HealthWatch by The Times

FEBRUARY 2014

The Smartsheet program allows better communication between doctors, nurses and EMTs PAGE 2

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Sunday, January 26, 2014

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‘Smartsheet’ offers high-tech help in cardiac emergencies By Andrew Akers

aakers@gainesvilletimes.com Work collaboration tools that allow co-workers to contribute to a single document in real time over the Internet have become popular in many offices worldwide, but few are using them in the same way cardiologists at the Northeast Georgia Medical Center are using them to treat heart attack patients. Traditionally, when patients are brought in by emergency medical personnel, information is exchanged verbally. In the fast-paced environment of emergency departments, this can cause important information to be missed or miscommunicated. “In the emergency room many decisions have to be made. The care is so rapid and dynamic, that it can’t always be written down immediately,” said the medical center’s regional STEMI coordinator Jason Grady. STEMI is an acronym for ST-elevation myocardial infarcation, which is a type of severe heart attack. According to Grady, information that is relayed verbally can miss important details that could have impacted treatment decisions, such as whether or not a patient received CPR. In order to combat this, the cardiology department began researching collaborative programs that would help streamline the exchange of information. “We started to think ‘how can we get that information to the emergency department and to the cardiologist who is going to make the treatment decisions?’” Grady said. “We needed some type of form, but paper forms take too much time. The solution needed to be Web-based, cloudbased and it needed to be secure.” The department researched several different tools, but few offered enough security to satisfy the hospital’s privacy compliance standards that are required by the Health Insurance Portability and

SCOTT ROGERS | The Times Smartsheet is used to share information efficiently, analyze trends, and help prevent emergency room miscommunication. After several months of using it, the Ronnie Green Heart Center has already used information gathered to determine that patients who received bystander CPR were much better off than those who didn’t. They hope to use this to help promote CPR classes and educational initiatives.

Accountability Act. Eventually, the medical center settled on Smartsheet, a cloud-based application that collects data through spreadsheets and allows its users to view and edit the data in real time. “For years companies have used

Excel, and for good reason — it works well,” said Smartsheet founder and Chairman Brent Frei. “We decided to take the spreadsheets that people like and modernize it for the Internet.” That decision has proved success-

ful. Smartsheet has been used to coordinate businesses ranging from small factories to the Super Bowl. NGMC used the program to setup a kiosk where EMTs can input some Please see Smartsheet page 3

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Smartsheet Continued from page 2

basic treatment information on an iPad. “Once the EMT brings a patient in, they enter the information right there with the nurse and it immediately becomes available to the doctor,” said Jeff Clark, registered nurse educator in NGMC’s critical care unit. “The form has 19 yes or no questions that were narrowed down by our cardiologist team. It doesn’t take long to fill out.” In addition to improving the passing of information from emergency personnel to hospital staff, the system also improves the hospital’s ability to analyze patient trends. “There are a few things about cardiac arrest that we suspected, but it is really difficult to make changes without data to support it,” Grady

said. “For instance, whether or not a patient received chest compressions before the hospital. We know that makes a big difference, but we had no real way to know how many patients got chest compressions. “Now we know that not many people have gotten it at all.” NGMC plans to use the data to apply for grants to promote public education on the benefits of CPR. “We have a certain amount of investment in the community, and we want to make sure we provide the public with what they need,” Clark said. “Smartsheet helps us do that.” SCOTT ROGERS | The Times (Right) Northeast Georgia Medical Center emergency room RN John Anderson, right, and Jeff Clark, RN, look at data on an iPad program called Smartsheet which is now being used in the hospital’s emergency room. Information on an arriving patient is added to the tablet when EMTs bring them in to the emergency room for a heart attack. The info is immediately shared with doctors and nurses who also use the system to make further notes as treatment is carried out.

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Sunday, January 26, 2014

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Keep germs out of the air to avoid infecting others By Alana Swain

land on the table and if somebody touches that, they can get it (the virus). It’s going to require putting Once you have been diagnosed with something over your mouth, like a an infectious illness and instructed by towel, or keeping a towel on hand your physician to remain at home, where you can just cough into it it seems more than likely to expect every time you have a problem,” he your contagion will spread to the rest said. of the family. Taking those aforementioned However, with the proper precau- steps is especially helpful to keeptions, that does not necessarily have ing an illness contained, according to be the case. to Villanueva. Additionally, making an Dr. Roberto Villanueva, FACP, of effort to keep sanitized any surfaces Northeast Georgia Diagnostic Clinic with which you come into contact is in Gainesville, said most contagious important. disorders requiring steps of precau“Anything that you come into tion are respiratory, such as colds, contact with, try and keep it clean, upper respiratory infections and the whether it’s using Lysol on the table flu, because of how easy it is to that you used or on other things that spread the virus through saliva drop- you’re touching, like a doorknob and lets and secretions. stuff like that,” he said, adding that Regularly washing your hands with “(these measures), they do work and water and a standard soap is one of they’re critically important.” the most important first steps you And of course, keeping to yourself can take to prevent others in your and trying to maintain some distance household from getting sick. from other individuals will also help “The big things are preventing the prevent spreading of the illness. spread of the virus and that’s going to “You certainly don’t have to be be in the hands because you’re con- locked up in a room, but comstantly going (to) be touching your- mon sense stuff, like keeping a litself. You’re going to be coughing into tle distance, is going to help a lot,” your hands, so it’s all over the hands Villanueva advised, pointing out that and (washing) is definitely going to those with weaker immune systems, be precaution No. 1,” said Villanueva. such as babies, children, the elderly Villanueva added that special soaps, and people with diseases like diabelike those with hand sanitizers and tes, are more vulnerable to picking up antibacterials, are not proven to work a contagious illness. any better than a regular, standard Not only does staying home to rest soap. and get well help to prevent from The same saliva droplets and secre- infecting others, it also aids in gettions that end up on your hands can ting over the illness. Villanueva said also get into the air through coughing many people will want to “power and sneezing. Villanueva recommend- through” a period of sickness, but ed having an object to cover your that often just prolongs it and can mouth, such as a towel or surgical cause extreme loss of energy, particumask, as another important precau- larly with the flu. tionary step. “Take some days off and let the “You’ve got to prevent your respira- body rest and recuperate,” he said, tory droplets from getting into the air continuing, “Give it some time; Most because once they get there, they can of these disorders, if properly treated, float down the hall and even infect within about three days will get away someone on the complete other side from that severe phase and be much of the house. They can float over and less infective.” aswain@gainesvilletimes.com

SCOTT ROGERS | The Times When sick, wash hands often to prevent the spread of germs.

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Various factors may cause sensitive teeth By Andi Eckardt

aeckardt@gainesvilletimes.com As the temperature drops this winter, the number of people with complaints of sensitive teeth rises. So how can you help the pain of sensitive teeth? “Many things can cause sensitivity, main thing is a cavity, when a tooth has to decay, it can cause sensitivity, also, periodontal disease, and exposed root surfaces,” said Dr. Paul Gannon of The Gainesville Dental Group. Gannon offered both short- and long-term fixes for tooth sensitivity. “If a patient has a cavity, we diagnose from radiograph and place a

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Sunday, January 26, 2014

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Painful gout is a The many forms form of arthritis arthritis By Alana Swain

Major types

aswain@gainesvilletimes.com Many people are afflicted with gout, a form of arthritis that flares up in the joints and is known to be extremely painful to those stricken with the condition. The disorder, which is hereditary, appears as a result of a complication with the process of metabolizing uric acid in the body. “It’s a problem with the metabolism of uric acid. Our bodies normally metabolize uric acid and generally excrete it through our kidneys, but in people who have gout, there’s a breakdown of that normal metabolism,” said Dr. John Hemmer, orthopaedic surgeon for Specialty Clinics of Georgia, Orthopaedics, PC, in Gainesville. “People get uric acid crystals that crystallize either in the joints or in the soft tissues, and that creates an inflammatory process. If it’s in the joint, it can lead to (that type of) arthritis and that’s primarily where I see it,” he continued. The uric acid crystals can build up in the soft tissues in the skin or underneath the skin and create nodules, which can appear to be an infection, Hemmer added. While it is most commonly thought to be found on the foot in the big toe, Hemmer said gout can affect any joint in the body. “The great toe is typically where people think of it, because that’s probably the most common joint that we see it in, and that’s what people think of, but gout can affect any joint,” he said. “It can even affect the TMJ joint in the jaw or even the spine. You can sometimes see it in the ear,” Hemmer continued. Flare-ups of gout are extremely

Arthritis is the overall name for about 100 diseases that cause pain in joints and connective tissue. It usually lasts a lifetime, and the specific causes of most forms of arthritis are still unknown.

OSTEOARTHRITIS Cartilage covering end of bone gradually degenerates; bone rubbing on bone causes pain in joint

Knee joint

Common site for arthritis

Femur

RHEUMATOID ARTHRITIS

Disabling “autoimmune” disease in which the immune system attacks joint lining, causing degeneration of joint, pain and restricted movement

Kneecap

Tendon

FIBROMYALGIA

Pain in the many parts of body where muscles and tendons attach to bones Lower leg bones

Other types SCOTT ROGERS | The Times Orthopedic Surgeon Dr. John Hemmer, of Specialty Clinics of Georgia Orthopaedics, PC, in Gainesville, recommends to see your doctor if you believe you may have gout.

Gout: Chemical abnormality in body; attacks small joints, especially big toe; often controlled with drugs, diet Juvenile: Children can develop several forms

Treatment

Aspirin, other anti-inflammatory drugs reduce pain but can cause stomach painful, with symptoms of swollen, ache Lupus: Serious autoimmune red and inflamed skin that is very disease attacks joints and connective sensitive to the touch. Exercise, rest, heat and cold can tissue Not only can gout affect most relieve symptoms any joint but also most any person. Infectious arthritis: Viral and While gout is usually considered Joint protection techniques used to bacterial; gonococcal is most prevent injury by many to only be found in older, common type; Lyme disease is a heavier men, that isn’t always the mild form Surgery sometimes used for pain, case. deformity, tendon rupture Scleroderma: Connective “Classically, people think about tissue disease; skin thickens and overweight males that drink too Knee and hip replacement with hardens much and eat too much,” said artificial joint often restores Hemmer, “but it can affect anybody movement; finger, ankle and shoulder Ankylosing spondylitis: Spinal joint replacement still being at any age. Generally, it’s going to inflammation; bones grow developed be the 40-50 years or older age together group though, and it does appear to be more common in males than SOURCES: American Arthritis Association, Current Medical Diagnosis & Treatment females.” Gout is typically treated with med- uric acid. LEARN MORE ABOUT THIS SUBJECT ONLINE AT: (Youror Webare site’s URL goes here) Hemmer also mentioned aware that you are predisications prescribed by a physician to that posed to developing Graphic/LEE it, schedule an HULTENG/KRT 5/20/99 gout is sometimes treated with prevent flare-ups, such as Benemid, certain types of cortisones. appointment with your doctor for which helps kidneys to excrete the If you suspect you have gout treatment.

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Sunday, January 26, 2014

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Regulations expected soon on e-cigarettes By Diane Stafford

The Kansas City Star The man at the nearby restaurant table is puffing away. Can he do that? Maybe. It depends what he’s smoking. What about the woman at the desk next to yours. Can she light up throughout the workday? Possibly. If the smoke is actually vapor from an electronic cigarette — depending on where you are — they may be perfectly within their rights. At least for now. Any day now, the federal Food and Drug Administration is expected to issue a proposed rule about electronic cigarettes — a ruling that could send ripples into the workplace and other public places. Except in a few locations, notably New York City, use of e-cigarettes isn’t specifically prohibited under the same laws or ordinances that ban tobacco smoking. Employers, though, may bar use on their properties if they choose. The relative lack of regulation and case-by-case handling to date could change depending on whether the FDA regulates e-cigs as a tobacco product. For now, whether you can use e-cigs on the job or in public venues usually is a case-by-case decision by employers and municipalities. Until the FDA issues a ruling, most e-cig users are legally free to puff on the tobacco-free cigarettes, which heat up a chemical solution and emit a smoke-like vapor upon exhaling. The vapor doesn’t smell like tobacco smoke and, unlike tobacco products, there’s no evidence that someone sitting next to an e-cig user has second-hand health effects. The FDA and the Office of Management and Budget, which now has the proposed regulation under review, do not reveal intended publication dates for proposed

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The nicotine liquid is shown in an electronic cigarette.

rules. But it could be imminent. “The FDA intends to propose a regulation that would extend the agency’s ‘tobacco-product’ authorities — which currently only apply to cigarettes, cigarette tobacco, rollyour-own tobacco and smokeless tobacco — to other categories of tobacco products that meet the statutory definition of ‘tobacco product,’” said Jenny Haliski, the FDA’s media officer for tobaccorelated inquiries. At Aqueous Vapor, an e-cig shop in south Kansas City, Michael Wooderson said he welcomes some form of government regulation to help ensure the safety and quality of electronic products, particularly the liquid involved. “Regulation could weed out the bad players and monitor the juice that we don’t always know what’s in it now, particularly if it comes Please see E-cig page 9

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E-cig

Continued from page 8 from overseas,” Wooderson said. Technically, e-cig users aren’t smoking; they’re “vaping” by drawing breath through a disposable or rechargeable cylinder. The user inhales through a mixture of chemicals such as propylene glycol, a food preservative; vegetable glycerine, a sugar substitute; polyethylene glycol, a medicinal compound; and nicotine, a highly addictive drug. The resulting e-cig vapor is unlike tobacco smoke, which, in addition to nicotine, contains tar, carbon monoxide, nitrogen oxide and other chemicals, including cyanide, benzene, formaldehyde, methanol, acetylene and ammonia. The American Cancer Society says at least 60 known tobacco smoke ingredients can cause cancer. Because most e-cig products give users a nicotine fix, the FDA is con-

Joon Ahn, MD Mitchell G. Davis, MD Allison G. Dupont, MD Abhishek Gaur, MD Brenda J. Hott, MD Jay H. Joesph, MD Christopher R. Leach MD Mark E. Leimbach, MD J. Jeffrey Marshall, MD Lalitha C. Medepalli, MD Gary M. Minkiewicz, MD Kashyap B. Patel, MD Salem N. Sayar, MD Timothy A. Scully, MD Mehrdad S. Toosi, MD Prad E. Tummala, MD S. Steven Wang, MD Heather B. Westmoreland, MD Mark W. Wolozin, MD Andrew D. Yen, MD

cerned about their use for public health reasons. The FDA hasn’t approved any electronic cigarettes as therapeutic, or medical products, like nicotine patches. And to avoid medical regulation, e-cig makers make no therapeutic claims about their devices. If the FDA doesn’t add e-cigs

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tool. The FDA’s attention also could speed up research into the health effects of long-term vaping. Unlike tobacco, e-cig substances haven’t been proven to cause cancer, but vaping is still in its infancy. The delivery system was developed in China in 2003, and there aren’t

Technically, e-cig users aren’t smoking; they’re “vaping” by drawing breath through a disposable or rechargeable cylinder. to the tobacco-regulation category, some business and government leaders could be more inclined to permit e-cig use as a stop-smoking

long-term health studies of users. One FDA study in 2009 did find diethylene glycol, an antifreeze ingredient, in e-cig vapors, and a

Sunday, January 26, 2014

2012 study at the University of Athens found changes in lung function by e-cig users. Other studies haven’t found harmful contaminants from vaping. To date, the e-cig market has been estimated at just about 3 million users, far short of the estimated 44 million adult Americans who use tobacco products. But e-cig use is growing. Major employers are noting the e-cig growth trend. Wal-Mart Stores and UPS are among companies that have taken the unhealthy view of e-cigs. Both are charging higher health insurance premiums to employees who use e-cigs, just as they do for their workers who smoke tobacco products. The kind of policy could grow widely if the FDA regulates e-cigs as tobacco products. The Affordable Care Act — Obamacare — permits insurers to charge up to 50 percent more for tobacco users. There’s no national survey yet that counts such policies.

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Sunday, January 26, 2014

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Maintaining sleep schedule best way to fight winter blahs By Andrew Akers

aakers@gainesvilletimes.com It’s winter, and even here in the sunny South, the cold weather and gray skies can put a damper on people’s moods. It can be as simple as a general feeling of “blah” or it can manifest in more serious conditions such as seasonal major depressive episodes. Dr. Ana Segarra-Brechtel, chief of psychiatry for the Northeast Georgia Medical Center, said the phenomenon is legitimate and can be explained medically. “Some people have a specific mood pattern that coordinates with daylight and the amount of light they are exposed to,” she said. Because days are shorter in the winter, many people arrive at work shortly after the sun has risen and leave after it has gone down, which can dramatically decrease the amount of sunlight they are exposed to. Although she said the best way to combat seasonal mood issues is to visit a psychiatrist, Segarra-Brechtel said there are some things people can do to get out of the winter funk. Her No. 1 recommendation is to build healthy sleep habits, or “sleep hygiene.” “It is critical for people to go to bed at the right time,” she said.“And don’t take naps during the day. “Oversleeping, undersleeping and lack of exercise can interfere with your mood.” It takes about 21 days in a row of going to sleep around the same time to establish a circadian rhythm, which makes you sleepy at night and gives you that extra pep in the morning, but it only takes two days to break it, she said.That means one weekend of late-nighters can disrupt your sleep schedule for weeks. Another tip is to eat healthy foods. This includes eating a low-fat diet,

refraining from late night snacking, eating heavy foods in the morning and not at night and eating more omega-3 fatty acids, which

mood changes can become more serious, possibly leading to depressive episodes. In those cases, Segarra-Brechtel recommends see-

Doing the same things at the same times each day can have a therapeutic effect. are often lacking in Western foods and can be easily supplemented, Segarra-Brechtel said. Limiting caffeine can also support good sleep habits. “Caffeine can interfere with your sleep pattern, which can then impact your mood,” she said. Exercising can help improve both your mood and your sleep, though it has to be done in context of your personal medical history. “Someone who has had a knee injury may not be able to do the same exercises as a healthy person, but the important part is to get your heart rate up,” she said. The last suggestion is to maintain a regular daily schedule. Doing the same things at the same times each day can have a therapeutic effect, she said. Since many seasonal mood changes are due to a lack of sunlight exposure, some people undergo “light therapy.” The treatment consists of sitting in front of a light machine for a few hours a day. “There are dozens of studies that say light therapy is beneficial,” Segarra-Brechtel said. “They show that after four days of using it, people see diminished symptoms. “But I would encourage people to discuss that with their psychiatrists. There are some side effects — headaches and other mild things — but overall it is safe.” However, sometimes seasonal

ing a psychiatrist. “Contrary to what most people think, most people who come to a psychiatrist are not crazy,” she said. “They are high-functioning people. There is just something that they are struggling with that limits their ability. “And the earlier you treat the illness, the better the person does.” Dr. Ana Segarra-Brechtel

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Sunday, January 26, 2014

Primates burn half the energy of other mammals, research shows By Steve Johnson

of the zoo’s Lester E. Fisher Center for the Study and Conservation of Apes. “That might change the You may think you’re working way we think about why primates hard. But relative to other mam- have evolved this slow process of mals, you’re kind of a slacker. maturing.” Primates, including humans, “When we started getting the expend about half the energy data in, we were just totally blown in daily activities compared to away by how different the prisimilar-size mammals, according mates were from anybody else,” to research conducted at Lincoln said lead author Herman Pontzer, Park Zoo in Chicago and else- associate professor of anthropolwhere. ogy at Hunter College in New The study, published this month York. “That’s a whole new trait for in the Proceedings of the National primates. ... It opens the door to a Academy of Sciences, sheds new lot of new kinds of questions.” light on the question of why priGroups of animals at zoos and mates grow, reproduce and age so in the wild were given doses of slowly. “doubly labeled water” contain“It presents a neat alternative ing biological markers — basically, hypothesis to our understanding additional molecules. A rough analof why primates have such extend- ogy would be to human medical ed life histories,” said Steve Ross, procedures that involve injecting an author of the study and director a dye to reveal internal processes, Chicago Tribune

the scientists said. The animals’ urine, in most cases, was then analyzed, and measurement of the marker molecules revealed how much energy the animals had spent. (In the case of chimps at the Tchimpounga Sanctuary in the Congo, saliva was analyzed instead.) In addition to wild and captive animals, primates of different sizes — including ring-tailed lemurs, bonobos, diademed sifaka and common marmosets — were included in the study, and the lower energy expenditure was found across the range of the group. The dozens of non-primate mammals whose energy expenditure was used in the comparison included the pygmy gerbil, the gray wolf and the Arabian oryx. “When we finally measure the

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total energy budget of primates, it’s 50 percent less than everybody else,” said Pontzer. Current understanding, says his paper, entitled “Primate energy expenditure and life history,” is that “primates’ slow life history schedules are generally thought to reflect an evolved strategy of allocating energy away from growth and reproduction and toward somatic (bodily) investment, particularly to the development and maintenance of large brains.” The new information suggests that slow metabolic rates also play a key role in our slow maturation and long lifespans. “People are very interested in what makes us age,” Pontzer said. “Now that we have a nice connection here to total metabolic rate, that gives us some idea of where to look next.”

Sunday, January 26, 2014

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Yale study identifies gene mutation as a cause of Tourette’s By William Weir

The Hartford Courant A team of Yale researchers says it has found a genetic cause of Tourette syndrome, a discovery that could lead to better medications for the hard-to-treat disorder. In a study published this month in the journal Neuron, the researchers say a genetic mutation that blocks histamine also leads to Tourette syndrome, a neurological disorder that can cause various tics, such as repeated motions and involuntary verbal utterances. But Tourette’s experts say that the way the researchers studied the gene mutation — a specially bred mouse — might be the real breakthrough. In 2010, the Yale researchers studied a family of eight children, all with Tourette’s. Their father also had the disorder. They all carried a mutation of a gene known as histidine decarboxylase (HDC), which blocks histamine production. It wasn’t until the most recent study, however, that they were able to prove that the gene mutation and the blocked histamine actually caused Tourette syndrome. Although histamine is a compound most commonly associated with allergies and the immune system, it also serves as a neurotransmitter, a chemical that sends signals throughout the brain. To actually measure levels of histamine in the brain — and determine what happened when those levels were disrupted — the scientists needed animal models. The researchers took two groups of mice, one bred to have Tourette’s, and a control group. They then examined the activity of histamine and dopamine — another neurotransmitter that plays a major

The U.S. Centers for Disease Control and Prevention identifies other possible causes of Tourette being researched, including smoking and drinking during pregnancy, complications during birth, and streptococcal infection. Kevin Black, a professor of psychiatry at the University of Washington in St. Louis, said that the Yale study was an impressive one overall. “I would say it’s one of the first chances there’s been to follow up and test whether a specific gene can really cause tics and whether it can give clues as to how to treat those tics,” he said.

role in the cause of Tourette’s — in “The specific findings about dopathe part of the brain known as the mine in this paper are a first step Please see Tourette’s page 15 in this direction.” basal ganglia. “We found that the neurons are more active in the animal model (with Tourette’s) and that they had a little more of the neurotransmitter dopamine,” said Christopher Pittenger, senior author of the study. But when the researchers increased histamine levels in the mice’s brains, they found that doing so reduced dopamine levels. Exactly why increased activity in the basal ganglia can lead to Tourette’s isn’t understood, Pittenger said. “What I really hope is that this is going to lead us to new insights as to what’s out of balance,” he said. The specific gene mutation is very rare — in fact, it’s never been found outside of the family involved with the 2010 study. But Pittenger said “all causes of Tourette syndrome are likely to be rare,” and each one could shed “Your Security is our Business” Since 1993 light on how the histamine/dopamine imbalance affects brain function. “That is what this animal model * A Division of ToTAl informATion ProTecTion GrouP puts us in a position to do,” he said.

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compare the tics of mice to those of humans. Carol Mathews, a professor of psychiatry at the University of California, San Francisco, who serves on the medical advisory board for the Tourette Association, said that Although the gene mutation in the the study could help understand the study is rare, he noted that a hand- biology of Tourette syndrome. “It won’t solve the problem of ful of genetic mutations linked to Parkinson’s disease have provided Tourette’s, but it’s one more piece a lot of information about certain of the puzzle,” she said. The specific gene mutation looked at for the brain functions of patients. The use of mice means that there study probably won’t prove to be are some limitations in the study, very important because it’s so rare, Black said. For instance, it’s hard to she said, but the means they devel-

Tourette’s

Continued from page14

“What I really hope is that this is going to lead us to new insights as to what’s out of balance.”

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oped to study it could end up being very helpful. Because you can’t take direct samples of the brain, she said, it’s difficult to study and diagnose certain neurological disorders. “This gives us another way of looking at (Tourette syndrome) by using the animal model,” Mathews said. Drugs now on the market can control dopamine activity, but they can also have serious side effects, such as significant sedation and weight gain, Pittenger said. But Pittenger said medications that control histamine, which then controls the levels of dopamine, might mean better treatment. Antihistamine medicines for allergies shouldn’t affect the symptoms of Tourette patients, Pittenger said. That’s because these medications affect different histamine receptors than those that factor into Tourette cases. The disorder affects between 0.7 percent and 1 percent of children.

NORTHEAST GEORGIA DIAGNOSTIC CLINIC DEPARTMENT

Most of those affected improve significantly by adulthood, Pittenger said. “Where there’s really a need are for the people who don’t grow out of it,” he said. “They tend to have more severe problems, and that’s where there’s a need for new treatment.” Although the disorder is commonly depicted as producing wild and often vulgar utterances, experts say that most cases involve fairly mild symptoms, such as repeated throatclearing or blinking. Histamine-regulating drugs have already been developed and are being tested for treating attentiondeficit disorder. Pittenger said that to study them for Tourette’s would require partnering with a pharmaceutical company to fund the testing and pay for the federal regulatory process. Even in a best-case scenario, he said, it could be a few years before such drugs would be available to Tourette’s patients.

ENDOCRINOLOGY

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• thyroiditis • thyroid cancer.

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Northeast Georgia Diagnostic Clinic is proud to announce the addition of our fifth board certified endocrinologist. Archana Swami, MD, will begin seeing patients in February. Endocrinologists provide treatment for disorders including diabetes, thyroid disorders, glandular cancers, osteoporosis and parathyroid disease. To schedule an appointment, please call 770-536-9864.

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Shoulder pain may signal rotator cuff problems By Charles Phelps

cphelps@gainesvilletimes.com Have you ever had pain in your shoulder? When you lay down to sleep, does it become uncomfortable and you have to change positions? If changing positions doesn’t help the pain, then you could be feeling the effects of a rotator cuff injury. The rotator cuff is a part of the shoulder that can affect how much strength and motion a person has in their arm. If the rotator cuff is injured, an ordinary task like bending down to pull a gallon of milk out of a refrigerator and lifting it up could be difficult, said Michael B. Gottsman, medical doctor and orthopaedics surgeon for The Longstreet Clinic. “Some people will notice pain on their neck more than the trapezius muscles,” he said about common symptoms of a rotator cuff injury. “Some people complain about pain on their outer arm.” According to Gottsman, there are two different common rotator cuff injuries: a strain and a tear. Most of the injuries seen are strains, or the beginning of tendinitis in the shoulder that’s causing pain and discomfort. He said most people who experience shoulder pain have neck pain as well, a very a common sign of a strain, or discomfort to the rotator cuff. He explained that one to two weeks of rest, anti-inflammatory medication and steroid shots are the first steps to help relieve pain if it is a strain. If that doesn’t work, then the person should take further steps in finding out what exactly has happened. “If that (medication), or anti-inflammatory medication doesn’t work, then an MRI is scheduled,” Gottsman said. “X-rays will not typically show the (rotator cuff) tear.” Most of the strains and tears come

SCOTT ROGERS | The Times (Above) Orthopedic Surgeon Dr. Michael Gottsman prepares to examine Samuel Taylor’s stitches during a routine visit as Taylor recovers from a torn rotator cuff which required surgery to correct.

from years of “wear and tear,” he said. Falling on the shoulder can also cause the injury. “A rotator cuff doesn’t repair itself once it tears,” Gottsman said. “If someone has a torn rotator cuff — especially someone with a higher demand on their shoulder — they will need to see a specialist.” Gottsman said rotator cuff injuries aren’t age-specific but demandspecific. Rotator cuff tears become more common in people age 40 or higher, he explained, comparing the cuff to a rope; in a 40-year-old, the rope begins to see a change because of the years of wear on it, while for a 20-year-old the rope stays solid and makes it difficult for a tear to occur. He also explained that while elbow Please see Rotator cuff page 17

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Rotator cuff Continued from page 16 injuries are more common with baseball pitchers, they can develop tendinitis in the rotator cuff from years of the throwing motion. If someone has surgery to repair a rotator cuff, Gottsman said they will be in physical therapy for the first two months of recovery to help regain strength. Competitive sports players will continue longer in therapy but will do it on their own after two months. At three months out, he said a person would be at 80-85 percent healed, and the six- to nine-month timeframe is where full recovery is expected. Recovery time also depends on whether if a person uses a lot of overhead motions.

SCOTT ROGERS | The Times With his arm held in place with a special sling, Samuel Taylor is allowed to squeeze a foam ball to keep his hand moving. Taylor’s shoulder is well supported making the ball essentially weightless so it does not irritate the shoulder.

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Steps to fend off the lure of sugar By Jen Mulson

a piece of fruit as a midmorning snack.A healthy fat My name is Jennifer, and I’m a and carbohydrate, sugarholic. such as an apple, As of this writing, I have four days can help keep you clean and sober from the white from feeling hunstuff. However, I probably should gry. admit that there are three Brachs Once the blood Peppermint Christmas Nougats sugar is stabilized, lurking in my pocket that I’m dying the body is less to have with a hot cup of coffee. likely to crave I turned to an expert for help. sugar. Cassandra Green is a certified “The body is holistic health counselor who just mourning that happens to co-own and teach at sugar,” she said. Cambio Yoga in Colorado Springs, “But once it’s stabiColo. She’s teaching a four-part lized, the body can “Kick Sugar to the Curb” workshop, react more diplostarting at the best time of year matically. You can — after our post-holiday feasting have huge change extravaganza. in personality due Letting go of the white stuff can to blood sugar.You be a challenge, my fellow sweet- can manage stuff toothed friends, but it’s a worthy in life a lot betbattle. ter (when blood “Every time you spike your blood sugar stabilizes).” sugar, it creates inflammation in the body, and that’s the root of • Take a multiall disease,” Green said. “It’s closely vitamin and a fish linked to cancer, heart disease and oil pill, which conall degenerative diseases.” tain micronutriI always observe that sugar oper- ents and healthy ates as crack in my body — the fat. Due to the more I eat, the more I want. Your Standard American body gets accustomed to having it, Diet (appropriately called SAD), Green said, which instigates a large many folks don’t get the proprelease of insulin to deal with it. er nutrition their bodies require, “What goes up must come down,” which can lead to sugar cravings. she said. “You go through a cycle of high blood sugar and insulin is • Fats can help combat cravreleased, then blood sugar plum- ings, so have some nuts or a piece mets and you crave sugar again.And of cheese. One also can mistake sugar releases dopamine. People hunger for thirst so stay hydrated. can be addicted to it just like drugs.” Cinnamon is also a handy spice to She’s not lying. Here are her rec- have as it can help control blood ommendations: sugar. Green recommends a baked • Eat five mini meals a day to apple with walnuts for dessert. (I keep the blood sugar level steady. can attest that this is a delicious Make sure to consume whole foods alternative.) and not processed foods, as those tend to unwind as sugar in the • Stick with it. By Day 5 of a sugar body, Green said. Try almonds and cleanse, the cravings will dissipate. The Gazette (Colorado Springs, Colo.)

Be wary of that cup of coffee, too, So maybe I’ll have one of those she said. Caffeine can trigger sugar tempting treats in my pocket, after cravings. (It’s like she’s reading my a nice big bowl of kale. And then I’ll brush my teeth, which my mama mind.) advised me to do long ago. She also “It’s psychological. We’re used to fought the sugar demons, mostly having cheesecake and a cup of over a carton of ice cream after coffee,” she said. “For a lot of us, dinner every night. She was right, the caffeine is a natural metabolism though — a minty mouth does help speeder, and it prompts you to have stop a sugar binge in its tracks. “If we look back before promore sweets than you normally would. Caffeine and sugar go hand cessed food was readily available, we see that people died over time, in hand.” Of course, moderation in all from infectious disease,” Green said. things, right? Eat well 80 percent to “They didn’t have a lot of degen90 percent of the time, depending erative diseases. Now we see we’re on your activity level, and treat your- dying of degenerative diseases. self every once in a while, accord- They’re starting out on a cellular ing to an article on livestrong.com. level.”

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For US kids, the rich get thinner and the poor get fatter By Melissa Healy

Los Angeles Times From many corners of the United States — Los Angeles, Philadelphia, Mississippi — recent years have brought heartening news about the relentless rise in obesity among American children: Several years into a campaign to get kids to eat better and exercise more, child obesity rates have appeared to stabilize, and might reverse. But a study published in the journal PNAS suggests that among adolescents, the hopeful signs are limited to those from better-educated, more affluent families. Among teenagers from poorer, less well-educated families, obesity has continued to rise. Nationally, rates of obesity among adolescents ages 12 to 19 did not rise between from 2003 to 2004 and 2009 to 2010. But during those times, obe-

sity rates among adolescents whose parents have no more than high-school educations rose from about 20 percent to 25 percent. At the same time, the obesity rates for teenage children of parents with four-year college degrees or more fell from 14 percent to about 7 percent. “The overall trend in youth obesity rates masks a significant and growing class gap between youth from upper and lower socioeconomic status backgrounds,” the authors of the latest research wrote. That class gap was not evident in younger children, the researchers said. But as children neared the cusp of adulthood, the class differences became increasingly stark. Disparities between rich and poor in obesity rates are not new, and they are only one of many health gaps that make poor patients sicker and more likely to die prematurely than richer ones. But

if the public health message on obesity “has not diffused evenly across the population,” as the authors of Monday’s report suggest, this disparity could stymie efforts to stem costly obesity-related diseases in the years ahead. In a detailed accounting of youth consumption and exercise patterns, researchers from Harvard University’s Kennedy School of Government found that physical activity may account largely for the divergent trend in obesity between rich and poor. In 2003, 86.6 percent of adolescents living with parents who had college degrees told survey-takers that they had exercised or played a sport for at least 20 minutes continuously sometime in the last seven days. By 2011, 90.1 percent said they had done so. In contrast, 79.8 percent of adolescent children with parents who did not go beyond high school said in 2003 that they had exercised or played

a sport for at least 20 minutes in the previous week. By 2011, the numbers of those adolescents who had done so had barely budged, at 80.4 percent. Asked whether they had engaged in at least 10 minutes of continuous physical activity in the last 30 days, 94.7 percent of adolescents with collegeeducated parents said yes. But among teens with parents with high school educations or less, 82.1 percent of teens said they had engaged in even that minimal level of exercise. Kids across the socioeconomic spectrum got the message that they should reduce their intake — and less advantaged kids took in fewer calories to begin with. From 1998 to 2010, the teenage children of parents with college degrees reduced their average calorie intake from 2,487 calories per day to 2,150. In the same period, less advantaged adolescents went from averaging 2,271 calories per day down to 2,105.

Sunday, January 26, 2014

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Tips on entertaining with special diets at the table By Judy Hevrdejs

Chicago Tribune Entertaining family and friends can be full of challenges whether you’re the guest or host. Those challenges may increase if food allergies, food intolerances and those who choose to follow special diets, perhaps vegan or vegetarian, are in the mealtime mix. Your vegan brother won’t eat a dessert that uses honey. A lactoseintolerant cousin will pass on the butter. “When it comes to an allergy, your immune system is involved. It can be as simple as having an itch or rash and potentially lead to a life-threatening reaction where you stop breathing. So an allergy is something that is much more severe,” says Vandana Sheth, a California-based registered dietitian, certified diabetes educator and representative for the Academy of Nutrition and Dietetics. With a food intolerance, on the other hand, “it’s more that your body’s not able to process specific things,” says Sheth. “With lactose intolerance, for example, the most common intolerance that people have, you’re not involving the entire immune system.” Determining whether the immune system is involved is an important factor with celiac disease and non-celiac gluten sensitivity. The term “gluten intolerance” often refers to the entire category of gluten issues: celiac disease, non-celiac gluten sensitivity and wheat allergy, according to Carol M. Shilson, executive director of the University of Chicago Celiac Disease Center. “Celiac disease is an inherited autoimmune disorder that affects the digestive process of the small intestine. ‘Non-celiac gluten sensitivity’ --what many call ‘gluten intol-

guest has food allergies or sensitivities, Sheth says. “When you’re shopping and preparing the menu, look at items that are easy to put together and can be the same dish for everyone rather than making many different versions.” Notes Sheth: “When you’re cooking and trying to keep food safe, people don’t think about using that same wooden spoon or cutting board for preparing foods that might say, ‘I’ve become vegetarian might cause problems.” and I should be able to eat most Host-guest conversations have to of the things, but if you’ve used be comfortable for both parties, chicken broth or something, I may Sheth says. “The host might be not eat it. Please don’t be offended. freaking out with all these differCan I bring something?’ ent restrictions. So as a guest, try “That way, you’ve let them know to be more understanding. Realize you don’t want to put pressure on ultimately it’s your responsibility them to make a whole entree that’s to ensure that what you’re eating vegetarian for you and that you can is safe.” bring that.” If you’re the host, find out if any Please see Special diet tips on page 21

Your vegan brother won’t eat a dessert that uses honey. A lactose-intolerant cousin will pass on the butter. erance’ -- causes the body to mount a stress response (often gastrointestinal symptoms) different from the immunological response that occurs in those who have celiac disease (which most often causes intestinal tissue damage).” And a wheat allergy, like most allergies, “causes the immune system to respond to a food protein because it considers it dangerous to the body when it actually isn’t,” Shilson notes. “This immune response is often time-limited and does not cause lasting harm to body tissues.” There are dozens of foods or food groups that can cause allergies, according to the U.S. Food and Drug Administration. But the eight major allergens are milk, eggs, fish (e.g. bass, cod), crustacean shellfish (e.g. shrimp, lobster, crab), tree nuts, peanuts, wheat and soybeans -- the FDA requires food labels to list them. Those with allergies, food intolerances or who follow a special diet know what foods cause problems. Friends or relatives may not. They may not realize there can be eggs in mayonnaise or wheat in soy sauce, or that there are often alternatives available for both. Avoiding confusion begins with the person with dietary considerations. Touch base with the host before a gathering that will include a meal or snacks, says Sheth, and be as specific as you can about what you can and can’t eat. “A guest

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Special diets and strategies There are many food allergies, intolerances and specialized diets. Here are a few guidelines:

baked goods, prepared sauces. Agar and guar gum are OK. Cooking tip: Consider soyor coconut-based milks and fats. Instead of mashed potatoes preVegetarian: Does not eat pared with dairy, Sheth suggests animal products or animal by- baked potatoes with toppings on products (e.g. butter, cheese). the side. Subgroups: lacto-ovo vegetarian (dairy and eggs OK), pescatarian Peanut allergy: Some recipes (fish OK). (Mexican moles, Thai sauces) may contain peanuts. Label alert: Check seasoning packets. No gelatin or animalLabel alert: Look for “May conbased rennet. tain traces of ...” Don’t cook with Cooking tip: Serve a vegetar- peanut oil. ian chili or lentils. Cooking tip: Sheth says consider using seed butters (sunflowVegan: Plant-based diet. Does er, pumpkin) or soy nut butter not eat eggs, milk, cheese. made from roasted soybeans. Label alert: Check labels of Tree nuts: Includes pecans,

walnuts, cashews.

almonds,

hazelnuts, used,” Shilson adds. If a person can tolerate a small amount of oats, use those labeled “certified Label alert: Be alert to cross con- gluten free.” tamination Cooking tip: Use cornstarch, Cooking tip: Try using roasted potato starch or arrowroot for pumpkin seeds, sunflower seeds thickening. Consider quinoa, for crunch on a salad. Or roasted brown rice, polenta. garbanzo beans. For further guidance and speCeliac disease and gluten cifics: eatright.org, foodallergy. intolerance: Gluten, a protein org and cureceliacdisease.org. in wheat, shows up in most traditional breads, pastries. Check deli meats, bottled sauces, sauced frozen vegetables. Label alert: Can also be found in other grains; sometimes rye, barley and oats. Be aware of “their derivatives in the ingredients

Sunday, January 26, 2014

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NGHC School of Cardiovascular Technology Opens in Gainesville Advertorial provided by Northeast Georgia Heart Center

An exciting opportunity has come to Northeast Georgia: The Northeast Georgia Heart Center School of Cardiovascular Technology. The school, offering an intensive, one-year program teaching both echocardiography and peripheral vascular ultrasound, is located in Gainesville and operated by leading cardiologists, technologists, and registered nurses at the Northeast Georgia Heart Center (NGHC). This program includes classroom instruction, laboratory instruction, and hands-on clinical experience. Students will have the opportunity to train at the #1 cardiology program in the state of Georgia. In the ever-changing field of healthcare, there is a demand for welltrained technologists with a wellrounded skill set.The NGHC School of Cardiovascular Technology was conceptualized and designed with that demand in mind. What sets this school apart from others? According to the program’s director, Paul Braum, “In the past, many schools focused on the ability to acquire adequate images, with little attention given to the clinical aspects of the exams.This program focuses on the clinical aspects, combined with the art of acquiring exceptional diagnostic images.” In fact, Braum began teaching when he realized it was becoming more and more difficult to find highly qualified techs with specific knowledge of how the heart works and how the images they capture can directly affect proper diagnoses. He began traveling to Atlanta each week to teach classes. However, considering the fact that his office, Northeast Georgia Heart Center, along with Georgia’s #1 cardiology hospital, Northeast Georgia Medical Center, are both located in Gainesville, starting a school in Gainesville seemed like a natural progression. The program, a culmination of years

of planning and preparation, is the first of its type in this area. According to Jeffrey Marshall, MD, a cardiologist with NGHC and medical director of the cardiac catheterization lab at Northeast Georgia Medical Center, “The NGHC School of Cardiovascular Technology is a great addition to the educational opportunities in North Georgia. Learning from expert technologists and doctors with prior experience teaching in medical schools will make the quality of instruction second to none.” Along with classroom time, students will spend considerable time observing first-hand all aspects of cardiology in a clinical setting. This provides students a more complete understanding of how the heart works, as well as exposure to various aspects of cardiology and its sub-specializations. “As a physician in this practice, it is very exciting to be part of an opportunity to train future cardiovascular technologists in not only mastering technologies, but to help them integrate these skills into an excellent clinical program,” states Prad Tummala, a cardiologist with Northeast Georgia Heart Center and medical director of the Ronnie Green Heart Center at Northeast Georgia Medical Center. An echocardiogram—an ultrasound of the heart—is one of the most common non-invasive tests performed by cardiovascular technologists. It measures the size and shape of the heart, blood flow through the heart, and pumping capacity. The images obtained during an echo are used by cardiologists to obtain a very valuable, non-invasive look at the patient’s heart. A properly trained technologist is able to recognize normal and abnormal images and will direct the exam accordingly, using contrast agents when necessary, and preparing a preliminary report. The cardiologist then views the images, edits as necessary, and finalizes the report. Other ultrasound testing performed by cardiovascular technologists include:

• Carotid artery: The carotid ultrasound detects plaque buildup and blockages that can lead to a stroke. • Renal artery: This ultrasound can reveal renal artery stenosis (hardening of the arteries), which puts patients at risk for high blood pressure and potential kidney failure. • Abdominal: This test can detect an abdominal aortic aneurysm (AAA) — a weak, bulging spot in the artery. Rupture of the AAA can be fatal within minutes due to blood loss. • Peripheral: Ultrasound of the veins and/or arteries in the limbs may detect blockages, narrowing or widening of the arteries, collapsed veins, deep vein thrombosis (DVT), and poor blood flow. The program at the NGHC School of Cardiovascular Technology will be taught by both technologists and cardiologists with extensive experience. Braum, B.S., RCVT, RDCS, RVT, FASE is the program director. Braum has been teaching in the field of cardiology and cardiac imaging since 1978. He was a senior technologist in the cardiac catheterization laboratory at Shands Teaching Hospital at the University of Florida in Gainesville, Fl. He also served as Chief of Pediatric Echocardiography at the Children’s Hospital of Pittsburgh in Pittsburgh, Pa. Braum participated in the pioneering stages of liver and heart transplantation, along with the early stages of cardiac catheterization interventions. He has educated Fellows in pediatric cardiology, participated in critical care medicine at Emory University and authored publications in a number of scientific journals. Braum has extensive experience in various areas of cardiology that will provide students with an indepth education unlike any other program. He has an A.S. in Cardio Pulmonary Technology from Santa Fe Community College affiliate of University of Florida, and a B.S., from the University of Pittsburgh (major in Health Administration/Education; minor in Premedical Sciences).

Because of the limited number of openings available each year, entry into the program is highly competitive, and classes begin March 4, 2014. To qualify, a candidate must provide transcripts verifying they possess either (1) a minimum four-year college degree (Bachelor’s or higher) in any major that includes the successful completion of two semesters of natural science, including an anatomy and physiology course, or (2) a two-year allied health degree in any specialty related to patient care. Students will complete courses in ultrasound physics, cardiovascular anatomy and physiology, electrophysiology, cardiac pathology, pharmacology, peripheral cardiovascular testing, and cardiac technology. Additionally, students receive personalized guidance on job searches, preparing a resume, and interview skills relative to their field. Successful completion of the program will allow candidates the ability to take a national credentialing exam. According to Cindy Dove, director of the Non-Invasive Cardiovascular Lab at Northeast Georgia Heart Center and also the school’s director, “One of the things that really sets this school apart from others is the personal, individualized attention provided to our students beginning with the first class, continuing throughout the entire year, and leading up to the culmination of a successful job search that sets students on the path to a career that is personally, professionally, and financially rewarding.” For those already certified and working as an echocardiography technologist, the school also offers continuing medical education (CME) courses year-round upon request. All CME courses offer credit through the Society of Diagnostic Medical Sonography (SDMS). For more information or to apply for admission to the NGHC School of Cardiovascular Technology, please visit the website at www.heartcenterCVschool.com

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Looking for a new career with heart? Become a Cardiovascular Technologist.

The NGHC School of Cardiovascular Technology is now accepting applications for its new program for those individuals who are interested in a career as a noninvasive cardiovascular technologist. Our program is taught by leading cardiologists, technologists and registered nurses with extensive experience in the field of cardiovascular technology. Contact us for further information about our program. 200 S. Enota Dr., Ste. 430 • Gainesville, GA 30501 • Tel: 678-997-2434 www.HeartCenterCVschool.com

Sunday, January 26, 2014

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