An Evangelist to the World

It seemed to me that most who attended Wheaton College felt the weight of the Reverend Billy Graham; a certain sense of responsibility to first, study to the best of our ability and then strive to impact the world as the College’s motto proclaims: “For Christ and His Kingdom”. His passing marks the end of an era of revival which swept across the country, and indeed the world, in part because of his dichotomously personal yet universal message, “Come… for if you tarry ‘til you’re better you will never come at all” as the hymn proclaims.

I am not qualified to speak about his personal life as a father, husband, and friend, and as an alumnus of his alma mater my connection to him is one of loose association, yet what I can speak to is his personal impact on me. That to stand at his podium, which is housed at the Billy Graham Center at Wheaton College, was for me a sort of “second call”.

I have a personal relationship with Jesus, which was my first call. The second came after reading that Rev. Graham struggled with a fear of public speaking. This man who spoke before millions! This is the power of Christ in the Christian. That our weakness, as the Apostle Paul wrote, give us reason to boast not shrink back. My second call is to boast in my weakness that should I impact anyone or anything for the better it should be as a result of a power outside myself. Placing my hands on the wood of his podium one could imagine the very word of God which was so frequently preached from its place was calling out for a new generation of leaders set apart for Christ.

This should serve as a challenge to my generation, to use whatever gifts and as presented above, weaknesses, to impact our communities, cities, country and this world. As Billy Graham said, “When we come to the end of ourselves, we come to the beginning of God.” For the sake of this world run then, run to the end of yourselves so that we may begin doing what we are called to do.

This man of God, champion of the faith, “Pastor to Presidents” who impacted me so greatly through both his preaching and legacy— whose desire to see others come to know Christ as he knew, welcomed now into glory will forever be an Evangelist for the World.

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Deaf to the Applause

By the time Beethoven had composed Ode to Joy, his great choral masterpiece, he was most likely completely deaf. The story is told that he was conducting his 9th symphony to a sold out concert hall no doubt with the great passion of conducting he was known for, a violinst perofrming that night writes “Beethoven directed the piece himself; that is, he stood before the lectern and gesticulated furiously. At times he rose, at other times he shrank to the ground, he moved as if he wanted to play all the instruments himself and sing for the whole chorus.” The final stanza of the 9th begins ominously, the cellos and bass in octave harmony, interrupted only by the occasional staccato of the brass section and tympani. But the tension of the introduction dissolves as the woodwind section harolds in a new and lighter tone. This lighter tone gives way through the same instruments which formerly played with such tension in a lighthearted chorus. The addition of the choir brings the piece to a majestic and thunderous praise! An die Frued! But something happened that night that many in the orchestra suspected might. When the music came to an end Beethoven kept conducting. He couldn’t hear that the music was over. Caroline Unger, who sang contralto had to stop him to turn him around to see the crowd on their feet tossing their hats into the air instead of clapping because they realized he couldn’t hear their applause.

Five times they gave him a standing ovation that night.

I am struck by the many symbolic elements in this great story.

First, one of the greatest classical composers, now deaf, cannot hear the applause of his audience. The lesson I have personally taken from this is that though many who are good at something perform it for others to see, those who are truly great perform first for the sake of the craft itself and for God alone. People are witnesses only in so far as they can magnify the greatness of God through the perfection of his gifts to a fellow man. Now, I believe he heard the music, not audibly but produced by his brain. How brilliant must the notes have sounded, perfectly sung and performed by each instrument, to a man who had studied music theory his entire life. All in perfect pitch and harmony.

Second, I am struck by the lyrics, they are not ones that you would expect to have included by a man who’s greatest joy in his vocational gift was stripped from him slowly. While he did not write the poem himself he chose it to include in his final complete symphony, “You millions, I embrace you. This kiss is for all the world! Brothers, above the starry canopy There must dwell a loving Father. Do you fall in worship, you millions? World, do you know your creator? Seek him in the heavens Above the stars must he dwell.” Here again, in the words we see Beethoven choosing to point his baton heavenward.

Third, he must be turned by another to see the fruit of his work. This I believe holds the greatest significance for all who endeavor to make great change. Tirelessly working, striving to perfect the gifts we have been given, unable to see the effect of our work on the world only seen once turned by another to see and observe the hats flying in the air, there could be no greater gift.

The Recipe for an Extraordinarily Mediocre Life

There is, I have found a terrible, awful, pull of this world to be exceptionally mediocre. In fact, everywhere we turn are rest stops where sit hundred of thousands of people indebted to themselves. By this I mean ultimately that their primary concern and focus is their own comfort and pleasure. This is the true recipe for an ineffective life. It is an awful dramatic irony, that only the universe is audience to, that it (the universe) would first convince us our drive for self satisfaction (over and above the needs of others) is biological and therefore natural and pure and second that it has convinced us it exists as an external source and not, as it truly is, a twisting of what was meant as true and pure from our roots in Eden.

Now I am not, as many might argue I am, proposing a pantheistic view of the physical. The physical is not divinity. Nor am I arguing a gnostic view: rejection of the physical as bad and acceptance of the spiritual as good. However we have, in Western culture, accepted a view that separates things as religious and others as secular. Church is religious but science is secular. Music, many believe, can be religious or secular. This is simply not the case. There is no separation of our actions into two realms. Nor is there a separation of what has been created into two realms; for we know what He made is good. It is only in our use of what was made for good that it can become corrupted (A user error of the highest and most destructive kind). It may be argued that there are things that are intrinsically bad and bad apart from our actions and many good examples exist: cancer, natural disasters, viruses. For this also we are to blame. What was made for good, for example, the process of mitosis, has been corrupted through our actions in The Fall into cancer. Weather, which was meant to provide a habitat necessary for human life has been corrupted through original sin into a destructive power, turned against us. Viruses are nothing more than an efficient delivery system of genetic material into a cell, but now they deliver deadly toxin (however in some cases scientists are redeeming this by hijacking this process to benefit humankind). All this to argue that both what exist today as “intrinsically bad”, but where not, and what exists as good were both initially made and affirmed as good. And that what was made is of one source, not secular and religious but existing, neutral apart from our actions.

So what implications does this have? What we do and what we believe are intricately connected and feed into each other. For example, who would consider me sane if I believed a bridge was incredibly unstable and about to collapse, yet walk across with confidence it was sound? We do this consistently. We know the truth yet fail to walk in it. We end up appearing incredibly irrational to all but those who walk across the bridge alongside us. This leads to my main and much belabored point: if what exists was made for good and is of one source, and what we believe and do are connected, then the decision to put aside the misuse of what was made for good (in a way not originally intended for our own pleasure, in essence subjecting it to The Fall) and instead focusing on the work of redeeming what has fallen is not only our highest calling but the recipe for an extraordinary life.

Michigan: A good home for the Physician Assistant

Michigan Leading the Way for Physician Assistants

unnamedWhen they asked where I was from on my first day of graduate school classes in Philadelphia my right hand instinctively shot up in typical Michigander fashion, “I’m from a city in Michigan right about here,” pointing to the middle of my palm, “It’s called Battle Creek.” My professor’s excitement was visible, she explained that Michigan was a good place for PAs to work because a new law was passed allowing greater practice authority which went into effect this year. I had known this bill: Public Act 379. It was an excellent leap forward for PAs that would allow for greater access for patients, less regulation for doctors, and fewer hurdles for midlevel providers to clear as they attempt to care for patients. My Michigan pride swelled with my classes clear admiration for these new practice guidelines. It’s as if I took a mini mental break from Philly and traveled back home, to my city, where concrete jungles were replaced with pine trees and pigeons become black squirrels, mourning doves, and bluebirds. It’s possible that during this mental break Tim Allen’s voice began narrating a new Pure Michigan commercial authored, however poorly, by me in the moment: “It’s same-day appointments, it’s providers returning the phone call, it’s scripts at your pharmacy and sick children seen not a week from today but now. It’s pregnant mothers cared for and teens educated about their health. It’s your grandparent’s checkup and your annual exam. It’s Michigan making a bold step forward for Physician Assistants. It’s Pure Michigan.”

It’s a bit wordy, I know and I’ll work with the scriptwriters when they call (I’m waiting by the phone). And if you’ve never seen one of these commercials, see the video below, it’s well worth it.

This move toward collaborative instead of supervisory language is good news for Michigan. PA students want to come here to practice which means all those benefits listed above. In addition, the timing, whether purposeful or coincidental, is similarly symbolic. This October 6th PAs across the nation are celebrating the 50th anniversary of the inaugural class of PA students from Duke University in 1967.

From just 4 students to now more than 115,000 practitioners the field was bound to experience some changes and it’s to our benefit Michigan is staying ahead of the curve. Michigan is leading the country in legislation and general support of midlevel providers as PAs all over this great state work to support families, prevent disease, have healthier pregnant mothers, and safer deliveries.

So this October, when you next visit your provider if you find yourself under the weather or the flu season has gotten to you first– take a look at the white coat of your provider, it just may read PA-C. Wish them a Happy National PA Day and then maybe say a prayer for me as I bury my head in medical textbooks for the next two more years.


Dante and Milton

I imagine it being late in the afternoon or early evening as Dante the Pilgrim finds himself where he does not want to be, "I found myself in a dark wilderness, for I had wandered from the straight and true." The path ahead is blocked by a beast and he has nowhere to go but to descend into the Inferno with Virgil as his guide. But how has he gotten here and by what deception has the devil lured him away from "the straight and true"? Dante the Poet wastes no time in answering this query, "I was so full of sleep just at the point when I first left the way of truth behind." He finds himself here because he was full of sleep. Here we have the first of two ways that we as Christians are led astray. We were asleep. "Be sober-minded; be watchful. Your adversary the devil prowls around like a roaring lion, seeking someone to devour". In The Inferno the devil remains incased in ice in the deepest level of hell, he hasn't need to prowl, for Dante, he only needed to let him sleep. Sleep and be ignorant of the path he walked along. A good many have been not so much "lead" astray as they have been sleep-walking along, unaware that they walk down the road "where all the prodigals have walked" (Lauren Daigle). Dante has no choice but to descend into Hell and it is a good thing he does, nothing else could wake him up from his sleep. Many who sleep are allowed a trial to wake them up for as C.S. Lewis said "pain is God's megaphone to rouse a deaf [and sleeping] world" [addition mine].

Eve had suggested that her and her partner split up. They could accomplish much more separately, and wasn't it their mandate to tend the garden? Surely a more productive work is more pleasing to God than work done in community? So Milton in Paradise Lost describes her going off alone and she is confronted not by a devil encased in ice as Dante was but by a crafty serpent, "Look on mee, mee who have touch'd and tasted, yet both live, and life more perfect have attained then Fate Meante mee, by ventring higher then my Lot. Shall that be shut to Man, which to the Beast is open? or will God incense his ire for such a petty Trespass, and not praise rather your dauntless virtue, whom the pain of death denounc't, whatever thing Death be, deterred not from achieving what might leade to happier life, knowledge of Good and Evil…" Eve is not asleep, far from it, she is awake and reasoning. The devil comes to her with skilled argument. She is the Christian who must be convinced. Her morals are good but her conviction is weak. First he asks her to compare herself to him. "Look on mee…" he is not dead but is a beast with a wisdom to share, and wisdom because of the fruit. Second he asks her to think on what is fair, "Shall that be shut to Man, which to the Beast is open?". Why should she not have what another lesser being has, the serpent knows well that, "knowledge puffs up…". Next he asks her to question God's righteous judgement of sin, "or will God incense his ire for such a petty Trespass?" This is especially prevalent today among those who forget we serve a God of judgement as well as a God of love. Finally he minimizes risk, "the pain of death denounc't, whatever thing Death be…". What is death? You have no need to fear death, in fact, we don't even know what it really is. The serpent knows death and that it comes as a consequence of disobedience but this knowledge he will keep from Eve; it will be her undoing.

And so Dante the Poet and Milton have presented two ways in which the Christian can be led astray. One by sleep to which we cry "Wake up, O sleeper, rise up from the dead" and the other by deception and rationality to which Christ has taught us to respond, "Get behind me Satan." May we continue to stay alert, "for you do not know when the master of the house will come…". And may we reject the wisdom of this world for "God chose what is foolish in the world to shame the wise."

Illustrations by Gustave Doré and Anna Lee Merritt.

Søren and Kohelet

Haunting to the optimist are Søren Kierkegaard's words, "Marry, and you will regret it; don't marry, you will also regret it; marry or don't marry, you will regret it either way. Laugh at the world's foolishness, you will regret it; weep over it, you will regret that too; laugh at the world's foolishness or weep over it, you will regret both. Believe a woman, you will regret it; believe her not, you will also regret it… Hang yourself, you will regret it; do not hang your self, and you will regret that too; hang yourself or don't hang yourself, you'll regret it either way; whether you hang yourself or do not hang yourself, you will regret both. This, gentlemen, is the essence of all philosophy."

The passage sits like a millstone at the bottom of a lake, quiet, heavy, and unmovable. How can the author of the concept of a "Leap of Faith" have held such a pessimistic view of the world? I'm reminded of Kohelet, the Teacher and the man surpassing in wisdom "all who came before" writing, "It is an unhappy business that God has given to the children of man to be busy with. I have seen everything that is done under the sun, and behold, all is vanity and a striving after the wind" (Ecclesiastes 1:14). The Christian reader, who picks random spots by opening to a page and placing a finger on the text often shuffle away from this book thinking God must have incorrectly divinely selected this scripture for their day's inspiration.

"Vanity of vanities", "You will regret both", like a duet these two philosophers echo a sentiment that I argue is essential for an effective life on earth: The understanding that the "business" that we have been given to complete "under the sun" is a fleeting and temporary endeavor. Like C.S. Lewis stated, "If we find ourselves with a desire that nothing in this world can satisfy, the most probable explanation is that we were made for another world."
All who desire more, who strive after not the things of this world but the things "that are above" will find ourselves at some point expressing what Søren and Kohelet have. A profound dissatisfaction in the here and now and a yearning for what is to come. If the very earth "waits in eager expectation for the children of God to be revealed" how much more should the children of God be crying out for that day?

For while here on earth we see that "I must leave [all my toil in which I toil] to the man who will come after me, and who knows whether he will be wise or a fool" we know that "our light and momentary troubles are achieving for us an eternal glory that far outweighs them all".

So study, you will regret it, don't study you will regret that too. Speak and you will regret it, keep silent, and you will regret that too… but "Remember also your Creator in the days of your youth" and "Set your mind on things above, not on earthly things" and the words of Kierkegaard and Solomon don't seem so pessimistic after all; rather they sing a song of dissatisfaction with what we should be dissatisfied with and a yearning for that realization of what we were uniquely made to become.

Remove Your Appendix

I wonder if the first incision came as a shock for Dr. O’Neill Kane. A new scalpel blade makes incisions through even tough tissue as if it were melted candle wax.Dr. Kane is a famous alumnus of Thomas Jefferson University, not only because he tattooed his initials in morse code on every patient he operated on but because he decided he wanted to take out his own appendix. He successfully performed this operation on himself, only with the assistance of local anesthesia and later went on to repair his own inguinal hernia (although with this surgery he became to tired and the responsibility of tattooing his own name on his body was left to another surgeon, he was 70 at the time, he deserves some slack).

Was Dr. Kane simply a glutton for pain? While I can’t get inside his head enough to know his exact reasons, I know there are several important reasons he would put his body through this type of experience.

First, he understood that general anesthesia during his time was dangerous. Ether was difficult to dose and many patients, for medical reasons, couldn’t tolerate it at all. Kane believed he could perform the surgery with only the use of local anesthesia. Many who needed emergency appendectomies that could not have ether would be saved.

Second, he wasn’t comfortable performing this surgery on patients without first understanding what he was putting them through. In no way am I advocating for practitioners to have to endure each procedure they recommend to their patients but Kane’s actions underscore an important part of medicine– empathy. It is easy to have sympathy, even more difficult to have empathy. Empathy involves stepping into the experience, as best as possible, and meeting the patient there. Similarly to the Jewish practice of Sitting Shiva (as Jobs friends sat with him following his hardship). As practitioners we must “sit shiva” with our patients. Not falsely stating we know exactly what they are going through but assuring them we are committed to walking with them through it.

Finally, he wasn’t content doing what was expected. Practitioners always have the opportunity to do more than what is expected for their patients. This isn’t easy however. There are many constraints on the medical provider: time, money, resources, constraints placed by hospitals or institutions, constraints placed by boss’s. These can serve as excuses for not doing more than expected or they can serve as hurdles to victoriously clear.

As we follow Dr. Kane’s example, let us seek to figuratively “remove our appendix” by entering into the experiences of our patients and going well above what is expected for them and for their health. 


The Long Thoracic Nerve

The smell of formaldehyde sticks in your nose, it hides, I believe, right on the olfactory bulb waiting for those brief 10 minutes when you decide to have some dinner and then makes a sudden reappearance. Standing in the cold lab room, double gloved, aproned, and with goggles on I stand before my cadaver. Holding the scalpel as steadily as possible the first incision is made, on the back (i’m told it’s easier this way, to start on the back rather than the front… gives time to dissociate). A long sagital cut made from the superior occipital protuberance to the space between the iliac crests and several horizontal cuts across to reflect the skin and reveal the muscle.

This is Physician Assistant School, summer semester, Advanced Human Anatomy Cadaver Lab. Most programs begin this way. Dissection of a cadaver is, for me a sort of contract. Somone donated their body to help me learn and it is my responsibility to make sure their gift is utilized well. We decided to name our cadaver, as many do, because it helps lighten the tension. I’m realizing, however, that PA school seems to be about tension. They (past PA studnets) use the phrase “Drinking from a firehose”. I find this especially true in lectures. One powerpoint presentation may take an hour to present but hours upon hours and cup after cup of coffee to master.

Some of the material we memorize has a popular mnemonic or rhyme to go along with it; as one of the former PA students said “It might suprise you to find out others have studied medicine before you. Use their resources.” Some are inappropriate, some are violent, some are insensitive but those are the ones that stick so those are the ones we use. Some don’t make any sense. My first day of class I settled into my seat in the lecture hall of Sydney Kimmel Medical School and the professor approached the podium to introduce the sylabus, at one point stating casually “Roses are red, violets are blue, and the long thoracic nerve innervates the serratus anterior.” Everyone laughed and I sat unsure of what just happened. Now just barely three weeks into classes I can tell you all about the long thoracic nerve, where it comes from, where it goes, what happens if it is impinged, what the tissue looks like under the microscope, where the serratus anterior muscle comes from and goes to, what action it helps you perform, and much more. It went this way with each muscle we learned in the back, the shoulder, the forearm and hand. We’ve been invited to drink deep from the firehose and store away as much as possible. As they tell us when we begin, “Don’t study for the test, study for the time when that information is the only thing standing between your patient and the grave.”

So I’ll eat my dinner with the formaldehyde still in my nose because I know it will be worth it in the end and it may mean the difference between a lifesaving decision or a deadly mistake. 

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The Physical Exam

Recently I visited the urologist. I was getting a consult to follow up with a previous diagnosis given to me after a night in the Emergency Room. I have kidney stones. For the exam, if you could call it that, I remained fully clothed. My temperature wasn’t taken, my blood pressure not checked, I wasn’t touched by the doctor a single time, not even to shake hands.

This isn’t uncommon.

I didn’t need a physical exam, but I was in pain, I desperately wanted the Physician to check my back and the pain near my kidney. I wanted the doctor to ask about the strange symptoms I was experiencing for the first time; but she didn’t.

What is the importance of the physical exam?

Doctors of old are pictured standing over their patients, listening to the heart, lungs, and stomach, sometimes with their ear. It was a ritual of care, love, and empathy.

The Doctor exhibited 1891 by Sir Luke Fildes 1843-1927

The Doctor exhibited 1891 by Sir Luke Fildes 1843-1927

The painting above is titled The Doctor, and was painted by Sir Luke Fildes in 1891. In it a doctor is seen anxiously poised over a gravely sick child. His face conveys a powerful mixture of confusion, fear, and empathy. In the background we see the child’s father watching the doctor and the mother with her head on the table, her obvious despair well out of the child’s view. From the parents position within the painting we see a situation of great trust. It is the doctor, not the parents, who has the responsibility of taking care of the child.  What a profound position, a position that deserves respect.

When I volunteer at medical clinics, regardless of what the patient is there for (whether it be a cough, a rash, chest-pain, or depression) I will look into their eyes and ears, listen to their heart, and ask them to say “ahh”. Why? Because it makes them feel better, and I’ve heard enough testimonies to convince me.

Today, the patient has been replaced by a computer screen, printed test results, and x-ray images.

There is no question that our diagnostic abilities have improved. But what have we lost with the abridged physical exam? Dr. Verghese argues we are missing diagnoses, and this very well may be true. What we can say with certainty, however, is that we have lost the position of care pictured above. There is no substitute for a physician’s touch and the impact it has on the emotional and physical well-being of the patient.

Next time I go for a checkup, I’ll make sure to ask my doctor to listen to my heart and i’ll explain the weird pain i’ve had in my side, or that unpleasant symptom that has stuck around a week too long. I won’t be shocked when they seem antsy to leave and be with their next patient, but perhaps my persistence will trigger something in my doctor. Hearing about my pain might make me a little less of a test result or x-ray image and instead I will become a flesh and blood patient and the doctor will assume the position of empathetic patient advocate once again.

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Did SPECT Kill God?

It wasn’t until I took Behavioral Neuroscience with Dr. William Struthers that I began to ask the question of how our brains are involved in experiencing God. We know that we live in a physical world and experience things through physical processes involving receptors in the skin, nerve pathways in the spinal cord, and neurotransmitters in the brain. How then does God, reveal himself to us? One of the first texts Dr. Struthers called us to was Lying Awake by Mark Salzman. In this work of fiction, Salzman tells a story of a devout Catholic nun living in this century who experiences dramatic visions of Christ. Her visions, however, are accompanied by a terrible side effect; she gets excruciating headaches and has frequent seizures. It is later revealed that the woman has Temporal Lobe Epilepsy which explains her headaches, seizures, and unfortunately her visions. She then struggles to decide whether or not she should have surgery to fix the TLE.

Photo Credit: Mark Salzman

Photo Credit: Mark Salzman

The visions in Mark Salzman’s book are not unlike the experiences of Margery Kempe in the late middle ages. Kempe began experiencing vivid visions of Christ, Mary his mother, and various saints after the birth of her first child. It has been speculated that she too suffered from either Temporal Lobe Epilepsy or an extreme case of Postpartum Depression. What would it mean for Kempe to have learned that her experiences with Christ were nothing more than unbalanced chemicals in her brain? Would it have shaken her faith?

Photo Credit: Penguin Classics

Photo Credit: Penguin Classics

A new field has emerged within the neuroscience community called Neurotheology. For the typical neuroscientist (if one even exists) this field is a joke; nothing more than a failed interdisciplinary combination. For a theologian, this new research area threatens to explain away miracles, visions, and other religious experiences. Some of the proposed research concepts are: what does an Electroencephalograph (EEG) or a Single-photon emission computed tomography (SPECT) of the brain look like while praying versus speaking in tongues? What areas of the brain light up during Functional Magnetic Resonance Imaging (fMRI) while someone is reading from the Bible verses reading a magazine?


Photo Credit: Dr. Andrew Newberg

A few of these studies have already been completed. Their results, while informative, are not surprising. Our brains do respond differently when we have or participate in religious experiences. Should this shake our faith to the core? For me it doesn’t. I believe in a God who is Lord over both the physical and spiritual world. I understand that I live in a particular moment of linear time in a physical world. It doesn’t surprise me that God would use our brains to speak to us. Our brains are, after all, the way we perceive and experience anything. An individual without a brain is incapable of sensation (or at least that is what is believed; a person without a brain is incapable of describing to a researcher subjective experiences).

Perhaps the ultimate fear isn’t whether God can use physical experience but whether he does. What if these religious experiences just happen without cause? What if God isn’t real at all? What if he’s just serotonin, dopamine, and a well-timed action potential propagated down the right axon?

This is where we reach the limit of science. No EEG or fMRI can disprove God’s existence. Science is incapable of quantitative measurement of anything outside the physical world (my apologies to the makers of the Dowsing Rod and Wigi Board). The discoveries made by scientists investigating religions impact on the brain find clues. For some, understanding how something works leads to the erroneous conclusion that there is no cause or purpose. For me I see clues that point to a God who is willing to reach down into this physical world and impact the lives of God’s followers in a way at one time immeasurable by scientific means. I marvel at the complexity of our synaptic circuitry and am directed to a greater, deeper sense of fear and awe at this God we have the ultimate privilege to serve.

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