WHAT IS APPLIED KINESIOLOGY?

PHILOSOPHY AND PRINCIPLES RELATED TO HEALING IN TODAY’S SOCIETY

 

 

WHAT IS APPLIED KINESIOLOGY?

Walter H. Schmitt, Jr., D.C.

 

Note: This is a brief explanation of AK and muscle testing which I have used for friends and patients over the years.
Kinesiology is the study of movement.

Applied Kinesiology (AK) is the use of muscle testing in the diagnosis and treatment of health problems.

The major breakthrough of AK muscle testing is that most people have an unusual type of muscle weaknesses in their bodies.  These muscle weaknesses are not due to a lack of exercise, but are due to a “short-circuiting” of the muscles and their nerve connections.  Muscle spasms and muscle tightness have been shown to be secondary in importance to, and in fact, caused by muscle weaknesses.

The “short-circuiting” which creates muscle weakness can be due to many health problems:  spinal misalignments (traditional chiropractic concepts), nutritional deficiencies, allergies, acupuncture problems, organ dysfunction, poor circulation, injury to the muscle itself, and on and on.  AK treatments are designed to correct these sources of muscle weakness using natural health care methods, thereby correcting the muscle imbalance, and restoring normal function.

 

AK was developed by Dr. George Goodheart of Detroit, Michigan.  Dr. Goodheart is the first chiropractor in history to be officially appointed to the Sports Medicine Modalities Committee of the United States Olympic Committee and served at the Lake Placid Winter Olympics in 1980.  Dr. Schmitt grew up living next door to Dr. Goodheart and practiced with him from 1975 to 1980, at which time he moved to Chapel Hill, North Carolina and started his own practice.  Drs. Schmitt and Goodheart teach a regular seminar series in Detroit.  Dr. Schmitt was one of two chiropractors to serve on a special U.S. Olympic Committee sponsored Chiropractic Research Protocol Committee in 1983.

“Applied Kinesiology Study Program” is the name of the seminar series which Dr. Schmitt teaches to doctors of all disciplines across the country and abroad.

 

 
The following articles are essays by Dr. Schmitt which have appeared in the ICAK-USA News Update, the newsletter of the United States chapter of the International College of Applied Kinesiology (ICAK).  The ICAK is a multidisciplinary professional organization which is dedicated to the research and education of applied kinesiology. The ICAK and its chapters, including ICAK-USA may be contacted by the following links.  ICAK-USA: www.icakusa.com and ICAK International site: www.icak.com.

 

 

DIAGNOSING THE PROCESS, NOT JUST THE NAME

Walter H. Schmitt, Jr., D.C.

 

One of Dr. Goodheart’s most valuable parables is about the “zebra in the bathtub”.  For those of you who may not have heard him tell it, the idea is something like this:  There is a zebra in your bathtub, and he is eating and eliminating you out of house and home and generally making your life miserable.  When someone comes over and tells you that his name is “Charley”, then you feel so much better, at least at first.  But the knowledge of his name does nothing to solve the fact that there is this offensive zebra in your bathtub who is eating and eliminating you out of your domicile.  What IS important is “How do I get the zebra out of my bathtub”, and secondly, “How did he get there in the first place so I can keep it from happening again!”

Giving the zebra a name is like giving a patient a diagnosis.  Many doctors pride themselves in being able to “diagnose” a disease by giving it a name.  This is fine as long as the “diagnosis” is not the only goal of the clinician.  There must be a therapeutic course implied by a diagnosis.  Diagnostics should be therapy oriented rather than an academic exercise.

Not too long ago, a young chiropractic college graduate who had not yet started practice proudly related to me how he had “diagnosed” a case of multiple sclerosis in his college clinic.  When I asked what had happened to the patient, the reply was “Of course, we referred the patient to a neurologist.”  This is a perfect case of naming the zebra while totally missing the boat on “understanding the process” of how the problem got there, not to mention what to do about it.

There are a very limited number of “processes” of physiology and pathology which are presently understood.  However, few clinicians, in any profession, seem to have a grasp on the concept of understanding the processes causing the patient’s complaints.  If we understand processes which are fundamental to health and disease, then when confronted with a sick patient, we can diagnosis the process and begin specific therapy to change its course.  Let’s discuss just a few of these processes.

 

1. CELLULAR CHEMISTRY:  At the level of cellular chemistry, there are basically only TWO things that can go wrong.  These are imbalances between oxidation and reduction processes.  The regulation of oxidation – reduction activity is homeostasis.  Breakdown of this regulation is disease.  This is true in every cell in our bodies.  Leo Galland, M.D. calls oxidation-reduction imbalances “dysoxia” implying that combinations of the two can be present simultaneously.  In other words, a patient’s cells can be over- or under-oxidized, or a patient’s cells can be over- or under-reduced, or different tissues can show different patterns at the same time.

Over-oxidized (under-reduced) patterns relate to free radical pathology and all the associated tissue and metabolic damage which can result.  This results in inflammation, pain, and tissue breakdown.

Under-oxidized (over-reduced) patterns relate to the inability of the cell to produce energy.  This results in cellular dysfunction and if the whole body has this tendency, the patient is tired, fatigued, or exhausted, depending on degree.  These are fundamental physiological processes which can be measured by a combination of AK techniques and standard diagnosis.  If these processes are altered, they can be corrected.

 

2. NEUROMUSCULAR PATTERNS:  Muscles not functioning normally can be in only two states: facilitated or inhibited.  Even in light of the fine 1980s work of Richard Utt and Sheldon Deal on the seven conditions of muscle balance, muscular dysfunction can be broken down into either facilitated or inhibited patterns.

We can get very technical and discuss the facilitation and inhibition of the intrafusal nuclear bag and nuclear chain, the extrafusal red, mixed and white muscle fibers, and so on.  But it always boils down to a pattern of facilitation and inhibition, and this we can measure by AK muscle testing patterns.  And when we identify the pattern of dysfunction, we can fix it and relieve the patient’s complaints.

 

3. SYMPATHETIC-PARASYMPATHETIC REGULATION: In visceral disturbances, there are only TWO possible neurological factors which relate to patients’ problems.  These are problems with the sympathetic and parasympathetic nervous systems.  One can have too much or not enough sympathetic activity.  Or one can have too much or not enough parasympathetic activity.  Neurologically, that is all that can possibly be wrong with viscera!

If we can understand the state of the autonomic nervous system in relation to a particular organ, we can make great impact on the patient’s condition by resetting autonomic function.  Normalizing sympathetic and parasympathetic activity can achieve either partial or total remission of the patient’s symptoms, regardless of whatever pathology or functional illness may be present.

I observed Dr. Goodheart totally eliminate the pain from my father’s cancer ridden abdomen by correcting his abdominal muscles and making a Logan basic correction, a technique which balances sympathetic-parasympathetic function when properly applied.  This in spite of massive malignant infiltration and ascites!  There are only so many things that can go wrong, and if we fix them, the patient responds to the maximum of his or her ability.

 

4. ENDOCRINE DYSFUNCTIONS: Although the endocrine system seems quite complicated, a dysfunctioning endocrine system presents one of only two problems: too much of a hormone or too little of a hormone.  If there is a hormone excess, it may also be for only two reasons: the gland may be producing too much hormone, or the body may not be breaking down (detoxifying) the hormone adequately.  Even though endocrine interactions may seem quite complicated on the surface, they can still be boiled down to these simple processes.

 

D. D. Palmer, the founder of chiropractic said in 1910 that “Too much or not enough nerve energy is disease.”  Perhaps it would be clearer if he said “Too much or not enough nerve energy is present in disease.”  But basically, that’s it.  Anything that goes wrong in the body will be sensed, evaluated, and reacted to by the nervous system.  Some call this realization “getting the big idea”.

But it is not our job to hide behind the philosophy of this statement.  It is our job to apply its practicality to our patients.  And it is through the neuromuscular component, via muscle testing, that we can amplify our abilities to understand the dysfunctional processes within the body, and hence begin a course toward normalization.

It is our job to identify where there is too much or not enough and correct the process, not just to take our educated minds through an academic review of signs and symptoms and assign the patient a “diagnosis”.  Is it too much or not enough oxidation?   Is it too much or not enough muscle activity?  Is it too much or not enough autonomic function?  Is it too much or not enough endocrine function?  These are the questions we must be asking in order to help our patients heal.

If another patient comes into my office and triumphantly announces that another doctor has finally diagnosed his or her problem calling it “fibrositis” or “fibromyalgia”, I will just scream….  No. Actually, I won’t.  But I WILL once again explain to the patient about the zebra in the bathtub and get on with identifying and correcting the faulty processes which are causing the problem.  After it is gone, they can call it anything they want!

 
“THERE IS NO SCIENTIFIC BASIS FOR…”

Walter H. Schmitt, Jr., D.C.

 

It happened again last week.  There, on the evening news was a postgraduate degreed person wearing a white lab coat and looking quite proper being asked her opinion about some new, non-establishment approach to health care.  Then she said it.  And she said it so typically, in an arrogant, self-righteous, almost disgusted tone, “There is no scientific evidence that the procedure has any value.”

What does it mean when someone with credentials says “There is no scientific evidence for this…” or “there is no scientific basis for that…?”  We have all heard it said dozens of times.  It is always stated as an argument AGAINST whatever new idea is being proffered.  And it is always expressed in a tone demeaning to the new idea.  But the terms “scientific evidence” or “scientific basis” have such an official ring to them that the average person is inclined to side with the “authority”.

Often, the authority adds to the declaration the fear that “not only is the new procedure of no value, it may be dangerous to a person’s health or well-being.”  This has always confused me.  How can a scientist proclaim that the same new, untested procedure which has no scientific basis for merit at the same time does have scientific basis for harm?  This fear tactic is not a device of scientists, but rather of questionably motivated people who are attempting to sway public opinion.

The term “scientific” is an adjective.  It means “of or dealing with science”.  And I’m sure what those illustrious professionals mean by “no scientific evidence or basis” is that they are unaware of a study on the subject which follows the scientific method and which has been reported in refereed, scientific journals.  This fact, however, does not prohibit a new finding from being scientific in nature or from being derived from sound scientific investigation.  A good scientific observation is just as scientific before it is published as it is afterward.

The scientific method is a good methodology.  And even though it is not applicable to all studies, we should all try to apply this method whenever possible in our research efforts.

But first and foremost, science is a state of mind; a state of an OPEN mind.  A true scientist will not make a rigid, “scientific” statement about an idea, be it his or someone elses.  There must always be room for new information and reevaluation of an idea.  This is not to disallow a scientist from expressing personal opinions; just that these opinions should be designated as personal and not confused with scientifically derived principles.

If there exists no actual evidence based on scientific methodology, the true scientist can not make a “scientific” statement as to the validity of an idea.  A true scientist will state with an impartial air that there is nothing that has been studied.  Taking a stand on a new idea (i.e., an untested hypothesis) before it has been tested, disqualifies a person from true scientific evaluation of the hypothesis.  Expectancy and operator prejudice arise from one making up one’s mind before a hypothesis is tested.  These are common errors of which we in AK are all aware.

And if testing the hypothesis ends in negative results, a true scientist will use a phrase like “The evidence at hand seems to suggest that…”  But still, the true scientist will not be able to make conclusive statements.

About ten or fifteen years ago, I spoke with two scientists from Ft.Lauderdale who had investigated some of John Ott’s theories regarding natural versus artificial light.  Using microscopic time lapse photography, their study showed a certain regular flow of cytoplasmic granules around the periphery of plant cells under natural light.  Under artificial lighting, there was a decided disruption of plant cytoplasmic flow.  I said, “This proves that

living things are better off under natural light than under  artificial light, doesn’t it?”

Their reply was, “Dr. Ott might say that in his application of this project to his concepts.  But there is nothing at present which suggests that a change in the flow of the cytoplasm is a bad thing.  As true scientists, all we can do is report our findings and let others make their own conclusions from them.”  I learned a lesson about science that day.

 

In the summer of 1987, I met for two hours with three Palmer College of Chiropractic faculty members in Davenport, Iowa.  One of the doctors, a Ph.D., began by telling me that he had only had one previous exposure to applied kinesiology and that it had been very negative.  He then continued, saying, “But that was my only exposure and I am very interested in what you have to say today.” The man is a true scientist.  In spite of his previous negative feelings, he maintained an open mind, still willing to listen to new information and accumulate a wider base for his opinion.

In my experience, there are many self-proclaimed scientists who are in reality “pseudoscientists” or “scientific cultists”.  These usually self-righteous folks hide behind the cloak of the term “science”.  They may even use the scientific method and publish in scientific journals.  They may have multiple degrees after their name, and may have even been the recipients of prestigious awards in their professions.  And due to their illustrious positions, this group is often asked their opinions about matters relative to science and new findings.  They are nearly always very outspoken and opinionated.  I think you know the type.  Too often they inhabit faculty positions in our chiropractic colleges and medical schools or find themselves in other positions of authority.

This type of scientific cultist lacks the one attribute that can qualify him or her as a true scientist: an open mind.  When scientific cultists begin to take their own positions and opinions too seriously, they lose this fundamental requirement for scientific evaluation and the humility that accompanies it.

Pseudoscientists are very proud of being part of the scientific community, even though they do not rightfully belong.  But if they can say the right words at the right times, they can pass themselves off, particularly to other pseudoscientists.  They can be easily spotted, however, by true scientists and by just about anyone else with a little common sense.  For example…

 

In July, 1987 I had the opportunity to attend the Olympic Sports Festival Medical Conference held at Duke University.  The program included presenters from all over the world including the U.S.A. and the Soviet Union.  The representative of the USOC Sports Medicine Committee made strong negative comments regarding the use of nutritional supplements and belittled any nutritionally associated benefits for athletes.  He stated, roughly, that “There has never been any scientific study that demonstrates that any of these nutritional supplements has any helpful effect on athletic performance.”  He continued to show slides of various nutritional supplements while he was speaking and when a slide appeared showing a bottle of bee pollen, he stated incredulously, “Can you believe it?  We even have athletes who take bee pollen thinking it will help!”  Everyone, or at least almost everyone, laughed.

Soon thereafter, the Russian doctor gave a short presentation followed by a question and answer period.  One question was “Is there anything that all Russian athletes take or do?”  As she answered through her interpreter, she listed seven or eight vitamin and mineral factors that all Russian athletes took, “And,” she said, “they all take bee pollen.”

‘Nuf said.

 

Clinical practice requires a delicate blend of training and experience.  No clear thinking practitioner would criticize another doctor for a therapeutic approach based on the doctor’s previous good experience.  And yet many approaches are called “unscientific”.  I have never understood this, particularly when applied kinesiology is so classified.

Scientific methodology requires developing a hypothesis, testing the hypothesis, and modifying the hypothesis based on the initial observations.  This process can be continuous.  In the laboratory, the process results in new theories.  In dealing with patients, the process should result in a diagnosis and an effective course of therapy.

In the patient care setting, the scientific methodology involves listening to the patient and asking questions, doing tests on the patient, and arriving at a working diagnosis.  This is developing the hypothesis.  Then a treatment is performed or prescribed based on all of the above.  This is testing the hypothesis.  The response to the procedure verifies or refutes the hypothesis (diagnosis).

Too often, this procedure is employed by the doctor listening to a patient’s complaints, maybe doing further diagnostic evaluation or maybe not, and arriving at a working diagnosis.  The working diagnosis is usually an attempt to classify the patient into standard named, category of disease (egs. pneumonia, rotator cuff syndrome, chronic fatigue and immune deficiency syndrome, etc.)  This is the development of the hypothesis.

Finally, the doctor performs or prescribes some previously determined treatment procedure based on the diagnostic category that most closely fits the patient.  Such a treatment by categorization procedure leaves little room for individual variations.  The treatment becomes the testing of the hypothesis.      I guess this fits the criteria of scientific methodology, but if the therapy is improper, the doctor must await the patient’s lack of response or negative response before modifying the hypothesis and attempting a new treatment.  This can be very tough on the poor patient!

What could be more scientific than monitoring each step of the diagnostic and therapeutic process along the course of the treatment.  This is exactly what we do in the practice of applied kinesiology.

In AK we are constantly making and testing hypotheses each time we perform a muscle test.  Armed with the results of one test, we redefine the hypothesis and test once again.  By the time we arrive at the treatment procedure, whether it be a manipulation, a nutritional supplement, or an exercise regime, we have already received the body’s biofeedback that the therapy is appropriate.

This approach of AK is the most efficient application of clinical science at the present time.  AK doctors practice and think like scientists.  But even more importantly, AK supplies a framework for simultaneously applying both the science and the art of clinical practice.  In the context of treating patients, AK sets the standard as the most scientific approach in the healing arts today.

 

So the next time I hear an authoritative person claim “no scientific basis” for this or for that, I will know that the person is a non-scientist of questionable motivation.  But when I hear “there is not enough information available at the present time to be able to formulate a reasonable scientific opinion on the subject…”,  my ears will perk up to hear what the scientist has to say.

 

 

 

LET’S ALL SPEAK “ENGLISH”

Walter H. Schmitt, Jr., D.C.

 

Can you imagine what a nightmare it would be if I.C.AK research papers from non-U.S.A. doctors were all published in their native languages?  No one would understand what anyone else was talking about.

And yet we suffer from exactly this same dilemma within the use of our own English language.  We all use different terminology from each other in describing what we do.  These various terminologies can only be understood by those initiated in a particular style of practice.  Followers of Dr. Goodheart use one set of terms, those of Wally Schmitt have another, devotees of Carl Ferrari still another, CK practitioners yet another group of terms, and craniosacral practitioners also have their own terminology.  And so on.  (I do not mean to pick on any one subgroup of I.C.AK or non-I.C.AK practitioners by their inclusion or exclusion in this list, which is why I have included my own name as one of the culprits.  I will elaborate on this below.)

There are two major problems with this predicament.  First, when we speak or write, the diverse terminologies may as well be foreign languages.  Few doctors are linguists who are fluent in all AK and para-AK related terms.  And second, physiologists, neurologists, anatomists, and other establishment professionals all use terminology which is standardized in global conferences which are held every so often for just such purposes.

Imagine the trouble foreign I.C.AK members, for whom English is a second or third language, have with our terminology, much less non-I.C.AK members and those in other professions.  If we are to reach the masses of patients who can be benefitted by our unique skills, then we must first reach the doctors who treat these patients.  We cannot do this without a common language.

 

GAMMA 1, GAMMA 2, BUCKLE MY SHOE . . .

This author is as guilty of promoting proprietary terminology as anyone, so I will use one of my own offenses as an example.  In 1985 and 1986, I first presented my findings regarding doctor started and patient started muscle testing, calling these “gamma 1” and “gamma 2” type testing, respectively.  These terms were based on the supposition that the two different types of gamma motorneurons were involved in the two different types of testing.  Who knows if this is, in fact, true?

In 1990, Dr. John Bandy and I realized that we were each doing a different type of test and calling it “gamma 2” testing.  In fact, we now had three types of testing.  What were we to call the third type of testing?  Certainly not “gamma 3” because there is no such thing as a gamma 3 motorneuron.  We had painted ourselves into a corner (or at least, I had) by trying to describe a procedure in anatomical terms when there is only speculative evidence that the gamma motorneurons are implicated.  It is far better to describe our procedures in descriptive terms such as “doctor started testing” (the old gamma 1), “patient started testing to maximum” (the old gamma 2), or “patient started submaximal testing” (the new, third method.)  Equally appropriate terms could be “eccentric testing”, “concentric testing to maximum contraction”, and “concentric testing submaximal” respectively.

From 1985 to 1990 we have used the terms “gamma 1 and 2” and it is time to change these.  For simplicity’s sake, and for continuity’s sake, we are trying to call the three types of testing “G-1″, G-2”, and “G-2 submaximal”.  Now in 1999, we are calling the three types of testing Type 1 (G-1), Type 2 (G-2), and Type 3 (G-2 submaximal).

In the future, I hope we all can avoid such pitfalls by labelling what we do in descriptive terms.  Therapy localization is such a term – it describes where we are going to direct our therapy.  We can always use abbreviations for record keeping, such as “TL”, but we need to define these abbreviations whenever we write so that people who are not familiar with our language can read our papers.

. . . CATEGORY 3, CATEGORY 4, CLOSE THE DOOR

Our failure to employ standard terminology will hamper our acceptance amongst other professionals within and outside the chiropractic profession.  Hence their patients will never get the benefits of our more optimal approach to care.  How many chiropractors know what a category 1, 2, or 3 pelvis is, much less those in other professions?

If you are reading an article which describes “solar pathway introduction technique – S.P.I.T.” you will have no idea what is being discussed. (Because I just made it up.)  But if you see “seasonal affective disorder” followed by its abbreviation “SAD”, you may have some idea.

There is a tendency for us to try to be cutesy with our terminology.  We shouldn’t.

There is a tendency for us to make anatomical assumptions.  We shouldn’t, unless we can prove them.

There is an elitist tendency for us to make up terms which only we can understand.  We shouldn’t unless we want to close the door on what we do to only our closest colleagues.

“LET’S ALL SPEAK ‘ENGLISH'”

The international by-laws of the I.C.AK state that all business of the organization shall be conducted in English.  The designation of one language for an international organization is essential for the communication and the growth and development of the group.

So is the development of a uniform terminology which is descriptive in nature and which can be understood by other health professionals who are non-I.C.AK members, much less by ourselves.

 
MUSCLE TESTING AND THE IMMUNE SYSTEM

Neuroimmunomodulation and AK

Walter H. Schmitt, Jr., D.C.

 

How many times has a patient told you, “That last treatment was the best you ever gave me.  Do that again.”  And when you try to duplicate the outcome, even try to duplicate the exact same treatment, the results are disappointing.

The nervous system is in a constant state of flux and the sensitivity of neurons to various neurotransmitters can change from one moment to the next, much less from one week to the next.  For example, at one moment norepinephrine (NE) will cause the depolarization of a nerve membrane and the nerve “fires”;  one minute later, the same amount of NE may have no effect due to a change in the sensitivity of the nerve membrane to NE.

Changes in the sensitivity of neurons to various neurotransmitters depend on the presence of other neurotransmitters and other chemicals called neuromodulators.  Neuromodulators are polypeptide molecules (i.e., long chains of amino acids as opposed to the neurotransmitters which are usually made from only one amino acid).  Only recently are the many neuromodulator factors beginning to be understood.

A rapid change in emotions, hormonal changes, infection or allergy, pain, and many other factors appear to affect neuromodulator activity and hence, the sensitivity of the nervous system to various other inputs, including chiropractic adjustments.  Changes in the immune system, in particular, have been shown to affect nervous system function.  These relationships are presently being researched under various names such as psychoneuroimmunology or neuroimmunomodulation.

The cells of the nervous system and the immune system arise from the same embryological layer.  The cell membranes of white blood cells and neurons both have receptors for the same groups of neurotransmitters, neuromodulators, and hormones.  That is, both the nervous system and the immune system are sensitive to the same influences.

It is almost as if the immune system (i.e. white blood cells) is an extension of the nervous system and vice versa.  And both are influenced (modified) by the same factors including the emotional state of the patient, the hormone balance at the moment, the presence or absence of pain, allergy, infection, and so on.

So the adjustment today may have a totally different effect on the patient than when the same adjustment is administered in an hour, tomorrow, or next week.

Using muscle testing as functional neurological evaluation has led us to begin to recognize certain patterns, especially those involving variations in immune system function.  We are now beginning to categorize the different patterns in order to more effectively correct them.

Based on the work of Dr. Michael Lebowitz and myself, we now think that we can identify muscle testing patterns when a patient is in the midst of allergic reactions initiated by IgE, IgG, or immune (antigen-antibody) complexes.  These represent type I, type II, and type III Gell – Coombs hypersensitivity reactions, respectively.  We are presently performing a single blind clinical study to attempt to test this hypothesis.  The preliminary results of this study appear to verify the relationship of muscle testing weaknesses and elevations of serum immunoglobulins and/or immune complexes.  If the results continue to be positive, it may mean that we can predict the different types of standard immunological response by muscle testing procedures. (Note: This study was recently published.  The reference is: Schmitt, W.H. Jr. & Leisman, G. Correlation of applied kinesiology muscle testing findings with serum immunoglobulin levels for food allergies. International Journal of Neuroscience, 1998, 96, 237-244.

Whatever the outcome of this study, we are becoming aware of one very important rule: “You cannot affect the nervous system without affecting the immune system . . . and you cannot affect the immune system without affecting the nervous system.”  And an extension of that principle also seems to be valid: “If it affects the nervous system, it will be demonstrable through muscle testing . . . and if it affects the immune system, it will also be demonstrable through muscle testing.”

No healing art at any time in history has had at its disposal the incredible clinical tools which muscle testing as functional neurological evaluation provides.  As basic science information becomes available, we in AK are most able to apply it clinically through these great tools.  As our knowledge expands, the words of Dr. Goodheart come to mind over and over again: “Your patients will make you the complete physician, if you let them.”

 

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