Safety Net

Texas Is Finally Doing Something About Its Maternal Mortality Rate

This week, the Texas legislature passed—and the Governor signed into law—a bill to address the state’s maternal mortality crisis. As it stands, Texas is the deadliest state to give birth in, and it’s the deadliest state for new mothers—especially for African American women, who are at the most risk. Among OECD member countries, Texas’ maternal mortality rate comes second only to Mexico.

It took the entirety of both the state’s regular legislative session and a month-long special session, but the bipartisan bill finally crossed the finish line. The new law will extend the state’s Maternal Mortality and Morbidity Task Force’s expiration date to 2023 and require it to report on disparities in pregnancy-related deaths (including socio-economic status) and best practices in lowering mortality rates in other states, as well as actually evaluate options to reduce maternal deaths.

The task force, which was created in 2013, has already identified a lack of early pregnancy care as a significant contributor to death. In some ways, that’s unsurprising: Nearly 25 percent of Texas women are uninsured, and the state leads the country in the total uninsured rate. Because of cost, over the past year 52 percent of Texas women reported skipping a doctor’s appointment or test, not getting specialist care, or being unable to fill a prescription. This is a far higher percentage than what was found in states with similar uninsured rates, such as Florida, as well as in states with similar populations, such as California.

Despite this bleak picture for women in need of care, the legislature failed to send any proposals to the governor that would have actually provided for greater coverage for the treatment and care of women struggling financially.

Nearly 25 percent of Texas women are uninsured.

One reason for the high uninsured rate is the state’s extremely restrictive Medicaid eligibility standards: In addition to failing to expand Medicaid under the Affordable Care Act, parents of two children in Texas must earn less than $386 a month to qualify for Medicaid coverage. (That’s only one-fifth of the federal poverty level, which is $2,050 for a family of four). Texas allows more women to gain care through Medicaid during the duration of their pregnancy, but drops them 60 days after delivery. The task force also found that the majority of deaths occur more than 42 days after birth—likely after many women at risk for death lost access to the program.

In discussing Texas’ maternal mortality rate, many advocates have noted that births paid for by Medicaid (which are unfortunately higher-risk than those paid for by private insurance) significantly increased after the state cut family planning programs by tens of millions in 2011. The cuts must also be factored into understanding why Texas’ mortality rate has stayed consistently high for years after the initial spike.

But, though the state has undoubtedly been slashing family planning funds and shuttering clinics at a reckless rate for several years now, the fact is that the dramatic increases in deaths began before these reckless policies were passed and implemented.

There are other early findings that do not have clear answers yet. Despite being among most likely to be uninsured, Latina women were found to have an even lower mortality rate than white women. In contrast, African American women are disproportionately likely to experience maternal death: While only accounting for approximately 11 percent of births, these women make up about 29 percent of deaths.

The task force’s new responsibility to evaluate approaches in other states will prove illuminating for some of these unanswered questions: North Carolina, for example, implemented a variety of programs to incentivize doctors examining women for conditions that could lead to high-risk pregnancies and provide wraparound supports for those expectant mothers facing health dangers. By doing so, the state made a huge stride forward that should—and must—catch the attention of Texas’ policymakers: It closed the racial gap in the rate of maternal deaths in white and black mothers.

After an onslaught of statistics, it’s important to remember that behind every death statistic is a woman who suffered. Expectant parents everywhere wake up worried about coping with the newborn months. Too many mothers-to-be in Texas, however, must also wake up worried about whether they will even live to see their child crawl or walk.

Given that mothers are the primary or co-breadwinners in more than 60 percent of Texas households, these deaths are not only personal tragedies but ones that can devastate the economic standing of a family. Already, 1 in 4 Texas children live in poverty. And since the average age of new mother is 26, health problems related to birth may hit as a young woman is still working to launch her career with little savings built up.

It would be unacceptable to allow this to continue. The legislature passed a law that will spur research that will illuminate a greater understanding of how to effectively improve maternal health and lower the rates of maternal death. It will be essential, however, for those who truly care to turn that analysis into meaningful change.

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Culture

A Confederate Monuments Expert Explains How We Memorialized White Supremacy

In the wake of the neo-Nazi attacks in Charlottesville, officials in several Southern states have renewed calls to remove Confederate monuments from public spaces.

This week, North Carolina Gov. Roy Cooper (D) called for the removal of all Confederate monuments in North Carolina. Mayor Jim Gray (D) of Lexington, Kentucky, announced the removal of two Confederate statues from a historic courthouse in the city. And officials in Florida and Maryland made similar announcements.

But the conversation around the monuments’ removal is missing crucial context around how they got there in the first place. Most Confederate monuments were constructed at the dawn of the Jim Crow era, decades after the Civil War, with a second uptick in the 1960s in response to the civil rights movement. Like the popularity of the Confederate battle flag, their construction neatly aligns with backlash against racial progress.

To learn more about the evolution of Civil War iconography, I spoke to Professor Kirk Savage. Savage has spent a career studying the history of monuments. He’s written about the construction of the National Mall, the 9/11 memorial, and he is perhaps best known for Standing Soldiers, Kneeling Slaves: Race, War, and Monument in Nineteenth-Century America, a book on the history of Civil War monuments.

Jeremy Slevin: I think a lot of people don’t know that most of these monuments were constructed after the Civil War, around the turn of the 20th century. Can you give us a sense of the timeline and why that happened?

Kirk Savage: The big boom in Confederate monument building was roughly between 1890 and 1920, and then there was a secondary boom in Confederate commemoration that was in reaction to the civil rights movement in the ’50s and ’60s. In both these cases, there were political reasons why those monuments were erected when they were. The first boom took place during the consolidation of Jim Crow and racial segregation in the South, the final defeat of the ideals of reconstruction and racial equality in the South. The second boom took place when that Jim Crow era came under threat from the civil rights movement.

Now, I should say that in the North, there was a less marked but similar lag in monument construction, simply because the veterans of that war were dying off. But what really distinguished the white Southern commemoration of the lost cause was the systematic campaign to build monuments, rewrite textbooks, and put Confederate flags and symbols in public schools. This was happening in the late 19th and early 20th centuries, a systematic propaganda campaign to advance the racial cause of the Confederacy.

JS: And the Robert E. Lee statue in Charlottesville was constructed at the tail end of that first wave, in the 1920s?

KS: Right, in the 1920s, if I remember correctly. That’s interesting in a way, that it took them so long. Richmond erected its huge monument to Robert E. Lee in 1890, and New Orleans a few years before that. The Richmond monument really kicked off the campaign to make the Confederacy respectable again.

JS: I was struck in your book that these weren’t necessarily initiated by the government. In a lot of cases, they were these volunteer, activist organizations that pushed for these monuments. Can you talk a little bit about that?

KS: Yes, yes, in fact it wasn’t until much later that state governments got involved. In the earlier days in the late 19th century it was these activist organizations that were in the South, largely driven by women’s groups. The United Daughters of the Confederacy was the outgrowth of that organization, which then conducted this systematic campaign that I just mentioned.

There were these pockets of resistance.

That’s the way public monuments worked in general in the 19th century. It was elite civic organizations that erected them, and only certain groups had real access to public space in that period of time. So of course African Americans, Native Americans, people of color had no access to that arena and no entry into those conversations.

JS: Was there public backlash? Of course this is the Jim Crow South we’re talking about, but was there public outcry to these monuments?

KS: There was some, which is interesting. To return to the example of Richmond and the monument to Lee in 1890, there was a black newspaper called The Richmond Planet that published a fiery series of articles in opposition to it, talking about the black community’s relationship to that monument, which of course is entirely different from the white community’s. There were these pockets of resistance. They were largely overlooked by the mainstream white media and politicians, but they were there. What it shows us is that that kind of resistance, that kind of attitude was always there. It just wasn’t reported for the most part.

JS: As you mentioned earlier, there was a second wave during the civil rights movement, which many of us associate with progress and the Civil Rights Act and the Voting Rights Act. But there wasn’t a systematic campaign to take down these monuments. In fact, we saw an uptick. Why do you think that was?

KS: Well, look who was in charge of the state and local governments in the South. They were still exclusively in white hands, and they were very worried about their loss of power and the potential that they might have to share power with African Americans. It was very much a backlash against that civil rights movement. You see places like Alabama for the first time in the 1960s displaying the Confederate flag on its capitol building. It was very much a defiant pushback against the forces that were trying to destroy segregation.

JS: It sounds like that mirrors the iconography of the Confederate flag as well. It became a symbol during the lost cause and was taken up by the segregationists in the 1960s. Have they followed a similar trajectory?

KS: Monuments and flags you mean?

JS: Yes.

In defining the past we define our present.

KS: Yeah, it’s interesting to me that after the Dylann Roof massacre in the Charleston church, the first symbols to be attacked were the flags. Of course, he was shown in those photographs holding the Confederate flags. So it’s interesting now that with the white supremacist rally in Charlottesville at the Robert E. Lee memorial, the attention has turned to monuments. But yes, in a sense, these always went in a parallel process. But the unraveling seems to go flag first, monument second.

JS: In the book you write, “Public monuments were meant to yield resolution and consensus … but the process of commemoration often leads to conflict, not closure, because in defining the past we define our present.” What do you see as the next step? Is there a closure? Do these monuments have to come down?

KS: That’s a really tricky question because I have, for a long time, been maintaining—hoping—that we can have a “truth commission” kind of dialogue around these monuments, so the monuments could inspire us and open the way to really confront the legacy of slavery and white supremacy in this nation. The question of what to do with any particular Confederate monument would raise those larger questions that we urgently need to explore and wrestle with as a society.

We can’t just take these monuments down and think that we have solved our problem.

Unfortunately though, I think what’s happened now with Dylann Roof and neo-Nazis in Charlottesville is that the time for dialogue is closing around these monuments. Local governments are put in a position where they have to take them down, because otherwise they’re going to be appropriated by neo-Nazis, or they’re going to be torn down by counter-protestors. It’s a little hard for me to know what the way forward is now because we need to have this dialogue. We can’t just take these monuments down and think that we have solved our problem, because we won’t have. But on the other hand, the monuments are honoring something that we absolutely need to repudiate. The easiest way to repudiate them is to take them down. And I understand why that was done in New Orleans, and I think the mayor there did an eloquent job of explaining why they had to come down. But now everything is lightning speed, and it’s hard to know where we’re going to be even a week from now.

JS: We shall see. I appreciate you joining me professor. Thanks so much, Kirk.

This interview was conducted for Off-Kilter and will air as part of a complete episode on August 18. It was lightly edited for clarity.

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Culture

No, There Isn’t a Self-Induced Abortion Crisis

For the past year, author and former Google data scientist Seth Stephens-Davidowitz has been making the media rounds. His research—and his book, Everybody Lies—uses big data to uncover behaviors and attitudes that Americans wouldn’t normally admit to. Some of the findings are fun (including tips for how to get a second date) and some feel depressingly self-evident (Americans are pretty racist), but none have caused the level of progressive panic as  Stephens-Davidowitz’s research on abortion. Using data tracked from Google searches, he concludes that abortion restrictions have led to “a hidden demand for self-induced abortion reminiscent of the era before Roe v. Wade.”

This inference is alarming and it has garnered significant press, including articles in Vox and The New York Times. However, there’s a basic misunderstanding at the core of the research that could harm women’s access to comprehensive reproductive health care—particularly affordable and safe abortions.

Stephens-Davidowitz’s research mistakenly conflates “self-induced abortion” with “illegal abortion,” though the two terms apply to two very different procedures. A self-induced abortion is simply an abortion that can be conducted within the comfort of one’s home. That includes medical abortions, also referred to as the “abortion pill,” which can be used to end early-term pregnancies. An illegal abortion, on the other hand, is often what we think of as a “coat hanger abortion”—it’s one of the risky procedures women undergo when other options (such as self-induced medication abortions) are not available.

Self-induced abortions are safe and fairly common.

Self-induced abortions are safe and fairly common: They accounted for 31 percent of all nonhospital abortions in 2014. “People choose to self-induce for a variety of reasons,” said Jill Adams, founding executive director of the Center on Reproductive Rights and Justice at Berkeley Law. “The flexibility of conducting the procedure at home on one’s own timeline is paramount, and self-induced abortion can be significantly cheaper than surgical abortion.”

But misinformation about self-induced abortion, namely that using the abortion pill is a dangerous practice, could ultimately make it harder to access. Anti-choice advocates and legislators have seized on this type of misinformation in the past, most notably through TRAP lawsTargeted Regulation of Abortion Providers, or TRAP laws, are specific legal requirements for abortion providers that are different (and more difficult to comply with) than the requirements for other medical practices. Examples include specifying specific hallway widths, staffing requirements, or admitting privileges. that require medically unnecessary updates to clinics that provide abortions as an indirect way to reduce abortions.

If that happens, it will hit women with few other options the hardest. Medical abortion is particularly crucial for people who would otherwise struggle to access reproductive health care, including people living in rural areas and women of color. Rural patients face clear physical barriers: 31 percent of women living in rural areas traveled more than 100 miles to access abortion services, and an additional 43 percent traveled between 50 and 100 miles. For women of color, who often suffer from a variety of barriers to abortion—such as financial instability, limited access to a broad range of providers, and distance from clinics—medication abortion can be the most cost-effective and low-risk abortion procedure.

These searches could simply be an increase in medically accurate information.

There’s a chance that the searches Stephens-Davidowitz reports could simply represent an increase in medically accurate information. Telemedicine has revolutionized abortion care for the aforementioned groups. In 2006, Planned Parenthood of the Heartland in Iowa launched a telemedicine service that provided medical abortion care at rural clinics. The initiative was wildly successful: Research showed that telemedicine availability increased access to abortion care for people living in remote parts of the state. Moreover, the study showed that telemedicine availability increased access for women seeking abortion services at earlier gestational stages, for which medical abortion could be a silver bullet against the cost, distance, and stigma of an in-clinic abortion. In short, Google results for “self-induced abortion” may have ticked up because more women are simply aware that it exists.

While it seems intuitive that restrictive abortion laws would increase the incidence of illegal abortions, the inference that Stephens-Davidowitz draws about self-induced abortions is not necessarily backed up by the Google search data. Clear, detailed terminology is critical in discussing abortion, especially when the consequences can result in devastating outcomes for people seeking health care. Mistaken inferences, even when they have good intentions, have harmful consequences when placed in the nefarious hands of anti-choice activists—and can result in even more limitations on women’s health care.

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Justice

Let Me Remind You Who Jeff Sessions Is

For the past several weeks, media coverage of Attorney General Jeff Sessions has taken a sympathetic turn. In article after article, the “beleaguered” Sessions is described as a victim of bullying, under Twitter assault by the president who appointed him. Meanwhile, Trump—angry that the law-and-order man he chose did not live up to his idea of loyalty—seems to be taking some joy in Sessions’s discomfort.

I have been reading about Sessions with a kind of perverse fascination—but I have not read anything that makes me feel sorry for him. The things he stands for—the things he has stood for over the course of his decades-long career—are abhorrent. The President’s mean tweets haven’t made Sessions’s brand of law enforcement any kinder to poor and black and brown people.

Sessions has bought into Trump’s false narrative about rising crime rates (which are actually near historic lows), and has proposed solutions founded on harsh punishment that’s meted out with impunity. He wants to reinstate lengthy, mandatory sentences for nonviolent offenses, and plans to undermine Department of Justice mandates designed to reign in abusive arrest patterns in communities of color. He believes racism in policing is a fact of life, but believes that being called a racist is the worst thing that can ever happen to a person.

His policy goals reflect a characteristically Southern paternalism towards black people, imbuing him with the air of a Great White Disciplinarian. He maintains an impersonal distance from the concerns of underserved black communities, such as Charleston’s Eastside, where I lived long enough to know that Sessions’s stances reflect the attitudes of many white Southerners.

The impoverished Eastside community was judged harshly. Passersby pointed at the trash on the street and the homes in disrepair as they drove through town, and shook their heads at the teenage drug dealers who idled on street corners looking bored or depressed.

I remember one young dealer—tall and lanky, without a wrinkle on his face—that I used to pass by almost every day. I assumed he was new to the trade when he appeared on my street in between my apartment and the local corner grocery, and I had no intention of speaking to him. Nope. I wasn’t giving encouragement.

Eventually, I noticed that he tended to frown and mutter at me when I passed by. I ignored him at first, but eventually his persistence made me curious. One day I stopped and listened. His hurried, garbled words astonished me.

“Teach me something,” he said.

If Jeff Sessions’ got his way, that young man would have been promptly arrested.

I didn’t know what to say. So, we talked. He did not need me to lecture him or tell him he was wasting his life. He knew that he was on a dead-end track, and that he was barely literate. He told me he had dropped out of high school. He had applied for jobs as a dishwasher, but never got called back. So he did the one thing he could do to make money.

At the end of our first conversation, I promised that I would “educate him” by telling him a new fact every day when I saw him on the corner.

This isn’t a cheesy Hollywood movie, so I’m not going to tell you that I changed his life by teaching him when the Constitution was ratified. No matter how many facts I shared, I could not give this young man what he really needed. I could not counteract the notoriously unequal South Carolina school system. I could not provide a decent summer job, a community energized by economic development, or a society committed to easing the plight of the people in poverty.

I knew I couldn’t do that when I started. And by the time he disappeared from the street corner a few months later, I was sure I hadn’t. He needed too much. The Eastside needed too much.

If Jeff Sessions’ got his way, that young man would have been promptly arrested and given the harshest possible sentence. For him, that’s the end of the problem. Put the criminal behind bars, and move on.

I would love to see that teenager teach Jeff Sessions a few facts. I would love to see him tell the Attorney General what it’s like to be young, black, and full of hope for a better life and opportunities, but facing bleak options.

Maybe Sessions would learn that the law enforcement policies he favors will only perpetuate a vicious cycle of wasted lives. Maybe Sessions would learn that educational programs, substance abuse counseling, and economic opportunity accomplish more than harsh sentences.

Maybe.

Or maybe Sessions will at least soon learn what it’s like to be unemployed—after the Donald fires Sessions during one of his tweetstorms.

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Media and Politics

Don’t Let the White House’s Dysfunction Distract You From the Things Trump Is Getting Done

While the media and much of the public have been consumed with the spectacle of dysfunction and failure in the Trump White House—The Mooch, the Russia investigation, and the demise of the Republican Party’s plans to repeal the Affordable Care Act—the administration has quietly succeeded in doing some real damage that has received little attention. In normal times, these actions likely would get more coverage, and that points to a problem of access to vital information as citizens and activists try to adjust to the daily tectonic shifts of Trump.

Here are a few big deal political maneuvers that haven’t received the reporting—or an outcry from a distracted public—that they need and deserve.

Reversing the Ban on Neurotoxic Pesticide

In March, the Trump administration’s Office of Pesticide Programs—which last year received 30 percent of its operating budget from the pesticide-manufacturing industry—canceled the Environmental Protection Agency’s proposed ban of chlorpyrifos, a common pesticide used on crops that was derived from nerve gas developed by the Nazis.

The Obama administration had called for the ban after “three long-term, independently funded studies showed the substance was toxic,” according to Reuters. Particularly vulnerable are farmworkers, and the brain development of children, infants, and fetuses.

“Chlorpyrifos has been shown beyond any shadow of a doubt to damage the brains of children, especially those of fetuses in the womb,” said Philip Landrigan, a pediatrician and dean for global health at the Icahn School of Medicine at Mount Sinai in New York. The American Academy of Pediatrics also urged EPA Administrator Scott Pruitt to reconsider his decision.

Yet Pruitt saw fit to hail the ban reversal as “returning to using sound science in decision-making.”

Dow Chemical—whose CEO leads a White House manufacturers working group—sells the chemical. More than 6 million pounds of it are used annually in the United States on crops like apples, oranges, broccoli, berries, and tree nuts. Two months after Pruitt’s decision, more than 50 farmworkers in cabbage fields were sickened when winds blew the chemical from nearby mandarin orchards.

You can get informed and fight for a chlorpyrifos ban here and here. You can tell grocers to stop buying foods that might have residue from the chemical here. Senator Tom Udall (D-NM) has introduced a bill to ban the pesticide.

Nixing Science-Based Teen Pregnancy Prevention Programs

Last month, the administration cut more than $213 million from teen pregnancy prevention programs and research, eliminating the final two years of funding for 5-year projects. More than 80 institutions across the country lost their funding, and none of the programs provided abortion counseling.

Health officials told the Center for Investigative Reporting (CIR) that denying funding midway through a grant is “highly unusual and wasteful because it means there can be no scientifically valid finding.”

Some of the programs cut include: work Johns Hopkins University has been doing with American Indian teens to reduce sexually transmitted infections and pregnancy; University of Southern California’s workshops for parents on “how to talk to middle school kids about delaying sexual activity”; the University of New Mexico Health Sciences Center program that helps “doctors talk to Native American and Latino teens about avoiding pregnancy”; and Planned Parenthood’s work in five states to bring “rural youths and parents together to share family values, strengthen family bonds, and talk about healthy relationships and sexual health.”

“We’re not out there doing what feels good,” Luanne Rohrbach, associate professor of preventive medicine at USC, told CIR. “We’re doing what we know is effective.”

Despite the fact that the teen birth rate has declined steadily over the past 20 years, the ongoing need for science-based approaches to pregnancy prevention is clear. CIR notes that the rate is still high compared to other industrialized nations, and the decline isn’t as steep in low-income communities. Perhaps that’s why the cuts were made outside the normal appropriations process as the administration pursues an ideologically-driven agenda that is out of step with real public health and education needs.

You can let your elected representatives know how you feel about this decision here.

DACA at Risk

In June, 10 states, led by Texas Attorney General Ken Paxton, informed the Trump administration that it must end the Deferred Action for Childhood Arrivals (DACA) program by September 5 or face a lawsuit that would be heard by an anti-immigrant judge who has halted similar initiatives in the past.

Past assurances by a notoriously fickle president to keep DACA intact are hardly sufficient. Even if the administration ignores the deadline, there is little reason to believe Attorney General Jeff Sessions would defend DACA in court. As Representative Luis Gutiérrez (D-IL) told The Washington Post, “Jeff Sessions is going to say, ‘Deport them.’ If you’re going to count on Jeff Sessions to save DACA, then DACA is ended.”

More than 780,000 young people, known as “Dreamers,” have been protected from deportation and made eligible to work since DACA’s inception in 2012. Seventy-eight percent of voters believe Dreamers should be allowed to remain in the United States permanently, including 73 percent of Trump voters.

Aside from the moral argument that people who grew up as Americans should be allowed to remain in the country, the Center for American Progress notes the economic case as well. Ending DACA would drain more than $460 billion from the national GDP over the next decade, and remove about 685,000 workers from the economy. Combined, the 10 states that are suing would lose $8 billion annually.

There is an opportunity take this issue out of the hands of extremists like the Texas attorney general and an unpredictable Trump administration. In July, the DREAM Act of 2017 was introduced with bipartisan support from Senators Dick Durbin (D-IL), Jeff Flake (R-AZ), Lindsey Graham (R-SC), and Chuck Schumer (D-NY).

You can let your elected representatives know you want them to support DACA here.

Chemical Accident Prevention and Protection Delayed

After a 2013 explosion at a fertilizer storage facility in West, Texas, killed 15 people, including 12 firefighters, and injured 260—the Obama administration directed the Environmental Protection Agency to strengthen the safety requirements for facilities using and storing potentially toxic or dangerous chemicals.

In January 2017, after four years of deliberations, the EPA finalized its Chemical Accident Safety Rule, which would apply to more than 12,000 chemical facilities across the nation. It included commonsense measures like making information more available to communities to support emergency preparedness, and safety audits.

However, in June, after complaints from the chemical industry that the new rule “may actually compromise the security of our facilities, emergency responders, and our communities,” the Trump administration delayed implementation until February 2019. Even as it did so, it released a fact sheet noting 58 deaths and $2 billion worth of property damage caused by 1,517 facility accidents over the past 10 years.

A coalition of 11 states led by New York Attorney General Eric Schneiderman has sued the EPA over the delay. You can tell EPA Administrator Pruitt to implement the new rule here.

Trump is losing many of his high-profile fights. But in dozens of less-noticed ways, his administration is advancing its extreme agenda that exacerbates political and economic inequality. As much of the media remains fixated on the Russia story and the Great Trump Dysfunction, journalists and advocates will need to work harder than ever to make sure the damaging daily actions of this administration aren’t ignored.

This article is a collaboration between TalkPoverty and The Nation.

Alison Cassady, Director of Domestic Energy and Environment Policy at the Center for American Progress, contributed research for this article.

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