The Trump administration's erratic handling of federal health grants is causing significant disruptions in Nevada's public health programs. Officials report that funding volatility has hampered recruitment and retention of staff, complicating efforts to maintain essential health services.

## Trump Administration's Health Grant Volatility Disrupts Nevada Programs

The Trump administration's abrupt cancellation and possible reinstatement of federal health grants have led to significant "funding volatility" in Nevada's public health programs.

Officials reported that ongoing cuts and policy changes are creating challenges for state and local health agencies in maintaining their operations and workforce.

Julia Peek, deputy administrator for the state Division of Public and Behavioral Health, described funding volatility as "probably the most painful part of our jobs right now." She emphasized the difficulties in recruiting staff for federally funded programs when there is uncertainty about funding continuity.

During a recent meeting of the Interim Committee on Health and Human Services, state lawmakers were briefed about the impacts of federal policy changes under the Trump administration.

State Senator Fabian Doñate (D-Las Vegas), chair of the committee, requested a comprehensive list of displaced workers and grants that have been cut in the past two years.

The Trump administration has made sweeping cuts to federal health grants over the last year, affecting disease prevention and treatment programs as well as support for behavioral and mental health services.

Officials reported instances where states received last-minute notifications of significant funding cuts, leading to panic among health officials.

A notable example occurred in January when the administration announced the cancellation of billions in mental health grants, creating chaos as states scrambled to respond.

The lack of timely information about grant renewals has also hindered health agencies.

Recently, Nevada health officials were uncertain until late last month whether the administration would renew funding for the Title X family planning grant, which is crucial for reproductive health services.

The state received only a few days' notice to reapply for the grant, which typically renews on April 1.

In response to federal funding instability, Nevada lawmakers passed Senate Bill 118 in 2023, allocating $15 million to support local health authorities in identifying and funding community health needs.

However, the expected expansion of local health initiatives has been compromised by "more volatility than expected" at the federal level, forcing agencies to use these funds to fill gaps left by federal cuts.

William Bendick, public health laboratory manager at the Southern Nevada Health District, noted that a grant from the Centers for Disease Control and Prevention (CDC) was essential for maintaining a 40-person staff responsible for disease monitoring.

Without state public health funding, he indicated that staffing could be reduced by 25%, which would severely impact local surveillance testing.

The instability in federal funding has contributed to challenges in retaining qualified staff.

Jeanne Freeman from Carson City's Health and Human Services reported losing five employees who sought more stable job opportunities due to the insecurity surrounding federal funding.

She also highlighted that state funds allocated under SB 118 only cover a fraction of the costs needed to fill these critical positions.

As officials reviewed the situation, they expressed concern that the funding volatility experienced last year shows no signs of improving this year.

The unpredictability surrounding federal health grants creates an environment that complicates the management of health services across Nevada.

In summary, the Trump administration's erratic approach to federal health grants is having a profound impact on Nevada's public health infrastructure.

The instability in funding not only affects the viability of health programs but also poses significant challenges in staffing, ultimately jeopardizing the health services available to the community.

Trump Administration's Health Grant Volatility Disrupts Nevada Programs

trump-administration-s-health-grant-volatility-disrupts-nevada-programs

MD/PhD students from the Carle Illinois College of Medicine are pioneering advancements in medical technology and surgical procedures. Their training merges engineering and medical expertise, enabling them to tackle complex health challenges through innovative solutions, including AI applications and surgical robotics.

## Illinois MD/PhD Students Drive Innovation in Medicine and Robotics

MD/PhD students at the Carle Illinois College of Medicine (CI MED) are at the forefront of transforming healthcare by integrating medical and engineering disciplines.

This unique approach prepares these future Physician Innovators to confront significant medical challenges with innovative solutions, particularly in fields like surgical robotics and artificial intelligence (AI).

The Medical Scholars Program (MSP) at CI MED combines rigorous medical education with extensive research opportunities at the University of Illinois Urbana-Champaign.

This dual-degree program not only equips students with clinical skills but also fosters a deep understanding of engineering principles, allowing them to develop new technologies and methodologies for patient care.

Dr Dan Llano, the MSP Director, emphasizes the importance of cross-disciplinary training, stating, "We want graduates who don't just adapt to the future of health care; they help design it." This philosophy is reflected in the projects being undertaken by students, who are already making strides in addressing issues such as heart and kidney diseases, neurological injuries, and access to care.

One of the notable areas of focus for these students is surgical robotics.

At institutions like Loyola Medicine, advances in technology are revolutionizing how surgical procedures are performed.

The use of mixed reality in shoulder surgeries allows surgeons to overlay 3D holograms onto the surgical field, providing real-time insights into a patient's anatomy.

This innovation has led to more precise surgeries and improved patient outcomes.

For instance, Dr Dane Salazar recently utilized this technology during a total shoulder replacement surgery, resulting in a significant recovery for the patient, who returned to normal activities pain-free.

Such advancements demonstrate how integrating engineering with medicine can yield transformative results for patients, enhancing both the surgical process and recovery experiences.

Beyond surgical innovations, Illinois MD/PhD students are also addressing critical issues in cancer care.

The University of Chicago Medicine is investing heavily in cancer research and treatment facilities, with plans for an $815 million cancer pavilion.

This facility will consolidate various cancer services, improving patient access and care quality while facilitating groundbreaking research.

As the second-leading cause of death in the US, cancer presents significant challenges, particularly in underserved communities.

The new pavilion aims to tackle these challenges by providing comprehensive cancer care that combines state-of-the-art facilities with research-driven treatment protocols.

AI applications are another critical area where Illinois MD/PhD students are making a difference.

The integration of AI into healthcare has the potential to improve diagnostics, treatment personalization, and patient monitoring.

With their training, these students are positioned to lead the development of AI-driven tools that enhance patient care and medical research.

The emphasis on innovation ensures that graduates from the MSP program will be prepared to navigate and influence the evolving landscape of healthcare.

By cultivating a new generation of clinician-scientists, CI MED aims to bridge the gap between medical practice and technological advancement, ultimately improving patient outcomes.

As Illinois MD/PhD students tackle some of medicine's toughest challenges, their work exemplifies the power of interdisciplinary collaboration.

By merging engineering innovation with medical expertise, they are not only preparing to advance their own careers but also to enhance the future of healthcare.

The ongoing commitment to research and innovation at institutions like CI MED promises to yield significant advancements in surgical practices, cancer treatment, and AI applications, ultimately benefiting patients and communities alike.

With groundbreaking projects underway and a focus on developing the next generation of medical leaders, Illinois is positioning itself as a hub for medical innovation, where the future of healthcare is being shaped by the minds of today’s students.

Illinois MD/PhD Students Drive Innovation in Medicine and Robotics

illinois-md-phd-students-drive-innovation-in-medicine-and-robotics

The FDA has revised its guidelines for the Breakthrough Devices Program, emphasizing the importance of health equity and accessibility in device designation. This evolution reflects a broader understanding of how medical technologies can address healthcare disparities while ensuring patient safety and efficacy.

## FDA's Updated Criteria for Breakthrough Device Designation

The US Food and Drug Administration (FDA) has been revising its framework for what constitutes a 'breakthrough' medical device, aiming to expedite access to innovative technologies that can significantly improve patient outcomes.

The Breakthrough Devices Program (BDP), initiated under the 21st Century Cures Act of 2016, allows certain medical devices that meet specific criteria to receive prioritized review, potentially leading to faster market authorization.

Under the revised guidelines released on September 15, 2023, the FDA is now considering a medical device's potential to address health and healthcare disparities as part of its evaluation criteria.

This marks a significant shift in the FDA's perspective, highlighting the agency's commitment to improving access to effective healthcare solutions for diverse populations.

To qualify for breakthrough designation, a device must provide more effective treatment or diagnosis for life-threatening or severely debilitating conditions and meet at least one of four secondary criteria.

These include representing breakthrough technology, offering significant advantages over existing treatments, addressing an unmet medical need, or being in the best interest of patients.

The BDP aims to facilitate quicker development and review processes while maintaining rigorous standards for safety and effectiveness.

However, as of June 30, 2023, only about 9.6% of devices designated as breakthrough have received marketing authorization, indicating challenges in meeting the necessary evidence requirements.

The FDA's recent updates place greater importance on how devices can improve health equity.

For example, the agency may consider whether a device's design enhances accessibility for disadvantaged populations, thereby increasing its potential to deliver effective treatments.

This evolution in criteria reflects a broader understanding of how social determinants of health can impact treatment outcomes and patient access to care.

One recent example of a medical device that exemplifies this shift is the EvoLiver test, which received breakthrough designation for its ability to detect hepatocellular carcinoma in high-risk cirrhosis patients.

The test boasts a significantly higher sensitivity compared to traditional methods, potentially transforming liver cancer surveillance and improving access to timely treatment.

### Regulatory Challenges and Opportunities

While the BDP aims to accelerate innovation, it is not without challenges.

The FDA's recent guidance underscores the need for manufacturers to showcase how their devices address disparities and improve outcomes for specific populations.

This focus on health equity may necessitate changes in clinical trial designs to ensure diverse representation of patients.

Moreover, the Centers for Medicare & Medicaid Services (CMS) has proposed repealing the Medicare Coverage of Innovative Technology and Definition of "Reasonable and Necessary" rule, which previously aimed to provide expedited coverage for breakthrough devices.

The CMS argues that the FDA's safety and effectiveness standards alone are insufficient for guaranteeing Medicare coverage, highlighting the need for robust clinical data relevant to the Medicare population.

This potential repeal raises concerns about the accessibility of breakthrough devices for Medicare beneficiaries, as it may slow the introduction of innovative technologies into the healthcare system.

The CMS has stated that while the MCIT/R&N rule was intended to enhance access, it could lead to coverage decisions without adequate evidence of a product's necessity for specific patient populations.

The FDA's evolving view on what defines a breakthrough device reflects a growing recognition of the complexities surrounding healthcare access and equity.

By emphasizing the importance of addressing health disparities, the agency is paving the way for a more inclusive approach to medical device innovation.

As these changes unfold, it will be crucial for manufacturers to adapt to the new criteria and ensure that their products meet both regulatory and patient needs in a rapidly evolving healthcare landscape.

The impact of these changes will likely continue to shape the future of medical device development and access, affecting stakeholders from manufacturers to healthcare providers and patients alike.

As the FDA and CMS navigate these regulatory waters, the goal remains clear: to enhance patient care through timely access to life-saving technologies while ensuring that all populations benefit equally from advancements in medical science.

FDA's Updated Criteria for Breakthrough Device Designation

fda-s-updated-criteria-for-breakthrough-device-designation

Wildfires pose significant health threats, exacerbated by climate change and human activity. Public health must play a crucial role in wildfire management, promoting strategies like prescribed burns while ensuring community safety from smoke exposure.

## The Role of Public Health in Effective Wildfire Management

Wildfires have become a pressing concern in the United States, with their frequency and intensity increasing due to climate change and human activity.

The annual costs associated with wildfire suppression and recovery exceed $400 billion, significantly impacting both the environment and public health.

A key factor in managing wildfires effectively is recognizing the role of public health in mitigating their adverse effects.

As wildfires continue to threaten ecosystems and human health, it is vital to integrate public health strategies into wildfire management practices.

The most significant public health threat posed by wildfires is smoke, which contains hazardous air pollutants like fine-particle pollution (PM2.5) and volatile organic compounds (VOCs).

These pollutants can lead to severe respiratory issues, cardiovascular diseases, and even cancer, disproportionately affecting low-income and rural communities who may lack resources to protect themselves.

For instance, the 2020 Oregon wildfires resulted in nine fatalities and extensive property damage, revealing the urgent need for effective wildfire management to protect vulnerable populations.

Indigenous and local communities have long understood the concept of "good fire"—controlled burns that help maintain healthy ecosystems while preventing catastrophic wildfires.

These prescribed fires are intentionally set to reduce excessive vegetation and debris that can fuel larger fires, thereby lowering the risk of intense wildfire events in the future.

Research indicates that prescribed burns are among the most effective management strategies for wildfire prevention, as they clear out dry underbrush and create healthier forest ecosystems.

However, the implementation of prescribed fires must be conducted with caution to avoid health risks associated with smoke exposure.

This necessitates robust coordination between public health departments and forestry agencies, ensuring that smoke from these controlled fires does not adversely affect nearby communities.

### Community Engagement and Preparedness

Preparation is crucial for communities at risk of wildfires.

Public health advocates can play a vital role in educating residents about the importance of creating defensible spaces around homes and improving indoor air quality through better filtration systems.

Such measures can help protect those living in wildfire-prone areas from the harmful effects of smoke during active fire events.

Furthermore, public health strategies should include comprehensive evacuation planning and emergency response systems tailored to vulnerable populations.

These initiatives can help save lives and minimize health impacts during wildfire incidents.

Effective wildfire management requires a collaborative approach that includes public health, environmental science, and community involvement.

Policymakers must recognize the interconnectedness of forest health, community safety, and public health outcomes.

By fostering partnerships among local communities, public health officials, and environmental agencies, it is possible to develop strategies that not only reduce wildfire risks but also enhance community resilience and health.

Investment in education and resources for wildfire prevention is essential.

The public can contribute significantly to mitigating human-caused wildfires, which account for approximately 85% of such events in the US.

Simple actions, such as properly extinguishing campfires and maintaining vehicles to prevent sparks, can collectively make a substantial difference in reducing wildfire occurrences.

As wildfires continue to pose significant risks to public health and the environment, the integration of public health strategies in wildfire management becomes increasingly critical.

By recognizing the importance of prescribed burns, improving community preparedness, and fostering collaboration among various sectors, we can better protect both human health and our natural ecosystems.

This holistic approach not only addresses the immediate threats posed by wildfires but also contributes to long-term ecological resilience and community well-being.

By prioritizing public health in wildfire management, we can take significant strides toward creating safer, healthier communities in the face of growing wildfire threats.

The Role of Public Health in Effective Wildfire Management

the-role-of-public-health-in-effective-wildfire-management

Long COVID affects millions, altering lives and challenging healthcare systems. As awareness grows, stories from patients reveal the complexities of this chronic condition, highlighting the urgent need for better understanding and support.

## Living With Long COVID: The Invisible Challenge of Recovery

Long COVID has emerged as a significant public health challenge since the onset of the COVID-19 pandemic.

Affecting approximately 6 to 7% of adults who have had acute COVID-19 symptoms, it is estimated that around 400 million people worldwide have experienced long-lasting effects since the pandemic began in 2019.

The condition presents a confusing array of symptoms that can persist long after the initial infection, leading to considerable disruption in daily life and raising urgent questions about effective treatments and support systems.

Patients with long COVID often describe their experiences as life-altering.

For many, the initial infection may have seemed mild, with symptoms such as fever and fatigue, yet the aftermath can include severe fatigue, cognitive dysfunction, and cardiovascular issues that radically change their quality of life.

The lack of objective medical tests to validate these symptoms often leads to disbelief and stigma from society and even healthcare providers, further complicating recovery for those affected.

The individual stories of long COVID patients reveal the profound emotional and social impacts of the condition.

For instance, Elle Seibert, a 31-year-old living with long COVID, expressed the emotional toll and isolation that comes with the illness, stating, "You're realizing how easily society at large and people in your life will abandon you when you cannot offer them things".

Similarly, Lawrence Totress, who experienced debilitating cognitive symptoms following a COVID-19 infection, described his struggles with memory and daily tasks, illustrating how long COVID can lead to profound changes in identity and social roles.

Research into long COVID has been significantly driven by patient-led initiatives and online communities, which have provided invaluable insights into the lived experiences of those suffering from the condition.

These communities have emphasized the need for validation of symptoms and the importance of alternative therapies, as traditional healthcare systems often fail to address the complexities of long COVID adequately.

The scientific community has also begun to recognize the multifaceted nature of long COVID.

Studies indicate that the condition can present with symptoms affecting multiple organ systems, often manifesting as fatigue, pain, and cognitive issues often referred to as "brain fog".

The persistence of SARS-CoV-2 particles in some patients' blood has been linked to ongoing inflammation, further complicating the understanding and treatment of the condition.

Notably, women, individuals of Hispanic origin, and those with severe initial infections appear to be at higher risk for developing long COVID, although symptoms can arise from even mild cases.

Despite growing recognition of long COVID as a serious health issue, access to appropriate medical care and support remains inconsistent.

Many patients report difficulties in obtaining disability benefits, highlighting the need for improved pathways to support those affected by long COVID.

The Los Angeles County Department of Public Health has initiated efforts to study policies and services to assist long COVID patients, yet significant gaps in care and understanding persist within the healthcare system.

As the conversation surrounding long COVID continues to evolve, advocates are calling for increased funding and research to better understand the condition, emphasizing the need for a patient-centered approach.

The Long COVID Moonshot initiative, which seeks $1 billion in annual research funding, aims to highlight the urgency of addressing the long-term impacts of COVID-19 on individuals and society.

With the ongoing circulation of the virus, new cases of long COVID continue to emerge, underscoring the critical need for public health strategies that recognize this chronic condition as a long-term consequence of the pandemic.

As healthcare systems grapple with the complexities of long COVID, collaboration between patients, healthcare providers, and researchers will be essential in developing effective treatments and support frameworks to improve the lives of millions living with this invisible illness.

In conclusion, long COVID represents not only a medical challenge but a profound social issue that affects the fabric of many lives.

By listening to patient experiences and prioritizing research, society can begin to address the urgent needs of those affected, paving the way for a more inclusive approach to health and recovery in the post-pandemic world.

Living With Long COVID: The Invisible Challenge of Recovery

living-with-long-covid-the-invisible-challenge-of-recovery

A new AI-powered diagnostic tool, developed by Abhishek Appaji, aims to enhance early detection of mental health conditions among young adults. The Smart Eye Kiosk utilizes retinal imaging to identify potential psychiatric disorders, addressing the growing mental health crisis and offering a noninvasive screening method.

## AI Tool Revolutionizes Mental Health Diagnosis for Young Adults

In an era where mental health issues are increasingly prevalent, a groundbreaking AI-powered tool, the Smart Eye Kiosk, is set to transform how healthcare professionals screen for psychiatric disorders among young adults.

Developed by Abhishek Appaji, a senior member of the IEEE and an associate professor of medical electronics engineering at BMS College of Engineering in Bengaluru, India, this innovative tool leverages advanced retinal imaging technology to detect potential mental health conditions noninvasively.

The Smart Eye Kiosk operates by analyzing the intricate vascular patterns in the retina, which can reveal vital information about an individual's mental health.

Appaji's research suggests that changes in these patterns may correlate with neurovascular changes in the brain, which are often associated with conditions such as schizophrenia and bipolar disorder.

This approach aligns with the growing recognition of the need for early intervention in mental health, especially given that approximately 75% of mental disorders start before the age of 25.

Appaji's journey into this field began with his doctoral research focused on computational methods to identify retinal vascular patterns.

His findings indicated that the retina serves as a unique window into the central nervous system, allowing for insights into both physical and mental health.

The kiosk he developed not only screens for psychiatric conditions but also monitors stress levels and identifies basic eye diseases like diabetic retinopathy.

The implications of such a tool are significant, particularly in light of the challenges faced by young adults in accessing mental health care.

Long waiting times and inadequate service provision often leave those with mild to moderate symptoms without the support they need, resulting in a higher risk of developing chronic mental health disorders.

AI systems like the Smart Eye Kiosk can help bridge this gap by providing healthcare professionals with additional tools for early detection and personalized care.

However, the integration of AI in mental health care is not without its challenges.

While AI holds promise for enhancing triage and patient participation, there are concerns regarding trust, inclusivity, and the potential for overdiagnosis.

Healthcare professionals have expressed the need for AI systems to align with their workflows and to incorporate shared decision-making (SDM) frameworks that engage patients in their care processes.

Appaji's work exemplifies the potential for AI to enhance diagnostic precision while addressing the pressing need for accessible mental health care solutions.

By employing a multidisciplinary approach that combines artificial intelligence, biomedical engineering, and neuroscience, Appaji aims to empower both healthcare providers and patients in managing mental health more effectively.

In addition to the Smart Eye Kiosk, Appaji has contributed to other health technologies, including a wireless smart bed designed to monitor patient vital signs without invasive procedures.

This technology is already in use in over 200 hospitals across India, demonstrating Appaji's commitment to creating impactful healthcare solutions.

As mental health challenges continue to rise, particularly among young adults, innovations like the Smart Eye Kiosk could play a crucial role in transforming the landscape of mental health care.

By facilitating early detection and personalized treatment, AI tools have the potential to significantly improve outcomes for individuals struggling with mental health issues, ultimately leading to a healthier society.

While the future of AI in mental health care is still unfolding, the developments made by Appaji and his team highlight the importance of leveraging technology to create accessible and effective solutions for mental health challenges faced by the next generation.

AI Tool Revolutionizes Mental Health Diagnosis for Young Adults

ai-tool-revolutionizes-mental-health-diagnosis-for-young-adults

The Iowa Senate has amended a bill aimed at increasing access to subacute mental health care, removing significant restrictions related to insurance authorization. The revised legislation aims to streamline the approval process for mental health professionals while maintaining support for existing care facilities.

## Iowa Senate Revises Mental Health Bill, Removing Key Insurance Limits

The Iowa Senate has made significant changes to a bill intended to expand access to subacute mental health care in the state, removing important restrictions on insurance authorization for treatment.

House File 2543, which had previously passed the House unanimously, aims to address the critical shortage of intensive mental health treatment options for individuals who require more than outpatient care but do not need emergency hospitalization.

Originally, the proposal sought to eliminate a 10-day limit on receiving subacute mental health care without approval from the Iowa Department of Health and Human Services (HHS).

It also aimed to ban preauthorization requirements for the first 15 days of treatment and limit Managed Care Organizations' (MCOs) ability to assess the medical necessity of treatment or discharge patients without professional oversight.

However, the Senate's amended version of the bill significantly modified these provisions.

Rather than eliminating preauthorization requirements, it established new deadlines for HHS to respond to such requests.

Specifically, HHS or MCOs are now required to provide determinations within 48 hours for urgent requests, five days for nonurgent requests, and up to 10 days for complex cases.

During discussions about the bill, mental health advocates expressed concerns that prior authorization and limitations on care could be barriers to access.

They highlighted the existing 10-day limit as a key reason why patients struggle to secure insurance coverage for necessary subacute mental health treatment.

Moreover, many providers hesitate to offer these services, citing economic unviability.

Contrarily, representatives from the insurance industry argued that prior authorization was not the primary obstacle to accessing subacute mental health care.

Lynh Patterson, a lobbyist for MCO Wellpoint Iowa, stated that their data indicated a 100% approval rate for prior authorization requests in 2025, suggesting that the issue may lie elsewhere.

Kara Warme, R-Ames, defended the amended bill during floor debate, asserting that it would resolve key issues preventing the utilization of subacute mental health care beds in the state.

She noted that extensive discussions had taken place with current service providers and Medicaid partners to inform the revisions.

Despite the changes introduced by the Senate, Democrats voiced opposition, advocating for the original House proposal as a more robust solution to the mental health care shortages.

Janet Petersen, D-Des Moines, emphasized that insurance coverage is a significant barrier to accessing mental health care in Iowa, complicating the ability of businesses to provide necessary services.

Although the Senate amendment was approved with a 29-16 vote, the overall bill passed unanimously, reflecting bipartisan support for expanding mental health care access.

Some Democrats, while critical of the changes, acknowledged the importance of improving access to subacute mental health services.

Molly Donahue, D-Marion, pointed out that the expansion of subacute capacity is crucial for preventing repeat hospitalizations and alleviating pressure on law enforcement and emergency systems.

She argued that Iowa's low ranking in psychiatric bed availability necessitates urgent action to fill these gaps in mental health services.

As the bill returns to the House, lawmakers will have the opportunity to approve or reject the Senate's amendments.

This legislative move is seen as part of a broader effort by the Republican-controlled Iowa Legislature to enhance mental health care services throughout the state.

With the ongoing discussions and modifications, stakeholders remain hopeful that the final version of the bill will effectively address the subacute mental health care needs of Iowans, ensuring that those in crisis receive timely and appropriate support.

Iowa Senate Revises Mental Health Bill, Removing Key Insurance Limits

iowa-senate-revises-mental-health-bill-removing-key-insurance-limits

A lawsuit filed by the family of Abdirashid Hussein alleges neglect at a Minnesota mental health facility, where staff allowed a patient with a violent history to play violent video games before he killed Hussein. The case raises serious questions about patient safety and staff accountability in mental health settings.

## Lawsuit Claims Mental Health Facility Neglected Patient's Safety

A lawsuit filed by the family of a man killed by a fellow patient at a Minnesota mental health facility brings to light serious allegations of negligence and policy violations.

The suit claims that staff at the Forensic Mental Health Program (FMHP) allowed David Michael Otey, a patient with a violent past, to play violent video games up until the moment he killed his roommate, Abdirashid Mohamed Hussein, on January 1, 2024.

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