Attn Vent

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nvshelat

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Just noticed your CT fellowship in your signature - congrats!

To pick your brain, what appealed to you about CT as opposed to, say, CC or other fellowships? In your mind, the +/- of a CT fellowship?

Curious,

nvshelat

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Just noticed your CT fellowship in your signature - congrats!

To pick your brain, what appealed to you about CT as opposed to, say, CC or other fellowships? In your mind, the +/- of a CT fellowship?

Curious,

nvshelat

I would also like to congratulate you vent on your CT fellowship. I am a new member to SDN but I have always enjoyed your post ( I would read them on my GF's account).

I also am interested in what appealed to you about CT opposed to CC or pain. As for me it it is a long road until i should even consider fellowships, but i guess i do it because it is enjoyable to dream of the future.
 
Well folks it was a totally personal decision.

Do you need a fellowship to get a job? Nope.

Why did I choose a CV fellowship?
Well I know my peeps will make fun of me, but its because I: 1) want to be able to confidently handle difficult cases for the rest of my career and this will help me accomplish that, 2) I love cardiac phys and the challenges it brings, 3) I want to be a bad ass anesthesiologist, 4) I want to set myself apart from the constant influx of general trained anesthesiologists, 5) job security is a good thing and #4 should help achieve that.

Why not CC? Bfffwah....well I dislike family chats for gomers who will only end up with trach/peg and a bed at a vent facility. Sorry not my game. Also, although I love the acute medicine aspect, I hate being in the unit. It sucks. Lastly, I dislike dealing with gomers in an ongoing care situation. There is little else that frustrates me more. At least in the OR, I can keep the gomer alive and dump it on the primary team once said surgery is over. Cold hearted you say? Naww...well maybe perhaps. But sanity is priceless.

Venty
 
Members don't see this ad :)
Do I confidently feel able to handle challenging cases now? Absolutely, but there is now way a CV fellowship is going to set me back in my abilities. It should only serve as a steroid boost to what I know mentally, clinically, and procedurally (is that a word? dunno.). I never, ever, want to be that guy who has to back down from a big case because of lack of experience or from overtly high sphincter tone.

Do I occasionally pull a diamond out of my ass from sphincter tone? You betcha. I just wanna pull less diamonds outta my ass once all is said and done.

My main decision is because I wish to be a bad ass anesthesiologist.
 
For what it's worth, some of our CA3s are being told by local groups (chicago and suburbs) that they are starting to shift toward hiring primarily fellowship trained physicians. Can't say this is a national trend, but it seems to be happening here...
 
In another few years when medical therapy for vascular disease gets perfected.....when stent technology has a ZERO percent stenosis rate....and IV Apolipoprotein therapy is the standard of care for atherosclerotic endothelial disease.....and getting your chest split is the only option for patients without access to standard medical care....and ONLY the surgeons who can't get into bariatric fellowships or who can't find regular jobs go into CT training...

Does it matter if you are a BAD ASS GAS PASSER getting 300 bucks for that BAD ASS case?

...oh and you won't have to talk to families...because only folks without any family would willingly get their chest split...because good family members would know enough to talk them out of such medieval torture?

Good luck with your fellowship:)
 
In another few years when medical therapy for vascular disease gets perfected.....when stent technology has a ZERO percent stenosis rate....and IV Apolipoprotein therapy is the standard of care for atherosclerotic endothelial disease.....and getting your chest split is the only option for patients without access to standard medical care....and ONLY the surgeons who can't get into bariatric fellowships or who can't find regular jobs go into CT training...

Does it matter if you are a BAD ASS GAS PASSER getting 300 bucks for that BAD ASS case?

...oh and you won't have to talk to families...because only folks without any family would willingly get their chest split...because good family members would know enough to talk them out of such medieval torture?

Good luck with your fellowship:)

WTF dude.

I'm not going to apologize for wanting to be a better physician. Ridiculous.
 
I must admit that i had some trepidation when i saw u start posting again. As Plank posted in another thread, you have a lot to offer and I enjoy your brusk, iconoclastic point of view. I have also held back from saying anything negative because you are an attending and jet likes you ( the main reason, frankly). You treat everyone like a complete idiot. Worse, you are as dogmatic and ridiculous in how you teach as the very academics you abhor.

Maybe you could provide evidence more often for all the sweeping statements you make. That is what I would demand of my attendings. If you really want to teach rather than just put people in their place, it would be nice to see those articles you have read.






In another few years when medical therapy for vascular disease gets perfected.....when stent technology has a ZERO percent stenosis rate....and IV Apolipoprotein therapy is the standard of care for atherosclerotic endothelial disease.....and getting your chest split is the only option for patients without access to standard medical care....and ONLY the surgeons who can't get into bariatric fellowships or who can't find regular jobs go into CT training...

Does it matter if you are a BAD ASS GAS PASSER getting 300 bucks for that BAD ASS case?

...oh and you won't have to talk to families...because only folks without any family would willingly get their chest split...because good family members would know enough to talk them out of such medieval torture?

Good luck with your fellowship:)
 
My main decision is because I wish to be a bad ass anesthesiologist.
I think this statement may have contributed to MilMD's response. By default it suggests that all other areas of anesthesiology are not "bad ass".
 
I'm not going to apologize for wanting to be a better physician. Ridiculous.

Rock on, dude. Don't apologize to anyone. That TEE certificate alone will be worth its weight in gold. Dude I know finishing fellowship this year is going into PP as a cardiac anesthesiologist. Know what his package is first year out? Gets 17 weeks vacation and is pulling $450K. Anyone who wants to argue that an extra year of training ain't worth that is, well... you figure it out.

-copro
 
I agree with vent on this.

Ventie just wants to be even more bad azz than the other bad azzes on this site. He should be respected for this, not made fun of.

Mil doesnt do ICU anymore, was this a waste for him? Emphatically no, I believe would be mine and his answers.


I think this statement may have contributed to MilMD's response. By default it suggests that all other areas of anesthesiology are not "bad ass".
 
Members don't see this ad :)
I think this statement may have contributed to MilMD's response. By default it suggests that all other areas of anesthesiology are not "bad ass".


very astute....

AND the more important point that you guys are missing is that I suspect CV surgery is a dying field...and the picture I painted is a possible future.

I know of a number of CT surgeons who spent years training to find that in the short 7 to 8 years since they started, the field is not what they thought it would be.
 
Rock on, dude. Don't apologize to anyone. That TEE certificate alone will be worth its weight in gold. Dude I know finishing fellowship this year is going into PP as a cardiac anesthesiologist. Know what his package is first year out? Gets 17 weeks vacation and is pulling $450K. Anyone who wants to argue that an extra year of training ain't worth that is, well... you figure it out.

-copro


Is that right? The used the say the SWAN told you everything you needed to know....

technology marches on

our understanding of medicine marches on.

our opinions of what's worth a lot of not changes with time.

If you REALLY like doing TEE's then great....but if that 17 weeks and 450 is any component of your perception....welll...

it could be working 45 weeks and getting paid 170.
 
very astute....

AND the more important point that you guys are missing is that I suspect CV surgery is a dying field...and the picture I painted is a possible future.

I know of a number of CT surgeons who spent years training to find that in the short 7 to 8 years since they started, the field is not what they thought it would be.

That's certainly an argument for not going into CT Surgery, but it's not an argument for not doing a CT Anesthesia fellowship. Cardiac anesthesiologists ARE rock star anesthesiologists. Not only can they throw in a TEE probe to determine hemodynamic issues intraop -- in both cardiac and non-cardiac surgery, but they have more experience in working with cardiac patients undergoing non-cardiac surgery. There's a reason cardiac anesthesiologists are in high demand, and it's not because of cardiac surgeries. It's because of a population that continues to age, live longer, have more and complicated comorbidities, all at a time when surgeons are able to offer procedures to sicker patients, that normally would've been reserved for healthier patients. Ergo, whilst demand for heart surgeons dwindles, demand for cardiac anesthesiologists IS on the up and up.
 
Is that right? The used the say the SWAN told you everything you needed to know....

technology marches on

our understanding of medicine marches on.

our opinions of what's worth a lot of not changes with time.

If you REALLY like doing TEE's then great....but if that 17 weeks and 450 is any component of your perception....welll...

it could be working 45 weeks and getting paid 170.


Even if this is the case couldn't Someone with a fellowship in CT still be able to do what none fellowshiped anesthesiologist do, and if they can Vent is correct in saying it is just making him personally more badass. I highly doubt he wanted to put anyone else down for not having a CV/CT fellowship.
 
That's certainly an argument for not going into CT Surgery, but it's not an argument for not doing a CT Anesthesia fellowship. Cardiac anesthesiologists ARE rock star anesthesiologists. Not only can they throw in a TEE probe to determine hemodynamic issues intraop -- in both cardiac and non-cardiac surgery, but they have more experience in working with cardiac patients undergoing non-cardiac surgery. There's a reason cardiac anesthesiologists are in high demand, and it's not because of cardiac surgeries. It's because of a population that continues to age, live longer, have more and complicated comorbidities, all at a time when surgeons are able to offer procedures to sicker patients, that normally would've been reserved for healthier patients. Ergo, whilst demand for heart surgeons dwindles, demand for cardiac anesthesiologists IS on the up and up.

Even if this is the case couldn't Someone with a fellowship in CT still be able to do what none fellowshiped anesthesiologist do, and if they can Vent is correct in saying it is just making him personally more badass. I highly doubt he wanted to put anyone else down for not having a CV/CT fellowship.

Here's another POV....CV anesthesia works in an environment where you have a CT surgeon and a CPB pump backing you up....not so in 99% of the cases out there

CV anesthesia is very specialized....There are a high number of things that you rarely do in CV anesthesia that is done in 99% of the other cases that exists in PP.

I'm not discouraging anyone from CV training...I'm just pointing out other POVs that , as a resident, you JUST don't get exposed to.

Remember, I've been at this since 1997.

A heart is a big deal to a CA-2 or even CA-3, but there's a LOT of OTHER stuff out there.


Just another POV
 
There was a :) in the post... plus it may be not that far form the truth :eek:
Mil has put value on fellowships in the past so i think it was a little sarcasm imho
 
There was a :) in the post... plus it may be not that far form the truth :eek:
Mil has put value on fellowships in the past so i think it was a little sarcasm imho


spot on my friend.
 
Our CT attendings have a hard time with regional :laugh:

...and awake fiberoptics...
...and pediatric cases...
...and rapid turnover ambulatory cases...

...or at least our CT attendings do.
 
A low blow is a low blow, I don't care if its followed up with 10 smiley faces. Gimme a break.

As for bad assness, I always want to step up to a case. The CV trained attendings at my institution ,which I look up to, do. They know when to say no of course. I have chosen to emulate them. Shocking eh?

If one is offended by that, then I'm not sorry. I never COMPARE myself to others. Only to myself. I know what I want to be. I want to be good at what I do. Shocking eh?

I don't foresee myself having touble with FO, regional, or anything else other than difficult peds cases. Shocking eh?

Who says that a CV fellowship is just you pushing etomidate droppen in a tube and an echo then waiting to disconnect before the pump goes on? Major vascular cases, VADS, sick as dog pulmonary and cardiac cripples, Cardiac ICU management with take back emergencies, F'd up vasculopaths, sick as dog folks coming in for lobectomies/pneumonectomies...over and OVER AND OVER again? C'mon man. Echo certified. Gimmie a break.

Whoever thinks that a CV trained fellow is LESS, clinically, than your average dude/ette graduating from residency is wrong. Period. Its just not possible.

I never said I want to be better than other people. Nor have I suggested that a CV fellowship makes you better than other anesthesiologists. The CV fellowship just is what it is. Perhaps you've misread my previous statement.

Again, do you need a CV fellowship to perform well in these types of situations? No. Does it help? What do you think? I guess anybody that graduates from a residency can sit in the heart room, pushen gas. Or take over a thoracic ruptured aneurysm, or just slap a double lumen tube in a lobectomy with an EF of 25%. No problem right? Then why doesn't every attending on staff do these cases? Seriously.

I didn't want to even write this, but ya know, I've spent too much F'n time on this site not to.

Vent
 
Last thing I'll add on this thread, is a question. Rhetorical of course.

Is it the fellowship that makes someone good at what they do? Or is it the underlying passion?
 
I am glad you wrote this post for many reasons. SOmetimes a smiley face is designed to point out a joke and sometimes it is passive aggressive.

A low blow is a low blow, I don't care if its followed up with 10 smiley faces. Gimme a break.

As for bad assness, I always want to step up to a case. The CV trained attendings at my institution ,which I look up to, do. They know when to say no of course. I have chosen to emulate them. Shocking eh?

If one is offended by that, then I'm not sorry. I never COMPARE myself to others. Only to myself. I know what I want to be. I want to be good at what I do. Shocking eh?

I don't foresee myself having touble with FO, regional, or anything else other than difficult peds cases. Shocking eh?

Who says that a CV fellowship is just you pushing etomidate droppen in a tube and an echo then waiting to disconnect before the pump goes on? Major vascular cases, VADS, sick as dog pulmonary and cardiac cripples, Cardiac ICU management with take back emergencies, F'd up vasculopaths, sick as dog folks coming in for lobectomies/pneumonectomies...over and OVER AND OVER again? C'mon man. Echo certified. Gimmie a break.

Whoever thinks that a CV trained fellow is LESS, clinically, than your average dude/ette graduating from residency is wrong. Period. Its just not possible.

I never said I want to be better than other people. Nor have I suggested that a CV fellowship makes you better than other anesthesiologists. The CV fellowship just is what it is. Perhaps you've misread my previous statement.

Again, do you need a CV fellowship to perform well in these types of situations? No. Does it help? What do you think? I guess anybody that graduates from a residency can sit in the heart room, pushen gas. Or take over a thoracic ruptured aneurysm, or just slap a double lumen tube in a lobectomy with an EF of 25%. No problem right? Then why doesn't every attending on staff do these cases? Seriously.

I didn't want to even write this, but ya know, I've spent too much F'n time on this site not to.

Vent
 
I guess you guys know it all already....ALL of 4 years after medical school.....ALL of ZERO years in practice....

I WAS NEVER that competent, smart, or all knowing.....

NO smileys here....AND LOTS of sarcasm.
 
I think this may be appropriate here:
http://www.changeboard.com/hrcircle...chive/2007/06/29/the-alpha-male-syndrome.aspx




THE FOUR TYPES OF ALPHA
A-types can be put into four categories. People are rarely all one type, but they may display a dominance in one of the four areas.
Commanders: Intense, magnetic leaders who set the tone, mobilise the troops and energise action with authoritative strength and motivation, without necessarily digging into the details.
Visionaries: Expansive, intuitive and proactive, they see possibilities and opportunities that others sometimes dismiss as impractical or unlikely, and inspire others with their vision.
Strategists: Methodical, systematic, often brilliant thinkers who are oriented toward data and facts, they have excellent analytic judgment and a sharp eye for patterns and problems.
Executors: Tireless, goal-oriented doers who push plans forward with an eye for detail, relentless discipline and keen oversight, surmounting all obstacles and holding everyone accountable.
DEALING WITH ALPHA ANGER
Whether or not you're an alpha yourself, dealing with a volatile alpha can be one of the great workplace challenges. Here are some vital tips:
1. Don't get defensive: No explanations. No excuses. Take 100% responsibility for whatever happened. Try to find a remedy.
2. Avoid feeling victimised: Of course, your alpha boss is a bully. Don't get even, get curious. Delve into why you're the one getting yelled at. If you focus on learning instead of sulking or venting, you'll stay out of the alpha quagmire.
3. Look in the mirror: Just because you don't deserve the abuse doesn't mean you didn't put the bull's eye on your back. Is being a target for someone else's anger a pattern from your long-ago past? Does it serve a purpose? If the drama offers you some secondary gain, you're likely to keep it going.
4. Get curious: Adopt the attitude that you can always learn from the alpha, no matter how explosive they are. Calmly restate their message. Ask questions to let them know you want to understand.
5. Clarify your standards: We train people how to treat us. If you're being yelled at or humiliated consistently, you've somehow made that acceptable. Be clear with yourself that abusive behaviour is not OK and the abuser will start to change.
6. Stand your ground: Be clear on what behaviour is unacceptable. Then make your boundaries known. Let the alpha know that if they cross the line, you'll walk away.
WHAT SORT OF ALPHA ARE YOU?
Strengths
- No matter what, I don't give up until I reach my end goal
- I say exactly what I think
- When I play a game, I like to win
- I have no problem challenging people
- I expect the best from the people I supervise and I help them deliver
- I make the decision I believe is correct, even when other people don't
agree
- I have strong opinions on issues I know about
- I seldom have any doubts about my ability to deliver
- When leading others, I set high performance standards.
- Even when I am successful, I always think about things that could have
been done better
Risks
- I believe that my value is defined by the results I achieve
- I don't care if my style hurts people's feelings, if that's what's
required to produce results
- When people disagree with me, I treat it as a challenge or an affront
- I tend to believe that others need to change more than I do
- If I'm asked to listen to inferior ideas, I can quickly become visibly
annoyed
- Sometimes I lose control of my temper and visibly express my anger
- People say I become curt or brusque when I have to repeat myself
- I have strong opinions about most things, even if I don't know much
about them
- Many of my work relationships have a competitive undertone
- I've been told that I don't listen as well as I should
 
A low blow is a low blow, I don't care if its followed up with 10 smiley faces. Gimme a break.

As for bad assness, I always want to step up to a case. The CV trained attendings at my institution ,which I look up to, do. They know when to say no of course. I have chosen to emulate them. Shocking eh?

If one is offended by that, then I'm not sorry. I never COMPARE myself to others. Only to myself. I know what I want to be. I want to be good at what I do. Shocking eh?

I don't foresee myself having touble with FO, regional, or anything else other than difficult peds cases. Shocking eh?

Who says that a CV fellowship is just you pushing etomidate droppen in a tube and an echo then waiting to disconnect before the pump goes on? Major vascular cases, VADS, sick as dog pulmonary and cardiac cripples, Cardiac ICU management with take back emergencies, F'd up vasculopaths, sick as dog folks coming in for lobectomies/pneumonectomies...over and OVER AND OVER again? C'mon man. Echo certified. Gimmie a break.

Whoever thinks that a CV trained fellow is LESS, clinically, than your average dude/ette graduating from residency is wrong. Period. Its just not possible.

I never said I want to be better than other people. Nor have I suggested that a CV fellowship makes you better than other anesthesiologists. The CV fellowship just is what it is. Perhaps you've misread my previous statement.

Again, do you need a CV fellowship to perform well in these types of situations? No. Does it help? What do you think? I guess anybody that graduates from a residency can sit in the heart room, pushen gas. Or take over a thoracic ruptured aneurysm, or just slap a double lumen tube in a lobectomy with an EF of 25%. No problem right? Then why doesn't every attending on staff do these cases? Seriously.

I didn't want to even write this, but ya know, I've spent too much F'n time on this site not to.

Vent

WTF are you talking about there? What low blow are you referring to?
 
NEJM
Volume 358:331-341 January 24, 2008 Number 4

Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel Coronary Disease. Edward L. Hannan, Ph.D., Chuntao Wu, M.D., Ph.D., Gary Walford, M.D., Alfred T. Culliford, M.D., Jeffrey P. Gold, M.D., Craig R. Smith, M.D., Robert S.D. Higgins, M.D., Russell E. Carlson, M.D., and Robert H. Jones, M.D.

Haven't read the article yet--but will do so at a more appropriate hour.
 

Quite timely! Seems that if you disagree with certain people on here, you are no better than the village idiot.

Good leadership doesn't equal being a complete know-it-all a$$wipe to people simply because they have a differing opinion. It seems to be the rule rather than the exception for some though.

Vent,
Good luck with your CT fellowship! Can you PM me with a short synopsis of what you've liked and not liked about Rush's program? That is if you get time. Thx.
 
In another few years when medical therapy for vascular disease gets perfected.....when stent technology has a ZERO percent stenosis rate....and IV Apolipoprotein therapy is the standard of care for atherosclerotic endothelial disease.....and getting your chest split is the only option for patients without access to standard medical care....and ONLY the surgeons who can't get into bariatric fellowships or who can't find regular jobs go into CT training...

Does it matter if you are a BAD ASS GAS PASSER getting 300 bucks for that BAD ASS case?

...oh and you won't have to talk to families...because only folks without any family would willingly get their chest split...because good family members would know enough to talk them out of such medieval torture?

Good luck with your fellowship:)


How do you repair valves with percutaneous procedures? Also, it's not like the CT surgeons aren't working on lesser invasive techniques. Who knows what the future will hold.

You, yourself have highly advocated a fellowship for future anes docs.
 
I think this statement may have contributed to MilMD's response. By default it suggests that all other areas of anesthesiology are not "bad ass".

I think that may be reading too far into what we've all come to agree is a laid back, personal, and friendly forum. Also Vents track record suggests humility rather than arrogance. MilMD knows that.
 
How do you repair valves with percutaneous procedures? Also, it's not like the CT surgeons aren't working on lesser invasive techniques. Who knows what the future will hold.

You, yourself have highly advocated a fellowship for future anes docs.

Dudes & Dudettes,

You guys are taking a (what I thought) humorous post and turning it into something else.

I have and always will advocate further and advanced training....I think our residency should be 5 years long.

I was just offering a different pov
 
NEJM
Volume 358:331-341 January 24, 2008 Number 4

Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel Coronary Disease. Edward L. Hannan, Ph.D., Chuntao Wu, M.D., Ph.D., Gary Walford, M.D., Alfred T. Culliford, M.D., Jeffrey P. Gold, M.D., Craig R. Smith, M.D., Robert S.D. Higgins, M.D., Russell E. Carlson, M.D., and Robert H. Jones, M.D.

Haven't read the article yet--but will do so at a more appropriate hour.

I've read the article... just more evidence against drug-eluting stents (which has been mounting recently), but not necessarily more evidence for CABG over stenting (eg: bare-metal stents).

And oh yes, valve replacements and paravalvular leak repairs are being done right now percutaneously by the cardiologists. Sure they lead to higher morbidity and mortality and failure rates, but it is a new technology. Plus they only perform these (or should only perform these) on patients who are too sick to go to the OR.

Does that mean CT surgery will go away? No, never. It just means the scope of their practice will change. And they will always need anesthesiologists, and a CT anesthesia fellowship can only help. So Vent, go for it, because it will only make you better.
 
Dudes & Dudettes,

You guys are taking a (what I thought) humorous post and turning it into something else.

I have and always will advocate further and advanced training....I think our residency should be 5 years long.

I was just offering a different pov

Thanks for clarifying. I find myself playing the devil's advocate often as well.
 
frikkin awesome convo going on here. I love SDN's anesthesiology forum.
 
Kudos to Vent and his CV fellowship. Yup, most definitely will be a bad ass anesthesiologist with that fellowship. I wish I would have done one years ago... You be totally bad ass when you can walk into a hospital as a locums guru and start doing CT cases literally that same day as if you've worked there your whole life--just nailin' that shiit. Runnin' Top Coin, dog, wherever ya go!! Regards, -----Zip
 
Believe it or not I try to emulate you bastards too. :)

Got the biceps curls up to 40lb dumbells now Jet. I know its not your 65's but I'm getting there. Slowwwwwwwwwwly.

Got the Tricep skull crusher to 55lb dumbells now. Yeah baby.

Got a baby gorilla on the way too. Find out the sex in 4 weeks dude. Maybe it'll be a hermaphrodite.
 
Believe it or not I try to emulate you bastards too. :)

Got the biceps curls up to 40lb dumbells now Jet. I know its not your 65's but I'm getting there. Slowwwwwwwwwwly.

Got the Tricep skull crusher to 55lb dumbells now. Yeah baby.

Got a baby gorilla on the way too. Find out the sex in 4 weeks dude. Maybe it'll be a hermaphrodite.

:laugh::laugh::laugh: Vent, bro, let's hope not....
I just knocked on wood for you. So, all should be good.
Congrats by the way!
 
Congrats vent!!!!
 
:clap:

Baby gorillas rock!!

Congrats!!
 
Believe it or not I try to emulate you bastards too. :)

Got the biceps curls up to 40lb dumbells now Jet. I know its not your 65's but I'm getting there. Slowwwwwwwwwwly.

Got the Tricep skull crusher to 55lb dumbells now. Yeah baby.

Got a baby gorilla on the way too. Find out the sex in 4 weeks dude. Maybe it'll be a hermaphrodite.


WOW!! A baby Venty gorilla!!

Congratulations!
 
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