Sunday, November 28, 2010

Medical Technology Advances

“First the surgeon would cut off the blood flow with a tourniquet. After that he would take a scalpel and slice through the outlying tissue and flesh. Then he would use a hacksaw-like tool called a capital saw to saw through the bone. It had replaceable blades. After the bone and flesh was all sliced off, the surgeon would take silk sutures in the North, and cotton sutures in the South, and sew the major arteries and veins together. The limb would be dropped on a pile that was higher up then the table and the pile got thrown out after the day. Time was of the essence, so the soldier would be carried off of the platform and another soldier would be placed on the platform. This would take about fifteen minutes.”(Amputations)It wasn’t much different to be killed in World War II then it was during the Civil War or World War I. However, if the World War II GI was wounded by a bullet, shrapnel or taken down to disease such as malaria, or anything else that did not kill him, his chances for survival were much greater then his ancestor in the Civil War. During the Civil War, 50 percent or more of the men admitted to hospitals died, during World War I, it was 8 percent, World War II, 4 percent. (Enc





When the Civil War began, the United States Army (North) medical staff consisted of only the surgeon general, thirty surgeons, and eighty-three assistant surgeons. In time for Antietam, the Army of the Potomac, under its medical director Jonathan Letterman, the Letterman Ambulance Plan was developed. The next huge advancement in medical treatment in war was the discovery of penicillin. After, the doctor would complete the surgery and the soldier would attempt to go on with his life. This place is well staffed and well equipped. Fortunately though penicillin gave those soldiers protection from those diseases. Without cleaning the surroundings and sterilizing his equipment the doctor would begin. When the doctor made his cut unknowingly he infected the soldier! with numerous bacteria for example, staphylococci, hemolytic streptococcus, gangrene, and other disease-producing bacteria. (Taylor, 71) Furthermore medical advances are the cause to lowering the casualty rates of war. Farther down the road, during the time of World War II the training and knowledge of a medic was astonishing. In some occasions they had little to no training. The medics became more knowledgeable and more skilled then ever before due to the high set goals that the military had for the medics. As there was no medical licensing board at this time, these diploma factories were tolerated. They could wear uniforms if they wished and were usually restricted to general hospitals away from the fighting front. These bacteria would cause diseases that would have horrible effects on the people they infect, from painful headache and fever, to paralysis and degeneration of internal organs, to agonizing death.



Some topics in this essay:
Civil War, War II, Aid Station, Technology Advances, Army North, Alexander Fleming, Ambulance Plan, Encarta Throughout, World War, Clearing Company, world war, civil war, world war ii, war ii, war world war, medical technology, war world, medics civil war, diploma factories, medical schools, saved lives, casualty rates, civil war world, development penicillin,

World Events

World Events

  Hitler, Hoover and FDR  
  • October, 1929, the Stock Market crashes. Fortunes of investors around the world are destroyed. President Herbert Hoover, an Iowa native, is President of the United States. Many eventually blame him for the plight of Americans. Unemployed and homeless people live in shantytowns they name "Hoovervilles."
  • In 1931, the "Star Spangled Banner" becomes the country's official national anthem.
  • 1931: Gangster Al ("Scarface") Capone is convicted of tax evasion after years of involvement in bootlegging and gambling, mostly in Chicago. In 1933, the nation repeals the constitutional amendment prohibiting the making, selling, possessing and consuming of alcoholic drinks. Prohibition had been the law since 1920, but was largely ignored by the public, making gangsters rich.
  • 1932: Franklin Delano Roosevelt, a democrat from New York, defeats Hoover for the presidency. In his first 100 days in office, Roosevelt launches the New Deal including dozens of federal programs to help agriculture. FDR calls for social security, a more fair tax system and a host of federal jobs programs to get people back to work.
  • 1932: Nebraska's state capitol is finished. Built in five phases over a 10-year period at a cost of about $10 million, the building is considered an architectural masterpiece. The large base layer represents the state's plains, and the 400-foot tower symbolizes the pioneers' dreams. On top of the tower is "the Sower," a statue of a man sowing seeds, clearly showing the state's agricultural roots. Birdie Farr's father helped build Nebraska's new capitol. He was in his early 20s and worked on the construction site for about two years while the family lived on an acreage near Bethany, a small town that was about five miles from Lincoln's downtown and is now part of the city.
  • 1933: Adolf Hitler becomes chancellor of Germany. Italian prime minister and dictator Benito Mussolini invades Ethiopia in 1935. Japan invades China in 1937. And Hitler marches into Austria in 1938. Germany, Japan, and Italy withdraw from the League of Nations.
  • 1932: Amelia Earhart becomes the first woman to fly solo across the Atlantic Ocean. In 1937 she is lost over the Pacific on a round-the-world flight. Her plane and the bodies of Earhart and her navigator are never found.
  • In the 1936 Olympics in Berlin, a black Alabama native educated at Ohio State University, Jesse Owens, wins four gold medals. He breaks Olympic and world records, but German dictator Aldoph Hitler refuses to recognize the American's achievements. Hitler had declared that the superior German Aryan race would dominate the games. He was wrong.
  • 1936: King Edward VIII of England gives up his throne to marry Wallace W. Simpson, "the woman I love." Simpson cannot become England's Queen because she's American and a divorcée.
  • 1939: Germany invades Poland. Great Britain declares war on Germany. Soon, all of Europe is fighting. The U.S. enters the war in December, 1941, although FDR is supplying Britain and the allies with guns and material before that date.

Money

  • Between 1929 and 1932, the average American's income drops 40 percent to about $1,500 per year. Milk costs 14 cents a quart, eggs are a nickel a dozen and bread costs 9 cents a loaf. During this decade, 86,000 businesses fail and 9,000 banks go out of business. In 1933 one-third of the U.S. working population is unemployed. By 1932, farm prices are about 65 percent of what they were about 20 years earlier.
  •   Union Strike Kansas  
  • Labor strife is widespread. In coal country, disputes between mine workers and operators turns deadly. A General Motors strike spreads to six states, putting 45,000 people out of work. Congress enacts the National Labor Relations Act in 1935, guaranteeing workers the right to join unions without managers retaliating. The Congress of Industrial Organizations representing mineworkers, steel, auto and rubber workers merges with the American Federation of Labor, forming the AFL-CIO.
  • 1935: FDR goes on radio to talk directly with citizens and reassure them that the banking crisis has passed. This is his first "fireside chat" and it gave the President a way to bypass the traditional print media.
  • In 1938, Congress passes the Fair Labor Standards Act, at first, creating a 44-hour workweek. Later, the act moved to a 40-hour week. Minimum wages start at 25 cents an hour and increase to 40 cents per hour within six years.
  • 1939: Oil is discovered in southeastern Nebraska helping to feed the growing demand for gasoline as more and more Americans buy cars.

Water

  Hoover Dam  
  • 1933: The Tennesee Valley Authority (TVA) is enacted into law. The project was championed by Sen. George Norris from Nebraska, and one of the first TVA dams was named after him. The massive project built tens of dams along the watershed to provide electrical power to the rural areas, control flooding, provide irrigation and create lakes for recreation.
  • In a period of drought, major dam projects are completed across the country, in part to put people back to work. In 1936, the Hoover Dam (photo at right) across the Colorado River is completed. The dam supplies power to fast-growing Los Angeles and irrigation water to the Central Valley. In Nebraska, the Kingsley Dam is completed.
  • 1937: The Great Flood overwhelms cities along the Ohio River. Two years earlier, the Republican River flood in Nebraska killed hundreds.

Life

  • Total U.S. population is about 123 million in 1930. The estimated U.S. farm population stands at a little more than 30 million. The number of farms in the U.S. peaks in 1934, and the average farm size is about 350 acres.
  • During the 1930s, boxing matches are so popular, they spur the sales of radios. Friday Night Fights are an institution. Joe Louis defends his world heavyweight crown three times in 1938, a record in boxing history. His most memorable match was against the former champion Max Schmeling. Louis beat the German in 2 minutes and 4 seconds, battering him so badly that Schmeling was hospitalized for 10 days. More than 70,000 people attended the fight in Yankee Stadium in New York City. Earlier that year, Louis had knocked out Nathan Mann at Madison Square Garden, and Harry Thomas in Chicago Stadium.
  •   African Americans in Omaha  
  • In 1934, Arthur W. Mitchell – who was born in Alabama and moved to Chicago – becomes the first black Democrat in the House of Representatives (Illinois 1935-1943). Throughout the decade, race relations are tense. In 1937, William Hastie becomes the first black federal judge as President Roosevelt appoints blacks to high offices. The president's wife, Eleanor Roosevelt, is strongly opposed to segregation and invites the National Council of Negro Women to have tea at the White House, a symbolic gesture that changed a long-standing tradition from earlier First Ladies. Agricultural chemist and noted African American scientist George Washington Carver receives the Roosevelt Medal for his role in developing products from cotton, peanuts and other crops.
  • CBS news chief Edward R. Murrow coordinates radio broadcasts from several European cities to keep urban and rural Americans informed of the coming crisis on the continent. These radio broadcasts make world events more real to isolated Americans.
  • Prominent 1930s artists include Thomas Hart Benton, Grant Wood, John Steuart Curry, Georgia O'Keeffe, Edward Hopper, Frida Kahlo and controversial Mexican artist Diego Rivera. The Empire State Building, the Chrysler Building and Rockefeller Center were completed in the 1930s. Architect Frank Lloyd Wright, a Wisconsin native, builds the famous "Fallingwater" house in Pennsylvania. Federal programs such as the Public Works of Art Project (PWA) help artists survive the Depression by paying them to paint murals in public buildings across the country. Many of these 1930s murals depict rural and urban life during that era and still exist in civic buildings. In South Dakota, Mount Rushmore is finished. The Golden Gate Bridge opens in San Francisco, California, in 1937.
  • In 1937, Cook County Hospital in Chicago opens the nation's first blood bank. Accidents and illnesses are still common. Medical advances – safer blood transfusions, new medicines, and improved anesthesia – are pioneered during the 1930s and will be vital during World War II.
  • In 1936, the British Broadcasting Corporation (BBC) starts a television service. Thousands of Americans see television at the 1939 World's Fair in New York City. However, World War II delays the development of television until the 1950s.

Machines

  • In 1930, 58 percent of all U.S. farms have cars, 34 percent have telephones, less than 20 percent own a tractor and less than 13 percent have electricity. The number of combines nationally rose from 4,000 in 1920 to 90,000 in 1937, despite the financial hardships of the Depression.
  • Federal policy encourages road building to help move agricultural products from farms and small-town cooperatives to larger markets. In 1935, the Motor Carrier Act brought trucking under federal regulation. Farmers see an increase in the use of trucks to haul crops and livestock to market.
  • In 1939, the first commercial air flight crosses the Atlantic Ocean, and the helicopter is invented.

Crops & Livestock

  • The extreme weather conditions also bring diseases to the small quantity of crops that can be raised. In the 1930s, farmers didn't use special hybrids that were bred to resist disease.
  • The federal government provides assistance to school lunch programs in the early 1930s, helping to feed hungry children. Later, the Federal Food Stamp Program is started to help low-income families buy food. Many proud and independent families feel humiliated to have to stand in line and "accept relief."
  • Nebraska Farmer magazine sponsors a national corn-husking contest. In 1933, Sherman Henrickson from Lancaster County, Nebraska, becomes national champion, husking by hand 27.62 bushels of corn in 30 minutes.

Pests & Weeds

  • The first outbreak of grasshoppers comes to Nebraska, South Dakota, and Iowa in 1931; the last plague hits in 1939. The grasshoppers descend on Great Plains crops, devouring whatever the drought has not already destroyed and exposing the soil to erosion. The insects eat grass, corn, wheat, vegetables, tree leaves, and even clothing hanging outdoors.

Patients & families needed for a new study on the social issues facing people with Hunter Syndrome

Researchers from the University of California, San Francisco and Pacific Graduate School of Psychology are planning a new study investigating social issues facing MPS II patients of all ages. The goal is to gather information of daily behavior and the impact of the disease on family functioning, gathering information on health-related quality of life, adaptive behavior, and the behavior of people with MPS II and its impact on family function.
If you choose to participate, you will be asked to complete questionnaires about how you or your child are living in the presence of a chronic illness. Your individual responses will be kept completely confidential. Participation in this study will take approximately one and a half hours for caregivers, and only about 15 minutes for patients. The questionnaires can be completed over the phone.
If you are interested in participating, you may contact Dr. Wendy Packman or Mary Needham at the Pacific Graduate School of Psychology by calling (650) 421-4870 begin_of_the_skype_highlighting              (650) 421-4870      end_of_the_skype_highlighting or email us at MPSresearch@gmail.com. We will be happy to answer any questions you may have.
You can also leave your contact information with your local MPS Society with permission for us to contact you.

Top 10 list of medical Advances in the Twenty First Century.( help to spreed please)



Animation of an MRI brain scan, starting at th...Image via Wikipedia
We already have gone through the first decade of the 21st Century . This first decade brought several discoveries, medical advances and mistakes that have influenced medicine. These changes changed deep-seated beliefs in medicine; in others, they opened possibilities.


It's always fun  peruse the end of era  best list ,that's why my  good times pals   and I decided to come up with our own list of  top 10 medical advances in the first decade of the 21st century.in order to come up with this list our panel of four medical resident who are  very expert (at least they think so) ,who fraught  i mean debated in very understanding and professional session  for hours  to bring you this list. We used our knowledge and several medical journals.  But I have got to say it's a really great list.


 So Here are the top 10 list of medical advances in the first decade into this century,starting from number 10.


 10. HPV Vaccine:
This  vaccine  was made available in the United States in 2006. It was approved for women in 2006 and men in 2009. With this vaccine now it is possible to prevent an HPV infection, thereby cutting the risk of cervical cancer for women. It is for the first time in human history to prevent cancer with vaccination.
 9.Robots doing surgeries :
 Tiny metal hands carefully manipulating sutures deep inside the heart, no this not a seen pulled from "Star Trek," it's the reality is that robotic surgery is occurring daily in a growing number of centers across the modern world. Ten years ago a patient would typically be left with a big ugly surgical scar. The greatest advantages of small openings into the body rather than large incisions made by traditional surgery is shorter and less painful recovery time. Robotic surgery also increased the ability of cancer surgeons to get clean margins and good magnification of the structures. But critics, and there are many, say the cost of the robotic hardware may outweigh the benefit and it is racing ahead of the evidence.


 8.Face Transplant Surgery:
No it is not  like something of 50’s B-movie ,but successful Face left surgery wasn't until the 2000s.French surgeons performed a partial face transplant in 2005. In December 2008, doctors at the Cleveland Clinic successfully performed a face transplant on Connie Culp, victim of a gunshot wound to the face. Although the procedure is still in it’s early stages , but doctors’ ability to reconstruct a recognizable countenance is the hope for anyone who has suffered facial disfiguration.  








7.Mind-reading :
Mind-reading has moved from carnival to the halls of medicine .The medical mind-readers are not trying to identify a card randomly selected from a deck -- they are using sophisticated  techniques to map the way the mind works. There are  two kind of techniques used ; The functional MRI and the repetitive transcranial magnetic stimulation (rTMS) .

  • The fMRI traces the working of neurons (brain cells) by tracking changes in the oxygen levels and blood flow to the brain. The more brain activity in one area, the more oxygen will be used and the more blood will flow to that area .It's done while the patient lies awake inside an MRI scanner, He or she is asked to perform a simple task, like identifying a color or solving a math problem.  
  •  The repetitive transcranial magnetic stimulation (rTMS) works on a part of the brain thought to be involved in rational inference --the right dorsolateral prefrontal cortex -- it's interfere temporarily with the activity in that part of the brain and test its effect on the ToM "Theory of Mind" abilities . This techneques doesnt affect the abilities to infer emotions (affective ToM). Now we know much more about cognition, social communication, reward systems, decision-making, and so on.





6. New Drugs for treating cancer:
cancer drugs that target specific molecules that control not only cell growth, but also the blood supply that feeds tumors. cancer drugs that target specific molecules that control only cell growth, but also the blood supply that feeds tumors. Cancer drugs that target specific molecules that control only cell growth, but also the blood supply that feeds tumors but the normal cells Two therapies burst on the cancer scene in late 1990s, which changed forever the concept of cancer treatment, making cancer a chronic illness instead of a fatal disease. 


  •  The first, Herceptin, is a drug that targets a type of breast cancer that expresses a specific cancer gene (an oncogene) called HER-2. Women whose cancers express HER-2, which is estimated to be about 25 percent of women with breast cancer, will respond to Herceptin even when other powerful chemotherapy drugs have failed.
  •  The other drug, a cancer pill called Gleevec, targets genetic mutation called bcr-abl (b.c.r. able) that causes cancer cells to grow and multiply in patients with a variety of cancers, including chronic myeloid leukemia or with a stomach cancer called GIST. 
 These two breakthrough agents opened the door to several cancer drugs that are highly effective and specific. 


4.Stem Cell Research:
 This area has generated more political action than reproducible clinical advances -- the much-publicized is funding of embryonic stem cell research But the clinical advances with embryonic or adult stem cells -- even when they have come from pilot studies -- have been exciting. For example, European researchers genetically manipulated bone marrow cells taken from two 7-year-old boys and then transplanted the altered cells back into the boys and apparently arrested the progress of a fatal brain disease called adrenoleukodystropy or ALD, which was the disease that affected the child in.  


Another great use is in organ transplants .Stem cells researches also seen now  as opportunity for 'replacement parts' . In 2009, Japanese scientists figured out how to use adult stem cells – rather than embryonic stem cells – to regenerate a fully functioning rodent’s tooth. So Doctors counting on stem cell research to give them , at least, new tissues hair bones ,cartilges ,skins for theire patients who need them ,opening the future to a new branch of medicine called regenerative medicine.


Stem cell  treatments will lead to cure of what known as disease like Diabetes or the end of debilitating diseases like Multiple Sclerosis. 
 3. Nanotechnology:
Nanotechnology is the accurate and controlled fabrication of atoms and molecules at nanometer dimensions, into novel materials and devices with unique properties. Nanomedicine the science that implements nanotechnology technology for diagnosing, treating and preventing disease and traumatic injury, of relieving pain and of preserving and improving human health, using molecular tools and molecular knowledge of the human body. This  technology still under study,and the results are promising.The Nanomedicine initiative launched in 2005  and it is expected to  yield its medical benefits as early as 10 years from its launching in 2005.

 
2.Information Technology among doctors and patients: 

Internet and information technology has actually changed the way doctors practice medicine for the better. Even doctors need to look things up from time to time. Early in practice, if physicians     had a clinical question to research, they had to go to the library, pull out multiple years of the Index Medicus, look up the topic, write down the references, go to the stacks and pull the volumes of journals, find the article, read the article, go to the copy machine and make a copy; if he/she was lucky, They would have the answer in about four hours. But now whenever I had question I just look at my PDA device ,go online and search at the best up to date medical liberaries to find my answers from among thousands of papers in matter of seconds and all that without leaving my patient or my rounds. Also ,thanks to the state of the art medical apps and eBooks I can and less than five minutes have more information on the topic than I need. 


On my iPod Touch, I can look up a medication, check the formulary to see if it's covered, check for interactions with a patient's other meds and double-check details of the pharmacology of the med plus quickly review the problem I am treating, and I do not even have to go online. 


 Information technology has also, somewhat, made life safer for the patient. Once admitted to a hospital, they get a bar code which matches their blood samples and their IVs. With the Electronic medical records all what we have to do is to login the system to put the patient medical number and see all patient medical history and even write the new updates .


 In my country Saudi Arabia some health sectors like military and national guards hospitals have implement an unified electronic records technology where patients records can be found in any of those hospitals.


 
1.The Bedside Human Genome Discoveries:



Mapping the human genome had accelerated since the 1990s, In 2000, scientists in with the International Human Genome Project released a rough draft of the human genome to the public. For the first time the world could read the complete set of human genetic information and begin to discover what our roughly 23,000 genes do. 
 Genes can be used now in screening for some diseases . Gene screens are fast becoming a powerful tool, not just for diagnosing cancer but for treating it as well



 With our knowledge of DNA and our ability to screen children before birth for several diseases and conditions. We may be looking at a new generation of extremely intelligent and healthy individuals. 


 Venter a scientist behind Celera Genomics said "doctors have developed a genetic test for a gene associated with prostate cancer, "and there's a drug available that greatly lowers the risk for prostate cancer in the future." "I think the biggest area of the future will be preventive medicine" said Venter. "By understanding the genetic causes and links to disease we can spend more and more attention on preventing disease."





That was my top 10 list of medical breakthrough ,what do you think of it? and do think think I SHOULD OR SHOULD NOT ADD ANYTHING?..


Finally this post was made as an entry for Top 10 Summer Contest. I HOPE you enjoyed it.

Poverty threatens medical advances


Poverty stricken child in India
This child's health is threatened by the surrounding poverty
World poverty is threatening to wipe out medical advances made over the last 30 years, according to an international group of doctors.
This child lives in a New Delhi slum
Doctors say much more must be done to help this child
In a letter to the British Medical Journal they warn: "The world is facing a health crisis that endangers the immense achievements of the past three decades." The doctors, from the World Health Organisation, universities, public health agencies and non-governmental organisations, say that health is the responsibility of society as a whole and not merely the medical establishment.
They all have first-hand experience of working in Africa, Asia and Latin America and the inner cities of developed countries in Europe and North America.
"The number one health problem is poverty," they say. "For the poorest countries, the health sector alone cannot ensure better health even if it were able to function at maximum effectiveness.
"We have to accept that we can no longer deal with health while ignoring poverty.

Water pump
Clean water is essential
"The World Health Organisation's annual report on the state of the world's health asserted in 1995 that poverty is the main reason why babies are not vaccinated, why clean water and adequate sanitation are not available to hundreds of millions of people, why curative drugs and treatments are not accessible, and why more than 500,000 mothers die every year - unnecessarily - during childbirth. "It is also the underlying cause of reduced life expectancy."
The doctors say there are now 1.3 billion people living in absolute poverty in the world, more than double the number in 1975, and the problem is not confined to the third world.
"One need not point only to a developing country in the south to quantify the effects of poverty on people's health.
"Take Scotland in the north. The inhabitants of the huge housing development in suburban Drumchapel live close to Glasgow's richest suburb of Bearsden, but they die on average 10 years earlier than their wealthy neighbours."

Slum in Derry
Health problems of the slums are returning
The group says they are seeing the return of problems experienced in large industrial cities in Britain and the United States a century ago. They say people's health improved dramatically with the introduction of clean drinking water, better sanitation and hygiene, female education, access to food, higher wages and labour legislation.
"Doctors and health professionals could not, and did not, do it alone."
They add: "Basic health care and basic education for all are vital, and investment for development must ensure that the poorest and most vulnerable groups of the population have access to them.
"Development from the bottom upwards with the active participation of poor people has proved to be the best and most sustainable approach."

Merck and The Merck Manuals

Merck and The Merck Manuals
Merck is committed to bringing out the best in medicine. As part of that effort, Merck has created The Merck Manuals, a series of healthcare books for medical professionals and consumers. As a service to the community, the content of The Manuals is now available in enhanced online versions as part of The Merck Manuals Online Medical Library. The Online Medical Library is updated periodically with new information, and contains photographs, and audio and video material not present in the print versions.
->Read More
Editors of The Merck Manual Online
Robert S. Porter, MD, Editor-in-chief
Justin L. Kaplan, MD, Senior Assistant Editor
Editorial Board of The Merck Manual Online
Richard K. Albert, MD
Glenn D. Braunstein, MD
Sidney Cohen, MD
Eugene P. Frenkel, MD
Susan L. Hendrix, DO
Robert M.A. Hirschfeld, MD
Michael Jacewicz, MD
Matthew E. Levison, MD
James Jeffrey Malatack, MD
Brian F. Mandell, MD, PhD
David A. Spain, MD
Paul H. Tanser, MD
Eva M. Vivian, PharmD
Michael R. Wasserman, MD
->See all Editors and Contributors, including those of the 18th Edition (print version)
Important: The authors, reviewers, and editors of this book have made extensive efforts to ensure that treatments, drugs, and dosage regimens are accurate and conform to the standards accepted at the time of publication. However, constant changes in information resulting from continuing research and clinical experience, reasonable differences in opinions among authorities, unique aspects of individual clinical situations, and the possibility of human error in preparing such an extensive text require that the reader exercise individual judgment when making a clinical decision and, if necessary, consult and compare information from other sources. In particular, the reader is advised to check the product information provided by the manufacturer of a drug product before prescribing or administering it, especially if the drug is unfamiliar or is used infrequently.

The Word Brain

The Word Brain - A Short Guide to Fast Language Learning
How long does it take to learn another language? How many words do we need to learn? Are languages within the reach of everybody? Which teachers should we avoid?
These are some of the questions you ask yourself when you or your children start to learn a new language. The Word Brain, by BSK, provides the answers. PDFs and MP3s (audio books) are free. New content will be available soon.


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