Position Statement: Multiple Chemical Sensitivity

If you agree with this position statement, you may sign it at:
http://www.petitiononline.com/MCSAPS/petition.html

Multiple chemical sensitivity (MCS) is an environmental illness (EI)
in which negative neurological, pulmonary, cardiac, and rheumatic
health effects, among others, are experienced from exposure to common
environmental chemicals including fragrances, cleaners, pesticides,
and other petrochemicals at concentrations that are below regulatory
toxicity thresholds and that are normally deemed as safe.1-2   In
1989, consensus criteria were established for the diagnoses and
definition of MCS and they were revised in 1999.3  The case criteria
define MCS for diagnostic purposes as meeting six criteria: 3

1. The condition is chronic.
2. Symptoms recur reproducibly with repeated chemical exposure.
3. Symptoms recur in response to lower levels of chemicals than
previously tolerated.
4. Symptoms appear in response to multiple chemically unrelated
substances.
5. Symptoms improve or resolve when chemical incitants are removed.
6. Multiple organ systems are affected.

This paper will support the position that MCS is a disorder of organic
biological origin induced by toxic environmental insults, and requires
immediate recognition in the workplace, medical community, school
system, and public places across America; and that it is crucial that
environmental toxicants are identified and reduced or effectively
regulated and enforced through legislation to prevent additional
injury to citizens.

Current Evidence of MCS

Nuclear medicine utilizes SPECT (Single Photon Emission Computerized
Tomography) technology to perform brain scans which records brain
functioning by measuring perfusion (blood flow).4  MCS patients
commonly have a lower baseline flow of blood to the brain, and develop
further decreases in brain perfusion upon exposure to perfumes and
petrochemicals.5-7  Individuals with chronic symptoms show long-term
reduced blood flow to the brain and reduced ability of the brain to
take up the tracer substance in the early phase of injection,
indicating a pattern of neurotoxic metabolic abnormality.7-11  Over
90% of MCS patients exhibit a pattern of neurotoxic metabolic
abnormalities in the brain that is consistent with toxic
encephalopathy, but that  is not consistent with the changes
associated with psychiatric disease.10-11  SPECT brain scans on MCS
patients with chronic symptoms following toxic exposure to various
petrochemical, perfume, and related compounds have thus provided
evidence to support an organic, biological basis to MCS when compared
with healthy control subjects.6-11

Numerous studies have documented toxic encephalopathy and other
adverse reactions resulting from low level chronic exposure to various
chemicals.12-15  Researchers have identified numerous physiological
abnormalities in MCS subjects, including cardiac abnormalities16-18,
reactive upper airway disease155, vasculitis19, thrombophlebitis20,
impaired Phase 1 and Phase II detoxification clearance16, glutathione
depletion16,21, tinnitus22, thyroid and adrenal abnormalities23,
gastrointestinal disturbances155, T-cell activation/impaired NK cell
function/auto-immune disorders16,25-26, vitamin and mineral
deficiencies16,27, nuerocognitive decline16,28-29, rhinitis30,
sinusitis30, respiratory inflammation17, abnormal methacholine
challenge17, somatosensory abnormality31, peripheral neuropathy16,
sleep disturbance32, impaired balance16, and elevated levels of
xenobiotics25 among others.

Mast cell activation and disorders of porphyrin metabolism have also
been linked to MCS.16,33  Those with mastocytosis can be exquisitely
sensitive to even small amounts of chemicals.33  A group of MCS
patients tested for mast cell disease showed some patients actually
had mastocytosis and others were found to have a mast cell disorder.
33   Porphyrin enzyme abnormalities have also been shown to manifest
in blood enzyme deficiencies and chemical sensitivity in 86% of
subjects.34

Research suggests substantial individual differences in chemical
sensitivity, often spanning orders of magnitude.35  There are more
than 40 studies on MCS published from the United States, Canada,
Europe, Japan, and Australia which have shown that most cases of MCS
are initiated after one or more exposures to organic solvents and
three classes of pesticides.157,163  The pattern of causality by
chemical exposure is well documented.157,163,165  Evidence now shows
that genes controlling the activity of enzymes known to have roles in
the metabolism of these organic solvents and pesticides, also have
roles in determining increased susceptibility to MCS.163,165  The
epidemiological evidence and genetic evidence of causality is further
supported by the Hill criteria, which was developed to determine the
likelihood of a causal role for environmental factors in disease.
163-165

Genetic differences relating to detoxification processes are present
more often in those with MCS than those without.67  Five genetic
polymorphisms have a statistically significant role in determining MCS
prevalence.67  People with a ''high'' expression of two specific genes
(CYP2D6 and NAT2) were shown to be 18 times more likely to have MCS.
67   Each of these genes encodes proteins that metabolize chemicals
previously implicated in MCS, notably some organophosphorus pesticides
(PON1 and PON2 genes) and the organic solvents (CYP2D, NAT1 and NAT2
genes). 67   Chemicals shown to initiate MCS must be in a specific
chemical form to be active; therefore, individuals who metabolize them
at different rates vary in their susceptibility to MCS.67   Genetic
predisposition for MCS may involve altered biotransformation of
environmental chemicals.66   Haley found similar, confirmatory results
with the PON1 gene in studies of the Gulf War syndrome veterans65,
findings that have been confirmed by Furlong, Hulla, and Thier.
156-158

Another study analyzed genetic variants of four genes: NAT2, GSTM1,
GSTT1, and GSTP1.  The GST- genes code for enzymes in the glutathione
system, the body's frontline defense against xenobiotics.37
Individuals who are NAT2 slow acetylators and those with homozygously
deleted GSTM1 and GSTT1 genes are significantly more likely to develop
chemical sensitivity.37  Glutathione S-transferases act to inactivate
chemicals; people without these GSTM1 and GSTT1 genes are less able to
metabolize environmental chemicals.37   Glutathione S-transferases
play a crucial role in the process of detoxification of chemicals.37
The deletion of another gene, the GSTP1 gene, leaves individuals more
susceptible to developing MCS, as lack of these genes means a loss of
protection from oxidative stress.37

MCS may also be caused by low molecular weight chemicals that bind to
chemoreceptors on sensory nerve C-fibers leading to the release of
inflammatory mediators.38   Brain inflammation, biochemistry,
oxidative stress, excitotoxicity and other interrelated mechanisms are
correlated with symptoms of MCS.39,163 An accumulating body of
consistent and well-documented evidence implicates elevated nitric
oxide (NO) and peroxynitrite (ONOO-) as the etiology of the central
nervous system and peripheral tissue sensitivities seen in MCS and
other multi-system illnesses, including fibromyalgia (FM), chronic
fatigue syndrome (CFS), post-traumatic stress disorder (PTSD), and
Gulf War syndrome.39  Peroxynitrite (ONOO-) is oxidized from nitric
oxide.39-40  Excess peroxynitrite, implicated in MCS and related
illnesses, depletes energy stores, which in turn causes extreme
fatigue.39-40  Peroxynitrite also increases the permeability of the
blood brain barrier; excess levels allow chemicals greater chemical
access to the brain.40   Breakdown of the blood brain barrier has been
shown in MCS patients by Kuklinski and in animal models of MCS by Abou-
Donia.161-162   The key effect of nitric oxide (NO) in the body is
inhibition of cytochrome P-450 activity and slowing degradation of
hydrophobic organic chemicals.39-40  Excess nitric oxide levels, as
found in MCS patients, slows down the body's natural detoxification
processes leaving chemical toxicants in the body for a longer period
of time.39-40  A reduced blood-brain barrier and increased time to
naturally detoxify the body may render MCS patients subject to
permanent and long-term brain and nervous system damage and toxic
encephalopathy.  At least thirteen stressors are implicated as
initiators that begin the NO/ONOO cycle of biochemistry in these multi-
system illnesses through chronic low-level exposure or a sudden acute
exposure to an inciting agent, including carbon monoxide exposure,
organophosphate poisoning , and ionizing radiation exposures.39,41

Prior Paradigms

There have been various claims that MCS is caused by some ill-defined
and unsupported psychogenic mechanisms.42-44,50  One such theory
suggests that MCS may be a Pavlovian learned fear response.44  There
is no supporting evidence for the claim of a Pavlovian learned
response, as Pavlovian conditioning requires the formation of an
association between a conditioned stimulus (CS) and an unconditioned
stimulus (US) through repetition in order for learning to occur.45
The subject would have to know, understand, and connect the dangers of
chemical ingredients of the same nature as incitants, despite these
ingredients being generally regarded as safe and, in the case of
fragrances and many cleaning chemicals, unlabeled on the product under
HHS § 720.9 of the Food and Drug Administration.46  It is quite
conceivable that MCS patients learn of the chemical content of common
products used in the environment after they develop MCS, when they are
thus forced to educate themselves in order to practice avoidance to
improve and ultimately remain well.  Subjects reliably react to
fragrances in provocation tests in which their nose was clamped,
showing symptoms were not transmitted via the olfactory nerve, since
the subjects could not smell the perfume.47-48,60-61  Much like those
unaware of chemical exposure to virtually odorless products, such as
carbonless copy paper or sick buildings, patients with MCS also react
to chemicals which are odorless, giving no hint of impending exposure
and invalidating the theory of MCS being a fear induced olfactory
response or learned behavior.24,47-48,60

Psychological proponents have also purported that co-occurring
depression and/or anxiety in a portion of subjects causes MCS.50-51
If this were true, then 100%, or at least a statistically significant
proportion, of the subjects would have co-occurring mental illnesses,
and that illness would likely have been present prior to MCS onset.
Since that is not the case and the rate of co-occurring mental illness
in MCS patients is similar to that of other physiologically based
chronically ill populaces, then depression and/or anxiety may be ruled
out as an etiologic mechanism and instead considered reactionary.
52-57    Further evidence against this theory is provided by
statistics that show psychotherapy and psychoactive drugs intended to
cure MCS have been shown to be more likely to harm patients than help
them.58    A study shows 80% of MCS patients report no benefit from
psychotherapy to cure MCS and 15% have reported further harm.58
Though 65% find psychotherapy helpful to cope with the dramatic life
changes MCS bestows upon them, psychotherapy is obviously not a cure,
as MCS is not a psychologically mediated disease.58  Further,
psychiatric drugs such as Zoloft, Prozac, Elavil, and other
antidepressants were reported to harm an average of 60% of those who
tried them and had no effect on an additional 25%.58  Drugs such as
Valium and Xanax proved to harm 45% and had no effect on an additional
30%.58   There is not a single empirical study that shows any
significant remission rate in the symptoms of a cohort of
environmental illness patients from counseling or psychiatric drug
therapy.

Proponents of a psychological etiology claim that MCS defies
classification as a disease because it supposedly lacks evidence, and
has no consistent characteristics or objective measurable features;
however, all these proponents have shown is their own failure to read
and cite the numerous studies in the peer-reviewed literature that
report the physiological, biochemical, and genetic findings of MCS.
17,30,38,58-62,76  Further, they have failed to provide any
explanation for the factors distinguishing the chemicals involved in
MCS from those that have no role; they have not shown how a
psychological mechanism could stand behind an odorless chemical
producing symptoms or a benign odiferous chemical failing to produce
symptoms.63  They have also ignored the prospects for objective
biomarker tests for MCS that have been published by Kimata, Millqvist,
Bell and Fox and their respective colleagues, each of which is based
on measurable physiological changes in response to low level chemical
exposures in MCS patients.17,58-62  They have disregarded SPECT
imaging results showing brain changes which are inconsistent with
psychiatric disease and indicate a biological origin for MCS in
neurotoxicity.7-11  More importantly, they have overlooked the genetic
data of Schnakenberg, McKeown-Eyssen and her colleagues, and the
earlier work of Haley and his colleagues showing that the chemicals
initiating MCS act as toxicants, not as odors generating some strictly
olfactory response.37,65.67  The proponents have given complete
disregard to the genetic roles that meet Hill criteria and which are,
by definition, causal, as subjects have no idea what forms of these
genes they carry and consequently, their psychology cannot be
influenced by the perception that they should be more susceptible.
37,65.67,163-164  Genetic studies, coupled with known biochemical
functions of the genes involved, are the recognized approach to
determining the biological mechanism of MCS.66-67 These specific
studies provide significant confirmation of the toxicogenic roles of
chemicals previously implicated in MCS.66-67

In the past, MCS patients have been labeled as being psychogenic,
largely due to the outward symptoms of physiological neurotoxicity.
28,58  Patients with MCS may develop hyperactivity in deep structures
of the brain during chemical exposure, explaining the emotional
liability some experience, on a physiological rather than
psychological basis.68   Petrochemicals and organic solvents are known
etiologic mechanisms with an organic basis that induce depression,
anxiety, panic attacks, and other apparent mental disorders via known
organic etiologic mechanisms; but these manifestations resolve when
incitants are removed, thus distinguishing them from true psychiatric
illnesses.69-71  The evidence is now abundant that MCS is a true
organic, biological illness.17,61-63   Patients may be helped with
detoxification protocols, biochemical stabilizing therapy, and/or
exposure education, and should not be sent for useless, and often
harmful, psychiatric treatment and medications to cure MCS.17,61-63
Patients with MCS desire qualified medical care and the opportunity to
return to a full life and career.27,73-73  Many report that they had
successful, professional careers prior to becoming ill and reported
that they would happily resume their old lives if they found relief
from their MCS.28,72-73  This relief includes the recognition and
acceptance of MCS, access to proper medical treatment, and
accommodations in the school system, workplace, and public community.
28,72-73

Prevalence

A surprising number of people report sensitivity to ordinary everyday
chemicals.74-81  The figures range from an average of eleven to
seventeen percent, with spikes as high as thirty percent of subjects
who report reactions to multiple chemical incitants.74-81  The figures
reveal that at least two percent, and as many as six percent, have
been so bothered by chemical exposures that they sought medical care
and received a doctor-diagnosis of multiple chemical sensitivity (MCS).
79,81   Applying the case definition criteria3 to the average reported
chemical sensitivity, it appears that 1.5 out of 10 people suffer from
MCS.74-81

Health care utilization costs directly related to MCS have been
estimated at approximately $1,581 annually per patient.82   The United
States Population is estimated to be 302.8 million.83   Prevalence
studies predict that approximately 15% of the United States
population, now estimated at 302.8 million, suffers from MCS;
therefore, direct health care utilization costs amount to a staggering
$71.8 billion dollars per year.74-82  Estimated costs for MCS and
other disorders linked to neurotoxicity amount to an additional $81.5
to $167 billion annually in lost productivity.84   Cumulative social
and economic costs identified in four case studies of illnesses that
are candidates for environmental causation totaled between $568
billion and $793 billion dollars per year.85

General Populace Reporting Symptoms of MCS

Bell, IR, Schwartz, GE, Peterson, JM and Amend, D. Self-reported
illness from chemical odors in young adults without clinical syndromes
or occupational exposures.  Arch Environ Health. 1993 48:6-13.
15%

Bell, IR, Schwartz, GE, Peterson, JM, Amend, D and Stini, WA. Possible
time-dependent sensitization to xenobiotics: self-reported illness
from chemical odors, foods, and opiate drugs in an older adult
population. Arch Environ Health. 1993 48: 315-27.
17%

Meggs WJ, Dunn KA, Bloch RM, Goodman PE, & Davidoff AL. Prevalence and
nature of allergy and chemical sensitivity in a general population.
Arch Environ Health. 1996 Jul-Aug;51(4):275-82.
33%

Voorhees, RE. Memo from Deputy State Epidemiologist Voorhees to Joe
Thompson, Special Counsel, Office of the Governor. New Mexico
Department of Health. 1998.
17%

Bell, IR, Warg-Damiani, L, Baldwin, CM, Walsh, ME and Schwartz, GE.
Self-reported chemical sensitivity and wartime chemical exposures in
Gulf War veterans with and without decreased global health ratings.
Mil Med. 1998 163:725-32.
30% (Gulf War Veterans)

Kreutzer R, Neutra RR, & Lashuay N. Prevalence of people reporting
sensitivities to chemicals in a population-based survey. Am J
Epidemiol. 1999 Jul 1;150(1):1-12.
15.9%          6.3% doctor diagnosed

Caress SM, & Steinemann AC. Prevalence of multiple chemical
sensitivities: a population-based study in the southeastern United
States. Am J Public Health. 2004 May;94(5):746-7.
12.6%

Caress SM, & Steinemann AC. A national population study of the
prevalence of multiple chemical sensitivity. Arch Environ Health. 2004
Jun;59(6):300-5.
11.2%

Caress SM, & Steinemann AC. National prevalence of asthma and chemical
hypersensitivity: an examination of potential overlap. J Occup Environ
Med. 2005 May;47(5):518-22
11.2%           7.4% doctor diagnosed

All studies report most common in women and not specific to any
particular socioeconomic status.

Evidence of the Toxicity of Everyday Chemicals

Various studies of product safety generating EPA safe limits have
failed to consider the impact of combined exposures in day-to-day
living, which add to the body burden of chemicals in humans and must
be utilized, expelled, or stored.2,86-116  Many of the chemicals that
act as MCS incitants, including fragrances, cleaning products, air
fresheners, fabric softeners, disposable diapers, and pesticides, have
been scientifically shown to elicit symptoms of toxicity in "normals"
at levels of common, and often unavoidable, exposure in the
environment. 117-128,130.134,136  At the time the Toxic Substances
Control Act (TSCA) of 1976 was passed, the chemical industry
effectively grandfathered substances already on the market and
exempted them from testing.160  Europe has taken a more pro-actively
protective stance than the United States through REACH (Registration,
Evaluation, Authorization and Restriction of Chemical substances)
legislation.159  The aim of REACH is to improve the protection of
human health and the environment through the better and earlier
identification of the intrinsic properties of chemical substances.159
Products used by United States consumers on a daily basis are
continually and routinely recalled for toxic effects, as recent
recalls of lead tainted toys, popcorn flavoring, and FEMA trailers, to
name a few, demonstrate.138-140

After inhalation, chemicals enter the limbic system, affecting the
hypothalamus and pituitary; and through pituitary control, elicit some
symptoms though affecting adrenal, thyroid and reproductive function.
130-132    Tests have shown verifiable and chronic changes in brain
function after petrochemical exposure and determined that exposure to
chemicals through inhalation may aggravate the allergic lung
inflammation.64,128,129,132, 135  Developing organisms are generally
recognized as differentially sensitive to chemical exposure because of
toxicokinetic and/or toxicodynamic factors.141

Fragrances have been shown to cause sensory irritation, pulmonary
irritation, decreases in expiratory airflow velocity, and alterations
of the functional observational battery in mice, indicative of
neurotoxicity after an hour of normal level exposure to common
cologne.  The severity of the symptoms increased after mice were
repeatedly exposed to the fragranced product.117  Subsequent analysis
of the test atmosphere revealed the presence of chemicals with known
irritant and neurotoxic properties, providing a toxicological basis to
explain human complaints of adverse reactions to fragrances.117

The use of consumer cleaning agents and air freshener may yield high
levels of volatile organic compounds (VOC's).133-134   Consumer
cleaning products were shown to contain glycol ethers, which are
regulated toxic air contaminants, as well as terpenes, which can react
with ozone to form a variety of secondary pollutants such as
formaldehyde and ultrafine particles.133  Known chemical toxicants are
emitted during air-freshener use, including d-limonene,
dihydromyrcenol, linalool, linalyl acetate, beta-citronellol, alpha-
pinene, beta-pinene, 3-carene, camphene, benzyl propionate, benzyl
alcohol, bornyl acetate, isobornyl acetate, and benzaldehyde.
118,133-134  Maternal depression has been significantly associated
with air freshener use in the home136  and one name brand air
freshener, which contains short chain aliphatic hydrocarbons, was
shown to induce fatal ventricular fibrillation.119  Air fresheners, at
concentrations to which individuals are actually exposed, have been
linked to increases in sensory and pulmonary irritation, decreases in
airflow velocity, and abnormalities of behavior as measured by the
functional observational battery score, providing a toxicological
explanation for human complaints of adverse reactions to air
fresheners.120

Laundry products, particularly fabric softener emissions, have been
shown to induce sensory irritation, pulmonary irritation, mild
inflammation of the lungs, and airflow limitation in mice.121   Dry
laundry and linen, like that which consumers wear and sleep on, was
shown to emit sufficient chemical residue to cause sensory irritation.
121   Analysis of the emissions of a dryer sheet revealed
concentrations of the respiratory irritants isopropylbenzene, styrene,
trimethylbenzene, phenol, and thymol, and induced respiratory affects
when left in a room overnight with mice.121   The results of this
study provide a toxicological basis for human complaints of adverse
reactions to fabric softener emissions.121

Pesticides are known endocrine disruptors and have been shown to delay
sexual maturity and interfere with sex hormone synthesis, and have
been linked to increased malaise, chronic illness, asthma, mortality,
cancer, leukemia, lupus, Parkinson disease, diabetes, and decreased
neuropsychologic functioning scores, neurobehavioral performance,
cognitive function, psychomotor function, sensory/motor function, and
nerve conduction.123-127,137

Disposable diapers have been demonstrated to emit mixtures of
chemicals with documented respiratory toxicity, inducing sensory
irritation, reduced mid-expiratory airflow velocity, increased
respiratory rates, and increased tidal volume.122

Advanced stages of multiple chemical sensitivity can lead to organ
failure.144-145   Many observable and empirical, scientific facts
accompany MCS including SPECT scan changes, vitamin deficiencies,
mineral deficiencies, excess amino acid deficiency, and disturbed
lipid and carbohydrate metabolism.2,7,9,146   While the germ theory of
illness was the main threat to health, the zeal to kill germs with
chemical toxicants has now created a health paradigm shift in which
chemicals have become the main threats to health, as many diseases are
now being linked to chemical and toxic origin.

Worldwide Recognition

The Centers for Disease Control (CDC) recently recognized chemical
sensitivity as a symptom of Chronic Fatigue Syndrome (CFS).147
Studies have shown that removal of incitants and proper environmental
control is the most efficacious treatment known to date.58,148-151
Ninety-five percent of patients report improvement upon practicing
avoidance and 94% report improvement upon moving to a chemical free
living space.58  Clearly educating patients to avoid chemical
irritants and toxicants is most helpful.58,148-151

MCS is already formally recognized by the national health care system
in Germany.152   The Danish Environmental Protection Agency has
already concluded that there is ample evidence that MCS is due to
environmental contaminants and has taken initiative to minimize off-
gassing materials in the indoor environment in efforts to prevent the
development of new cases of MCS.152   The government of Sweden
recognizes electrical sensitivity as a disability.152   Canada has
also recognized MCS and has taken preventive measures by limiting the
use of pesticides, fragrances, and other toxicants.152   Diagnostic
criteria for MCS have been accepted internationally and are currently
under review to consider new findings; the recognition of MCS at all
levels of government is steadily increasing.152   We are now seeing
public policy and regulations advance towards protecting people from
tobacco smoke, pesticides, fragrances, vehicle exhaust, and other
chemicals in public places.152   More than one half of the states in
the US have already provided a proclamation deeming at least one day
or month dedicated for MCS and/or Toxic Injury Awareness.153

Therefore, it is essential that MCS be immediately and fully
recognized in America as an organic physiological disorder induced by
toxic environmental insults.  Environmental toxicants and irritants
from perfumes, smoke, pesticides, industry, and building materials
must be reduced or effectively regulated through legislation and
enforcement to prevent injury to all citizens.  Immediate
accommodation with a safe environment for school, work, and housing
should be granted to MCS victims who are still capable of working,
while those permanently injured should receive disability benefits.
The Americans with Disabilities Act must be enforced, to provide the
same rights to MCS patients as other disabilities, with protection
from abuse, harassment, and discrimination.  As new information is
published regarding MCS, it is crucial that it be communicated to the
medical and public communities.  Accurate, objective information which
is free from conflicts of interests, ties to the chemical industry,
and connections to the pharmaceutical industry must be rigorously
researched and widely disseminated.  Funding is immediately and direly
needed for additional investigation into the etiology, treatment, and
prevention of this costly, devastating, and disabling disorder.

The future of America is in our collective hands.  It is crucial that
industrial financial gain must not be permitted to compromise the
health and well being of all citizens.  There are alternatives to the
toxic products and pollution man has created.  A shift to these safer
alternatives will be market-driven as accurate information on risks
becomes readily available; meanwhile informed and enlightened
regulation is highly encouraged in order to prevent MCS in the future
and allow current patients to engage fully in society as productive
members without threat of further injury.  We must never forget that
many MCS patients can and do function normally in exposure free
conditions.  It is time to move past the view that science does not a
grasp of MCS.154   Sufficient clear and present evidence is currently
available to show that MCS is real and disabling, and to justify,
indeed to demand, immediate action.

On Behalf of MCS America,

Lourdes Salvador, President
October 1, 2007
Copyrighted (c) 2007

If you agree with this position statement, you may sign it at:
http://www.petitiononline.com/MCSAPS/petition.html

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