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The earlier the treatment, the better the result

Around 52 percent of the patients treated with alteplase responded well to treatment and suffered no or only slight impairment, while in the placebo group, there were only 45 percent responders. The mortality rate was very low and identical in both groups (8 percent).

Based on these results, the researchers suggest treating stroke patients with thrombolytic drugs even after three hours. “But having more time does not mean that we can take more time”, warned Professor Hacke. Patients with signs of a stroke should still be brought to the hospital and treated as soon as possible. Previous analyses clearly showed that patients respond best the earlier they received treatment.

But in addition to this, the study will set an important course – there had been no positive study on acute stroke therapy for more than 12 years, and ECASS 3 is just the second acute study ever to have a positive result for strokes. “This study will have an impact on the entire field of stroke treatment. It has finally been demonstrated again that stroke can be treated and this will encourage many researchers and companies to continue to work in this field”, according to Professor Hacke.

About stroke: Every year, more than 250,000 people in Germany suffer a stroke and more than 10 million patients die annually from strokes all around the world, making it the second most frequent cause of death in the world, now ahead of cancer. As life expectancy increases, a dramatic increase in the incidence of strokes is expected in Germany, but even more so in developing countries. Stroke is not fate, it can be prevented and treated!

Contact: Professor Dr. Werner Hacke

Medical Director of the Neurology Clinic at Heidelberg University Hospital

Tel.: 06221 / 56 8211 (office) E-mail:

References: Hacke W et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. 2008. New England Journal of Medicine, Sept. 25, Vol. 359, p. 1317-1329.

(The original article can be requested at the press office of Heidelberg University Hospital at .)

Study reveals an oily diet for subsurface life

(Santa Barbara, Calif.) - Thousands of feet below the bottom of the sea, off the shores of Santa Barbara, single-celled organisms are busy feasting on oil.

Until now, nobody knew how many oily compounds were being devoured by the microscopic creatures, but new research led by David Valentine of UC Santa Barbara and Chris Reddy of Woods Hole Oceanographic Institution in Massachusetts has shed new light on just how extensive their diet can be.

In a report to be published in the Oct. 1 edition of the journal Environmental Science & Technology, Valentine, Reddy, lead author George Wardlaw of UCSB, and three other co-authors detail how the microbes are dining on thousands of compounds that make up the oil seeping from the sea floor.

"It takes a special organism to live half a mile deep in the Earth and eat oil for a living," said Valentine, an associate professor of earth science at UCSB. "There's this incredibly complex diet for organisms down there eating the oil. It's like a buffet."

Bubble of oil oozing from the ocean floor.

And, the researchers found, there may be one other byproduct being produced by all of this munching on oil - natural gas. "They're eating the oil, and probably making natural gas out of it," Valentine said. "It's actually a whole consortium of organisms - some that are eating the oil and producing intermediate products, and then those intermediate products are converted by another group to natural gas."

Reddy, a marine chemist at Woods Hole, said the research provides important new clues in the study of petroleum. "The biggest surprise was that microbes living without oxygen could eat so many compounds that compose crude oil," Reddy said. "Prior to this study, only a handful of compounds were shown, mostly in laboratory studies, to be degraded anaerobically. This is a major leap forward in understanding petroleum geochemistry and microbiology."

The diet of the single-cell microbes is far more diverse than previously thought, Valentine said. "They ate around 1,000 of the 1,500 compounds we could trace, and presumably are eating many more," he said.

Research for this project began seven years ago and much of the testing was done at one of the planet's best natural labs. "We have the world's most prolific hydrocarbon seep field sitting right offshore of Santa Barbara, about two miles out," Valentine said. "We have something on the order of 100 barrels of oil a day coming up from the sea floor."

The source of this oil seepage is near Platform Holly, but it's not being caused by the drilling. "It's just oil that is naturally oozing out, probably has been for thousands of years," Valentine explained. "Holly just happens to be near some of these seepage areas, which is fortuitous because we were able to get samples from about a mile deep."

By studying samples from the subsurface, the ocean floor, the mid-water, and then from the surface, the researchers could determine how much of the oil was being degraded and digested by the microbes.

Using a new technique devised by Reddy, the scientists were able to pick apart the differences in the makeup of the oil, which is migrating to the surface through faults from deep below the sea floor. The microbes prefer the lighter compounds of oil, the gasoline part of the black goo. They tend to leave behind the heavily weathered residue, which is what makes its way to the surface and, sometimes, to the beaches in the form of tar.

"There always seems to be a residue," Valentine said. "They (bacteria) hit a wall. There seems to be stages in which they eat. There's the easy stuff - the steak. And then they work their way to the vegetables, and then garnish, and then they stop eating after awhile. Just depends on how hungry they are and what's fed to them."

Reddy's new diagnostic technology is called a comprehensive two-dimensional gas chromatography (GCxGC). Typically, chromatography involves heating up a sample and putting it into a column around 60 meters long. Compounds are then separated based on their boiling points, which works well with light crude oil, Valentine said. But, with the two-dimensional test, the compounds are put into a cooled trap, for about 10 seconds, and a flash pulse of hot air releases them into the second column. This two-dimensional separation allows the researchers to pick out the many thousands of compounds.

"This new technology was actually too good at its job," Reddy said. "It was able to separate and help identify significantly more compounds in the oil samples than traditional analytical techniques. The end result was that we were handcuffed with too much data afforded by the GCxGC. However, we overcame this hurdle by using new algorithms to help us interpret the data, which in turn led us to these milestone discoveries."

The next steps in their research are already under way, according to Valentine. They are following the oil diet in controlled laboratory conditions, and tracking the fate of the oil once it forms a slick at the sea surface.

"When you fly out of the Santa Barbara Airport, you can look down and see these massive slicks," Valentine said. "You can follow them for about 20 miles. A lot of the oil comes up on the beaches, but then what happens to it after that? Certainly the microorganisms continue to act on it. Evaporation occurs, but most of it can't evaporate. Some of it breaks down from sunlight. So where does the rest of it end up? We want to know how far the organisms will go in eating the oil and what happens to the residual tar. It doesn't all stick to our feet and there must be a lot of it out there somewhere."

Wardlaw, the lead author of this paper, is a graduate student in the Marine Science program at UCSB. The other co-authors were J. Samuel Arey of the Swiss Federal Institute of Technology, and G. Todd Ventura and Robert K. Nelson, both of Woods Hole Oceanographic Institution.

Funding for this research was provided by the National Science Foundation, the Department of Energy, and the U.S. Minerals Management Service.

Applying Science to Alternative Medicine


More than 80 million adults in the United States are estimated to use some form of alternative medicine, from herbs and megavitamins to yoga and acupuncture. But while sweeping claims are made for these treatments, the scientific evidence for them often lags far behind: studies and clinical trials, when they exist at all, can be shoddy in design and too small to yield reliable insights.

Now the federal government is working hard to raise the standards of evidence, seeking to distinguish between what is effective, useless and harmful or even dangerous.

“The research has been making steady progress,” said Dr. Josephine P. Briggs, director of the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health. “It’s reasonably new that rigorous methods are being used to study these health practices.”

The need for rigor can be striking. For instance, a 2004 Harvard study identified 181 research papers on yoga therapy reporting that it could be used to treat an impressive array of ailments — including asthma, heart disease, hypertension, depression, back pain, bronchitis, diabetes, cancer, arthritis, insomnia, lung disease and high blood pressure.

It turned out that only 40 percent of the studies used randomized controlled trials — the usual way of establishing reliable knowledge about whether a drug, diet or other intervention is really safe and effective. In such trials, scientists randomly assign patients to treatment or control groups with the aim of eliminating bias from clinician and patient decisions.

Sat Bir S. Khalsa, the study’s author and a sleep researcher at the Harvard Medical School, said an added complication was that “the vast majority of these studies have been small,” averaging 30 or fewer subjects per arm of the randomized trial. The smaller the sample size, he warned, the greater the risk of error, including false positives and false negatives.

Critics of alternative medicine have seized on that weakness. R. Barker Bausell, a senior research methodologist at the University of Maryland and the author of “Snake Oil Science” (Oxford, 2007), says small studies often have a built-in conflict of interest: they need to show positive results to win grants for larger investigations.

“All these things conspire to produce false positives,” Dr. Bausell said in an interview. “They make the results extremely questionable.”

That kind of fog is what Dr. Briggs and the National Center for Complementary and Alternative Medicine, with a budget of $122 million this year, are trying to eliminate. Their trials tend to be longer and larger. And if a treatment shows promise, the center extends the trials to many centers, further lowering the odds of false positives and investigator bias.

For instance, the center is conducting a large study to see if extracts from the ginkgo biloba tree can slow the progression of Alzheimer’s disease. The clinical trials involve centers in California, Maryland, North Carolina and Pennsylvania and recruited more than 3,000 patients, all of them over 75. The study is to end next year.

Another large study enrolled 570 participants to see if acupuncture provided pain relief and improved function for people with osteoarthritis of the knee. In 2004, it reported positive results. Dr. Brian M. Berman, the study’s director and a professor of medicine at the University of Maryland, said the inquiry “establishes that acupuncture is an effective complement to conventional arthritis treatment.”

In an interview, Dr. Briggs said another good way to improve clinical trials was to ensure product uniformity, especially on herbal treatments. “We feel we have really influenced the standards,” she said.

Over the years, laboratories have found that up to 75 percent of the samples of ginkgo biloba failed to show the claimed levels of the active ingredient. Scientists doing a clinical trial have a large incentive to fix that kind of inconsistency.

Dr. Briggs said such investments would be likely to pay off in the future by documenting real benefits from at least some of the unorthodox treatments. “I believe that as the sensitivities of our measures improve, we’ll do a better job at detecting these modest but important effects” for disease prevention and healing, she said.

An open question is how far the new wave will go. The high costs of good clinical trials, which can run to millions of dollars, means relatively few are done in the field of alternative therapies and relatively few of the extravagant claims are closely examined.

“In tight funding times, that’s going to get worse,” said Dr. Khalsa of Harvard, who is doing a clinical trial on whether yoga can fight insomnia. “It’s a big problem. These grants are still very hard to get and the emphasis is still on conventional medicine, on the magic pill or procedure that’s going to take away all these diseases.”

Eureka! How distractions facilitate creative problem-solving

How many times have you spent hours slaving over an impossible problem, only to take a break and then easily solve the problem, sometimes within minutes of looking at it again? Although this is actually a common phenomenon, up until now the way that this occurs has been unclear. But new research in the September issue of Psychological Science, a journal of the Association for Psychological Science, demonstrates the answer is more complex than simply having an “Aha!” moment.

The new research, led in part by Kellogg School of Management Professor Adam Galinsky, suggests that unconscious thought results in creative problem-solving via a two-step process.

According to Galinsky and fellow psychologists Chen-Bo Zhong from the University of Toronto and Ap Dijkstererhuis of Radboud University Nijmegen, distractions may be helpful in coming up with creative solutions to a certain problem, but must be followed by a period of conscious thought to ensure that we are aware of those solutions and can apply them. Likewise, while distractions are more useful in solving difficult problems, it may be better to stay focused on finding the solution when confronted with easier problems.

The researchers conducted two experiments to test their idea. In the first experiment, 94 subjects participated in a Remote-Association Test (RAT), which tests for creativity. In this test, participants were presented with three words (a triad) and were asked to come up with a fourth word that is linked with all three words. For example, if presented with the words cheese, sky and ocean, the correct answer would be blue (blue cheese, blue sky, blue ocean). Subjects were shown nine very difficult triads (but were instructed not to solve them yet) and were then divided into groups. For five minutes following the RAT, participants were either concentrating on the triads they had just seen (the conscious thought group) or engaging in a test completely unrelated to the RAT (the unconscious thought group). Following the five-minute interval, all of the subjects participated in a lexical decision test. During this test, subjects were shown sequences of letters and had to indicate as quickly as possible if the sequences were English words or not. The sequences presented included answers to the RAT triads, random words and non-words. Finally, subjects were again shown the RAT items and had to write down their answers.

The second experiment involved 36 subjects and had a similar set up to the previous experiment, although the RAT triads presented were much easier to solve compared to those in the first experiment.

The results showed that in the first experiment, during the lexical decision test, members of the unconscious thought group had much faster responses to letter sequences which were answers to RAT items, compared to the conscious thought group. However, when it came time to solve the RAT problems, both groups had similar results. In the second experiment (using an easier set of RAT triads), the conscious thought group had more correct RAT answers compared to the unconscious thought group, but there was no difference in response time during the lexical decision test.

“Conscious thought is better at making linear, analytic decisions, but unconscious thought is especially effective at solving complex problems,” said Galinsky and his co-authors. “Unconscious activation may provide inspirational sparks underlying the ‘Aha!’ moment that eventually leads to important discoveries.”

MORE INFORMATION: To see the full article, published in the September 2008 issue of Psychological Science, or to arrange an interview with Professor Adam Galinsky, contact Meg Washburn at the Kellogg School of Management at (773) 848 - 4461, or at

Driving Fatalities Surge on US Presidential Election Days

Sunnybrook researcher Dr. Donald Redelmeier and Stanford University statistician Robert Tibshirani have found an increased risk of fatal motor vehicle crashes on United States (US) presidential election days.

“We thought efforts that mobilize about 55 per cent of the population to vote, along with US reliance on motor vehicle travel, might result in increased fatal motor vehicle crashes during US presidential elections,” says Redelmeier, lead investigator of the study and staff physician at Sunnybrook Health Sciences Centre, “indeed, we found a significant increase in traffic deaths on election days.”

The investigation looked at all US presidential election days over the last 32 years, from Jimmy Carter in 1976 to George Bush in 2004, during the hours of polling. They also looked at the same hours on the Tuesday immediately before and immediately after as control days. Their main finding was that the average presidential election led to about 24 deaths from motor vehicle crashes.

Explanations for the increased risk include speed, distance, distraction, emotions, unfamiliar pathways traveling to polls, and the potential mobilization of unfit drivers. "A 4 per cent increase in average driving speed," says Redelmeier, "would be sufficient by itself to account for the 18 per cent observed increase in fatal motor vehicle crashes."

“What these findings suggest is the immediate need for safety reminders by electioneers who encourage people to get out to vote,” says Redelmeier, also a professor of medicine at the University of Toronto. “Good advice would be to avoid excess speed, alcohol, and other distractions as well as to ensure seatbelt use.”

Other interventions worth considering might include subsidized public transportation, voting centers within walking distances, tamper-proof remote voting, or more traffic enforcement on election day. "In light of these findings, the US president owes a larger debt to the American people than is generally recognized" says Redelmeier.

The results of the study are published in the October 1, 2008 issue of the Journal of the American Medical Association.

Vitamin C supplements may reduce benefit from wide range of anti-cancer drugs

PHILADELPHIA – In pre-clinical studies, vitamin C appears to substantially reduce the effectiveness of anticancer drugs, say researchers at Memorial Sloan-Kettering Cancer Center.

These new findings, published in the October 1 issue of Cancer Research, a publication of the American Association of Cancer Research (AACR), came from studying laboratory cancer cells and mice, but the study's authors say the same mechanism may affect patient outcomes, although they add this premise needs to be tested.

"The use of vitamin C supplements could have the potential to reduce the ability of patients to respond to therapy," said Heaney, an Associate Attending Physician at Memorial Sloan-Kettering Cancer Center.

Use of vitamin C during cancer treatment has been controversial. Some studies have suggested that because vitamin C is an antioxidant it might be beneficial to cancer patients. But some classes of chemotherapy drugs produce "oxygen free radicals," unpaired oxygen molecules that can fatally react with other molecules in a cell, forcing cell death. In this theory, vitamin C could sop up the radicals, keeping the cancer cell alive despite chemotherapy treatment.

Heaney and his colleagues tested a wide variety of chemotherapy drugs – those that produce reactive oxygen and those that work in other ways – on cancer cells in the laboratory, that were pretreated with dehydroascorbic acid (DHA), the form that ascorbic acid (vitamin C) takes to enter cells.

They found to their surprise that every chemotherapy drug they tested – which included targeted agents like Gleevec – did not work as well if cells were pretreated with vitamin C, as they did on untreated cancer cells. In the cell culture experiments, 30 to 70 percent less cancer cells treated with vitamin C were killed depending on the drug tested.

They then checked these findings by implanting the cancer cells into mice, and again found that, in an animal model system, while chemotherapy kept untreated cancer in check, tumors grew more rapidly in mice that were given cancer pretreated with vitamin C.

The research team, which includes researchers from Columbia University, then delved into the mechanism by which vitamin C may be protecting these cells, and discovered that it wasn't because the nutrient was neutralizing oxygen-free radicals.

They found instead that DHA was restoring viability to the cancer cell's damaged mitochondria – the cell's all-important power plant that, when injured, sends signals to force a cell to die.

"Vitamin C appears to protect the mitochondria from extensive damage, thus saving the cell," Heaney said. "And whether directly or not, all anticancer drugs work to disrupt the mitochondria to push cell death."

Heaney says that the amount of DHA used in the experiments resulted in an intracellular buildup similar to what could be seen in cancer patients using large supplemental doses of vitamin C.

Researchers at Memorial Sloan-Kettering Cancer Center have long been researching the connection between vitamin C and cancer therapy, and these new findings expand on their earlier observation that vitamin C seems to accumulate within cancer cells more than in normal cells.

"We recognized that DHA is the form of vitamin C that gets into cells, and that the tumor microenvironment allows cancer cells to convert more vitamin C into DHA," he said. "Inside the cell, DHA is converted back into ascorbic acid, and it gets trapped there and so is available to safeguard the cell."

Heaney says that he suspects that vitamin C is good for the cells of normal tissue because it provides more protection for the mitochondria, and thus probably extends cell life. "But that isn't what you want when you are trying to eliminate cancer cells," said Heaney, who notes that cancer patients should eat a healthy diet, which includes foods rich in vitamin C. It is use of large doses of over-the-counter vitamin C that is worrisome, he says.

Asian-white couples face distinct pregnancy risks, Stanford/Packard

STANFORD, Calif. - Pregnant women who are part of an Asian-white couple face an increased risk of gestational diabetes as compared with couples in which both partners are white, according to a new study from Lucile Packard Children's Hospital and the Stanford University School of Medicine.

The researchers also found that Asian women whose partners are white are more likely than white women with Asian or white partners to have a caesarean delivery, as part of a broad analysis of perinatal outcomes among Asian, white and Asian-white couples.

The study will be published in the October issue of American Journal of Obstetrics and Gynecology. The findings, the authors say, could benefit clinicians working with an increasingly diverse patient population.

"There's great heterogeneity in our country; there are people of many different races and backgrounds," said co-author Yasser El-Sayed, MD, a Packard Children's Hospital obstetrician and associate professor of obstetrics and gynecology at the medical school. "Gaining better insight into the risks facing specific populations provides for better counseling and better prenatal care."

It's difficult to estimate the prevalence of Asian-white couples, but 14.3 percent of Americans reporting Asian race in the U.S. Census Bureau's 2000 survey also reported being of mixed Asian-white ancestry. Although past studies have looked at ethnic differences in perinatal outcomes, the majority of research has focused on white- African-American couples. Few studies have focused specifically on Asian-white couples, said El-Sayed, who is also associate chief of maternal-fetal medicine.

To learn more about outcomes and risks in this population, the researchers looked at data from white, Asian and Asian-white couples who delivered at the Johnson Center for Pregnancy and Newborn Services at Packard Children's from 2000 through 2005. (During that time period, 5,575 white, 3,226 Asian and 868 Asian-white couples delivered babies at the hospital.) The team recorded the type of delivery - caesarean vs. vaginal - and examined perinatal outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm delivery and birth weight.

El-Sayed and his colleagues found, as noted in their paper, that Asian- white couples "represent a population with distinct perinatal risks that differ depending upon which parent is of Asian race."

More specifically, the researchers found that white mother/Asian father couples had the lowest rate (23 percent) of caesarean delivery, while Asian mother/white father couples had the highest rate (33.2 percent). Because birth weights between these two groups were similar, the researchers say the findings suggest that the average Asian woman's pelvis may be smaller than the average white woman's and less able to accommodate babies of a certain size. (Asian couples had babies with the lowest median birth weight, so caesarean delivery was less common among those women.)

It's important for clinicians to know which women may have an increased risk of caesarean delivery, so they can conduct proper counseling prior to childbirth, El-Sayed said.

El-Sayed and his colleagues also found that the incidence of gestational diabetes was lowest among white couples at 1.61 percent and highest among Asian couples at 5.73 percent - and just under 4 percent for Asian-white couples. These findings weren't altogether surprising: past studies have shown an increased risk of diabetes among Asian couples, which researchers attribute to an underlying genetic predisposition. But the interesting finding, El-Sayed said, was that the risk for interracial couples was about the same regardless of which parent was Asian.

Based on their findings, El-Sayed said clinicians should consider both maternal and paternal race when determining a patient's risk for perinatal complications. "One has to factor in as many relevant variables as possible when you counsel a patient about pregnancy," he said. "We've shown in this paper that if you have an interracial couple, depending on which parent is of which race, there may be different relative risks of certain outcomes that could inform and enhance clinical management."

Noting the growing number of interracial couples in the San Francisco Bay Area and beyond, El-Sayed said he expects to see more outcomes research like this in the future. "These kinds of studies will become increasingly common," he said.

Michael Nystrom, MD, who was a resident at Stanford when the research was done and is now a resident at UC-San Francisco, was first author of the paper. El-Sayed's other co-authors were Stanford faculty Deirdre Lyell, MD, and Maurice Druzin, MD; and Aaron Caughey, MD, from UCSF.

Logging On for a Second (or Third) Opinion


Correction Appended

When Terri Nelson learned she had a large fibroid tumor in her uterus, she went online.

There is nothing new in that, of course. The intrepid and the adept were going to the Web for health information as long ago as the 1980s, well before Google and other search engines made it accessible to a wider audience.

Nola Lopez, with Bryan Christie

These days, that is pretty much everyone. At least three-quarters of all Internet users look for health information online, according to the Pew Internet and American Life Project; of those with a high-speed connection, 1 in 9 do health research on a typical day. And 75 percent of online patients with a chronic problem told the researchers that “their last health search affected a decision about how to treat an illness or condition,” according to a Pew Report released last month, “The Engaged E-Patient Population.”

Reliance on the Internet is so prevalent, said the report’s author, Susannah Fox, the associate director at Pew, that “Google is the de facto second opinion” for patients seeking further information after a diagnosis.

But paging Dr. Google can lead patients to miss a rich lode of online resources that may not yield to a simple search. Sometimes just adding a word makes all the difference. Searching for the name of a certain cancer will bring up the Wikipedia entry and several information sites from major hospitals, drug companies and other providers. Add the word “community” to that search, Ms. Fox said, and “it’s like falling into an alternate universe,” filled with sites that connect patients.

As a result, said Dr. Ted Eytan, medical director for delivery systems operations improvement at the Permanente Federation, “patients aren’t learning from Web sites — they’re learning from each other.” The shift is nothing less than “the democratization of health care,” he went on, adding, “Now you can become a national expert in your bedroom.”

These expanded capabilities allow people to share information easily, upending the top-down path of information between doctors and patients. Today, said Clay Shirky, an expert in the evolving online world, patients are “full-fledged actors in the system.”

And they have plenty of company. Benjamin Heywood, the president of, a site that allows patients to track and document their conditions and compare notes with other patients, says that with a growing online population, it becomes possible to research highly specific conditions — say, being a 50-year-old with multiple sclerosis who has leg spasms and is taking a certain combination of drugs.

“We are really about measuring value in the real world,” he said.

There are so many sites today and the landscape is changing so rapidly that it would take an encyclopedia rather than a newspaper to list them. But they can be grouped into five broad, often overlapping, categories:

GENERAL INTEREST Sites like WebMD (, Discovery Health ( and The New York Times ( provide information about disease, news and lifestyle advice, as do medical institutions like the Mayo Clinic (

MEDICAL RESEARCH SITES offer access to the published work of scientists, studies and a window into continuing research. Examples include PubMed ( from the National Library of Medicine;, which tracks federally financed studies; psycinfo (, with its trove of psychological literature; and the National Center for Complementary and Alternative Medicine (, the government’s registry on alternative medicine research.

PATIENT SITES for groups and individuals are booming — so much so that they are increasingly used by researchers to find patients for studies. These include the Association of Cancer Online Resources ( and e-patients (, as well as Patients Like Me and Trusera (, which provide a bit of Facebook-style social connectivity for patients, along with the ability to share their stories in clinical, data-laden detail.

DISEASE-SPECIFIC SITES focus on a particular condition and are often sponsored by major organizations like the American Heart Association (, the American Cancer Society ( and the American Diabetes Association ( But smaller groups can put together extensive resources as well, with sites like and Diabetes Mine (, which calls itself the “all things diabetes blog.”

WEB TOOLS These sites help people manage their conditions — for example, for diabetes, Destination Rx ( for comparing drug prices, and, a service of the Washington University school of medicine that helps patients determine their risk for various problems.

All of the changes in the Internet and the ways people use it help explain why Terri Nelson’s experience in 2008 is very different from what it might have been in 1998.

Ms. Nelson, who lives in Portland, Ore., received her diagnosis on Aug. 11. She had two weeks before a follow-up visit with her surgeon. Ms. Nelson and her husband, Stewart Loving-Gibbard, used the time to research fibroids and the most common treatments.

Ms. Nelson started with straightforward information gathering, checking the articles on fibroid tumors at sites that included the Mayo Clinic and PubMed. Then she reached out to the community of people with fibroid tumors at ACOR and other sites. (“Those had to be evaluated carefully,” she said, “to find the nuggets of valid information in the vast sea of online hypochondria.”)

Having spent many years trolling roisterous online forums, however, she had developed that essential Internet tool: what might be called a personal baby/bathwater algorithm that helps people to sift through mountains of information to find what is relevant. She found a blog for the layperson, “Inquisitive Geek With Fibroid Tumors,” that featured wide-ranging discussions and, she said, “was really useful” and specific to her condition.

By the time she went into the consultation with her surgeon, she knew that the old-school way of dealing with her grapefruit-size tumor would probably have been a hysterectomy. But that can impair sexual response, among other side effects; a growing number of doctors prefer abdominal myomectomy, which leaves the uterus intact. The surgeon laid out the options and recommended that approach as well, confirming Ms. Nelson’s research.

During the surgery and recovery, Mr. Loving-Gibbard used Twitter, the short-message communication service, to keep friends and family apprised of her condition. Twittering an operation might seem frivolous, but when Ms. Nelson’s teeth began chattering after the procedure, a friend following the updates suggested it could be a potentially hazardous side effect, tardive dyskinesia, that can occur with one of the antinausea drugs Ms. Nelson was taking. Mr. Loving-Gibbard, who had been researching that very point when the message from the friend, Ken Yee, came in, was able to get the medication changed.

After the procedure, they posted photographs of the surgery and tumor on the photo-sharing site under the heading “Extracting a Pound of Flesh” (

They are not for the squeamish, but as Ms. Nelson said, “My husband’s family is mostly doctors, so they were all interested in seeing the photos, and most of my friends are morbidly fascinated.”

As patients go online to share information and discuss their care, they are becoming something more: consumers. Amy Tenderich, the creator of Diabetes Mine has turned her site into a community for diabetes patients and an information clearinghouse for treatments and gadgets — even going so far as to publish an open letter last year to Steven Jobs, the Apple Computer co-founder, challenging him to design medical devices like insulin pumps that are as sleek and easy to use as an iPod.

Dr. Talmadge E. King Jr., chairman of the department of medicine at the University of California, San Francisco, says doctors are coming around to seeing the value of a patient who has gone online for information.

Patients in his pulmonary practice, he said, sometimes come into his office holding medical journal articles he has written “and quiz me.” The better-educated patient might stump the doctor, he went on, but these days “it’s much easier for me to look them straight in the eye and say, ‘I don’t know’ ” and promise to get back to them. “Patients know you’re not all-knowing,” he said. “They’re not upset by that.”

Can online information be trusted? The answer, increasingly, is yes. In a study earlier this year, a report in the journal Cancer looked at 343 Web pages about breast cancer that came up in online searches. The researchers found 41 inaccurate statements on 18 sites — an error rate of 5.2 percent. Sites promoting alternative medicine were 15 times as likely to offer false or misleading health information as those sites that promoted conventional medicine, the study found.

Matthew Holt, who with Indu Subaiya created a conference, Health 2.0, that showcases innovation, says the marketplace in information can correct itself over time. “In the end,” he said, “the more people you have in the conversation, the better information drives out the worse information.”

This article has been revised to reflect the following correction:

Correction: October 1, 2008

An article on Tuesday about online research into health-care topics misstated the Web address for one site, e-patients. It is
Health on the Web

A Google search for "cancer" returns 299 million results; narrow that to, say, "prostate cancer" and you still get 12.7 million. It's a vast, bewildering world out there, but here's a look at six of the most interesting and potentially useful online health resources. - JASCHA HOFFMAN

Web Site


Created more than a decade ago by the National Library of Medicine, PubMed includes millions of citations from medical journals dating to the 1950s. Doctors and students have learned to rely on the database to track studies. Patients, on the other hand, may be overwhelmed by the flood of results: more than 500 abstracts crop up when the system translates a naïve query for "causes of bad breath" into "etiology of halitosis." But if you know what you're looking for, and how to make sense of it, PubMed is a power tool without peer. A free log-in allows easier filtering, and a new iPhone application holds the promise of a second opinion right there in the waiting room.

The art of diagnosis is subtle. But when it comes to skin conditions, sometimes the answer is right there in front of your eyes. Enter the Skin Disease Finder at, a kind of Flickr for bites, boils, cysts, moles, rashes, sores, warts and more — even the hard-to-describe skin infections caused by MRSA. Drawn from an even larger visual library sold by Logical Images in Rochester, this free dermatological atlas will satisfy all but the most fiendish amateur skin detective. You can select a location as precise as scalp, cheek, toenail or “finger webspace,” or you can shoot the moon by clicking on “widespread rash.” Presto, a sort of lineup of skin diseases appears, with instantly recognizable mug shots that enable anyone to tell eczema from rosacea, shingles from ringworm, scabies from psoriasis. The whole thing is certainly more thrilling than a visit to the dermatologist’s office — especially if you don’t have a rash.

San Francisco City Clinic

San Francisco City Clinic, which offers low-cost testing and treatment for sexually transmitted diseases, is also a bracing and realistic source of information. Its front page comes on gently with a little box marked “About You.” This leads to a customized list of diseases one can get as, say, a middle-age transsexual who sleeps with both men and women. For those who would rather see all the risks at once, a handy chart of “S.T.D. basics” catalogs the infections that can be transmitted by nine kinds of sexual activity. Bay Area residents can consult an exhaustive catalog of local resources. For the rest of us there is the clinic’s “Dr. K,” whose advice columns reveal, for example, that two condoms are not better protection than one.

Clinical Trials

Looking for experimental treatment? With more than 25,000 open trials testing a dizzying variety of new drugs, surgeries and vaccines, this site may have something for everyone. The upside is bargain-priced treatment; inpatient volunteers can be well compensated. The downside is that you may be pumped full of an untested drug with serious effects. (You may get a placebo.) By and large, the trials sponsored by universities and the National Institutes of Health are more likely to be monitored for safety than those offered by private companies.

Patients Like Me

If you learned you had a life-changing illness, broadcasting it on the Internet might be the last thing on your mind. But PatientsLikeMe encourages people to do just that. Founded by Ben and James Heywood after their brother Stephen received a diagnosis of Lou Gehrig’s disease, the site is a kind of Facebook for the chronically ill. It holds thousands of profiles of patients living with diseases as diverse as multiple sclerosis, Parkinson’s and H.I.V., with a special section for mood disorders like depression and anxiety. Patients can use slick visual tools to chart their symptoms over time, rate their drugs and treatments, and track their progress against fellow patients with a degree of transparency that borders on the voyeuristic. Users should be aware that the site shares data, stripped of names and other identifying material, with nonprofit groups, research hospitals and pharmaceutical companies.

Mayo Clinic

It may be tough to get an appointment at the Mayo Clinic, which for over a century has set the standard for medical care in America. But it’s much easier to consult its encyclopedic site, which may be the most concise source of medical information on the Web. Unlike many other health sites, Mayo writes its own material, with a tone that manages to be both conversational and precise, straightforward and sympathetic. (“Suicide is the act of taking your own life. ... You may think suicide is a solution when, in fact, it’s not.”) The no-nonsense symptom checker, while remarkably simple to use, should probably be kept away from hypochondriacs. (Wheezing and drooling? You may have epiglottitis. Dizzy and stumbling? Might be ataxia.) The site could be easier to navigate, but the guide to ailments is so terse and authoritative that you may find yourself reading it for pleasure.

You’re Sick. Now What? Knowledge Is Power.


Are patients swimming in a sea of health information? Or are they drowning in it?

The rise of the Internet, along with thousands of health-oriented Web sites, medical blogs and even doctor-based television and radio programs, means that today’s patients have more opportunities than ever to take charge of their medical care. Technological advances have vastly increased doctors’ diagnostic tools and treatments, and have exponentially expanded the amount of information on just about every known disease.

The daily bombardment of news reports and drug advertising offers little guidance on how to make sense of self-proclaimed medical breakthroughs and claims of worrisome risks. And doctors, the people best equipped to guide us through these murky waters, are finding themselves with less time to spend with their patients.

But patients have more than ever to gain by decoding the latest health news and researching their own medical care.

Illustration by Nola Lopez, with Anatomical Images by Bryan Christie

“I don’t think people have a choice — it’s mandatory,” said Dr. Marisa Weiss, a breast oncologist in Pennsylvania who founded the Web site “The time you have with your doctor is getting progressively shorter, yet there’s so much more to talk about. You have to prepare for this important meeting.”

Whether you are trying to make sense of the latest health news or you have a diagnosis of a serious illness, the basic rules of health research are the same. From interviews with doctors and patients, here are the most important steps to take in a search for medical answers.

Determine your information personality.

Information gives some people a sense of control. For others, it’s overwhelming. An acquaintance of this reporter, a New York father coping with his infant son’s heart problem, knew he would be paralyzed with indecision if his research led to too many choices. So he focused on finding the area’s best pediatric cardiologist and left the decisions to the experts.

Others, like Amy Haberland, 50, a breast cancer patient in Arlington, Mass., pore through medical journals, looking not just for answers but also for better questions to ask their doctors.

“Knowledge is power,” Ms. Haberland said. “I think knowing the reality of the risks of my cancer makes me more comfortable undergoing my treatment.”

Dr. Michael Fisch, interim chairman of general oncology for the University of Texas M. D. Anderson Cancer Center, says that before patients embark on a quest for information, they need to think about their goals and how they might react to information overload.

“Just like with medicine, you have to ask yourself what dose you can take,” he said. “For some people, more information makes them wackier, while others get more relaxed and feel more empowered.”

The goal is to find an M.D., not become one.

Often patients begin a medical search hoping to discover a breakthrough medical study or a cure buried on the Internet. But even the best medical searches don’t always give you the answers. Instead, they lead you to doctors who can provide you with even more information.

“It’s probably the most important thing in your cancer care that you believe someone has your best interests at heart,” said Dr. Anna Pavlick, director of the melanoma program at the New York University Cancer Institute. “In an area where there are no right answers, you’re going to get a different opinion with every doctor you see. You’ve got to find a doctor you feel most comfortable with, the one you most trust.”

Keep statistics in perspective.

Patients researching their health often come across frightening statistics. Statistics can give you a sense of overall risk, but they shouldn’t be the deciding factor in your care.

Jolanta Stettler, 39, of Denver, was told she had less than six months to live after getting a diagnosis of ocular melanoma, a rare cancer of the eye that had spread to her liver.

“I was told there is absolutely nothing they could help me with, no treatment,” said Ms. Stettler, a mother of three. “I was left on my own.”

Ms. Stettler and her husband, a truck driver, began searching the Internet. She found Dr. Charles Nutting, an interventional radiologist at Swedish Medical Center in Englewood, Colo., who was just beginning to study a treatment that involves injecting tiny beads that emit small amounts of radiation. That appeared to help for about 18 months.

When her disease progressed again, Ms. Stettler searched for clinical trials of treatments for advanced ocular melanoma, and found a National Institutes of Health study of “isolated hepatic perfusion,” which delivers concentrated chemotherapy to patients with liver metastases. After the first treatment, Ms. Stettler’s tumors had shrunk by half.

“I don’t like statistics,” she said. “If this study stops working for me, I’ll go find another study. Each type of treatment I have is stretching out my life. It gives me more time, and it gives more time to the people who are working really hard to come up with a treatment for this cancer.”

Don’t limit yourself to the Web.

There’s more to decoding your health than the Web. Along with your doctor, your family, other patients and support groups can be resources. So can the library. When she found out she had Type 2 diabetes in 2006, Barbara Johnson, 53, of Chanhassen, Minn., spent time on the Internet, but also took nutrition classes and read books to study up on the disease.

“I was blindsided — I didn’t know anybody who had it,” said Ms. Johnson, who told her story on the American Heart Association’s Web site, “But this is a disease you have to manage yourself.”

Tell your doctor about your research.

Often patients begin a health search because their own doctors don’t seem to have the right answers. All her life, Lynne Kaiser, 44, of Plano, Tex., suffered from leg pain and poor sleep; her gynecologist told her she had “extreme PMS.” But by searching the medical literature for “adult growing pains,” she learned about restless legs syndrome and a doctor who had studied it.

“I had gone to the doctors too many times and gotten no help and no results,” said Ms. Kaiser, who is now a volunteer patient advocate for the Web site The new doctor she found “really pushed me to educate myself further and pushed me to look for support.”

Although some doctors may discourage patients from doing their own research, many say they want to be included in the process.

Dr. Fisch of M. D. Anderson recalls a patient with advanced pancreatic cancer who decided against conventional chemotherapy, opting for clinical trials and alternative treatments. But instead of sending her away, Dr. Fisch said he kept her in the “loop of care.” He even had his colleagues use a mass spectroscopy machine to evaluate a blue scorpion venom treatment the patient had stumbled on. It turned out to be just blue water.

“We monitored no therapy like we would anything else, by watching her and staying open to her choices,” Dr. Fisch said. “She lived about a year from the time of diagnosis, and she had a high quality of life.”

Dr. Shalom Kalnicki, chairman of Radiation Oncology at the Montefiore-Einstein Cancer Center, says he tries to guide his patients, explaining the importance of peer-reviewed information to help them filter out less reliable advice. He also encourages them to call or e-mail him with questions as they “study their own case.”

“We need to help them sort through it, not discourage the use of information,” he said. “We have to acknowledge that patients do this research. It’s important that instead of fighting against it, that we join them and become their coaches in the process.”

Mars Weather Forecast: Snow


The latest findings from the Martian Arctic offer more hints of a wet past but paint a very arid present, scientists reported Monday.

And in a prelude to winter and the demise of NASA’s Phoenix Mars lander, snow has been spotted falling from the clouds above. As the Martian days shorten and temperatures drop, Phoenix’s solar panels will eventually not be able to produce enough energy to keep the spacecraft warm.

NASA, however, has given a second extension to the mission, originally intended to last just three months and now in its fifth month. The extension will allow scientists to gather data until Phoenix’s final day, anticipated to arrive in mid- to late-November or perhaps early December.

“We are trying to literally make hay as the sun shines,” said Barry Goldstein, Phoenix’s project manager during a news conference on Monday, “and really try to get the most of the science instruments in these last few days before the end of the mission.”

The Phoenix landed north of the Martian Arctic circle on May 25, during late spring for Mars’ northern hemisphere. Its mission was to explore whether that environment, currently dry, cold and presumably lifeless, might have been habitable in the past when Mars’ axis was tipped farther over and pointed toward the Sun half of the time.

The mission has produced a trove of data for scientists to sift and ponder, but no blockbuster discoveries.

Instruments analyzing samples of dirt dug up by the Phoenix have now identified signs of clays and calcium carbonate, materials that on Earth form only in the presence of liquid water.

That liquid water is not there currently. A layer of water ice exists a few inches below surface, and the layer of soil on top of the ice is “very, very dry,” said Michael Hecht of NASA’s Jet Propulsion Laboratory.

Earlier, scientists had announced the presence of perchlorates, a class of chemicals that are toxic in high concentrations, although the implications for the possibility of life are unclear. The perchlorates could also explain the dryness of the soil, soaking up any moisture. No organic molecules have yet been identified. “If there is any there, it’s not very much,” said William V. Boynton of the University of Arizona, lead scientist of the instrument known as the thermal and evolved gas analyzer.

The weather station, by shining a laser beam straight up and looking at the reflections, has spotted crystals of water ice - snow - from clouds 2.5 miles above the surface, although the snow has so far not reached the ground.

As the season moves to winter, the Phoenix will eventually be encased in a tomb of carbon dioxide ice. Mission managers said that after the spacecraft thaws out when spring returns, they will attempt to invoke its “Lazarus mode,” but they doubted the spacecraft would revive.

Mr. Goldstein said the extreme cold would make electronic components brittle and prone to shattering. “The vehicle will probably not survive that,” he said.

Short RNAs show a long history

MicroRNAs are found in animals that appeared a billion years ago

CAMBRIDGE, Mass. (Oct. 1, 2008) – MicroRNAs, the tiny molecules that fine-tune gene expression, were first discovered in 1993. But it turns out they've been around for a billion years.

Evidence reported in Nature on October 1 by scientists in the lab of Whitehead Member and Howard Hughes Medical Institute investigator David Bartel provides a window into the early evolution of these key regulators, placing their origin within the earliest of animal lineages. The research also suggests that microRNAs present early on have undergone extensive changes, which likely have altered their functions across various lineages.

"This is the first evidence that microRNAs were present within the earliest animal lineages and are not just characteristic of more complex animals," says Andrew Grimson, a postdoctoral fellow in Bartel's lab. Scientists knew that microRNAs existed within bilaterians, an evolutionary group that includes everything from worms to fruit flies to humans, he explains. "Remarkably, we discovered their presence within sponge, a member of the earliest diverging group of animals."

The scientists used high-throughput sequencing to probe samples from animals that diverged before the origin of bilaterian animals. The sponge (Amphimedon queenslandica) represents a group of animals that split off in evolution very early, whereas the starlet sea anemone (Nematostella vectensis) split off more recently.

The sequences of microRNAs within each lineage were different from each other, suggesting that microRNA functions are almost certainly very different in these different lineages. "In a relatively narrow spectrum of evolution microRNAs are often conserved," says Grimson. "But in a broader spectrum they have completely changed. This suggests that microRNA evolution is more flexible and may be evolving more rapidly than suspected."

Researchers also pinpointed piRNAs, another class of small RNAs, among these two species. Although less is known about piRNAs, they characteristically have longer sequences than microRNAs and are thought to dampen the activity of transposons—chunks of DNA that can move around the genome, causing mutations.

"It appears that both microRNAs and piRNAs have been available to shape gene expression throughout the evolution of animals and perhaps even helped to usher in the era of multicellular animal life," says Bartel.

David Bartel is a Member at Whitehead Institute for Biomedical Research, where his laboratory is located and all his research is conducted. He is also a Howard Hughes Medical Institute Investigator and a professor of biology at Massachusetts Institute of Technology.

Full citation: Nature on-line, Oct. 1, 2008 "The Early Origins and Evolution of microRNAs and piRNAs in Animals"

Urbanization in Africa at dawn of 20th century marked outbreak of HIV

UA-led research indicates the HIV/AIDS pandemic began around 1900 in sub-Saharan Africa, decades earlier than first thought

New research indicates that the most pervasive global strain of HIV began spreading among humans between 1884 and 1924, suggesting that growing urbanization in colonial Africa set the stage for the HIV/AIDS pandemic.

The estimated period of origin, considerably earlier than the previous estimate of 1930, coincides with the establishment and rise of urban centers in west-central Africa where the pandemic HIV strain, HIV-1 group M, emerged. The growth of cities and associated high-risk behaviors may have been the key change that allowed the virus to flourish.

The research, led by Michael Worobey, an assistant professor of ecology and evolutionary biology at The University of Arizona in Tucson, was co-sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the David and Lucile Packard Foundation. The findings are published in the current issue of the journal Nature.

Worobey and his collaborators screened a number of tissue samples and uncovered the world's second-oldest genetic sequence of HIV-1 group M, which dates from 1960. They then used it, along with dozens of other previously known HIV-1 genetic sequences, to construct a range of plausible family trees for this viral strain. The lengths of the tree branches represent the periods of time when the virus genetically diverged from its ancestors.

The timing and number of these genetic mutations enabled the scientists to calibrate the probable range of rates at which the trees have grown. That is, the probable rates of evolution of HIV-1 group M. Based on this range of rates, the scientists projected back in time to the period when the trees most likely took root: around the turn of the 20th century. This marks the probable time of origin of HIV-1 group M, according to Worobey and the others.

Using newly developed techniques, the scientists recovered the 48-year-old HIV gene fragments from a wax-embedded lymph-node tissue biopsy from a woman in Kinshasa in the Democratic Republic of the Congo. The oldest known HIV-1 group M genetic sequence comes from a 1959 blood sample from a man, also from Kinshasa. A comparison of the same genetic region in the 1959 virus and the 1960 virus provided additional evidence that the common ancestor of both viruses existed around 1900. The comparison revealed that the amount of genetic divergence between these two HIV sequences took more than 40 years to evolve.

Worobey, who teaches the evolution of infectious diseases and molecular phylogenetics at the UA, has spent several years studying how to recover the fragmented pieces of viral DNA and RNA from archival specimens, to track when the virus first jumped from chimpanzees to humans.

"Previous work on HIV sequencing had been done on frozen samples and there are only so many of those samples available," Woroby said. The 1959 and 1960 samples are presently the oldest links to the HIV epidemic.

"From that point on, the next oldest sequences that anyone has recovered are from the late 1970s and 1980s, the era when we knew about AIDS. Now for the first time we have been able to compare two relatively ancient HIV strains. That helped us to calibrate how quickly the virus evolved and make some really robust inferences about when it crossed into humans, how quickly the epidemic grew from that time and what factors allowed the virus to enter and become a successful human pathogen."

Research shows that HIV spread from chimps to humans in southeastern Cameroon. Worobey said the resulting HIV epidemic among humans correlates to the growth of urban centers near this area, principally the present-day city of Kinshasa in the Democratic Republic of the Congo, which began as a colonial center for Belgium. Other countries ringing this area include the Central African Republic, Congo, Gabon and Equatorial Guinea.

By 1960 a large number of people in this region were infected with HIV, reflected by the considerable amount of genetic diversity of the virus. From there events seeded the epidemic in different parts of the world. By 1981, people started realizing that something was happening and the rest is history.

Worobey said laying the technical groundwork for analyzing samples of HIV's ancient history was extraordinarily painstaking.

"The DNA and RNA in these samples is in a really sorry state. It's highly fragmented, so instead of a nice, pearl-strand of DNA or RNA, you have a jumbled mass that's all jammed together. It's been gratifying, but a ridiculous amount of work."

Worobey said his research in the near term will be on recovering more samples and assembling the fragmented DNA and RNA sequences to form a clearer picture of HIV's history. He said the Nature paper "does a lot to snap everything into sharp focus and allows us to understand the timing of these events and the growth of the epidemic."

"There's still a lot of interesting work we can do with these techniques. We have lots more samples to analyze and hopefully recover nucleic acids from and it's pretty exciting to be in that position," Worobey said.

"I think the picture that has emerged here, where changes the human population experienced may have opened the door to the spread of HIV, is a good reminder that we can make changes now that could help reverse the epidemic. If HIV has one weak spot, it is that it is a relatively poorly transmitted virus. From better testing and prevention, to wider use of antiretroviral drug therapy, there are a number of ways to reduce transmission and force this virus back into extinction. Our results suggest that there are reasons for such optimism."

Worobey's colleagues on the paper include Marlea Gemmel, Dirk E. Teuwen, Tamara Haselkorn, Kevin Kunstman, Michael Bunce, Jean-Jacques Muyembe, Jean-Marie M. Kabongo, Raphael M. Kalengayi, Eric Van Marck, M. Thomas P. Gilbert and Steven M. Wolinsky.

Lunar endurance mission to act as 'boot camp' for Mars

* 21:54 01 October 2008

* news service

* Paul Marks, Glasgow

NASA chief Mike Griffin has outlined the punishing lunar endurance mission that would have to be completed before NASA could ever consider sending humans to Mars.

Speaking on NASA's future mission priorities at this week's International Astronautical Congress in Glasgow, Scotland, Griffin said that Mars is not automatically the next destination simply because humans have already been to the Moon (see NASA urged to focus on sending people to Mars).

He believes that we have too little knowledge of the Moon to head straight for the Red Planet.

"The total human experience on the Moon is less than 27 human working days – on a world that is the size of Africa," he says. "So whether the Moon is a stepping stone to Mars or a place of interest in its own right depends on knowledge we don't have yet."

To improve that knowledge, and to test the logistics and human factors of potential Mars missions in the bargain, Griffin proposes an elaborate lunar mission experiment. It would mimic the travel and landing time of a Mars mission by using the International Space Station as a mock Mars spaceship – and the Moon as a surrogate Mars.

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