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Abstract

Bariatric surgery is becoming very common, and most physicians will have contact with bariatric patients. Many aspects to follow-up are not generally known. The objective of this article is to help other physicians understand what follow-up entails to assist them with the care of these patients. It is expected that patients are followed up by the bariatric team for a lifetime, as care is complicated and lifetime follow-up is the key to long-term success.

Keywords: Bariatrics, bariatric surgery, laparoscopic adjustable band, laparoscopic Roux-en-Y gastric bypass, long-term follow-up

Bariatric surgery improves quality of life and comorbid conditions and decreases overall cost of care.1 Patients who undergo surgery will likely increase the length of their lives due to improvement in diabetes and heart disease and decreased risk of cancer.2,3 Long-term bariatric follow-up requires a team approach and attention to several aspects of care. Nutrition is the most important aspect of follow-up to safely maximize weight loss and prevent weight gain. Exercise helps to maintain weight loss. Complications need to be identified early and can result from improper behavior or from surgical complications. Emotional difficulties occur in many patients. This article addresses all these factors.

Two common procedures performed for weight loss are the laparoscopic adjustable gastric band (LAGB) and the laparoscopic Roux-en-Y gastric bypass (LRGBY). The LRGBY constitutes 80% of all bariatric procedures.4,5 The main factors contributing to successful weight loss after bariatric surgery are the patient's ability to make lifestyle changes and to maintain those changes for years to come following the surgery. Success is measured by excess body weight (EBW) loss, which is current body weight minus ideal body weight. After LRGBY, 80% of patients achieve greater than 70% EBW loss over 2 years, and 70% of patients after LAGB achieve greater than 50% EBW loss over 3 years.4 Those who maintain the lifestyle changes for the rest of their lives will maintain the weight loss. These changes include following a healthy well-balanced diet, taking the recommended vitamin supplementation, and exercising regularly (we recommend exercise for 30 minutes 5 d/wk).6 In some patients with severe physical disabilities, physical therapy is often used to help them become mobile and to incorporate the appropriate amount of exercise.6

During the period of weight loss, we closely observe our patients; we then follow up with them once a year. During these visits, patients commonly have appointments with multiple persons on the bariatric team, including the surgeon, a physician extender, a registered dietician, and/or a mental health care provider, depending on the needs of each patient. All team members are important to guide, support, motivate, and educate the patient continuously, so that he/she may achieve a healthy weight after surgery.4 Adjustments to LAGBs are required regularly during the first 2 years to maintain the green zone, at which patients are eating properly and feeling satiated with their small meals for 2 to 3 hours. Later adjustments are needed every year or two as saline slowly leaks out of the band.7,8

In the early postoperative period, the main goals of office visits are to assess proper nutrition status, identify maladaptive eating disorders, evaluate potential complications (internal hernia, ulcers, etc), monitor status of comorbidities, encourage regular exercise, discuss weight loss progress, and check laboratory values (vitamin B1, vitamin B12, magnesium, phosphorous, blood counts, albumin, and a metabolic profile). For most patients, this is a time of emotional turmoil. Family physicians are intimately involved during the period of weight loss because of the changes in comorbidities and in medication requirements.4

During the patient's consultation with the dietician before surgery, specific weight loss goals are calculated based on EBW. After LRGBY, 80% of patients achieve greater than 70% EBW loss over 1218 months, and 70% of patients after LAGB achieve greater than 50% EBW loss over a 2-year period.9 The slower weight loss with LAGB is sometimes discouraging to patients.4

Successful weight loss also results in resolution or improvement of associated comorbidities. Particularly after LRGBY, type 2 diabetes mellitus is commonly in remission on postoperative day 1 and at a bare minimum is better controlled with less medication. Blood pressure should also be managed closely within the first 3 months, but improvements are seen over the first year. Improvement is also noted in arthritis, heart function, and stress incontinence, among other medical problems.4,1014 The use of diuretic agents should be reduced or discontinued in the first month or so to avoid dehydration and electrolyte abnormalities.15,16 The first sign of blood pressure improvement is often light-headedness. Lipid changes are seen during the first year.17 Sleep apnea resolves in most patients, which may require successive sleep studies.

Depression and anxiety medications should be continued for at least the first 6 months. Symptoms of depression should be monitored closely at the first few appointments. Many patients have difficulty with the extreme and instant lifestyle changes. If patients were previous stress eaters and become stressed after surgery, they no longer have the ability to eat for stress relief. After LRGBY, patients usually will experience dumping syndrome (which includes abdominal pain, nausea, vomiting, diarrhea, and diaphoresis). Many patients also experience changes in their social scenes, as many American holidays are centered on a big meal. The way patients interact with the significant people in their lives changes dramatically, and their social structure can be irreparably broken. This is challenging, but patients can overcome these difficult situations with guidance, understanding, and professional counseling when needed.4,18

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Long-term Management of Patients After Weight Loss Surgery

When dieting we always prefer faster ways as they are much easier and there is no need to fight food cravings for a long time. But you should know that long term dieting is healthier and gives better results, besides the right way of keeping it will not do any harm to your organism.

During the long-term dieting your body gets nutrition so that not to cause any problems.

One of the most important things when starting a diet is to be able to control cravings. What does it mean, if you will you want to eat something, which is not the right food for your diet then you should fine its substitution. We have talked about the substitutions for food cravings for healthy diet, you can read it once again, for knowing what to eat, for example, when you are eager to eat ice cream or chocolate.

You know that exercising is very important, not only during the process of dieting, but in usual life. However, when dieting you should know a few things. For example, do not think that everyday gym exercising is a perfect idea, no, you would rather start from everyday walking. Walk in the fresh air and enjoy it. Exercising at the gym should come step by step, when you feel you are already ready to go for it.

Pay attention to what you eat. Gather some info about the food and the calories it includes, find calorie counting lists and follow them. If you want to lose 1/2 pound every week you will need daily 250 calorie deficit. We do not say not to eat your favorite food, you can surely use it but your portions should not go above 200 calories tops.

Try to use mostly vegetables and fruits, they are perfect for health. Reduce the use of sweets and fats.

You should find the reward that does not consist of food, you should find other motivations for feeling good and satisfying your wishes. Do the things which you were not able to do before starting you diet, at that moment you will feel the good result and will have the motivation to continue your long term weight loss diet.

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Long Term Weight Loss | Hairstyles, Nail Designs, Fashion ...

A national, nonprofit, low-cost, peer-led weight-loss program led to the maintenance of clinically significant weight loss for an extended period of time, according to researchers.

In the Taking Off Pounds Sensibly (TOPS) program and among participants who kept up their program membership, the cumulative mean weight change as a percentage of initial weight ranged from -6.0% for 74,629 participants who renewed at 1 year to -8.3% for 2,289 participants with 7 years of consecutive annual renewal, reported Nia S. Mitchell, MD, MPH, of the University of Colorado Anschutz Medical Campus in Aurora, and colleagues.

This is the first time that any national weight-loss program has looked at everybody who joined over a 7-year period and said this is what happens to the people who come back, Mitchell said.

Mitchell said she believes that low cost and high accessibility are what make TOPS a successful program. Because only four people are needed to start a peer-led, local TOPS chapter, the program is more readily available to people in rural areas who may not have a large enough base for a commercial program, she explained.

TOPS also emphasizes community support and personal accountability, which Mitchell said helps to keep people on track with their weight-loss goals. In addition to educational programs, weekly TOPS meetings include a full roll call.

If someone hasnt shown up for a couple times, people are going to call them and ask whats going on versus other programs where if you dont show up, theres no accountability, she said. TOPS is very much about support, and most people like to have that support so they continue to come back.

While the study showed that people who stayed with the program were able to sustain weight loss, it did not include any data on people who dropped out of the program, and that was a study limitation, the authors pointed out.

Mitchells group conducted a longitudinal weight change study of TOPS members who joined from Jan. 1, 2005, to Dec. 31, 2011.

Participants pay $90 a year in membership fees and chapter dues. The chapters meet weekly. Participants are weighed privately and then take part in group educational programming on nutrition, physical activity, and behavior modification.

There is no penalty if members miss weekly meetings, and members are encouraged to continue to attend meetings even if they do not lose weight, the authors explained.

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TOPS for Long-Term Weight Loss? | Fitness Seed

Weight-Loss Products, Programs, and Diets

by L. Bellows and R. Moore* (10/13)

Approximately 70% of Americans over 20 years of age meet the criteria for being overweight or obese. Excess body fat from an unhealthy diet and lack of exercise can also increase the risk for health problems such as hypertension, heart disease, and diabetes. According to the USDA Dietary Guidelines for Americans, healthy keys to weight management include: monitoring calorie and fat intake, staying active, and maintaining a healthy lifestyle.

Certain dieting and weight-loss resources may include over-the-counter products, commercial programs, and diets. Short-term weight-loss from a low calorie intake is possible with many of these methods. However, most weight-loss methods fail to contribute to healthy long-term weight maintenance, though some may provide helpful guidance regarding a healthy diet, positive lifestyle changes, and physical activity. The following information compares the strengths and weaknesses of several popular weight-loss products, programs, and diets, and also discusses alternatives to dieting that include healthy recommendations for effective weight-loss and long-term weight maintenance.

Weight-loss products may be sold in prescription or over-the-counter form- and may include pills, supplements, beverages, or medication. Many of these substances may have serious side-effects and often do not work for long-term weight-loss. In the past decade, the Food and Drug Administration (FDA) has banned many weight-loss products including the appetite suppressant PPA (phenylpropanolamine hydrochloride), which can increase the risk of stroke. Additionally, over-the-counter pills that contain the drug ephedra have been banned and are now illegal due to serious side-effects that include dizziness, increased blood pressure and heart rate, chest pain, heart attack, stroke, seizure, and even death. Essentially, many weight-loss products contain drugs and other ingredients that could potentially to lead to adverse sideeffects that ultimately place the consumer at risk for serious health consequences.

Another product intended for weightloss is powdered beverage formulas or shakes- often mixed with a glass of milk and substituted for one or more meals. Those who consume these beverages may lose weight initially, though it is usually regained once the beverages are discontinued. By relying on shakes instead of whole foods, dieters follow artificial dieting methods and avoid learning how to incorporate healthy food choices into their lives.

Weight-loss programs are usually run by a commercial business or organization that provides weight-loss guidance. These programs may be run by a one individual, a gym, or a nationwide service. They may also sell products to accompany their program which may include exercise equipment, workout DVDs, or food and beverage items. Ideally, an effective weight-loss program should include guidance in maintaining a healthy weight after the weight-loss phase is over. The program should teach skills that help improve dietary habits, increase physical activity, and help change lifestyle habits- with an ultimate goal of long-term weight maintenance.

Commercial weight-loss programs such as Weight Watchers, Jenny Craig, NutriSystem and Diet Center, usually offer a 1,000 to 1,500 calorie diet and individual or group counseling. Though many individuals find long-term success with these programs, some participants still struggle with healthy weight-maintenance. In the past, the Federal Trade Commission (FTC) has brought action against some of these companies, challenging their weight loss and maintenance claims.

Refer to a medical professional for recommendations concerning weight loss programs available in your community.

The term diet simply refers to food and drink that is regularly provided or consumed. However, it can also refer to eating or drinking sparingly or according to a prescribed set of rules. A diet may be considered healthy or unhealthy, often depending on individual needs. An unhealthy diet is often referred to as a fad diet, which is designed to help one lose weight and is temporarily popular. The decision to follow a fad diet is often made without the support or recommendation of a medical professional, and considered an unhealthy practice. An example of a fad diet might include recommendations that severely restrict calories or even entire food groups in an unhealthy way. Cleanses, juice diets, and detoxification diets are all examples of fad diets. Although many fad diets promise quick weight loss, most are not recommended for long-term use and do not support a healthful and balanced diet. Though many individuals may lose weight initially, it is often easily regained. At two-year follow-ups, research demonstrates a very low success rate for many of these diets. In fact, only 5% of the individuals who go on a diet each year keep off the weight that they lose.

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Weight-Loss Products, Programs, and Diets

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Best Weight Loss Pills - Diet Pills and Weight Loss ...

Brent Hofacker

Recent studies examined different approaches to dieting.

Two new diet studies that appear to reach opposite conclusions on what works better for weight loss have left me scratching my head. Both were published last week in highly respected medical journals, but one found that following a high-fat, Atkins-style diet for 12 months led to more weight loss than a low-fat diet, while the other found that it didnt matter which diet people followed; they all lost similar amounts of weight over the course of a year simply by cutting calories.

The first finding, published last Monday in the Annals of Internal Medicine, randomly assigned nearly 150 people to follow either a low-fat or low-carbohydrate eating plan and found that those in the low-carbohydrate group lost an average of nearly 8 pounds more by the end of the study than those who followed a low-fat diet. The low-carbohydrate group which capped their carbohydrates at 30 percent of total calories also lost more body fat compared to muscle and experienced a greater improvement in their cholesterol levels and overall heart disease risk compared to those who limited their fat intake to no more than 30 percent of calories.

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On the other hand, a review of 48 randomized weight loss trials published last Tuesday in the Journal of the American Medical Association found that both low-fat and low-carbohydrate diets led to a 16-pound weight loss over a year compared to following no diet. This led the researchers to conclude that weight loss differences between diet plans like the low-carbohydrate Atkins and Zone diets and low-fat Ornish plan were minimal and that overweight folks should try any diet thats easy to stick with in order to lose weight and keep it off.

I asked cardiologist Dr. Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University, to sort out the confusion. Here are edited excerpts from our interview.

How is it possible that two groups of reputable researchers could reach such diametrically opposed findings on these diet studies? There are two important differences between these studies that show theyre not contradictory. In the single trial published in the Annals journal, researchers didnt ask people to reduce their calorie intake but just instructed them to change the composition of their diet eating fewer carbohydrates or less fat. In the JAMA meta-analysis looking at commercial diet plans, participants reduced how much they ate and also altered their diet composition, so its impossible to know what actually led to the weight loss.

The meta-analysis also didnt determine how much of the weight lost was fat and how much was muscle. In the single trial, researchers determined that study participants lost 1.5 percent more body fat following a low-carbohydrate diet compared to those who followed a low-fat diet.

Do calories still matter, or do we not need to think about portions if following an Atkins-style eating plan? If you want to lose weight fairly quickly, cutting calories will help you succeed, and it doesnt really matter whether you eat fewer carbohydrates or less fat. But its hard to cut calories long term, which is why so many people who lose weight gain it back over time. If youre willing to change the kinds of foods youre eating, you can lose weight slowly over time and keep it off. Thats what the Annals study found.

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Which diet is best for long-term weight loss? - Health ...

For Release: 01/29/2013

Arlington Heights, Ill. - Undergoing abdominoplasty ("tummy tuck") may lead to significant and lasting weight loss for many patients-especially those who were overweight or obese before surgery, reports a pilot study in the February issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Long-term weight loss after abdominoplasty may be related to increased satiety-feeling full after eating-according to the study by ASPS Member Surgeon Dr. Rex Edward Moulton-Barrett of Alameda Hospital and colleagues. The researchers discuss possible "neuroendocrine mechanisms" that may promote weight loss after abdominoplasty.

High Rate of Sustained Weight Loss after 'Tummy Tuck' The researchers evaluated short- and long-term weight loss after abdominoplasty in 20 women. Popularly known as "tummy tuck," abdominoplasty is a cosmetic surgical procedure to eliminate excess abdominal fat and skin. For the 20 women, the average amount of abdominal tissue resected was approximately five pounds.

One year later, 14 of the women had sustained weight loss-greater than the weight of the tissue resected. Patients with a preoperative BMI greater than or equal to 24.5 maintained long-term weight loss at one year. They decreased in weight by an average of 4.5 percent of their original BMI one year later. A normal BMI is between 18.5 and 25, overweight is between 25 and 30, and obese is 30 or higher.

The other six women also had some degree of weight loss after abdominoplasty. However, one year later, they had regained weight and increased BMI.

Long-term weight loss was more likely for women whose initial BMI was 24.5 or greater, just under the borderline for overweight. Of the 14 women with sustained weight loss, just one had an initial BMI of less than 24.5.

Sustained weight loss was also more likely for women with a greater amount of excess abdominal tissue removed at abdominoplasty. Twelve of the 14 women with long-term weight loss had more than 4.5 pounds of tissue resected.

Can a 'Cosmetic' Procedure Help Patients Lose Weight? Increased satiety seemed to be an important contributor to long-term weight loss. Three-fourths of women reported an increased feeling of satiety, either after eating or throughout the day, after undergoing abdominoplasty.

As obesity rates continue to increase in the United States, new treatments are needed to achieve and maintain weight loss. Gastric bypass and other bariatric surgical procedures are among the few treatments to produce permanent weight loss, but are generally limited to patients with morbid obesity-BMI 40 or greater.

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Many Women Have Long-Term Weight Loss after 'Tummy Tuck ...

"I remember the exact moment I fell off plan," a friend recently confessed. "The compliments had faded away, I felt super stressed after a brutal workday, and so I assuaged my grief with a gargantuan slice of turtle cheesecake that triggered a downward spiral into eventually regaining everything I worked so hard for."

If you've lost weight, you likely know the blissful exhilaration of sliding into your skinny jeans, having a "you look slimmer" compliment boost your day, and discovering a newfound confidence -- dare I say, sexiness.

Don't shoot the messenger: University of California, Los Angeles (UCLA) researchers analyzed 31 long-term studies and found people who lose weight often rebound.

The report, published in American Psychologist (the journal of the American Psychological Association), concluded many losers regain their original weight plus more, whereas sustained weight loss only occurred with a few participants. (1)

Losing weight can be fun; maintaining that loss often becomes a tedious, never-ending obstacle. Sustaining fat loss demands determination, big-picture focus, and uncomfortably saying "no" to your carb-pushing aunt's chunky cheesecake brownies.

Over time, as compliments fade, your skinny jeans become the new normal (you can always blame the dryer if they feel a little tight, right?), and you struggle saying no to that second piece of cheesecake, you perhaps resign that regain becomes inevitable.

You needn't succumb. Fat loss can become lasting, and the right long-term strategies can bolster that success. Science confirms what I've learned over nearly three decades in my own practice: People who maintain their fat loss frequently employ these nine strategies.

1. They measure to improve. Simply put, tracking keeps you on track. One study found a calorie-counting mobile app combined with health education classes help improve fat loss in 70 overweight men. (2) Another found 84 obese women who used a pedometer for three months lost more body fat and improved body composition compared to the control group. (3) The scales can also keep you honest. One study with 47 overweight people found those who weighed themselves daily lost significantly more weight and adopted significantly more weight control behaviors compared with those who weighed themselves less than daily. (4)

2. They journal. Successful losers write everything down, from food intake to body measurements. A study from Kaiser Permanente's Center for Health Research, one of the largest and longest weight-loss maintenance trials ever conducted, found those who kept daily food records lost twice as much weight as those who kept no records. (5) Their journal also includes lofty goals. Dr. Gail Matthews, a psychology professor at Dominican University in California, conducted a study about goal setting with 267 participants and found they were 42 percent more likely to achieve their goals by writing them down. (6)

3. They eat mindfully. Successful losers remain present while they're eating, savor every bite, put their forks down to chew, (7) and avoid the urge to Instagram their meal while they eat. They know even a few moments of mindless eating -- such as a perilous 11 p.m. cookie dough fridge raid -- will derail their best efforts. They wouldn't be surprised one study found people who ate slowly consumed fewer calories but sustained better satiety. (8)

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9 Science-Based Strategies for Long-Term Weight Loss ...

Weight loss: Strategies for success

Make your weight-loss goals a reality. Follow these proven strategies.

Hundreds of fad diets, weight-loss programs and outright scams promise quick and easy weight loss. However, the foundation of successful weight loss remains a healthy, calorie-controlled diet combined with exercise. For successful, long-term weight loss, you must make permanent changes in your lifestyle and health habits.

How do you make those permanent changes? Consider following these six strategies for weight-loss success.

Permanent weight loss takes time and effort and a lifelong commitment. Make sure that you're ready to make permanent changes and that you do so for the right reasons.

To stay committed to your weight loss, you need to be focused. It takes a lot of mental and physical energy to change your habits. So as you're planning new weight-loss-related lifestyle changes, make a plan to address other stresses in your life first, such as financial problems or relationship conflicts. While these stresses may never go away completely, managing them better should improve your ability to focus on achieving a healthier lifestyle. Then, once you're ready to launch your weight-loss plan, set a start date and then start.

No one else can make you lose weight. You must undertake diet and exercise changes to please yourself. What's going to give you the burning drive to stick to your weight-loss plan?

Make a list of what's important to you to help stay motivated and focused, whether it's an upcoming beach vacation or better overall health. Then find a way to make sure that you can call on your motivational factors during moments of temptation. Perhaps you want to post an encouraging note to yourself on the pantry door, for instance.

While you have to take responsibility for your own behavior for successful weight loss, it helps to have support of the right kind. Pick people to support you who will encourage you in positive ways, without shame, embarrassment or sabotage. Ideally, find people who will listen to your concerns and feelings, spend time exercising with you or creating healthy menus, and who will share the priority you've placed on developing a healthier lifestyle. Your support group can also offer accountability, which can be a strong motivation to stick to your weight-loss goals.

If you prefer to keep your weight-loss plans private, be accountable to yourself by having regular weigh-ins and recording your diet and exercise progress in a journal.

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Weight loss: Strategies for success - Mayo Clinic

The following article will give you advice on how to make a weight loss regimen possible.

If you want to shed pounds, start exercising. Many people are unaware of how easy it is to get some exercise in. But for many of us, it's tough to find the time. Give your body every chance you can to boost your metabolism a little more than before, whether that's parking a little farther out or taking the stairs instead of the elevator. Just walking several hundred extra steps per day can make a big difference.

Trying a fad diet might sound like a great short-cut to losing weight. Avoid fad diets if you really want to lose weight. Fad diets are exhausting, boring and very hard to stick to, especially if they focus on eating only one type of food. Additionally, these types of diets don't promote learning any sustainable, good nutrition habits. Choosing a nutritious diet will help you to learn how to make healthy choices.

Nutrisystem is a popular weight loss program that has helped many people to lose weight safely. If you are looking for the best nutrisystem deals, you can check out online forums or review sites like yeointernational.com to save more money on this program.

Try sucking on an ice cube when you feel as if you want to have a snack or some junk food. This can eliminate the urge to snack, especially during those times when you aren't really craving food so much as wanting something to keep your mouth busy.

You can still enjoy restaurant meals when trying to lose weight. Watch out and though, for the way restaurants often provide super-sized portions. One way to avoid overeating is to ask your server to for a to-go container when you order. You should cut your meal's portions down to size when it arrives and pack the excess as leftovers before you dig in. Taking home leftovers not only means you eat smaller portions for dinner but then you have a yummy lunch for tomorrow.

When you are aiming to lose weight, put some yogurt into the shopping cart. Low-fat and plain yogurts are the best choice. Plain yogurt with a little salt and pepper makes a great salad dressing. Try putting some fruit in yogurt to keep sugar away if you are buying yogurt in the market. Yogurt contains an abundance of calcium, which is needed for good bone health, and it's a yummy snack option.

If you are planning on exercising, try to do it with a friend or family member. This way, exercising will feel more like socializing sessions rather than drudgery to lose weight. The two of you can offer encouragement to each other while having great conversation. Socializing and having fun makes you want to exercise, and exercise leads to weight loss.

You can lose weight much quicker when you avoid late-night, food cravings. When you eat late at night, you will not metabolize the food properly while sleeping. Leave eating for the daytime hours.

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Tips For Long-Term Weight Loss | FSSCA

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