with blood tests if you need them, as well as recommended supplements to consider.

    She also has a blog, which has an interesting relevant article added weekly.

    Enjoy, and take care of yourself!

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  • Can a child legally take puberty blockers? What if their parents disagree?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Young people’s access to gender-affirming medical care has been making headlines this week.

    Today, federal Health Minister Mark Butler announced a review into health care for trans and gender-diverse children and adolescents. The National Health and Medical Research Council will conduct the review.

    Yesterday, The Australian published an open letter to Prime Minister Anthony Albanese calling for a federal inquiry, and a nationwide pause on puberty blockers and hormone therapy for minors.

    This followed Queensland Health Minister Tim Nicholls earlier this week announcing an immediate pause on access to puberty blockers and hormone therapies for new patients under 18 in the state’s public health system, pending a review.

    In the United States, President Donald Trump signed an executive order this week directing federal agencies to restrict access to gender-affirming care for anyone under 19.

    This recent wave of political attention might imply gender-affirming care for young people is risky, controversial, perhaps even new.

    But Australian courts have already extensively tested questions about its legitimacy, the conditions under which it can be provided, and the scope and limits of parental powers to authorise it.

    MirasWonderland/Shutterstock

    What are puberty blockers?

    Puberty blockers suppress the release of oestrogen and testosterone, which are primarily responsible for the physical changes associated with puberty. They are generally safe and used in paediatric medicine for various conditions, including precocious (early) puberty, hormone disorders and some hormone-sensitive cancers.

    International and domestic standards of care state that puberty blockers are reversible, non-harmful, and can prevent young people from experiencing the distress of undergoing a puberty that does not align with their gender identity. They also give young people time to develop the maturity needed to make informed decisions about more permanent medical interventions further down the line.

    Puberty blockers are one type of gender-affirming care. This care includes medical, psychological and social interventions to support transgender, gender-diverse and, in some cases, intersex people.

    Young people in Australia need a medical diagnosis of gender dysphoria to receive this care. Gender dysphoria is defined as the psychological distress that can arise when a person’s gender identity does not align with their sex assigned at birth. This diagnosis is only granted after an exhaustive and often onerous medical assessment.

    After a diagnosis, treatment may involve hormones such as oestrogen or testosterone and/or puberty-blocking medications.

    Hormone therapies involving oestrogen and testosterone are only prescribed in Australia once a young person has been deemed capable of giving informed consent, usually around the age of 16. For puberty blockers, parents can consent at a younger age.

    Anonymous teenage girl at table, clutching hands
    Gender dysphoria comes with considerable psychological distress. slexp880/Shutterstock

    Can a child legally access puberty blockers?

    Gender-affirming care has been the subject of extensive debate in the Family Court of Australia (now the Federal Circuit and Family Court).

    Between 2004 and 2017, every minor who wanted to access gender-affirming care had to apply for a judge to approve it. However, medical professionals, human rights organisations and some judges condemned this process.

    In research for my forthcoming book, I found the Family Court has heard at least 99 cases about a young person’s gender-affirming care since 2004. Across these cases, the court examined the potential risks of gender-affirming treatment and considered whether parents should have the authority to consent on their child’s behalf.

    When determining whether parents can consent to a particular medical procedure for their child, the court must consider whether the treatment is “therapeutic” and whether there is a significant risk of a wrong decision being made.

    However, in a landmark 2017 case, the court ruled that judicial oversight was not required because gender-affirming treatments meet the standards of normal medical care.

    It reasoned that because these therapies address an internationally recognised medical condition, are supported by leading professional medical organisations, and are backed by robust clinical research, there is no justification for treating them differently from any other standard medical intervention. These principles still stand today.

    What if parents disagree?

    Sometimes parents disagree with decisions about gender-affirming care made by their child, or each other.

    As with all forms of health care, under Australian law, parents and legal guardians are responsible for making medical decisions on behalf of their children. That responsibility usually shifts once those children reach a sufficient age and level of maturity to make their own decisions.

    However, in another landmark case in 2020, the court ruled gender-affirming treatments cannot be given to minors without consent from both parents, even if the child is capable of providing their own consent. This means that if there is any disagreement among parents and the young person about either their capacity to consent or the legitimacy of the treatment, only a judge can authorise it.

    In such instances, the court must assess whether the proposed treatment is in the child’s best interests and make a determination accordingly. Again, these principals apply today.

    Parent talking with son/daughter outside, one hand on child's shoulder
    If a parent disagrees with their child, the matter can go to court. PeopleImages.com – Yuri A/Shutterstock

    Have the courts ever denied care?

    Across the at least 99 cases the court has heard about gender-affirming care since 2004, 17 have involved a parent opposing the treatment and one has involved neither parent supporting it.

    Regardless of parental support, in every case, the court has been responsible for determining whether gender-affirming treatment was in the child’s best interests. These decisions were based on medical evidence, expert testimony, and the specific circumstances of the young person involved.

    In all cases bar one, the court has found overwhelming evidence to support gender-affirming care, and approved it.

    Supporting transgender young people

    The history of Australia’s legal debates about gender-affirming care shows it has already been the subject of intense legal and medical scrutiny.

    Gender-affirming care is already difficult for young people to access, with many lacking the parental support required or facing other barriers to care.

    Gender-affirming care is potentially life-saving, or at the very least life-affirming. It almost invariably leads to better social and emotional outcomes. Further restricting access is not the “protection” its opponents claim.

    If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. For LGBTQIA+ peer support and resources, you can also contact Switchboard, QLife (call 1800 184 527), Queerspace, Transcend Australia (support for trans, gender-diverse, and non-binary young people and their families) or Minus18 (resources and community support for LGBTQIA+ young people).

    Matthew Mitchell, Lecturer in Criminology, Deakin University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • How Love Changes Your Brain

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    When we fall in love, have a romantic attachment, or have a sad breakup, there’s a lot going on neurochemically, and also with different parts of the brain taking the wheel. Dr. Shannon Odell explains:

    The neurochemistry of love

    Of course, not every love will follow this exact pattern, but here’s perhaps the most common one:

    Infatuation stage: This early phase is characterized by obsessive thoughts and a strong desire to be with the person. The ventral tegmental area (VTA), the brain’s reward center, becomes highly active, releasing dopamine, one of the feel-good neurotransmitters, which makes love feel intoxicating, similar to addictive substances. Additionally, activity in the prefrontal cortex, responsible for critical thinking and judgment, decreases, causing people to see their partners through “rose-tinted glasses”. However, this intense stage usually lasts only a few months.

    Attachment stage: As the relationship progresses, it shifts into a more stable and long-lasting phase. This stage is driven by oxytocin and vasopressin, hormones that promote trust/bonding and arousal, respectively. These same hormones also play a role in family and friendship connections. Oxytocin, in particular, reduces stress hormones, which is why spending time with a loved one can feel so calming.

    Heartbreak stage: When a relationship ends, the insular cortex processes emotional and physical pain, making heartbreak feel as painful as a physical injury. Meanwhile, the VTA remains active, leading to intense longing and cravings for the lost partner, similar to withdrawal symptoms. The stress axis also activates, causing distress and restlessness. Over time, higher brain regions help regulate these emotions. Healing strategies such as exercise, socializing, and listening to music can help by triggering dopamine release and easing the pain of heartbreak.

    For more on all of this, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like:

    Neurotransmitter Cheatsheet

    Take care!

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  • Built to Move – by Kelly starrett & Juliet Starrett

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    In our everyday lives, for most of us anyway, it’s not too important to be able to run a marathon or leg-press a car. Rather more important, however, are such things as:

    • being able to get up from the floor comfortably
    • reach something on a high shelf without twinging a shoulder
    • being able to put our socks on without making a whole plan around this task
    • get accidentally knocked by an energetic dog or child and not put our back out
    • etc

    Starrett and Starrett, of “becoming a supple leopard” fame, lay out for us how to make sure our mobility stays great. And, if it’s not already where it needs to be, how to get there.

    The “ten essential habits” mentioned in the subtitle “ten essential habits to help you move freely and live fully”, in fact also come with ten tests. No, not in the sense of arduous trials, but rather, mobility tests.

    For each test, it’s explained to us how to score it out of ten (this is an objective assessment, not subjective). It’s then explained how to “level up” whatever score we got, with different advices for different levels of mobility or immobility. And if we got a ten, then of course, we just build the appropriate recommended habit into our daily life, to keep it that way.

    The writing style is casual throughout, and a strong point of the book is its very clear illustrations, too.

    Bottom line: if you’d like to gain/maintain good mobility (at any age), this book gives a very reliable outline for doing so.

    Click here to check out Built to Move, and take care of your body!

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  • How To Recover Quickly From A Stomach Bug

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    How To Recover Quickly From A Stomach Bug

    Is it norovirus, or did you just eat something questionable? We’re not doctors, let alone your doctors, and certainly will not try to diagnose from afar. And as ever, if unsure and/or symptoms don’t go away or do get worse, seek professional medical advice.

    That out of the way, we can give some very good general-purpose tips for this one…

    Help your immune system to help you

    So far as you can, you want a happy healthy immune system. For the most part, we’d recommend the following things:

    Beyond Supplements: The Real Immune-Boosters!

    …but you probably don’t want to be exercising with a stomach bug, so perhaps sit that one out. Exercise is the preventative; what you need right now is rest.

    Hydrate—but watch out

    Hydration is critical for recovery especially if you have diarrhea, but drinking too much water too quickly will just make things worse. Great options for getting good hydration more slowly are:

    • Peppermint tea
      • (peppermint also has digestion-settling properties)
    • Ginger tea
    • Broths
      • These will also help replenish your sodium and other nutrients, gently. Chicken soup for your stomach, and all that. A great plant-based option is sweetcorn soup.
      • By broths, we mean clear(ish) water-based soups. This is definitely not the time for creamier soups.

    ❝Milk and dairy products should be avoided for 24 to 48 hours as they can make diarrhea worse.

    Initial dietary choices when refeeding should begin with soups and broth.❞

    Source: American College of Gastroenterology

    Other things to avoid

    Caffeine stimulates the digestion in a way that can make things worse.

    Fat is more difficult to digest, and should also be avoided until feeling better.

    To medicate or not to medicate?

    Loperamide (also known by the brand name Imodium) is generally safe when used as directed.

    Click here to see its uses, dosage, side effects, and contraindications

    Antibiotics may be necessary for certain microbial infections, but should not be anyone’s first-choice treatment unless advised otherwise by your doctor/pharmacist.

    Note that if your stomach bug is not something that requires antibiotics, then taking antibiotics can actually make it worse as the antibiotics wipe out your gut bacteria that were busy helping fight whatever’s going wrong in there:

    A gentler helper

    If you want to give your “good bacteria” a hand while giving pathogens a harder time of it, then a much safer home remedy is a little (seriously, do not over do it; we are talking 1–2 tablespoons, or around 20ml) apple cider vinegar, taken diluted in a glass of water.

    ❝Several studies indicate apple cider vinegar (ACV)’s usefulness in lowering postprandial glycemic response, specifically by slowing of gastric motility❞

    (Slowing gastric motility is usually exactly what you want in the case of a stomach bug, and apple cider vinegar)

    Source: Effectiveness of Nutritional Ingredients on Upper Gastrointestinal Conditions and Symptoms: A Narrative Review

    See also:

    Take care!

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  • The Osteoporosis Breakthrough – by Dr. Doug Lucas

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    “Osteoporosis” and “break” often don’t go well together, but here they do. So, what’s the breakthrough here?

    There isn’t one, honestly. But if we overlook the marketing choices and focus on the book itself, the content here is genuinely good:

    The book offers a comprehensive multivector approach to combatting osteoporosis, e.g:

    • Diet
    • Exercise
    • Other lifestyle considerations
    • Supplements
    • Hormones
    • Drugs

    The author considers drugs a good and important tool for some people with osteoporosis, but not most. The majority of people, he considers, will do better without drugs—by tackling things more holistically.

    The advice here is sound and covers all reasonable angles without getting hung up on the idea of there being a single magical solution for all.

    Bottom line: if you’re looking for a book that’s a one-stop-shop for strategies against osteoporosis, this is a good option.

    Click here to check out The Osteoporosis Breakthrough, and keep your bones strong!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

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