​Dr. Shanah Salter
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Medical Articles For
Parents & Caregivers

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​
​A health-related blog for parents and caregivers of young children,
with Australianisms thrown in for good measure!

​
​Back in Australia, the Land Down Under, I worked as a family physician treating snake and spider bites, colds and flus, and everything in between. Well, perhaps the snake bites are a slight exaggeration, but the spider bites are actually true. 

Now that I live in the U.S.A, I've exchanged clinical practice for blogging. So please read on and enjoy my chinwag (Aussie for chat) about all things health-related.
​
P.S. If there are any topics you would like to see covered, just give me a bell (Aussie for call/contact).

Sun-sense & Stingers

6/5/2017

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As we head toward lazy summer days filled with smiles and shenanigans, it is important to be thinking about sun protection and avoiding things that sting.

SUN-SENSE
A great Aussie campaign called SunSmart was created to teach Aussies about sun safety- I think everyone should know it. So, here are the 5 S’s of being SunSmart:
SLIP on clothing:
- clothing should cover as much skin as possible (so should bathers*)
- choose clothing with a good UV rating (check the garment label). Generally speaking, dark colored clothing with a tight weave offers good protection. Oh, and don’t forget that the UV rating of fabric drops when it gets wet.
SLOP on sunscreen:
- i.e. a water resistant, broad-spectrum (protects against UVA and UVB) sunscreen with an SPF rating of SPF30 or SPF50+. There is little difference between these two SPF ratings- 30 filters out 97% UVB, 50+ filters 98%.
- Apply 20-30 minutes before sun exposure and re-apply every 2 hours or sooner if excess sweating or swimming.
- Ensure the sunscreen you are applying is within date and not expired.
SLAP on a hat:
- Hats with a large brim so that the whole face, neck, top of head and ears are protected are best (think Crocodile Dundee* style)
SEEK shade:
- Children should not ‘sun-bathe’. Shade can be created with items such as big beach umbrellas, canopies, and tents.
SLIDE on sunglasses:
- Sunnies* should block UVA and UVB light. For kids, sunnies in the style of swimming goggles are great.

What about vitamin D?
The American Academy of Dermatology advises that vitamin D levels should be maintained through diet rather than UV exposure: fish, dairy, and fortified foods/beverages. Supplements can be used if advised by your physician.

What about skin cancer?
1 in 5 Americans will develop skin cancer. For Australians, that number is 2 in 3! Skin cancer is a leading cause of death and most cases are preventable through protected sun exposure, regardless of age.


STINGERS
As well as being irritating, stinging bugs (mozzies*, biting flies, ticks) can pose a serious disease risk (e.g. Lyme disease, Zika virus). So AVOID and if that doesn’t work, REPEL!
Bug avoidance strategies
- avoid use of scented soaps, perfumes, and scented hair products (i.e. don’t smell like a flower!)
- stay away from areas where insects nest/congregate such as stagnant water and blooming flowers
- manage areas near your home that may encourage breeding of stinging bugs such as ponds and damp leaf litter and treat your pets for ticks
- ensure screens are fitted on all windows and repair any holes in old screens
- consider enclosing your verandah* with framed netting
- cover-up as much skin as possible with appropriate clothing when outdoors
- avoid being outdoors in peak stinger time e.g. peak barbie* time- dusk
- after time out-doors, perform a tick-inspection on family members clothing and skin. Remove any ticks promptly with fine-tipped tweezers and flush down the toilet. Ticks on clothing can be killed with a hot machine wash and low tumble dry. Consult a doctor if a rash or fever begins within a few weeks of tick removal to ensure it is not tick-related.

Repellant
- use repellant in addition to bug avoidance strategies when required
- never use a sunscreen/repellant combination as sunscreen needs to be reapplied far more frequently (excess use of repellant can be dangerous)
- do not use any type of repellant on a baby younger than 2 months of age
- products containing 20% DEET (only use <30% DEET on kids) or 20% picaridin will provide the best protection for serious situations (e.g. high risk areas, overseas travel).
- Natural repellants containing various blends of citronella/eucalyptus/mint/lemongrass/pine/other herbal ingredients are in abundance. Unfortunately, to date, there is a lack of high quality evidence to support the effectiveness of these products. Anecdotally, people say they work (especially in the first hour after application) but remember, ‘natural’ isn’t always safe. For example, oil of lemon eucalyptus should not be used on children under 3 years of age.
- Regardless of which repellant you choose, follow these tips for maximizing repellant safety:
     • Only apply repellant to exposed skin.
     • Do not allow children to apply their own repellant. A responsible adult should apply the repellant- avoiding the          hands, eyes, nose, and mouth and applying as per the product label. Repellant should not be applied to broken or          irritated skin.
     • Children should not consume food or drink while wearing repellant if there is a chance that the repellant from            their skin could contaminate the food/drink, resulting in repellant ingestion.
     • After returning indoors, repellant should be washed off the skin immediately and clothes sprayed with repellent          should be promptly removed and laundered.
     • Before using a repellant for the first time, perform a test patch to check for sensitivity/skin irritation

FOR MORE INFORMATION:
American Academy of Dermatology
https://www.aad.org/media/news-releases/sunscreen-remains-a-safe-effective-form-of-sun-protection
Cancer Council Australia
http://www.cancer.org.au/preventing-cancer/sun-protection/
CDC- Bug Bites
https://wwwnc.cdc.gov/travel/page/avoid-bug-bites
Study on natural repellants
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059459/

AUSTRALIAN-ISMS:
Barbie = short for barbecue = an outdoor grill
Bathers/togs/swimmers = any type of swim-wear e.g. swimsuit, bikini
Crocodile Dundee: if you haven’t heard of this classic Aussie movie, you’re missing out
Mozzie = mosquito (remember Aussies abbreviate everything)
Sunnies= sunglasses (abbreviating again!)
Verandah = porch
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Sublime Slumber

4/28/2017

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Ever wondered if striving for sublime slumber matters? Bloody oath* it does!

Why sleep matters
Poor quality sleep and/or an inadequate amount of sleep leads to:
  • Daytime sleepiness and irritability
  • Reduced concentration and attention -> learning difficulties
  • Hyperactivity (sleep-deprived kids may be misdiagnosed as ADHD)
  • Inadequate growth and cardiovascular problems (due to apnea- see below)

How to ensure a sublime slumber for your bub*
  • Make sure your child is getting an age appropriate amount of sleep. For 3-5 year olds this is 10-13hours of sleep/24 hours (including naps). Adults need 7+ hours/24 hours.
  • Don’t be fooled into thinking your child needs less sleep if they are hyperactive, stroppy*, feral* larrikins* at bedtime or wake overnight- this likely indicates they are overtired and need MORE sleep (try putting them to bed 20minutes EARLIER than usual)
  • Ensure consistent sleep and waking times
  • Have a set routine/wind-down sequence in the 30-45 minute interval before bed e.g. bath, pajamas, teeth, stories (no screen time or wild play)
  • Bedroom should be dark (black-out curtains are great!) and cool (ideally 68-70 degrees)
  • Discourage early rising by use of a clock or an okay-to-wake device that changes color when it is an acceptable time for the child to get up

Snoring
Snoring is defined as a noise caused by partial blockage of air passage through the back of the mouth when inhaling.
Occasional snoring can be a sign of an allergy, stuffy nose or respiratory infection.
Loud and regular snoring is often ABNORMAL in an otherwise healthy child and must be investigated. OBSTRUCTIVE SLEEP APNEA may be the cause.

Obstructive Sleep Apnea
Refers to a condition of intermittent airflow blockage during sleep. In its most severe form it can impact oxygen flow to vital organs such as the heart.
It is estimated that 3-12% of children snore while 1-10% of children have sleep apnea syndrome.
The most common cause of sleep apnea in children is enlarged adenoids/tonsils.
Untreated, sleep apnea leads to reduced growth, bedwetting, attention disorders, behavioral problems, poor academic performance, and heart/lung problems.
Symptoms:
  • Snoring
  • Mouth breathing and sucking in ribcage when inhaling during sleep
  • Unusual sleep position e.g. head tilted right back/neck hyper-extended
  • Chronic bed-wetting
  • Complaining of morning headaches
  • Feeling tired/flaking out* or needing a kip* (once naps given up) during the day
  • Issues with hyperactivity/inattention at school
  • Frequent overnight waking and night terrors
  • Gasps, pauses in breathing, and snorts during sleep

Diagnosis:
If your child is a frequent/nightly loud snorer please alert your pediatrician so they can consider a sleep apnea assessment. The assessment usually includes a questionnaire (asking about symptoms), review by an ENT/sleep specialist and an overnight sleep study.
Treatment:
Treatment depends on the cause of apnea. In children, adenoid/tonsil removal is usually all that is required. Weight loss (if severe obesity), jaw devices, and/or ventilation (CPAP) machines are used in some instances.

Further Reading
http://sleepfoundation.org
http://sleepcenter.ucla.edu/child-snore

*Australianisms
Bloody oath- certainly/absolutely
Bub- baby/child
Feral- wild
Flake- collapse from tiredness/fall asleep
Kip- nap
Larrikin- mischievous/wild person
Stroppy- irritable





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Spring Into Spring!

3/24/2017

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Although you wouldn’t know it (thanks to recent LARGE snow dumps), spring is here! Hooray, this Aussie survived another Chicago winter! It will be so wonderful to watch plants come back to life and flowers bloom, but allergies will abound soon, too.
​
So, read on, blokes and sheilas* to help keep the spring in allergy sufferers’ steps this spring.

Seasonal Allergy Checklist
✓ Start prescribed antihistamines and nasal sprays BEFORE allergies get bad
o Oral medications help sneezing and itchiness; nasal sprays tend to help nasal symptoms. Speak to your physician before embarking on daily allergy treatment. If treatment and avoidance strategies are not successful, you can always request referral to an allergist for testing and to discuss next steps such as allergy immunotherapy.
o Cold compresses on itchy eyes, saline nasal sprays/irrigation for congested noses and use of soft tissues with lotion can also help.
✓ Plan outdoor activities when pollen levels are low (the arvo* is best!)
o Pollen levels tend to peak mid-morning, early evening and in windy weather.
✓ Keep windows closed and use an air conditioner (if available), preferably with a HEPA filter. o Avoid the temptation to ‘air out’ the house, keep pollens OUT.
✓ Wash off allergens before sleep
o Have children bathe/shower (and wash hair) before bed to make sure all pollens are washed away before sleep time.

Is it an allergy?
It can be tricky to tell a cold from an allergy flare. The combination of sneezing with nose, throat, and eye itchiness PLUS nasal congestion usually suggests an allergy, whereas fever PLUS nasal congestion suggests a cold. Additionally, nasal mucous from an allergy is usually clear, and watery, like a cuppa without milk.*

Do allergies matter?
The symptoms of untreated allergies irritate and distract. At night, this can lead to poor quality sleep. In the day, this can lead to reduced concentration, impact learning, and cause a whole lot of sooking*. Additionally, asthma sufferers can experience dangerous asthma flares if allergies are left untreated. Allergies can also inflame the ears and the cause fluid accumulation, which may promote ear infections and reduce hearing (and subsequent learning).

Want to know more? 
American Academy of Asthma, Allergies & Immunology (aaaai.org) has lots of great information for further reading.

Enjoy spring, mates!

P.S Don’t forget to re-commence sunscreen use as days get warmer and outdoor play begins again (with skin exposed as opposed to being covered with kilos* of clothing!) PLUS always think about water intake and maintaining hydration.

* Australianisms
Arvo= afternoon (Australians are lazy, they abbreviate every word possible!)
Blokes and sheilas = gentlemen and ladies
Cuppa without milk= cuppa refers to a cup of tea. Australians typically drink black tea with milk (NOT CREAM!!)
Kilo= kilogram = a much more sensible measure of weight than the pound ;)
Sooking= moping/feeling miserable/complaining
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Knowing Noses

2/3/2017

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How are your family doing this winter? Are your cuties happy little Vegemites*? Is everyone much healthier than normal, thanks to the mild weather?

Unfortunately, preschoolers get crook* with a cold (viral upper respiratory tract infection) around 8-10 times per year. Each of these colds lasts around 10-14 days and most are clustered in winter and spring. So if it feels like your kids have been snot machines the entire winter- they probably were! But how do you know a nose?

Stages of Snot (during a cold)
Days 1-2: thin clear mucous from nose as body attempts to wash away germs
Days 3-4: mucous changes from clear to white/yellow as our immune cells fight
Days 4 on: mucous develops a green tinge as normal nose bacteria re-populate 5 Yes! You do need to have a captain cook*. Tissue checks are advised. Yes! Green is (initially) good! BUT if green mucous lasts for more than 10-14 days or is associated with increasing fevers or increasing sinus pain- consult a doctor.

How You Can Help
- Make sure your child is getting plenty of fluids and is well hydrated.
- Teach nose blowing and good tissue hygiene (no bush hankies* please!)
- Use acetaminophen or ibuprofen as needed for fevers and aches/pains
- Consider a cool mist vaporizer or room humidifier
- Help clear the nose and sinus passages with saline nose drops or a saline irrigation system e.g. neti pot. As well as mucous clearing, saline reduces inflammation in the nasal/sinus passages.
- Avoid medicated nose drops/sprays in children under 6 (they have limited evidence regarding effectiveness and can be dangerous)
- Don’t rush to start antibiotics unless advised by a doctor (antibiotics can’t treat viruses. Taking antibiotics unnecessarily can lead to antibiotic resistance –> that means when you child really needs antibiotics they may not work)

Want to read more?
Sniffle or Sneeze? No Antibiotics Please (CDC ARTICLE) https://www.cdc.gov/getsmart/community/downloads/sniffle-sneeze-matte.pdf

*Australianisms 
Happy little vegemites: from the famous vegemite spread TV commercial, which focuses on children being healthy, thanks to vegemite consumption!
Crook: feeling sick or unwell
Captain Cook: to have a look. Captain Cook was a famous explorer.
Bush hankie: blowing your nose into the air or your hand (without using a tissue or handkerchief)
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Winter Warmers

11/18/2016

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Are you gearing up for a snowy, chilly festive season? This Aussie is certainly going to be rugging* up (a high of 40 degrees would be an extremely cold and unusual winter’s day in Sydney, Australia).
So, here are some winter warmers (with thanks to the American Academy of Pediatrics and the CDC) to keep you all safe and toasty for the big chill ahead.

Dress for success
It is advisable to dress your ankle biter* in one more layer of clothing than you would wear in the same conditions. (Think- flannie*, jumper*, trackie daks*) As for outerwear, the school heads to the playground as long as it is not below 15 degrees outside (gross motor activity must continue, thank you brave teachers!).
Therefore, sending your child to school with appropriate clothing is essential-
 Waterproof snow pants/bib
 Waterproof, non-slip snow boots WITH SOCKS
 Waterproof snow jacket
 Hat (with ear coverage)
 Neck gaiter (optional)  Balaclava (optional)
 Mittens/gloves (need to put on without assistance. Jacket fasteners are helpful too)
(Note- scarves are not safe, think strangulation and falls)
The order here is important from a practical perspective (it can be hard to reach your boots with a bulky jacket on!).
Practice this dressing sequence at home until your ankle-biter becomes proficient, the teachers will thank you for it! And make sure to LABEL EVERYTHING with a marker so items don’t go missing (or get placed on another child).

Have Skin Sense
Consider putting these 3 things on your winter radar-  Skin dries out in winter and dry skin can be itchy, or even become sore and crack. So avoid very hot baths/showers and apply body moisturizer liberally and regularly. Plus, consider a barrier cream (e.g. petrolatum) for delicate exposed areas such as cheeks/lips.
 Even though it is cold, sunburn can still occur, particularly with light reflection off the snow. Use sunscreen on exposed skin if you plan on being outside for a while.
 Take care of that delicate skin inside the nose, especially for little ones who nose pick or tend to suffer from winter nosebleeds. Saline nose drops, petrolatum barrier cream applied inside the nose and nighttime bedroom humidifiers can all help.

Stay Safe In The Car
- When riding in the car, children should wear thin snug layers rather than bulky snow gear. This allows the harness to stay tight and keep them safe in the event of an accident.
- Keep a flashlight, snacks and warm blankets in your trunk in case you get stranded and help is a while away.

In The Home
- Have a safe alternate heating source (and fuel), non-perishable food, bottled water and a flashlight in case of power outages.
- Keep all space heaters at least 3 feet away from anything that could burn, and turn them off when you leave the room or go to sleep.
- Install smoke and carbon monoxide detectors and check them regularly to ensure functionality.

Outdoors
- Ankle-biters should wear helmets for ice-skating, sledding and skiing
- Set reasonable limits on outdoor play and beware of hypothermia and frostbite. Come inside periodically to warm up, and watch for wet clothing.

*Australianisms
Ankle biter- young child
Flannie- flannel shirt, popular amongst Australian farmers/country folk
Jumper- sweater/pullover/jersey
Rugging up- putting extra layers of clothing on to stay warm
Trakie daks- fleece
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Safe Spooking!

10/21/2016

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Ready to get your Halloween on? Want to enjoy fun and frights, instead of injuries or ill health?

In Oz*, Halloween has always been an in/out fad; some years it seems the streets are teeming with witches and ghosts, then the next it’ll be as quiet as a kookaburra with a gob full of worms*. In the land of the stars and stripes, however, Halloween is always huge! In fact, it’s such a big deal that even the Center for Disease Control (CDC) writes safety recommendations and health warnings (included within).

So without further mucking* around, read on mates* to learn how to spook safely this year!

Home safety
Before you start decking out your castle* in spectacular haunted trimmings, consider fire safety and falls minimization. For example, beware flammable decorations near fireplaces, decorative light bulb chains near young nippers*, and ropes and cords along walkways. And don’t just think about the inside; make sure the outside is safe too.
Protecting trick-or-treaters by trimming overhanging branches, and ensuring the path to the front door is well lit and clear of obstacles is a good place to start.

Costume Safety
Before you get your nippers* all scrubbed up*, check
- Costume labels for flame resistance
- Costume length (long costumes can get caught underfoot and result in a fall) - Ties/straps that could pose a strangulation risk
- Masks that could reduce the wearer’s visual field - Props/accessories that may be sharp or dangerous (e.g. knives)
Also, beware of fancy light up costumes; whilst dazzling, they can be a disaster. Besides being a fire hazard, they are often powered by button batteries, which, if swallowed, can be fatal.

Allergen Caution
Protect skin by performing a patch test on the inner arm before applying face paints/make ups. Regarding food allergy concerns, the best advice is to avoid putting any foods in your gob* that you cannot confidently confirm are allergen free. Instead, consider a candy trade with your child (they trade you candy they have collected for a safe treat- e.g. home-made cupcakes, safe candy, small non-food gifts, screen time etc.). The candy can then be donated to charity if you don’t want to be left with a source for midnight sugar binges (e.g. Operation Gratitude, which sends candy to U.S troops).
Also, look out for teal pumpkins on your trick-or-treat route and consider this for your own home. The Teal Pumpkin Project was started by FARE (Food Allergy Research & Education). You simply place a pumpkin, painted in the color teal, on your doorstep if your household offers non-food treats (check out the website for more information: www.tealpumpkinproject.org).

External Threat Avoidance
Road safety is important, cars going flat chat* can come out of nowhere, including driveways. Supervise young children closely and consider placing reflective tape on costumes, carrying a torch* and walking in groups rather than alone.
In regard to treats, be mindful when accepting treats from strangers and inspect for tampering and choking hazards (as well as allergens, of course!).

Aim for Health
People with medical conditions should seek advice from their health professional about any particular things they should consider before trick-or-treating. For example, asthmatics should carry inhalers with them (in case of smoke machine irritation) and those with severe food allergies should carry rescue medications with them (in case of accidental allergen ingestion).

Ok, enough with the safety spiel, it’s spooking time!

*Australianisms
Castle: a home (from the old English proverb ‘a man’s home is his castle’, made popular in Australia by the Australian film “The Castle”)
Flat chat: fast
Gob: mouth
Kookaburra: a native Australian bird, which is known for calling loudly, but with a mouth full of worms, is quiet.
Mate: friend Mucking around: messing about, wasting time
Nippers: kids (Nippers is actually the name given to children who are learning surf life saving, but colloquially it also refers to children in general)
Oz: Australia
Scrubbed up: dressed up/nicely
Torch: flashlight
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Fabulous Fall & Flicking The Flu

9/23/2016

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The leaves are beginning to change color and fall like art in motion. Fall is a truly beautiful showcase of Mother Nature, and one that goes largely unnoticed in Australia, where it is usually hot or hotter.
So, let’s enjoy this spectacular season, by keeping our families and community well. Ok, that is a tall order. At the very least, let’s aim for minimizing the spread of germs; let’s stop flicking the flu (i.e. passing the flu on) to others. Hopefully, these tips will help-

STOP FLICKING THE FLU WITH THESE TIPS:
1/ Look for the early warning signs of a cold/flu. If any of these signs are present, keep your child home from school until they are well or have been cleared by your pediatrician as ‘safe for school.’
People with a cold/flu are actually contagious several days before any classic symptoms
(such as fever, cough, nasal discharge) appear. This period of high infectivity then continues for the first few days of classic symptoms too. Whilst it is hard (even for
fair dinkum* MD’s) to diagnose a cold/flu before classic symptoms begin, there are usually early warning signs.
So, lose the she’ll be right mate* attitude, and keep your child home from school when you suspect a cold/flu is brewing. In doing so, you are not only looking after the well-being of your child (who is not going to be fit to learn anyway, due to low energy and poor concentration associated with the ensuing viral illness), but also protecting the school community from the spread of germs.
Early warning signs of a cold/flu may include-
- Sudden, excessive fatigue (e.g. day napping in a nap free child, falling asleep in car) - Extraordinary level of grumpiness/irritability
- Complaining of body aches and/or chills
- Lack of appetite
- Lack of energy during playtime - Reduced concentration on tasks
Classic cold/flu symptoms include-
- Elevated body temperature (fever i.e. 101 F or greater)
- Nasal discharge (whilst this symptom is also common in allergy sufferers, if unsure of the
cause, keep your child at home until they have been reviewed by your pediatrician) - Sneezing
- Coughing
- Body rash
- Red and sore throat - Vomiting or diarrhea

2/ Reduce the spread of germs by encouraging germ minimization strategies in your home
such as hand washing and mouth covering (with an elbow) during coughing/sneezing

Whilst we don't want our children to become germophobes or obsessive hand washers, it is important to make children aware of their role in community health.
For example, using an elbow to cover the mouth when coughing/sneezing, and regular hand washing. The importance of childhood immunizations and flu vaccinations in germ harm reduction can also be explained.

Your local library will have various books on the subject. Some great reads include- Germs, Germs, Germs by Bobbi Katz, Germs Make Me Sick by Melvin Berger, and The Berenstain Bears Come Clean for School by Jan & Mike Berenstain.

If you are interested in organizing a germ presentation at your school, local library or parent/child meeting, don't hesitate to give me a bell* and we can chinwag* about it.


That’s it for now! Stay tuned for more Down Under Doc soon.

*Australianisms:
• Chinwag: a chat/discussion
• Give me a bell: phone me (click on 'contact' at the top of this page to email me)
• Fair dinkum: in this context it means ‘genuine’, but can also mean ‘wow’
• She’ll be right mate: typical (sometimes inappropriate) laid back/ ‘everything will be
fine’/no stress attitude of many Australians 

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