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How the President’s Budget Impacts Healthy Housing

The National Center for Healthy Housing is saddened to see the priorities being presented by the president’s FY19 Federal Budget Request. We know that Congress can do better.

We believe most Americans care about health and that our budget should reflect that, but some of the core federal agency programs that work to keep us all healthier will be underfunded or canceled under the president’s latest proposal. Below are just the programs that NCHH tracks and reports on to advocates and policy makers regularly; many more are also on the chopping block in the president’s budget.

Department of Housing and Urban Development (HUD)

  • Office of Lead Hazard Control and Healthy Homes: The president’s budget is $145 million; our request is $230 million. The $145 million is the same as the 2017 request and lower than the Senate’s FY18 number of $160 million. As our understanding of the impact of exposure and the cost-effectiveness of investing in eliminating lead hazards grows, certainly the funding that works to thwart lead exposure and hazards should be keeping pace.
    • Within this program, the president’s budget removes $5 million from the healthy homes account—from $30 million to $25 million—and redistributes those funds to the lead account. 
  • CDBG and HOME: The president’s budget zeroes out these programs, which provide vital services to low-income and underserved populations across the country. The Community Development Block Grant (CDBG) program alone feeds into myriad programs across the states that effect the health and well-being of Americans of all ages.
Learn more about HUD’s valuable programs and services with NCHH’s new Healthy Homes Agency Fact Sheet

Environmental Protection Agency (EPA)

  • Eliminates Indoor Air and Radon Programs. We request level funding for these programs. 
    • Indoor Air: Radon, previously funded at $2.91 million.
    • Reduce Risk from Indoor Air, previously funded at $13.733 million.
  • Eliminates Lead and Radon Categorical Grants. We request level funding for these programs. 
    • Radon Categorical Grant: previously funded at $8.051 million.
    • Lead Categorical Grant: previously funded at $14.049 million. 
  • Eliminates the Lead Risk Reduction Program, which was previously funded at $13.275 million; we request level funding for this program
    • Lead paint certifications will continue, through the Chemical Risk Review and Reduction Program, but this program is also getting a minor cut. 
    • The budget states that “Other forms of lead exposure are addressed through other targeted programs, such as the State Revolving Funds, to replace lead pipes.” 1 
  • Decreases the Children and Other Sensitive Populations program, under Information Exchange/Outreach, from $6.548 million to $2.081 million. We request level funding for this program.

Learn more about EPA’s valuable programs and services with NCHH’s new Healthy Homes Agency Fact Sheet.
 

Centers for Disease Control and Prevention (CDC) – Environmental Health 

Learn more about CDC’s valuable programs and services with NCHH’s new Healthy Homes Agency Fact Sheet. NCHH has also created a fact sheet for the Department of Health and Human Services (HHS), which is CDC’s parent agency.

Other Impacted Line Items

A Note on the Impact of the President’s Budget on State Funding

A note about how these changes would directly impact state budgets: NCHH tracks 11 grant/funding programs on our state healthy housing fact sheets. Between the eliminations and cuts at HHS, CDC, HUD, EPA, and DOE, this budget cuts or eliminates at least seven of them (eight if you count the expiring CDC lead money as a cut). 

The president and his administration have identified their priorities in this new budget. We'll do all we can to convince Congress of the necessity and cost-effective return on investment of these reduced or eliminated programs and implore Congress to restore programs to present funding levels or increase funding, as well as continue to work to educate the administration about what these programs do to have impact on the long-term health of the entire country. If you'd like to join us in that effort, please join our distribution list

1 One wonders how eliminating this program and the state grants supports Administrator Pruitt’s statement to other federal agencies that “All areas of lead exposure – from lead pipes to contaminated soil – need to be pursued and addressed in a comprehensive and consistent approach” (from the invitation to the principal’s meeting).



Citations:

CDC FY19 Budget Documents 
EPA FY19 Budget Documents 
All of our FY18 request numbers and justifications live here



Darcy Scott,
NCHH Senior Policy Adviser, has been engaged in federal advocacy efforts for over 15 years. She has worked with a number of large-scale organizations, such as the ACLU and Susan G. Komen for the Cure, to influence legislators through public engagement. Ms. Scott ran the government affairs department at M+R Strategic Services, leveraging the power of organizations and coalitions to influence the legislative process, and her consulting clients include Habitat for Humanity International and United Way Worldwide. Ms. Scott holds an undergraduate degree from Southern Methodist University and a graduate degree from Northwestern University. 

Sarah Goodwin joined NCHH as a Policy Analyst in June 2017. She previously served NCHH as a policy intern, helping to establish and run the Find It, Fix It, Fund It lead action drive and its work groups. She holds a Bachelor of Arts degree in Interdisciplinary Studies: Communications, Legal Institutions, Economics, and Government from American University.

Introducing NCHH's Healthy Housing Fact Sheets: EPA Region 1

Think about your home community. What makes it special? What specific challenges does it face? I’m sure, if given the chance, we could all go on at length about the individuality in the places we live and work. Those of us doing policy work at national organizations spend much of our time focused on the big picture, but the healthy housing needs of each state are unique and varied. We are far more effective as an advocacy community when we remember to take advantage of the perspective and challenges each state brings.

That’s why the National Center for Healthy Housing has created 53 state healthy housing profiles – including the District of Columbia and an overview of the whole U.S. – for use by policy makers and advocates across the country. Each fact sheet offers eight statistics about the healthy housing situation in each state, covering topics including asthma prevalence and financial burden, childhood lead poisoning numbers and age of housing, radon levels, carbon monoxide fatalities, and unintentional falls among older adults. The fact sheets also tell you which of 11 programs at CDCHUD, and EPA are currently funding your state efforts. Most information was found from federal or state governments, and each fact is hyperlinked back to the source material.

EPA Region 1

Throughout 2018, we’re posting highlights of our state fact sheets by EPA region, one region per month. In January, we’re starting off with EPA Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.

  • It’s well known among the healthy housing community that the Northeast typically has older housing stock than other parts of the country, and that is one of the first things that sticks out among these six states. Between 55% and 73% of housing in each state was built before lead paint was outlawed in 1978; 20-30% was built before 1940.
  • In 2015, the combined regional total of blood lead level tests over 5 µg/dL, the CDC action level, was 9,148. Forty percent (40%) of New Hampshire children are estimated to have had elevated blood lead levels at some point in their lives.
  • The region also shares high predicted and tested radon levels. In Connecticut, one in five homes has elevated radon; in Maine and New Hampshire, this number is nearly one in three. An estimated 628 cases of radon-related lung cancer occur in Massachusetts each year.
  • Rhode Island has the highest proportion of residents 85 and older in the U.S. at 15.8%, and nearly one in four Rhode Islanders are over 65. Risk of falling is a particular healthy housing issue for older adults. For example, hospital charges for unintentional falls among older adults totaled over $630 million in Massachusetts in 2010.
  • Another medical expense that has proved costly to the region is emergency asthma treatment. In 2014, Connecticut spent $135 million on acute care where asthma was the primary diagnosis; in 2012, Rhode Island spent $21 million on asthma hospitalizations.
  • The region also boasts some healthy housing milestones. Vermont was the first state to lower its definition of elevated blood lead levels to 5 µg/dL. This legislation was passed in 2008.
  • Maine was one of 14 states and localities that benefited from the additional funding for CDC’s Lead Poisoning Prevention program passed in December 2016.

Other NCHH Resources

NCHH’s state fact sheets will be updated annually with current information. For questions or comments, please email Laura Fudala at lfudala@nchh.org.


 


Sarah Goodwin joined NCHH as a Policy Analyst in June 2017. She previously served NCHH as a policy intern, helping to establish and run the Find It, Fix It, Fund It lead action drive and its workgroups. She holds a Bachelor of Arts degree in Interdisciplinary Studies: Communications, Legal Institutions, Economics, and Government from American University.

A Shower of Benefits: Drinking Water and Healthy Housing

The American Public Health Association today hosts a Twitter chat on “What's in Your Water: The State of Water and Our Health” (#SafeWater). The state of the nation’s infrastructure that delivers drinking water to our homes is nothing short of appalling, with Flint being only the tip of the iceberg. It’s outdated, and like much of our roads, bridges, electrical grid and housing stock, it’s seriously underfunded and ill-maintained, causing high healthcare costs and needless suffering. At best, this is penny-wise and pound-foolish; at worst, it’s criminally negligent. Just today, Pew Charitable Trusts, Robert Wood Johnson Foundation, NCHH, and others released a major new report showing that the benefits of lead poisoning prevention far outweigh the costs.

The nation still has no health-based standard for lead in drinking water, and protocols for sampling for lead in water are all over the place and hard to interpret. The only real standard that does exist is designed to determine how well corrosion control treatments are working, not whether health is being adequately protected. The same is true for other contaminants, like PFAS/PFOS/PFOAs (e.g., perfluorooctanoic acid [PFOA], perfluorooctane sulfonate [PFOS], and other perfluoroalkyl substances [PFASs], which are chemicals used for stain-resistance, Teflon coatings for frying pans, and other purposes. We hear of outbreaks of legionella and other diseases related to poor water treatment standards.

How did we come to this mess? After all, indoor plumbing was installed in housing to help conquer tuberculosis, typhoid, and cholera as part of the sanitation movement—and it worked! But today, the reality is that the failure to invest in infrastructure maintenance and improvements has provided local water authorities with limited options and complex, delicately balanced water chemistry trade-offs. Adding or subtracting one water treatment option often leads to unintended outcomes resulting in dire public health consequences. In a previous blog, "Infrastructure and Mortgages," we wrote that lead in water and housing in general must be part of the nation’s infrastructure rebuilding.

Are we really going to allow our nation to be forced to buy millions of plastic bottles to access drinkable water, instead of a high-quality water supply system? We should also point out that the quality of that bottled water and all those plastic bottles have their own problems and environmental costs.

What does this mean for parents? I recently had the opportunity to sample the water in the home of a friend with a newborn baby. They had previously gut-rehabbed their home and had asked the local water and sewer authority to sample their water for lead content. The results suggested a very low level—but  this was after flushing the system for 5-10 minutes, which means it didn’t determine the presence of a lead service line or lead in solder for copper pipes, and it didn’t reflect the water they actually drank. (Do you know anyone who runs the faucet for five minutes before filling a glass or pot with water?) As part of the rehab, their contractor had replaced the lead service line on their private property but failed to notify the water authority, who would’ve replaced the section on the public side at the same time as the private side was being replaced. The mom and dad thought the problem had been taken care of, but they asked me to check just to be sure. When I sampled the water, I did a first-flush and then, using a back-of-the-envelope calculation, took a second sample after a two-minute flush, which I suspected would be the water that had stayed in the public side of the lead service line overnight. Sure enough, when I got the results back, the second sample was much higher than what the earlier testing had showed. I contacted the local water authority, and they confirmed that they had not replaced their public section of the lead pipe, but they said they would do so after I sent them the results, which I did.

Parents shouldn’t have to put up with such a scattershot, hit-or-miss approach. We have to do better. And we have to put our people back to work with good paying jobs to fix things like this, instead of waiting for children to get sick or overexposed to contaminants. Here’s what needs to happen:

  1. Make drinking water quality a clear part of the healthy homes strategy. There are currently eight key principles for such a home: A healthy home means one that is free of excessive moisture and mold, free of injury hazards, properly ventilated, well-maintained, clean, free of pests, thermally controlled, and free of contaminants. “Free of contaminants” includes a drinking water supply without lead or other contaminants.
  2. Locate exactly where drinking water lead pipes are located using state-of-the-art technologies. (We created technologies to locate lead in paint, and we can do it for water too).
  3. Improve water treatments to minimize lead and other chemicals and contaminants entering the drinking water system.
  4. Implement a long-term plan to replace all lead drinking water pipes
  5. Implement a plan to eliminate other contaminants and biological agents.
  6. Create a health-based exposure standard for lead in water like we have for lead in dust and soil and enforce it. The current EPA maximum contaminant level goals in drinking water for lead is “zero,” which doesn’t help anyone to make real decisions on taking action.
  7. Fund an infrastructure improvement program that includes improving children’s health. (It makes no sense to treat children only after they get sick—that’s expensive and causes needless suffering.)
  8. Ensure that the infrastructure work creates good paying jobs for our people. An estimate suggests that at least 75,000 jobs can be created for lead mitigation alone doing this type of work. 
  9. Implement the recommendations provided in National Environmental Health Partnership Council’s Environmental Health Playbook: Investing in a Robust Environmental Health System.
  10. Implement the National Safe and Healthy Housing Coalition's “Find It, Fix It, Fund It” campaign, which would save billions of dollars and protect our children.

The science is clear, and we must act on what it tells us, not ignore it or create some so-called “alternative facts.” That action must include all of us—parents, citizens, government, private and public entities, foundation, workers, engineers, scientists, and advocates. 

There is simply no reason to tolerate lead or other contaminants in our drinking water. I’m going back to my friend’s house to see what happens when that pipe gets replaced. But it should never have happened in the first place. And if we eliminate the lead, we eliminate exposures. We’ve taken lead out of food canning, gasoline, new paint, many consumer products, and we have efforts to address lead in existing homes—all of which have succeeded in reducing blood lead levels by more than 90% over the past several decades. But with over half a million children with too much lead, we can and must do better.


Dr. David Jacobs, former Director of the Lead Poisoning Prevention Program at the U.S. Department of Housing and Urban Development, is the Chief Scientist for the National Center for Healthy Housing and an adjunct professor at the University of Illinois at Chicago School of Public Health

Threats or Promises: Which Way for the Trump Administration on Childhood Lead Poisoning Prevention?

Recent news articles suggest that Trump’s EPA hopes to drastically cut funding and staff for its lead poisoning prevention programs ("EPA Memo Outlines Plans to Defund Lead-Paint Program," in Remodeling, April 4; and "Trump’s EPA Moves to Dismantle Programs that Protect Kids from Lead Paint," in The Washington Post, April 5). This follows on the heels of a high-level meeting between the EPA’s new administrator, Scott Pruitt, and the National Association of Home Builders (NAHB). NAHB complained about so-called “excessive” regulations, specifically EPA’s Renovation, Repair, and Painting (RRP) Rule

But it was exactly inadequate regulations that led to the Flint crisis and others like it, such as the East Chicago disaster in Indiana, the vice-president’s home state.
 
The fact is that congressional action and regulations have worked: Blood lead levels in the nation’s children have been greatly reduced  as a result of the implementation of statutes and regulations (see "U.S. Policies vs. Children's Average Blood Lead Levels" below). When we as a nation mandated the removal of lead from food canning, gasoline, new residential paint, plumbing and other sources, all through regulations, it worked. If anything, the regulations should be strengthened, not weakened, because over half a million children still have blood lead levels above the CDC reference value.1 

Some industries have supported these regulations over the years,2 but a few others have actively opposed them.3 Most recently for example, the National Association of Home Builders (NAHB) wants the EPA’s RRP regulation restricted to only pre-1960 housing, even though lead paint was not banned (by regulation) until 1978. They want “training” of their contractors to be only online, when in fact construction contractors don’t really learn that way. They want a new cost-benefit analysis, even though many previous studies have already shown that the benefits far outweigh the costs.4, 5 NAHB already succeeded in previous years in eliminating a dust testing requirement that has existed for years in federally assisted housing rehab work with scientifically proven positive results.6 (Children’s blood lead levels in assisted housing are lower than in non-assisted low-income housing, and dust testing [dust is one of the main ways children are exposed] is the major reason why). NAHB should protect the interests of its members by ensuring that homes are safe, not cutting corners and weakening laws and regulations that, if anything, need to be strengthened. And it should work to ensure that its member contractors don’t inadvertently do sloppy work that can cost $100,000 per house to clean up.7

Furthermore, preventing childhood lead poisoning not only protects children, it will create at least 75,000 good-paying jobs.8

During his campaign, the president promised to fix things that don’t work right. What better example is there that lead poisoning needs to be fixed than the 24 million homes that still have lead paint hazards, or the 6-10 million homes that still have lead water pipes? The solution is not to weaken regulations or to cut budgets but to strengthen them, putting the resources in place to end this preventable disease. Lead problems are a sign of our crumbling infrastructure, something the president also vowed to fix. We think that an infrastructure bill should include lead poisoning prevention. 

At HUD, the new Secretary, Dr. Ben Carson, promised to “enhance” lead poisoning prevention and healthy housing, proposing to increase the budget for that program from $110 million to $130 million. But at the same time, the proposed HUD budget wipes out the multi-billion-dollar Community Development Block Grant (CDBG) program. Many local jurisdictions use CDBG to provide their local “match” funding, anywhere from 10% - 25%, for lead hazard control. So, even though the proposed increased funding for the lead program is welcome, it appears that with the CDBG proposed elimination, the net effect will reduce, not increase, the total HUD resources to protect our children from lead poisoning. Why give with one hand only to take away more with the other? 

The National Safe and Healthy Housing Coalition has produced a number of recommendations that will protect our children

We urge the new administration and the new Congress to act on those recommendations to improve (not weaken) regulations and to propose a budget that will get the job done.

Instead of paying over $50 billion a year for lead poisoning, let’s solve the problem, not eliminate EPA programs or reduce HUD funding. At its beginning, the Flint fiasco was supposedly an attempt to save money, and NAHB’s wishes sound just like that, don’t they? We cannot afford another Flint, and we cannot afford to continue to pay the high costs of needlessly poisoned children. In Flint and across the nation, we will now spend far more now than had we acted to solve the problem in the first place. And we do know how to solve it. We should act on what we know, put our people to work, protect our children, and stop wasting money by caving in to a few narrow short-sighted industries at the expense of the rest of us.





_______________

1 Wheeler, W., & Brown, M. J. (2013, April 5). Blood lead levels in children aged 1–5 years — United States, 1999–2010. Morbidity and Mortality Weekly Report (MMWR), 62(13), 245-248. Retrieved April 6, 2017, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6213a3.htm

2 National Safe and Healthy Housing Coalition. (2016). Declaration of the Lead and Environmental Hazards Association. Retrieved April 6, 2017, from  http://www.nchh.org//Portals/0/Contents/LEHA_Declaration_2016.pdf 

3 Jacobs, D. E. (2016 July-August). Lead poisoning: Focusing on the fix. Journal of Public Health Management and Practice, 22(4):326-330. doi: 10.1097/PHH.0000000000000430. Retrieved from http://journals.lww.com/jphmp/Citation/2016/07000/Lead_Poisoning___Focusing_on_the_Fix.2.aspx
   
4 Gould, E. (2009, July). Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives, 117(7), 1162-1167. Retrieved April 6, 2017, from https://ehp.niehs.nih.gov/wp-content/uploads/117/7/ehp.0800408.pdf

5 Nevin, R., Jacobs, D. E., Berg, M., & Cohen, J. (2008, March). Monetary benefits of preventing childhood lead poisoning with lead-safe window replacement, Environmental Research, 106(3), 410-419. Retrieved April 6, 2017, from http://www.ncbi.nlm.nih.gov/pubmed/17961540
 
6 Ahrens, K. A., Haley, B. A., Rossen, L. M., Lloyd, P. C., & Aoki, Y. (2016, November). Housing assistance and blood lead levels: Children in the United States, 2005-2012. American Journal of Public Health, 106(11), 2049-2056. Retrieved April 6, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/27631737
 
7 Jacobs, D. E., Mielke, H., & Pavur, N. (2003, February). The high cost of improper removal of lead-based paint from housing: A case report. Environmental Health Perspectives, 111(2), 185-186. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1241348/
 
8 National Center for Healthy Housing & National Safe and Healthy Housing Coalition (2017, February). Find It, Fix It, Fund It: A lead elimination action drive: Policy recommendations to Congress and the new administration. Retrieved April 6, 2017, from http://bit.ly/FFFAdmin

9 Jacobs, D., & Weinberg, A. (2017, February 22). Infrastructure and mortgages: What about the kids? National Center for Healthy Housing website. Retrieved April 6, 2017, from http://bit.ly/Infra_Kids



Dr. David Jacobs, former Director of the Lead Poisoning Prevention Program at the U.S. Department of Housing and Urban Development, is the Chief Scientist for the National Center for Healthy Housing and an adjunct professor at the University of Illinois at Chicago School of Public Health

Stand Up and Be Counted in the Fight Against Lead Poisoning



Lead poisoning—you know, it seems like we should’ve had this problem licked by now.

Every year, we (NCHH and our partners) get out and stomp the figurative pavement, reminding people—parents, teachers, doctors, members of Congress, the President—that lead is still a very real and dangerous problem. And every year, despite our best efforts, more kids are exposed to lead. This year, we heard of a city (Flint, Michigan) that was exposed to dangerous levels of lead in its water.

All of this despite the fact we’ve known lead was poisonous for over 100 years and despite the fact that lead-based paint was banned in the U.S. back in 1978. That's nearly 40 years ago. The banning of lead-based paint in homes was a major victory, but the war rages on: While no new lead-based paint is being manufactured for residential use here in the United States, lead is still being used in other types of paint. Meanwhile, the lead-based paint that exists in older homes continues to disintegrate into poisonous dust. Lead exposure also comes from aging pipes entering homes and schools, from soil, and in consumer products.

According to Dr. David Jacobs, NCHH's Chief Scientist, "Lead is […] one of the best studied toxic substances that we know of. It’s one of the metals that you don’t need in your body; it has no useful biological value whatsoever. It creates a range of effects [including] neurodevelopmental effects for children at an early age, but it also causes cancer, kidney disease, and many other adverse health effects."

Today, there are still over 500,000 children with elevated blood lead levels in the U.S. Untold numbers of adults—possibly in the millions—struggle daily with the lifelong consequences of their own childhood lead exposure: decreased IQ and cognitive function, developmental delays, and behavioral problems. It’s both unfortunate and unacceptable for any child to be harmed by lead exposure, yet it continues to happen every day, regardless of race, creed, color, or social strata, though children of color and those living in low-income housing have been affected most.

Advocacy groups, philanthropic organizations, and federal, state, and local governments have done much to educate the public about lead hazards—a herculean task. NCHH and its allies in this war on lead poisoning have also made great progress over the last 40-plus years. The studies we and our partners have done, the research we’ve provided, the articles we’ve written, and our advocacy efforts have resulted in a significant reduction in the number of Americans with elevated blood lead levels, as well as medical treatment for those affected. We’re proud of our work, and we’re proud of all the others who’ve joined us in the fight.

Now we need for you to join us as well, and we need you today. NCHH and the National Safe and Healthy Housing Coalition have just created a petition entitled “Tell Congress to End Lead Poisoning Now” that outlines a comprehensive strategy to end lead poisoning within five years.

Take a few minutes to check out the petition. Now we want you to sign it. Yes, YOU. And then we want everyone you know to sign it as well, which means that we need you to share it with people you know and ask them to share it too. Sign it, share it, and change the world—just a little.

Some of you have probably already signed the petition. You read the title and said, “I’m IN!” (Thank you!) Maybe you’re in because someone in your family has been exposed to lead. Maybe there’s lead in your house or apartment right now, and you don’t have the money you need to make your home safe once and for all. Or maybe you know someone down the street, one street over, or someone who goes to school with your kids, who’s been touched in some way by lead poisoning. Maybe you know someone who’s sitting in jail, and you think that maybe his or her life would be completely different right now if only they hadn’t been exposed to lead.

But maybe you haven’t gotten around to signing the petition just yet. We know that some of you are thinking, I don’t know anyone with this problem or This isn’t really a problem for me. But it really is. Whether or not we realize it, we’re all affected by lead poisoning:
  • Because families move into older homes every day.
  • Because children attend older schools every day.
  • Because some kid visits his or her grandparents’ home every day.
  • Because water flows through old pipes every single day.
  • And because lead poisoning can lead to learning disabilities, impulse control issues, and violent behavior, we pay tax money to fund educational services, law enforcement efforts and the judicial system to fix lead-related problems after they’ve happened. 
We want to tell Congress to invest more in the system upfront so that problems don’t happen. It’s a sound investment in our collective future: The return on investment for lead poisoning prevention is estimated at no less than $17 for every $1 spent.

As NCHH’s David Jacobs and Amanda Reddy commented in a recent editorial, lead poisoning is preventable, and we know how to prevent it; but our investment has to be more widespread and sustained.

Help us tell Congress that it is time to end childhood lead poisoning. Won’t you help us to reach our goal of 20,000 signatures? Stand up and be counted: Please sign the petition right away and share it with your friends, associates, and family.

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