Questions and Hurdles for GoogleGlass in Medicine

I was recently asked these three questions, by Dr. Jennifer M. Joe, of  and Editor-in-Chief  of, in regards to the convergence of GoogleGlass and Medicine.

–What will be the top 5 mistakes that physicians/clinicians will have about Google Glass?

–What are the top 5 fields who will benefit from Google Glass? Surgery, Emergency Medicine, Radiology, Dermatology, and Neurology?
–What will be the top 5 biggest hurdles in getting Google Glass into the clinical setting?

Obviously, I’m not able to exactly predict the future, but I feel that my experience of several years as a surgeon and of a few years as an innovator in healthcare and, more recently, as a GoogleGlass Explorer might give me some extra advantage as well as insight to be able to come up with interesting thoughts, arising from EXPERIENCE and INTUITION.

A- What will be the top 5 mistakes-misconceptions that physicians/clinicians will have about Google Glass?

I believe that in the initial phases, as Glass is publicly released, many healthcare providers will purchase it; the interest and curiosity about the device will be  based on the reports of medical peers, GoogleGlass Explorers, after several months of experience with it, along with the spectacular and exciting coverage and spread by the media.

1-I think that one of the most common mistakes that I can foresee, is that most users will assume that the device has connectivity of its own.It does not! It needs a wifi network to connect to, or a smartphone that it can tether to, in order to have internet capabilities.

2-Another issue, will be related to its inappropriate use regarding privacy regulations and HIPAA.To use this device in the clinical setting (with patients), the device needs, or should be,”cleared” by your institution’s compliance office, but ONLY when there will be transmission of patient’s data through the device, through the internet. If the device is being used during a visit, for instance,  to look up information related to the patient’s condition in the internet, or to help explain a subject to a patient, using a digital resource, or in any way that does not involve patient’s Private Health Information (PHI), there should be no concerns about HIPAA compliance.

3-The device is not fully functional with only voice commands. It does need the “tap or swipe” on the right frame, to navigate certain menus; this makes it unsuitable, at least in an efficient manner,  for use when the user’s hands need to remain sterile.

4- The screen on the device is the equivalent of a 28″ screen seen from approximately 6-8 ft away; despite this, the content display allowance on the screen is in no way the same to what you can fit on an equivalent “non-Glass” display.

5-The battery life of the device is very limited, and if used continuously, the charge would likely not last much more than an hour or two, almost always requiring an additional, external, portable power supply.

B- What are the top 5 fields who will benefit from Google Glass? Surgery, Emergency Medicine, Radiology, Dermatology, and Neurology?

I think that “procedural” specialties (Emergency, Surgery, EMS), as well as those that rely heavily in the direct observation and “inspection” of the patient and the gathering of visual data to make a diagnosis (Radiology, Psychiatry, Neurology) will be the ones that will initially benefit from this type of device. After the device evolves, and eventually presents itself as the next step in the evolution of the computing platform to connect us to the digital realm, any medical specialty will integrate it as part of the routine, just as we now have PC’s, laptops, tablets, etc.

C- What will be the top 5 biggest hurdles in getting Google Glass into the clinical setting?

1-I believe that the protection of Private Health Information (PHI) and compliance with HIPAA are at this point the main obstacles being faced by GoogleGlass incorporation into the clinical setting (at least in the USA). There are developers working on this topic, and also some who have come up with solutions which are currently being tested in different locations.

2-Integration with the Electronic Medical record (EMR) is a feature that must be accomplished, if GoogleGlass is to be useful in the current setting of Healthcare. The device needs to be an extension of the current platforms that we routinely use, running the same EMR software or at least agnostically conversing with it.

3-Cost has to come down for it to be universally adopted as a new platform, likely substituting  the smartphone in  the near future. The price would have to be competitive with the cost of current portable devices.

4-There will have to be a change of “culture”, in the side of both the providers and the patients. This will naturally happen, as it did with the smartphones and tablets.

5- The network infrastructure will have to be enhanced. The bandwidth of current cellular and wifi networks, does not allow an optimal transmission of data.Dedicated networks will have to be developed so that medical users can have priority channels to allow connectivity without delays, flaws or intrusiveness.

I think that for now, these are my few thoughts regarding these very interesting questions; I hope this helps.

Please don’t forget to connect with me via Twitter at @ZGJR, or to visit the blog for further follow up comments or inquiries regarding this topic or the general theme of Innovation Technology in Healthcare.

As always, I’m very interested in spreading this information and my vision for the use of GoogleGlass in Healthcare, as well as conversing about what the future of technology in medicine will be like. Image

Always looking for speaking engagements and platforms.

Best ,

Rafael Grossmann, MD, FACS

OTHER Links, including my three recent TEDx talks about Glass in Healthcare in 2013.
#TEDx on the intuitive #GoogleGlass preventing Med errors and empowering the #EMR
“OK Glass”:Disrupt HC
#TEDx on wearable #GoogleGlass #mHealth “OK Glass: I need a surgeon My Journey from the Amazon to GoogleGlass in 2014GoogleGlass & other Marvels, for Youth – My latest vid at #TEDx Youth@JBMHS, “GoogleGlass and other Marvels
How will #googleglass fit in with #medicine? @ZGJR has answers. Watch his short vlog here:

GoogleGlass vs. Healthcare

Hi there. This is the body of an e-mail I recently wrote. After reading it (before it was sent), I thought that in a way, and in very few words, it represented my abbreviated thoughts on how wearable technology (like GoogleGlass) really has an inevitable and imminent role in the healthcare game. Here we go:

What is the central idea, topic, or concept (50 words or less)?
 “Wearable” user platforms (i.e. GoogleGlass) represent the evolution of the hardware interface, connecting humans to the digital realm, and have the potential to revolutionize medical care, changing the current paradigms.
Despite advances in EMR (Electronic Med Records) engagement, data flow is still archaic and inadequate, prone to inaccuracy and promoter of errors, because the input is being done by the human element, the same way we did it when “pen and paper” charts were the norm. 
Intuitive, “human-free” data flow, by an “artificially smart”, deep-learning capable system (imagine “Google Now for Healthcare”) will make the system more efficiently dynamic, more accurate, providing only the pertinent, correct data, when needed, improving care, preventing medical errors and decreasing cost. Let “the data come to us”, rather than us go searching for it.
Such a system would allow the user to input data as well, smoothly, instantaneously, by intuitive means (i.e. voice commands, although not exclusively), again, making it more efficient.
It will Improve Communication and Connectivity between All the elements of this Healthcare Equation, and that will make the ultimate result BETTER.
 Why is this idea timely now? How is this a significant difference from the status quo in health, medicine, or society?
Healthcare is in crisis. The cost and the incidence of medical errors are unacceptable unsustainable, from a financial and, more importantly, a moral societal perspective. The change needs to happen now. We have reached the developmental, technological level and have the means to make this a reality.
What is the impact on health and medicine if this idea is fully embraced? How big and wide-spread is this impact?
The impact is self-explanatory. BETTER Healthcare overall. It would reach all stages of medical care, from prevention to cure and rehabilitation. 
What changes or innovations need to occur in order for this idea to be realized?
We have the technology! We need to boldly change the approach, enact the ideas for the smart use of the tools we have (i.e. GoogleGlass). We need to change the “culture” of healthcare , from corporations, to hospitals to providers…and patients. Preaching loudly about this, like in TEDMED, will spread the news, and the more people see the possibilities, the sooner the changes will be demanded!
I hope you like it. Please provide me with feedback. Thanks
As always, my Best to you.

OK Glass: not a new idea !

It’s really been an evolution. It’s not a new idea.
Recently, while researching for information to complete a few talks I have coming up at different conference venues, I came across a 1962 issue of a magazine that really surprised me and got me thinking.
I’m attaching the original article and some pics for you to enjoy and hopefully be as surprised and excited as I was.

I have said it many times, GoogleGlass represents the natural evolution of the computing device, of the platform connecting the information-the Web to the individual; from the first computers that filled up a room, to the big desktop PC, to the laptop, to the tablet, to the smartphone…down to a wearable device like Glass, so far, the ultimate gadget.

I believe Glass has great potential in Healthcare. When Glass apps are made available, I do believe, I do know, this platform will revolutionize the process of providing care and educating future generations of providers. In the meantime, the device, as it is, still can change the way we work and teach medicine. By allowing us to do a Hangout from “our forehead”, and streaming our point-of-view to an individual or a crowd anywhere, ” show and tell” takes a new meaning, a whole new dimension.

In my last post, I showed both perspectives, the traditional recording of a procedure vs. the actual view of the surgeon performing a thoracostomy.

When I performed the first surgical procedure ever done while wearing GoogleGlass, it was not only very intuitive to use, but also I could appreciate how it would be helpful to enhance communication and connectivity to and from the operating room.

See: 1st time Glass In The OR by R Grossmann MD FACS !
&MedEd”OK Glass:Teach me Medicine!”






In that old article from 1962, the last paragraph actually tells about how such a device could logically help surgeons provide better care, that’s 51 years ago, long way before the Internet was even thought of. A Real Evolution indeed.

“OK Glass, I need a Surgeon…now!” . A Telemedicine Revolution…or Evolution!

Some people have called me a “Telemedicine Innovator”. To me, the fact is that I only try to make the workflow easier, more efficient, intuitive  and, at the end, provide as good or better patient care with New Ideas and the tools already available.

I work at a tertiary care hospital, which means that we get referrals from a vast area, underserved in regards to many medical specialties, including mine, which is General Surgery and Trauma. The surface area that only ONE surgeon covers, at any particular moment,  24/7, is larger in size than the combined area of Ma., Vt. and NH!

More and more ( and this will only get worse!), the demand for specialty medical services increases, much faster than the supply of medical professionals, which actually, in most acute care specialties, trends in the opposite direction.

An added BIG issue, is that the cost of Healthcare is currently unsustainable (and this will also get worse!), with an expected expenditure of approximately 33% of the GDP by 2050.

We have been using telemedicine for several years, in order to improve the access to our system. In prior entries, I have recounted how mobility in telemedicine is an advantage and how using iPodTouch we could connect to several hospitals in our Tele-Health network in more efficient manner, faster and with no added real cost or disadvantage. Since then, we evolved, to be able to use any smartphone device, enabling us to connect agnostically to any device thru the appropriate software (our administration chose a commercial, medical grade application called ClearSea, which so far seems to be working very well).

So, almost every time I’m on duty call, I have been using ClearSea thru my iPhone to connect to a remote tele-trauma device in any of our Tele-health network hospitals. I have been trying to use ore and more frequently, almost replacing the “phone call” , if indicated and if possible.

One big limitation, is the fact when the remote, referring provider tries to “show” me a specific lesion, wound or burn area in a “difficult-to-see” location. Let’s say in a patients back or between the legs, axilla, etc. The fixed wall cameras and even the mobile units (camera on top of a screen in a cart) are almost useless for this purpose.



If we had a device that allowed for a “point-of-view” of the user perspective, with synchronous (live)  streaming conferencing capability , so that we could see exactly what the other person (the referring provider) was seeing, that would be a “game-changing” tool!

Well, nowadays, we have such a device; Google Glass has all of that, and much more (check the GoogleGlass advertisement videos that follow)

Glass really allows for a direct view of what the user is seeing. For instance, when we are trying to show someone, how to perform a procedure, to get the best view, they really have to “peek” behind our shoulder.If we had a head-mounted camera, the view would not we live. Google Glass really solves that problem. There is also a “screen-share” mode , where the Glass view can be shown on a projector or a monitor, so that many people can see the actual streaming, to the minimal detail, from the “surgeon’s eye” ( a medical education dream).

The following are two videos from the last edition of  an “Advanced Trauma Life Support” (ATLS) course that we offer at our institution a few times per year (all the participants gave their permission to be featured, even the “Trauma-Man”, a high tech mannequin that we use for the hands-on session, instead of animal models). The first video shows a traditional recording of the How-To-Do a thoracostomy (chest tube placement). The second video is recorded thru Glass. You are the judge!

So, having GoogleGlass allows the user to share a direct point of view of the actual patient in a way never thought possible before.

I do believe that telemedicine could potentially be revolutionized by the use of this device.

The regulation regarding privacy issues and HIPAA, will have to continue to adapt to the development of new technology.

I’m certain that very soon, the industry will provide Glass specific “apps” that will allow the video-conferencing in a secure, encrypted fashion, just as it happened when mobile telemedicine solutions were initially deployed ( When we started using iPodTouch and then smartphones for teletrauma, Skype was the application of choice because of HIPPA compliance issues. Within a few months ClearSea, Vidyo, Jabber, etc. were all developed and made available to consumers. See TEDxDirigo talk “iPodTeletrauma, the $229 130 million sq. ft. Trauma Room)

As I have written and said before, I think the future will be brighter than we think.

Technology is developing exponentially, but it is the smart application of the available technology that will allow us to provide much better and less expensive patient care, and, at the end, potentially save lives.

So, when a referring provider in a remote area , needs a surgeon NOW, Google Glass will make it happen.

CPRGlass, The augmented reality APP that can help you save a LIFE


Amazing idea on Glass in Medicine!

Originally posted on The MedBonsai:


*UPDATE: 7/8/2013 It is my pleasure to announce that @AED4US is uniting with CPRGLASS to make it even more functional and useful! This is thanks to the vision and efforts of my friend and colleague, Lucien Engelen, Director Radboud REshape & Innovation Center / Faculty Singularity University – FutureMed / Founder & Curator, TEDxMaastricht @compassion4care @aed4US 

We have recently seen Google Glass used for MEDED purposes, from tutorials on how to do medical procedures to the Telemedicine potential (Check Surgeon, Rafael Grossman’s work in “Inside The Operating Room With Google Glass” and “How Google Glass Is Changing Medical Education”) I am part of such projects and will continue to work on these aspects but in my opinion that is not the strongest point GLASS has. In order to see the potential of glass one needs to answer the following question. What is a smartphone without the applications you install?…

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“OK Glass:..Teach me Medicine!”

Or it could be : “OK Glass: teach me how to save a life!”

Today, we made history again…with GoogleGlass.

When thinking about its potential in Healthcare, it is a bit overwhelming. When I imagine what medical education could be like, if along with the incredible technology available, we would be inventive enough to apply it to enable learning, the results could be really be amazing.

Our current ability to remotely connect and enhance “virtual presence”  and communication has never been paralleled in history; this fact along the possibility to access all of “human knowledge” (in the internet!), by commanding a device- or a pair of glasses…

The future (really, the present!) of Medical Education will be awesome.

I have addressed some of my thoughts and vision for its use in clinical medicine before, and obviously, until the Private Health Information (PHI) exchange can be fully safeguarded, the full potential of Glass in this area will not be achieved. I’m not worried at all, because I know that the industry will soon provide HIPAA compliant applications ( soon, “there will be an App for that”!).

This morning, I had members our elite medical transport team, the LifeFlight of Maine (LoM) crew here in the office (, along with their “top-of-the-line”, high-tech medical simulator mannequin, ready to show the potential of GoogleGlass in Medical Education. We set up a treatment room and then created a computerized clinical scenario. The mannequin “patient” was wirelessly connected to a laptop, where any set of clinical variables could be created.

We worked in three basic forms; first, a critical care LoM RN, emergently treating a patient and requesting advice from a remote GoogleGlass Surgeon. The second scenario involved the G-Glass Surgeon, remotely teaching a procedure to a group of students (PA’s, medical students and EMS students); here, the instructor is hands-free, concentrating on the actual procedure and the different steps to make it easy for the students to learn. The third one was a clinical situation where a request for advice was placed to a remote GoogleGlass cardiologist, my good friend and colleague, glass Explorer pioneer Dr. Christian Assad (@Christianassad), whom was able to give his expertise to the provider in need, from a remote location, wearing GoogleGlass in a Hang-out. Unfortunately, When Dr. Assad gives his advice to the me through GoogleGlass, you are not able to appreciate that on the video, since the audio comes to the GoogleGlass user by the way of bone conductivity.

The experience was very intuitive. The potential to improve the interface between the human user and the device, connecting to the internet and enabling synchronous audio-video communication is what strikes me most about GoogleGlass. Remote mentoring of students and providers with less experience, could be radically improved upon with this technology.

As I said and wrote before, the possibilities are endless and only limited by our imagination and creativity.

Enjoy the videos. Pass them along and please contact me with any questions, advice or needs.

My Best.


“OK Glass: hand me the scalpel, please…” GoogleGlass during surgery!


Obviously, the one of the MAIN concerns regarding the use of Google Glass during surgery, with live streaming of data, would be to take every measure and to ensure the privacy of the patient’s health information (PHI).

That’s exactly what I did. Not only I obtained informed consent about what we were going to attempt (and documented it), but most importantly, made sure that no recording or transmission of any identifying information was done. The streaming of video and photos, to “myself” thru Google Glass, did not reveal any PHI, or even show the patient’s face.

By performing and documenting this event, I wanted to show that this device and its platform, are certainly intuitive tools that have a great potential in Healthcare, and specifically for surgery, could allow better intra-operative consultations, surgical mentoring and potentiate remote medical education, in a very simple way.

To my knowledge, this is the first time that Google Glass has ever been used during live surgery, by a surgeon, and Glass Explorer, with streaming of non-identifying patient information thru a Google Glass Hang-Out.

The patient involved needed a feeding tube (Gastrostomy) and we chose to placed it endoscopically, with a procedure called PEG (Percutaneous Endoscopic Gastrostomy. You can Google that to learn more…). Being the first time, I wanted to do this during a simple and commonly performed  procedure, to make sure that my full attention was not diverted from taking excellent care of the patient.

I arranged for a Google Hang-Out (HO) between my Glass and a Google account I created ahead of time for this very purpose.

The connection is remote. The iPad used as a receiver was just yards away, but it could have been practically thousands of miles away.

Before starting the operation, I briefly recorded myself explaining the planned event, and once again, talked about the importance of not revealing any PHI.

I had Google Glass on at all times, with the HO active thru-out the procedure. The live video images that I saw thru Glass, were projected in the iPad screen, remotely.  We kept the volume down on purpose. We tried to keep it very simple (the KISS principle!) and straight forward. As I said, even the procedure was a simple one.

I was able to show not just the patient’s abdomen, but also the endoscopic view, in a very clever, simple and inexpensive way. I think that there should be ways to directly stream the endoscopic view thru Google Glass ( My friend @Julianmb, also a Google Explorer, and his team of experts from @Droiders are working on that !) but this was a “Poor’s Man’s” set up…

The whole thing was fairly quick and went very well. We used “home-made” techniques, so the pictures and video are not optimal, but I think the point stands: Google Glass Streaming During Live Surgery…By  a Glass Explorer Surgeon…IS POSSIBLE.


OK Glass: hand me the scalpel, please” !

For another link on disruptive Healthcare Innovation, watch TEDx talk, “iPodTeletrauma, the $229, 130 million sq. ft. Trauma Room, in your pocket”


“OK GLASS”: Improve Health Care! Now


Well, a couple of weeks ago, I finally got my Google Glass.The experience to pick them up was just as great as I expected; they host you at Google and present you with several options of colors to choose from.I decided on black, just to be neutral, and thinking that it would probably make them less noticeable, since my main idea and objective is to use them at work, caring for patients. They custom fit them to make them comfortable and to make sure they do not block your field of view.They register and connect them for you, and suddenly, “OK Glass”: magic starts to happen…right in front of your eyes (Your RIGHT EYE, actually!).

For weeks, I have been thinking of ways to apply Glass to my daily routine of taking care of patients.I’m a surgeon and depending on the day, I can be in one of many areas, from the clinic, to the OR, from the ICU to the ED or the Trauma Bay;taking care of patients during rounds or teaching third or fourth year medical students.

The idea of having a device that allows me to instantly and effortlessly look up a concept or an image, take a picture or record a video
(and share it, if I choose to do so) or connect with someone by live video (thru a “Hang Out”) is a bit mind-blowing.

I imagine performing an operation and connecting live with group of students or surgeons, anywhere, doing a live “Hang Out”, letting them virtually “BE” in the OR with me, SEEING what I’m seeing, pointing to anatomic structures and different steps of the procedure, THRU my eyes…I envision the possibilities in distance MedEd, taking surgeons thru a complicated procedure, or one that they might not be so familiar with (surgical missions without leaving the country!).

The potential for remote presence medicine, TELEMEDICINE, is also amazingly exciting. I could be “video-connected” with a physician who needs my advice, and then even see and listen to the patient him/herself. I could advice a child’s parent and give them reassurance, while looking at their eyes…All these without having to go to a tele-station, hold a device in front of me or be limited by “where and when” I am. What I see and what I hear thru Glass, ONLY I can see and hear (the image is right in front of the users right eye, and audio happens via bone conductivity, so it is not audible to anyone else but the Glass user)

I imagine being in the middle of a difficult surgical case and suddenly finding the unexpected. Just by a voice command, being able to call for help, having a colleague to “virtually join” me and and give advice; or encountering an unusual finding, and sending the image or recording of it to a pathologist or sub-specialty colleague, for their opinion on the gross appearance and their opinion on how to proceed.

Imagine how “Grand Rounds” could be revolutionized. Doing them at a distance, with both presenters wearing GoogleGlass, and doing a simultaneous “Hang Out”. Even connecting two groups or classes, in different schools/surgical programs (even different countries). The potential for a better exchange of information, ideas, experiences, knowledge, is only limited by our creativity.

There are so many ways to use GoogleGlass in medicine and not have to worry about breaching patient’s privacy. Until there are “secure”, “encrypted” and HIPAA compliant applications, its use can exclude any mention of a patient’s identifying information.
But when this applications are developed (and they will be!), the game will change even more radically. Then, we will be able to exchange any health private information without worrying about legal or ethical penalties. Envision Glass on the field for EMS providers, connecting them to hospitals, being guided thru difficult procedures if needed; or having them advise the receiving hospital’s set up in case of disasters or major traumas. Giving set up instructions before patient’s arrival, based on their “first responder’s” knowledge of the situation (chest tube set-ups, massive transfusion protocols, OR teams, etc.) It would certainly be a “time saver” and, in trauma, “Time is Gold”.I think that if one aspect of the trauma care process could be improved, it is the communication between the teams.

Have you been to a doctor’s office and then have someone sit close to you, turn around and look at a monitor screen, while they ask you questions, while you face their backs? Imagine then, a doctor accessing patient’s images, medical history, tests and laboratory results or any EMR data, all of these without leaving the patient’s presence, or turning away from them, to look at the computer screen. Not just obtaining data but uploading it, with verbal commands, right to their charts, in real time. Medicine will be “personalized” again. We could be in front of a patient, face-to-face, again.

There have been a few, well publicized and ingeneously marketed reports of live “Tweeting” during surgeries in recents
months. Well, I ask myself, what’s a tweet in front of a “Hang Out”? (Sorry Tweeter!). A story like this would be all over social (and “regular”) media.

A Health System should embrace this innovation. A system should support and encourage this radical thinking, which can only bring advertisement and great PR to its grounds.

A professional association (I mean you, American College of Surgeons) must BE THE CHANGE YOU WANT TO SEE. Surgeons are leaders, innovators, “ground-breakers”! Let’s do it! Help me do it.
I, and a few other physicians and surgeons, would really like to lead this revolution. Not a revolution, BUT the EVOLUTION of the current, decadent Health Care. From inefficient to efficient. From obsolete, to “cutting edge”.From slow to “as-fast-as-your-High-Speed-or-Fiber-Connection”; from error-prone, to designed-for-safety; from unsustainably expensive, to cost conscious ( I do believe that, while technology can be expensive, the smart use and application of technology to solve problems and improve processes, is the best way to decrease costs in healthcare).

For many years now, doctors and health care providers have been using machines, technology and the internet to optimize the care of patients.
GooGoogle Glass is just one more step in the right direction. One more gadget people might say…but what a gadget! This is the natural evolution of the interaction between human, device and the Virtual Highway.I do believe that in medicine, it will make our work better, and that only means, “OK GLASS”: improve patient care, now!

Rafael J. Grossmann, MD, FACS



Google Glass, iWatch and IBM Watson Revolutionizing The Practice of Medicine


Disruptive evolution of healthcare

Originally posted on ScienceRoll:

People have been thinking about the potential ways Google Glass could be used in medicine and healthcare. Even though it will probably be bad for your eyes, early testers seemed to love using it and didn’t feel it would distract them from anything. A few examples how it could be used in the future:

  • Displaying the patient’s electronic medical records real-time.
  • Assisting the doctor in making the diagnosis with evidence-based and relevant information from the medical literature.
  • Recording every operation and procedure from the doctors perspective. Every movement of doctors will be archived and screened for potential mistakes. (I know it’s harsh.)
  • Based on the lab tests of the patient, it will give an estimated prognosis and suggest next steps in the treatment.
  • Live consultations with colleagues as they will be able to see what I see live.
  • It will guide users through all the steps during an emergency…

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