Lauryn Schroeder

Enterprise Data Reporter

Hot Spots: Pinpointing Shaken-Baby Syndrome Cases

My new story for The Medill Justice Project has officially been published! It is by far the most difficult piece of journalism I have ever dared to tackle, with months of data verification, and weeks of analyzing the numbers, reporting and writing the actual story. Despite the headaches, lack of sleep and loss of personal time, I think it turned out well! Check it out on The Medill Justice Project's website or read the reposted version below. Enjoy!

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Sarpy, Neb. Richmond, Ga. Weber, Utah. Douglas, Neb. Summit, Ohio.

These unheralded counties throughout the nation share an unlikely distinction. They have the highest rates of shaken-baby syndrome cases in the United States, adjusting for population, according to a new Medill Justice Project study on this criminal justice concern.

On a statewide level, Nebraska ranks first with the most shaken-baby syndrome cases per 100,000 people, followed in order by Utah, Oklahoma, Wisconsin and Ohio.

This is the first known study that has identified where people are being accused of shaken-baby syndrome crimes throughout the country. Given the complexity of the issue and lack of public records, it has taken The Medill Justice Project a year and a half to collect, verify and analyze more than 3,000 cases and identify countrywide patterns and trends. That number of accusations is primarily comprised of criminal charges but also includes some instances where individuals were accused but not charged, or charges were dropped. Not even the FBI’s Uniform Crime Reporting program, with data collected by nearly 17,000 U.S. law enforcement agencies, specifically identifies shaken-baby syndrome crimes.

Criminal justice experts, statisticians, health authorities and others interviewed for this article offered several possible explanations for the higher rates of cases in certain regions. The factors include aggressive prosecutors in places like Queens, N.Y.; influential physicians, medical examiners and hospitals; particularly focused state laws; and a large amount of local media attention on shaken-baby syndrome issues.

All of the factors contributing to a locality’s higher rate of cases could not be determined. A higher rate, for instance, could mean authorities are being effective in catching the cases when they occur, or it could mean there is a high number of caregivers who are violently shaking infants. Bias in the media and misdiagnoses may also be impacting the number of reported accusations, experts said.

With the publication of this article, The Medill Justice Project is releasing its database on shaken-baby syndrome cases to the public for the first time. The Medill Justice Project hopes the public will use this information to better understand this largely opaque issue, which affects families throughout the nation.

“I think that it’s incredibly important we have this quantitative data to help explain this,” said Deborah Tuerkheimer, a professor of law at DePaul University in Chicago who has written about shaken-baby syndrome and the courts. “It’s much more powerful that you have evidence that this is going on in certain places more than others.”

Shaken-Baby Debate

The issues surrounding shaken-baby syndrome or its broader term, abusive head trauma, are the focus of a growing national discussion within the medical community and criminal justice system. In cases involving shaken-baby syndrome, caregivers are accused of violently shaking an infant, typically under the age of 2, inflicting severe head trauma that may lead in some cases to the infant’s death.

The diagnosis is marked by a triad of symptoms: brain bleeding, brain swelling and bleeding within the eyes. Recent medical studies show accidental trauma and other medical conditions may mimic the symptoms of shaken-baby syndrome, and forensic experts have started to question whether the triad of symptoms is pathognomonic, or exclusively characteristic, of shaken-baby syndrome.

“Everyone wants it to be a clear-cut case, where these symptoms mean this and nothing else,” said Dr. Michael Laposata, director of laboratory medicine in the department of pathology at Vanderbilt University Medical Center in Nashville, Tenn. “But nothing about shaken-baby syndrome is pathognomonic.”

Laposata said he has been involved in the evaluation of more than 50,000 cases of patients with excess bleeding or abnormal clotting disorders. Laposata, whose research focuses on cases of medical error, particularly the over-diagnosis of child abuse, said while many shaken-baby syndrome cases include corroborating medical evidence such as cuts, bruises, burns or broken arms and legs, other cases do not. He said he believes innocent people have been imprisoned for crimes they did not commit.

“There must be hundreds,” Laposata said. As an expert witness in legal cases, he said, “I have around 40 cases that look like they’re misdiagnosed, and I’m just one doctor.”

Dr. Randell Alexander, clinical professor of pediatrics at the University of Florida in Jacksonville and a member of the international advisory board for the National Center on Shaken Baby Syndrome in Farmington, Utah, acknowledged misdiagnoses are possible.

“I hope it doesn’t happen, but it’s not impossible,” he said. “These are heavy-duty decisions where someone’s life is involved, and so I do think we need to be sure that it’s a thoughtful process and we’re getting it right.”

Sarpy and Douglas County, Neb.

Sarpy County, the smallest county in Nebraska by area but the third largest in population, has the highest rate of shaken-baby syndrome cases in the United States, 7.45 per 100,000 people, according to the study. Just to the north of Sarpy, Douglas County is ranked fourth in the nation for its rate of shaken-baby syndrome cases. Encompassing the city of Omaha containing the state’s largest population, Douglas has a rate of 4.85 cases per 100,000 people. The counties’ higher rates are partly due to the impact of Nebraska laws, experts said, including one in 1992 requiring every county to create a multidisciplinary team to investigate child abuse or neglect cases.

The team—comprised of law enforcement, child advocacy centers, prosecutors, the Department of Health and Human Services and medical professionals—was established to help reduce the high number of infant mortalities in Nebraska and create a statewide standard for child abuse case investigations. Public health experts said the effects of the law are felt more in Sarpy and Douglas because the two counties have more than 30 percent of the state’s population.

The agencies on the team “review the cases together and if they need help they assist each other,” said Sarpy County Attorney Lee Polikov, who has acted as the lead prosecutor in Sarpy since 1999. “[The law] added continuity and consistency in the area instead of having multiple agencies try and tackle a problem independently.”

Michael D. Nelson, an Omaha criminal defense attorney for more than 20 years, said the teams help set a standard for investigations but they can also lead to quick prosecutions.

“Being a team also means that they will get together on a case and all go in one direction instead of investigating into other possibilities,” he said. “When you do that you break the golden rule in the criminal justice system, which is we don’t want to convict innocent people.”

Nelson recently represented a 30-year-old Omaha babysitter who was found not guilty last year in the shaking death of her cousin’s 16-month-old daughter. The judge cited authorities’ lack of investigatory evidence.

Nelson said the area’s higher rate of shaken-baby syndrome cases may also be connected to a Nebraska law requiring each lead county attorney to also be the county’s coroner, or chief death investigator. Nebraska is the only state in the nation that requires all of its counties to follow such a law.

As coroner, Nebraska county attorneys determine whether an autopsy is performed and oversee suspicious death investigations to declare a cause of death. According to a recent study of medical examiner and coroner systems in the United States, the systems are organized at a county, regional or statewide level, depending on the laws in each state. Medical examiners are physicians, usually with training in pathology, death investigation and forensic autopsies. Coroners are elected or appointed officials and most states implementing this method require those officials to have death investigation training or a medical background.

According to a 2008 Nebraska survey of the state’s county coroners that examined its system and death investigation procedures, 32.2 percent of county attorneys surveyed believed the system’s weakness was a lack of training in forensic science and technology. Additionally, 28.8 percent believed the lack of expertise could result in mistakes being made during major investigations. In survey comments, one attorney said, “I am afraid I will make a horrible mistake because of my lack of expertise and this antiquated system.”

Until 2009, when a law was revised, there was no requirement for Nebraska county attorneys to have specialized medical training in death investigations, nor were they legally required to consult with a certified forensic pathologist in the event of an autopsy. Brenda Beadle, the deputy county attorney in Douglas, said training is now continuous and county attorneys are required to attend an annual death investigation education course. Other counties offer additional programs ranging from attending two annual workshops in investigating deaths to a 10-week forensic school. The law also requires coroners to contract with regionally based coroner physicians, who are trained pathologists at local medical centers.

“Because I have to make a medical determination, and I am not medically trained, I almost always require that an autopsy be done,” Polikov, the Sarpy County Attorney, said. “I trust the pathologists that we contract with, and I only have pathologists I trust do the job.”

Douglas County Attorney Don Kleine, who is also the county coroner, said Douglas employs five coroner physicians who assist in determining the cause of death. Kleine said his office also relies on the opinion of local physicians.

Douglas public defender Scott C. Sladek said he believes some physicians are not adequately considering other causes of death when making a diagnosis.

“When they see certain injuries, the cause is attributed much more to shaken-baby syndrome than any other possibilities,” he said.

 

Richmond County, Ga.

About two hours east of Atlanta, Richmond County, Ga., ranks second in the country for shaken-baby syndrome cases with a rate of 6.12 per 100,000 people in part because of a highly concentrated local medical system that is attuned to shaken-baby syndrome cases.

Lt. Calvin Chew, who has worked in law enforcement for more than 20 years and is the director of the internal affairs division at the Richmond County Sheriff’s Office, said his office is frequently referred cases from local hospitals.

“If the child comes in with certain injuries, and [hospital officials] think there’s something suspicious about it, they will ask us to investigate,” Chew said. “So we get referred cases for just child abuse all the time.”

Augusta, Richmond’s largest city, is home to a sizeable medical community including Doctors Hospital of Augusta, Children’s Hospital of Georgia Pediatric Surgery, Georgia Regents Medical Center, Trinity Hospital, University Hospital, Aiken Regional Medical Centers, Medical College of Georgia Hospital and Clinics, Charlie Norwood VA Medical Center, Dwight D. Eisenhower Army Medical Center, East Central Regional Hospital and several small medical practices and specialized treatment centers.

Tuerkheimer, the DePaul University law professor, said certain hospital systems are more predisposed to making a shaken-baby syndrome diagnosis. In her research, Tuerkheimer said she identified certain hospitals, doctors, hospital systems and child abuse programs more frequently than others. She declined to identify the specific hospital systems but said her research was consistent with the findings of this study.

“To a certain extent, it is probably linked to the mindset of a doctor or a hospital system as a whole,” she said. “We know now that the triad doesn’t prove shaking anymore, but depending on who’s doing the ruling out of other causes…the mindset going into a diagnosis will certainly influence their result.”

Dr. Maureen Claiborne, a pediatrician at Georgia Regents Medical Center in Augusta who handles many child abuse cases brought to the hospital, said when there is an unexplained injury or death of a child, the hospital calls Department of Human Services and law enforcement officials to investigate the case. She also said the child goes through an extensive testing process and analysis before any diagnosis is made. Analyses include CT scans and full skeletal X-rays in addition to extensive blood tests to rule out clotting disorders and other underlying causes. The doctors take a full medical history from the parents, and an ophthalmologist evaluates the child for retinal bleeding.

“Basically we’re trying to make sure the child doesn’t have any underlying cause for the type of injury we’re seeing,” she said. “You don’t want to accuse someone of shaking their baby if the child has an underlying problem.”

Claiborne, who has worked at Georgia Regents for more than 20 years, said the diagnostic process hasn’t always been this thorough, and during her career the methods have been adjusted as the medical community’s understanding of shaken-baby syndrome grows.

“There are borderline cases and there are clear-cut cases,” she said. “But we do our best.”

Claiborne was unsure how many shaken-baby syndrome cases have come through the hospital but said she serves as an expert witness in Richmond child abuse cases about two or three times a year.

Sandy Hodson, a veteran reporter for The Augusta Chronicle who writes about crime, the courts and legal issues, said she covers at least one case of shaken-baby syndrome each year and that child abuse problems are not just local but statewide.

In 1989, Jane O. Hansen, a reporter from the Atlanta Journal-Constitution, reported 51 Georgia children died in 1988 after local child services departments had received notice about alleged maltreatment or neglect. Hansen’s work sparked a further Atlanta Journal-Constitution investigation, which helped uncover hundreds of wrongful or preventable deaths where caseworkers from the Division of Family and Children Services had failed to detect or report evidence of child abuse. The findings caught the attention of then-Gov. Roy Barnes, who ordered the Georgia Bureau of Investigations to seize the agency’s records.

“I think there is a realization that we have a problem with child abuse here in Georgia,” Hodson said.

The Richmond District Attorney’s Office did not respond to several requests for comment.

Weber County, Utah

Weber County, Utah, which includes Ogden-Clearfield, a metropolitan area Forbes named one of the best communities in the country to raise a family in 2010, is ranked third nationally in the number of shaken-baby syndrome cases with a rate of 5.06 per 100,000 people. Experts said the high rate may be due to a quirk of geography.

A manager of Weber-Morgan Children’s Justice Center, which serves children who suffer from sexual or physical abuse, said she was surprised by the results but surmised the high rate may be due to increased awareness of shaken-baby syndrome in the area. The National Center on Shaken-Baby Syndrome, one of the main organizations that works worldwide to educate and prevent this type of child abuse, used to be headquartered in Weber County. The center moved about 15 miles south to Farmington, Utah, in 2011.

Amy Wicks, an information and research specialist for the National Center on Shaken Baby Syndrome, said media coverage plays a bigger role than the location of the organization’s headquarters, because the center works internationally, not just locally.

“Sometimes small publications have the resources to allow reporters to cover court cases and sometimes they don’t,” Wicks said. “We’ve had local training conferences in Salt Lake before, but we’ve also had conferences” elsewhere.

Richard Spitzer, chief executive officer of TrendPointers, a predictive media analytics company headquartered outside of Chicago, agreed media coverage may play a role in a community’s awareness of shaken-baby syndrome. Spitzer said newsworthiness of an issue depends on several variables in each media market, but the amount of attention a story receives can be controlled by the public’s awareness of a certain subject. This means news publications would be more likely to cover an issue or event that falls within the public’s interest, and Spitzer said this might alter the perception of how often crimes occur.

“In general, [the media] does the best it can to cover important issues,” Spitzer said. “But there have been many reports indicating that the unevenness in criminal reporting distorts the true picture.”

Summit County, Ohio

Summit County, Ohio, just south of Cleveland, ranks fifth nationally in shaken-baby syndrome cases, with a rate of 4.55 cases per 100,000 people. The higher rate may be due in part to influential doctors. Donald Caster, an attorney for the Ohio Innocence Project at the University of Cincinnati, said the project noticed an unusually high number of shaken-baby syndrome cases in Summit. Further research led the project to physicians at Akron Children’s Hospital in the county’s most populous city.

An article published by a local Ohio newspaper in 2009 stated that in a little more than two years, 36 cases of shaken-baby syndrome had been reported in a 25-county area served by Akron Children’s Hospital. Caster said Dr. Richard Daryl Steiner, director of the hospital’s child abuse center, has testified as an expert witness in many cases throughout the northeastern part of Ohio.

Caster cited, for instance, a 2011 case in which a Columbiana County, Ohio, juvenile court judge expressed concerns about Steiner’s diagnosis in one case, according to court records obtained for this article. In the court’s written statement, the judge said he was “somewhat shocked” Steiner used “deductive reasoning” to arrive at his diagnosis of child abuse in the case before him. The judge also said, “To simply say I cannot find any reason for this condition; therefore, it must be child abuse is, in the Court’s opinion, taking a rather cavalier attitude toward a serious matter.” The judge dismissed the child abuse case against the parents. Through a hospital spokesperson, Dr. Steiner declined to comment for this article.

Lisa Kohler, lead medical examiner for Summit since 1998, said the county doesn’t have an unusual number of shaken-baby syndrome cases. “I don’t think that our numbers are that high,” she said.

Jennie Shuki, the county’s assistant prosecutor, said she was surprised by the higher rate of cases in Summit.

“We take any kind of child abuse case extremely seriously,” Shuki said. “If more than one medical expert comes to us with a diagnosis of abusive head trauma, we’re going to prosecute for that little life that was taken away. Then it’s up to the jury to decide what’s next.”

Shuki said there’s a possibility of misdiagnosing shaken-baby syndrome but other possible causes of death are always discussed.

Oklahoma, Wisconsin and Queens, N.Y.

When ranking by number of cases alone, The Medill Justice Project found states with the highest populations tend to also have the most shaken-baby syndrome accusations.

“With data like this, there is going to be a probability effect when it comes to population,” said Phillip Stevenson, director of the Arizona Statistical Analysis Center in Phoenix and former president of the Justice Research and Statistics Association, a national nonprofit in Washington, D.C., that acts as a liaison between various state agencies and the U.S. Department of Justice. “The more people there are in that area, the more likely these types of cases will occur.”

An exception is Oklahoma, which has a rate of 2.33 shaken-baby syndrome cases per 100,000 people and ranks third in the country, although its population ranks 28th nationally.

The high rate of shaken-baby syndrome cases may be due in part to socioeconomic problems and a high rate of female incarcerations in the state, said local authorities.

According to the Oklahoma Department of Corrections and the U.S. Bureau of Justice Statistics, Oklahoma has the highest rate of female incarcerations per capita in the country, and it has held this distinction for more than 15 years. That, experts said, along with other factors, such as high teen pregnancy rates, may be contributing to a lack of knowledge about the dangers of shaken-baby syndrome and partly explain the state’s high rate of cases.

For Wisconsin, which ranks fourth with a rate of 2.03 cases per 100,000 people but 20th in population, data indicated certain counties skewed the rate of shaken-baby syndrome cases.

Keith Findley, co-founder of the Wisconsin Innocence Project, noted Dane County, Wis., which is ranked 16th nationally in the rate of cases, was the site of a high profile shaken-baby syndrome case that received a large amount of attention from the local and national media. Findley said this could have increased awareness in the area and influenced how cases were prosecuted.

Audrey Edmunds, a then-35-year-old mother, was convicted of reckless homicide in the 1995 shaking death of a neighbor’s infant daughter. Edmunds was sentenced to 18 years in prison but was granted a new trial in 2008 when a Wisconsin appellate court determined new medical evidence cast doubt on her guilt. After reviewing Edmunds’ case, the Wisconsin court wrote there is “fierce disagreement” among doctors about the shaken-baby syndrome diagnosis, which points toward a change in medical opinion. Prosecutors later dropped the case and Edmunds was released from prison for time served.

The Dane County District Attorney’s Office declined to comment.

Mark Jurkowitz, associate director at the Pew Research Center’s Journalism Project in Washington D.C., which conducts media content analysis and other social science research, said high profile cases have a strong influence over the public and law enforcement, especially when cases are extensively televised.

“The whole idea of televised court cases just really captivates everyone’s attention,” Jurkowitz said. “Once the issue surfaces and sensitivities are heightened, it’s likely that the coverage will be more extensive.”

Queens County, N.Y., which lies southeast of Manhattan, has the 10th largest population by county in the United States and ranks third in the nation for total number of shaken-baby syndrome cases. After adjusting for population, it ranks 36th in cases by county per 100,000 people. Experts said the Queens County District Attorney’s Office is nationally known for aggressively prosecuting shaken-baby syndrome cases. The office also co-sponsors an annual conference with the county medical examiner’s office on abusive head trauma that invites medical and legal professionals nationwide to learn about the diagnosis, investigation and prosecution of these cases.

“A poor investigation doesn’t help anyone,” said Queens County Senior Assistant District Attorney Leigh Bishop. “I wouldn’t have a job if there was just a formula to prosecuting these cases. They’re all different.”

Verification Methods

Working with undergraduate and graduate journalism students at Northwestern University’s Medill School of Journalism, Media, Integrated Marketing Communications, The Medill Justice Project collected and verified more than 3,600 cases where people have been accused of violently shaking infants using more than 30 sources, including press accounts, public record searches, databases such as LexisNexis and court documents.

In the first phase of the project, the gender of the accused was identified and then the locations of those 3,043 cases were confirmed and analyzed to identify where shaken-baby syndrome accusations are occurring at higher rates.

The Medill Justice Project identified shaken-baby syndrome cases by the location of the county court where they were heard. Those locations were verified using prison, trial and appellate court records, government websites, Google maps, the U.S. Census and the LexisNexis database.

In instances where press accounts mentioned a shaken-baby syndrome accusation but no charges were filed or a case didn’t reach trial, The Medill Justice Project verified the location with such identifiers as the names of judges, prosecutors, public defenders, magistrates and county sheriffs investigating the case. In the event of a trial’s change of venue, which is rare and requires the approval of a judge, The Medill Justice Project chose to confirm the county in which the crime occurred, instead of the new trial location.

Criminal justice and statistics researchers said they consider such sources as press accounts as well as court and prison records an effective way to identify shaken-baby syndrome cases for a national database, given there is no way to systematically track such cases through the U.S. court system where they are identified by terms other than shaken-baby syndrome, such as murder.

Cases were identified over about the past 25 years. Anne Elixhauser, a senior research scientist with the Agency for Healthcare Research and Quality at the U.S. Department of Health and Human Services, said to find county rates—while also controlling for a change in population—a mean population must be calculated from the 1990 and estimated 2012 U.S. Census data. This mean was used to calculate the rate per 100,000 people.

Only counties with 10 cases or more were included in the rankings to focus on specific locations with a higher number and rate of cases. Experts in criminal justice statistics said low-populated counties would skew the results because even a single incident of shaken-baby syndrome could create a statistically insignificant spike in the rate per 100,000 people and incorrectly make it appear as if the county had a high rate of cases even though there were few occurrences. The Medill Justice Project used the same method to determine the states with the higher rates of cases and excluded states with less than 50 cases to control for areas with smaller populations.

The database excludes individual defendant names in line with the recommendation of several national criminal justice experts. That’s because, for instance, recent caregivers’ cases have shown that some people are innocent of these violent crimes. The goal is to identify national patterns and trends.

The database research builds on previous studies on this topic. In August, The Medill Justice Project published its first database finding that men are nearly three times more likely than women to be accused of violently shaking an infant. Following this report, The Medill Justice Project is examining shaken-baby syndrome cases abroad, starting in South Africa, where authorities said it is a little-understood criminal justice concern.

If you have information about a shaken-baby syndrome case or cases and would like to add it to The Medill Justice Project’s national database, please contact us at medilljusticeproject@northwestern.edu, or 847-491-5840. Please also contact us in cases where those accused of such crimes wish to have their attorneys’ names and contact information published as part of The Medill Justice Project database.

 

Safety in Lincoln Park: What community members are saying

[vimeo 54382270 w=500 h=281] CHICAGO — Chicago's Lincoln Park is home to DePaul University students and many young professionals working in the in the city. I interviewed residents near the Fullerton stop to see what they think about their safety in the community.

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Ritualistic use of mercury remains a mystery—but health effects aren't

Journalists from Medill Reports visited seven different botanicas in Pilsen, Humboldt Park and Logan Square looking for mercury. They were met with some resistance, and none of the botanica owners and employees said they had mercury for sale. Botanicas typically serve members of the close-knit Hispanic communities in those areas and are wary of outsiders. Samantha Andreacchi and Erica Tempesta contributed to this report. To see the full version click here Botanicas are Hispanic alternative medicine shops that sell religious and magical paraphernalia and folk medicine remedies, including herbs, perfumes, oils, and candles. There are over 20 botanicas in Chicago, typically located in predominantly Hispanic neighborhoods.

CHICAGO — When Arnold Wendroff asked his special education ninth grade chemistry class in June 1989 in Brooklyn, N.Y.  “What is mercury used for?” he didn’t get the answer he was expecting.

“I asked…thinking someone would likely know a thermometer,” he said. “And a Puerto Rican boy named Jamie raised his hand, and instead of saying a thermometer he said, ‘My mother uses it in Santeria.’”

Santeria is a magico-religious practice that originated in Cuba. It combines the magical practices of the Yoruba people from Africa with some of the traditions of the Roman Catholic Church.

The religion is particularly popular in Latin American and Caribbean countries, including Cuba, Puerto Rico, Mexico, Venezuela, Colombia and the Dominican Republic, and it has also spread into the U.S.

An exact number of Santeria practitioners in the U.S. is nearly impossible to calculate, said Migene Gonzalez-Whippler in his bookSanteria: The Religion.  People who practice Santeria often keep their faith hidden because of the stigma behind the religion, which is typically associated with animal sacrifice, black magic and spiritual possession, where a spirit physically takes over a person’s body.

The young boy said his mother sprinkled mercury on their floors to keep away “brujos,” or witches, and she bought the mercury at a botanica in Brooklyn, said Wendroff, who has since dedicated his life to educating the public, especially ethnic communities, on the real dangers of the ritualistic use of mercury.

To see if this was true, he asked Jaime to buy him some mercury the next time Jaime’s mother went to the botanica, and sure enough, he did.

“I paid him a dollar and he gave me a colorless gelatin capsule about half full of what was obviously mercury, a total gross weight of 7.2 grams,” Wendroff said.

Mercury is a naturally occurring element found in air, water and soil, but it is also a neurotoxin that can cause various health problems, including psychological and physical symptoms, for someone who is exposed to it.  (For more information on the health effects of mercury exposure, see the infographic to the right.)

There are three types of mercury: organic mercury that is typically found in fish, inorganic mercury, or mercury salt, and elemental mercury.

Elemental mercury is the most common form and is the only metal that is liquid at room temperature.  It is found in common items and products, such as certain batteries, antique clocks, mirrors and thermometers, and energy-saving compact fluorescent light bulbs and other fluorescent bulbs.

Mercury capsules, similar to the ones Wendroff described, were once available and may still be available right here in Chicago, said Esther Sciammarella, executive director of the Chicago Hispanic Health Coalition.

The Chicago Hispanic Health Coalition, established in 1991, is an organization that promotes healthy living in Chicago’s Hispanic community to help prevent chronic disease and health disparities in the ethnic group.

Health effects of mercury.

“You can go to a Santeria shop and ask for a container of mercury,” Sciammarella said.  “Go to a botanica and ask for ‘azogue.’” Azogue is a Spanish word for quicksilver or mercury.

Botanicas are Hispanic alternative medicine shops, typically filled with herbs, perfumes, natural remedies, oils, sprays, religious candles and other magical paraphernalia. And there are over 20 botanicas in Chicago, most of which are in communities where the Hispanic population is prevalent, including Pilsen, Logan Square and Humboldt Park.

Sciammarella worked with the Chicago Department of Public Health’s Office of Hispanic Affairs in 2000 on a study that addressed the use of mercury in the city’s Hispanic community.

The study found that Hispanics in Chicago use mercury for religious purposes and as a form of folk medicine. The study also found that “the mercury was available through natural goods stores called botanicas, mystics and curanderos” which "claimed that mercury serves to cure ailments, provide spiritual benefits, and/or solve domestic issues.”

But Richard Gelb, who has been a santero — or Santeria priest — since 1990, has never heard of mercury being used in Santeria rituals. Gelb, 62, is the assistant principal and an English teacher at Benito Juarez Community Academy in Pilsen.

Still, Dr. Daniel Hryhorczuk, director of environmental health at the center for global health at the University of Illinois College of Medicine, conducted a study on the topic in 2000 with the Illinois Department of Public Health, and his research yielded similar results as Sciammarella’s, showing the city’s Hispanic community used mercury.

“It is not limited to one Hispanic community; there are actually several different communities that use mercury in either cultural or religions practices and also several different religions—it’s not just one religion,” he said.

Hryhorczuk said mercury use in the study was primarily tied to Santeria, though he heard it is also used in voodoo. He found that outside of religious practices, members of certain communities were also using mercury to treat ‘empacho,' which is a Hispanic folk illness typically characterized by symptoms such as indigestion, constipation, diarrhea, vomiting or lack of appetite.

“It was also being used by some members of communities...who believed that injecting yourself with mercury would make you stronger,” he said. "And that was one of the most dangerous practices that we encountered in our clinical practice."

Dr. Estella Hernandez confirmed that some Hispanics in Pilsen, the largest Hispanic community in Chicago, buy mercury from local botanicas. She is a doctor of family and bariatric medicine at NutriMedicos, a physician-guided diet and weight management clinic in Pilsen.

Hernandez said she has seen a few patients who have told her they ingest mercury for medicinal purposes.

“One of the conditions they use it for is empacho,” she said, confirming what Hryhorczuk found during his Chicago study. “But it’s not something that’s scientifically and medically based.”

And when patients tell her they’ve taken the metal for health purposes, Hernandez said she warns them about the dangerous health effects of mercury, as she does with any other treatment or practice that may cause them harm.

Sherrie Elzinga, assistant to the director of the Illinois Environmental Protection Agency, said that the Illinois EPA is also aware that people use mercury for religious purposes, particularly in the Hispanic population.

She noted it’s not illegal to possess the toxic metal, “but we don’t suggest that you possess it, and we suggest you dispose of it properly.”

The U.S. Consumer Product Safety Commission allows the sale of mercury as long as the product is properly labeled as “Not Recommended for Household Use.”

Elzinga said the Illinois EPA does not have an initiative at this time to address the ritualistic use of mercury in Chicago’s Hispanic communities.

Even though mercury use has been known to be prevalent within certain communities in Chicago, both Sciammarella and Hryhorczuk experienced community resistance during their respective studies.

The study done by Sciammarella and the Chicago Department of Public Health ended up focusing on education and resulted in the creation of informational brochures. These brochures were printed in Spanish and handed out within the community.

And the study that Hryhorczuk and the Illinois Department of Public Health intended to do was never completed.

“We started to get some pushback from the community,” he said. “They felt that this was intrusive because mercury was being used in some of their religious practices, and they felt that this was an intrusion on their religious freedom.”

Hryhorczuk said to successfully complete an in-depth survey about mercury use in the Hispanic community, “you would need to be either an anthropologist or ethnographer who builds trust with the community, who can speak the language and who can go in there and actually work with members of the community.

“To have outside researchers, like university scientists, come in and do this is very difficult”.

Even a little bit of mercury exposure can be dangerous, and most people are not always aware that they have been exposed. This is typically because mercury is not just used in traditional and religious practices—it’s still found in common items and products.

When mercury is exposed to air it, immediately starts giving off fumes that can be inhaled, and it will continue to evaporate as long as the little metal balls are in the atmosphere, environment, or room, said Dr. Susan Buchanan, director of the University of Illinois at Chicago’s Great Lakes Center for Children’s Environmental Health.

According to Melaney Arnold, communications director at the Illinois Department of Public Health, the main way people are exposed to the toxic metal is by inhaling invisible fumes, allowing it to be absorbed by the lungs.

However, there are other ways people can be exposed.

“Mercury can enter the body through the skin, especially if it contacts a cut or wound,” Arnold said. “If you swallow mercury, very little is absorbed. Most of the mercury is eliminated through the digestive tract.”

Buchanan described dramatic symptoms associated with severe poisonings including upset stomach, mental confusion, irritability, memory loss, tremors, numbness, tingling and skin peeling.

But mercury exposure and poisoning severely affects children, Buchanan said.

“We are concerned about mercury exposure in children because the brains are still developing at least through age 6 and probably longer,” she said.

If children have been exposed to elemental mercury, they will typically have a combination of a toxic reaction with an allergic reaction, Hryhorczuk said.

“We can see this illness called acrodynia, or pink disease, and that manifests itself as rashes over the body which looks like an allergic reaction,” he said.

For adults, mercury exposure is more detrimental to the central nervous system, Hryhorczuk said.

According to Buchanan, you should never throw away or vacuum mercury because it can disperse the particles throughout a large area. She suggested using two pieces of paper to roll the metal balls off the floor and into an envelope.

But she said the best option is to call a local health department to take care of it. In addition to the health departments, there are free programs that help to safely dispose of mercury-containing items, including the Illinois EPA’s Household Hazardous Waste Collection Program.

“It’s not going anywhere,” Buchanan said. “So as long as it’s around, it is going to give off those mercury fumes.”

The highest concentration of botanicas are in Pilsen, Logan Square, Humboldt Park and South Lawndale. Pilsen is the largest Hispanic community in Chicago.

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CDC reports flu no longer widespread in Illinois

Illinois Department of Public Health CHICAGO — The worst may be over for the flu season that hit earlier than expected this season. Influenza levels in Illinois are no longer “widespread,” according to the Centers for Disease Control and Prevention’s most recent data.

Illinois has experienced a high level of influenza activity for the last six weeks, but the CDC reported Friday that numbers have been gradually decreasing over the last month. The decrease has moved Illinois out of the widespread category.

The CDC reported that depending on the severity of the season, between 3,000 and 50,000 people die in the United States each year from influenza-related illnesses. Melaney Arnold from the Illinois Department of Public Health said that there have been 98 flu-related deaths in Illinois this year, with 651 total hospitalizations.

According to the department’s most recent data released last week, outpatient visits for influenza-like illness is now 2.6 percent, which is a huge decrease from the 3.3 percent the previous week. In addition, Illinois’ influenza activity is now being monitored and reported on a regional scale, instead of a widespread basis.

This flu season started in early December, which is earlier than previous years, according to the CDC. Despite the early start, Dr. Thomas Frieden, the CDC's director, said in a congressional hearing that this season did not reach "pandemic proportions."

Curtis Allen, a spokesman for the CDC, said 22 states are still reporting a widespread influenza activity level — a decrease from 31 states in the previous week and 38 states the week before.

“Overall it’s been a moderate-to-severe season,” Allen said. “Currently the influenza activity still persists but it’s going down at a steady pace.”

He said the number of deaths and hospitalizations are similar to the results of previous years that had a H3N2 strain circulating. The H3N2 strain, which is also known as influenza A, tends to be more severe. The CDC reported that as of Tuesday, there have been 78 pediatric deaths this season. Typically this number averages about 100 each year and Allen said unfortunately this was not a surprising result. He added that there was one thing the CDC did not expect this season: The vaccine’s effectiveness in different age groups.

Overall the vaccine was 56 percent effective, Allen said. The CDC reported that it was less effective against the influenza A strain — protecting 47 percent — and it protected 67 percent of those who received the vaccine from influenza B.

“Those are the typical numbers we’re going to see when the vaccine is well-matched with the strains being circulated,” he said. “But we did experience the biggest change in those 65 and older.”

According to the CDC, only 9 percent of people 65 years or older were protected from influenza A after receiving the vaccine, and about 90 percent of flu-related deaths this year were those in this same age range.

Allen said there are two important factors that determine the vaccine’s effectiveness: One is whether or not the vaccination is a close enough match to the strains circulating. The second is the age of the person receiving the vaccine and any chronic health problems they may have. He said that studies have shown that both age and health can diminish the body’s response to the vaccine and make someone more vulnerable for infection or further complications.

Even though the benefits for the vaccine vary for different age groups, Allen said it does not mean the public should lose faith in its overall effectiveness. It can still help to prevent the illness from spreading to others.

“It’s the best we have at the moment,” he said. “And because it’s the best we have, the best thing you can do is get vaccinated if you’re living with someone that’s very young or over 65.

“Bottom line is we need to advance the research on influenza vaccinations but we’re just not there yet.”

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Typhoid fever case confirmed at Purdue University

The graph represents the most recent data from the Illinois Department of Public Health. Purdue University and Indiana public health officials are reaching out to students, faculty and visitors who may have eaten in three locations on campus in West Lafayette, after a food handler tested positive for typhoid fever on Tuesday.

The unnamed employee was wearing gloves, but could have spread the illness while at work from Jan. 23 to Jan. 25, according to a press release issued by Richard Ghiselli, head of the School of Hospitality and Tourism Management at Purdue. Anyone who ate at the Boiler Bistro, John Purdue Room, or the coffee shop in Marriott Hall during this time may be at risk.

The illness can be treated with prescribed antibiotics and a vaccine is available for those who plan to travel abroad. If left untreated, the disease can last up to a month and serious complications may occur including tears or hemorrhaging in the intestinal track.

"We want all of our students and other patrons to know that we put their health first," Ghiselli said. "We are informing our students and patrons and are working together with the Indiana State Department of Health.”

The Purdue employee contracted the disease while traveling abroad and will not return to work until cleared by the state health department, Ghiselli said.

Lola Russell, a spokeswoman for the Centers of Disease Control and Prevention, said that while the disease is rare in the United States — about 400 cases each year — more than 22 million cases worldwide are reported annually and an estimated 200,000 people die due to the illness or complications. Most of the reported cases in the United States come from those who had recently traveled abroad.

In Illinois, 240 cases of typhoid fever have been reported since 2000, according to Melaney Arnold, a spokeswoman for the Illinois Department of Public Health.

Russel said the bacteria that causes typhoid fever, which is a type of salmonella known as S. typhi, spreads through contaminated food, water or other beverages.

“The salmonella bacteria only lives in humans who are contaminated and it’s carried in their blood streams,” she said. “But people who have recovered from the disease can also be what we call carriers, and they can spread it to other people.”

According to the CDC, symptoms typically appear within eight to 14 days but can begin up to 30 days after exposure. Sometimes patients will have symptoms that gradually worsen each day, while others experience a continuous rise and fall during the day. The most common symptoms include a high fever — usually ranging between 103-104 degrees — weakness, stomach pains, nausea, vomiting, headache, diarrhea, or loss of appetite. In some cases, a rash of rose-colored spots may appear on the torso.

The CDC says the risk of getting typhoid fever is highest for those who travel in southern Asia, in particular East and Southeast Asia. Other areas of heightened risk include Africa, the Caribbean, and Central and South America. A longer stay in these areas can increase the risk of infection but some travelers have contracted the disease in less than a week where typhoid fever is endemic.

Russel said the vaccination will help prevent typhoid fever while abroad and should be administered about two weeks before a trip to developing nations where hand washing and sanitation aren’t as common. Purdue Student Health Center has announced that, under these circumstances, it will offer advice or health care without charge to anyone who is showing symptoms and ate at Marriott Hall locations during the potential contamination days.

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Stomach flu quarantines 700 inmates at Cook County Jail

Courtesy of Cook County Sheriff's Department: The Cook County Jail is now in quarantine after a stomach flu outbreak in one of its largest divisions. CHICAGO — An outbreak of the stomach flu in about 30 prisoners has prompted a quarantine of one of the largest divisions in the Cook County Jail, officials said Wednesday.

The quarantine of Division II will remain in effect until further notice, according to a press release issued by Cook County Sheriff Thomas J. Dart. Detainees in the affected unit will have limited movement and visitations will be prohibited during the quarantine.

To prevent further exposure, the division’s living, dining, shower, toilet areas as well as all high-touch surface areas are being disinfected. The inmates' linens have been changed and are being laundered separately, Dart said.

Sophia Ansari, a spokeswoman for the sheriff’s office, said as of Wednesday afternoon about 30 inmates have fallen ill. Symptoms include nausea, diarrhea and vomiting.

Ansari said the quarantine could possibly put pressure on the jail’s finances over the next few days.

“The inmates housed in Division II are more minimum-security prisoners and they’re the ones that help out in a lot of the programs within the jail,” she said.  Because of the quarantine, prisoners within this division will be unable to participate. As a result, medium-security inmates may be needed to cover the food transportation and cleaning responsibilities.

Ansari said medium-security inmates would require more supervision from officers and could drive up costs. Additional staff members might also be needed if the flu bug continues to spread.

Jail employees from the quarantined division are being closely monitored to prevent an outbreak within the staff, according to the release. Exposure to sick detainees is being limited and the sheriff’s office is closely monitoring the jail to ensure the virus does not spread to other divisions.

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Alcohol mixed with diet drinks may increase intoxication, researchers say

According to a new study, mixing alcohol with a diet or sugar-free soft drink may increase intoxication more than mixing alcohol with a regular sugared drink. CHICAGO — Cutting calories with diet drinks may not be a good idea anymore — at least not at the bar.

According to a new study published Tuesday in the journal Alcoholism: Clinical and Experimental Research, mixing alcohol with a diet or sugar-free soft drink could result in a higher breath alcohol concentration compared with mixing alcohol with a regular sugared drink.

Cecile Marczinski, an assistant professor of psychology at Northern Kentucky University, was one of the lead researchers of the study. She specializes with energy drinks and their effects on the body when mixed with alcohol. Marczinski and her research team initiated the study when they noticed a higher level of breath alcohol content, or BrAC, in people – particularly women -- who had consumed diet drinks at a bar.

During the study, subjects were given one of three doses: vodka and diet soda, vodka and regular soda, and a placebo beverage that was made to smell like vodka. By using breath tests, which measure the alcohol exhaled from the lungs, Marczinski found that subjects who drank with a diet mixer had a BrAC that was 18 percent higher than those who consumed the same amount of alcohol with a sugar-sweetened drink. The cause starts with the digestive track and is the same reason health experts recommend eating a full meal before drinking alcohol.

“The stomach treated the sugary drink as food so it keeps it in the stomach longer to allow time for digestion,” she said. “Diet drinks contain no sugar, so it goes through the digestive track immediately, and the alcohol is then absorbed by the liver.”

Even though the study was small — eight males and eight females — the results reflected similar studies performed during field research. For the past decade, Dennis Thombs, a professor and chair of the department of behavioral and community health at University of North Texas Health Science Center, has been assessing and systematically sampling bar patrons on their way home.

“We found the same result,” Thombs said. “Those who drank diet drinks were more intoxicated than those who had consumed drinks with sugar-based soda.”

Thombs’ study also found a significant difference between the intoxication level of young men and women. He said this might be because women tend to be more weight conscious than men, and therefore women were more likely to specify that they wanted a diet soda.

“Women are probably wanting to consume healthier drinks that have less calories,” he said. “But they may not be aware that they’re getting more intoxicated than they intended to.”

Both Thombs and Marczinski agreed that the most frightening result of the study was that subjects were unaware of the difference in intoxication levels. Those who mixed diet drinks with alcohol had BrAC levels of .09, which is above the legal driving limit of .08, whereas those who mixed sugared sodas with alcohol averaged about .07.

“Both groups felt the same and both groups were willing to drive,” Marczinski said. “Choices to drink and drive often depend on how people feel rather than some objective measurement of impairment.”

Subjects were then asked to perform computer tests, which simulated situations that they might face behind the wheel while their reaction times and errors were measured. Those who drank with a diet mixer were more impaired and slower to react.

According to data from the National Highway Traffic Safety Administration, there were 927 reported deaths in Illinois due to traffic accidents in 2010. Approximately 32 percent — 292 deaths— was related to drunken driving. This number didn’t improve in 2011 with 926 total deaths with 278 related to drunken driving.

“Alcohol impairs judgment,” Marczinski said. “It’s not surprising that people are bad at judging how drunk they actually are when they’re drunk.”

Marczinski said she will likely follow up with more research in this area to examine different dose levels of alcohol. She said she would also like to focus on the different types of drinks to replicate in the lab what people are doing in real life, specifically if there are certain drink combos that are more problematic than others.

Thombs said he would continue his research as well because the results are not conclusive yet. There are only a few studies that have closely examined the link between someone’s level of intoxication and the type of mixer they use.

“For those of us who are interested in increasing the safety of the bar atmosphere, we need to take a closer look at alcohol mixers,” Thombs said. “Not just soda and diet soda but energy drinks as well.”

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What to expect when Obamacare hits full swing in 2014

Photo courtesy of the University of Chicago Medical Center Dr. Elbert Huang is an associate professor of medicine at the University of Chicago. From 2010 to 2011 he worked in Washington, D.C., on the implementation of the Affordable Care Act — also known as Obamacare.

As President Barack Obama was sworn into his second term at the White House, the Patient Protection and Affordable Care Act — commonly known as Obamacare or ACA — was set in stone for the next four years with virtually no risk of repeal. Even though the legislation was initially approved in April 2010, many Americans still don’t know how this legislation will affect their health service providers and insurance cost over time.

Dr. Elbert Huang, an associate professor of medicine at the University of Chicago, worked on the implementation of the Affordable Care Act in Washington D.C., from 2010 to 2011. He said it was an opportunity he could not pass up. Huang helps to answer some common questions people have about the new health-care reform.

Q: When Obama first signed the legislation in 2010, what changes did we see to health care immediately?

A: In general the first portions of the law [to be implemented] dealt with insurance coverage regulation. One of the early changes was allowing parents to keep children under their insurance until the child turns 26, regardless of school enrollment status. The other changes were related to pre-existing conditions. Now insurance companies are not able to prevent people from getting insurance and they can’t make it difficult for someone to keep insurance if they get sick. There was also affordable preventative care [such as screening tests] for those on Medicare. Most of the procedures for these patients have no co-pay.

Q: What should we expect to see this year?

A: It’s difficult to say what regular people on the street will see this year. People probably won’t notice anything because 2012 and 2013 are preparation years for what we’re going to see in 2014. The states that have decided to participate and set up their own insurance exchanges for the following year are doing all of this outside of the public eye.

Q: It’s been estimated that in 2014, approximately 30 million new people will be able to purchase private insurance on these federal or state regulated exchanges, making it the largest spread of health coverage since the establishment of Medicare in 1965. What will this do to medical facilities? Will there be enough medical care to go around with that large of an influx?

A: There is already a lot of experience from the Massachusetts [law] that tells us what will happen. It depends on where you live in the country. How many people are insured, how many will become insured in 2014 and how many medical facilities the area has. It will vary from place to place. We know that the system will work in terms of getting people insured because almost 98 percent of people are covered [in Massachusetts]. The reason it’s somewhat disturbing for other states is that [Massachusetts] has the highest density of primary-care doctors per population. Some of these newly insured patients might still end up in the emergency room instead of a primary-care office and there’s always a concern about discriminating against people who have certain types of insurance.

Q: So we’ve talked about how this will impact patients. What about the doctors? Is Obamacare going to be a positive or negative change for both public and private medical facilities?

A: Right now we pay doctors for every piece of work they do. That hasn’t changed. Most doctors can and will function just as they did before. But because of more pressure on insurers, hospitals and doctors are going to be under more scrutiny to maintain costs and be efficient when practicing medicine. But this has always been the case too.

The law is actually very friendly to primary care-doctors. There’s a financial incentive for primary-care doctors to stay in business. In general it will make it easier for private practices to run as efficiently as a public hospital. But it will definitely encourage doctors who are innovators. The law has set aside about $1 billion to fund pilot studies in health- care innovation. University of Chicago currently has two large-scale grants from the fund, to study more efficient medical practices.

Q: You mentioned the added pressure on insurance companies. Because of Obamacare, they are now required to spend 80 percent of a patient’s premium dollar on actual medical care. How do you think this will impact the health insurance business, and why was this an important factor in the legislation?

A: The insurance regulation definitely puts a squeeze on insurers, but this is a good thing. Premiums have continued to rise for years when the economy has continually gotten worse. Even doctors think that insurers spend too much money on administration and advertisements. This law has helped to shine a light on incredibly high health-care costs in the U.S. and hopefully bring about a better use of our health-care dollars.

Q: After personally working on the legislation, what are your final thoughts about Obamacare? Do you think we’re heading in the right direction with this legislation?

A: The Affordable Care Act is an incredibly complex and imperfect law, but this is landmark legislation for American health-care history, kind of the starting place for a lot of important changes. The country was already facing problems of rising health-care costs and this has sort of sparked the changes that needed to happen. More people are going to be able to afford coverage, which is really a moral step in the right direction for everyone. It will be a bumpy road but in about 10 years expect to see a much better health-care system.

Illinois flu death toll reaches 50, vaccines still available

By Lauryn Schroeder/MEDILL CHICAGO — The influenza virus is still at large in Illinois, but health officials are saying the worst may be over.

Sabrina Miller, spokeswoman for the Illinois Department of Public Health, said the state’s death toll has reached 50 and approximately 476 people have been hospitalized in the intensive care unit for flu-related illnesses. The previous week, there were 27 reported deaths and 370 hospitalizations.

However, the department reported an encouraging steady two-week decline in hospitalizations. Nine patients in Illinois were hospitalized with flu-related symptoms as of Friday, a significant decrease from the 30 patients the previous week.

According to the most recent data from the Centers for Disease Control and Prevention, Illinois is among the 30 states still experiencing a high flu activity level since the surge over the holidays.

These numbers are still discouraging for Illinois, considering there were no deaths due to the influenza virus in 2012.  Health officials continue to promote the flu vaccine and say it is the best way to prevent the spread of the virus and avoid falling ill.

CDC spokesman Curtis Allen, said approximately 129.2 million doses of the influenza vaccine has been distributed through the end of last week. Vaccine manufacturers anticipate 145 million doses total will be produced to cover the demand. He said most of the vaccinations are distributed to pharmacies and clinics in September, but the majority is given out from October to early January.

“It’s not unusual for some places to not have the vaccinations this late in the season because so many have already been distributed earlier in the year,” he said. “But it’s definitely not too late.”

Allen did say it may be necessary for some people to call their local pharmacies or clinics to make sure they have the vaccine in stock before heading outside.

Illinois Department of Public Health Director LaMar Hasbrouck spoke with Gov. Pat Quinn on Monday about the severity of this flu season. He said that some spot shortages of the vaccine is a good thing because it means more people are getting the message and taking action against the virus. While there may be some areas that are in short supply, Hasbrouck said statewide shortage will not be an issue in Illinois.

Allen said prices for the vaccine typically range anywhere from $9 to $16 but can reach $40 depending on the medical provider. Receiving the shot from a private physician or clinic may cost more, but some insurance policies cover the shot's fee. After the shot, it takes approximately two weeks for the body to build up antibodies against the influenza virus. The vaccine protects against four strains circulating this year, including the H3N2 virus, which has caused the majority of flu-related complications for patients this year.

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