Bartek
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It is good to find a place like this, where one can write what he feels and receive such an excellent support before exam!
I have just decided to try to take this exam: USMLE step 1.
According to my schedule it should be possible abt. June 15th.*
*[May 8th., small correction - I was really VERY optimistic, with my schedule and with full-time job, 3 children, and 13 yrs. after graduation! It will take a bit more time, and my first schedule remake now points at October 10th.]
I am over 10 yrs. after graduation, with quite a big family, with nice work... but it is not the work I've always been dreaming of... I don't work as doctor. I work in pharma business & research. In my country (Poland) to come back to MD profession... in my case I have to take 1.5 yrs. 'voluntary' 'residency'. 'Voluntary' means that you have to work for free: 18 months! 'Residency' means that this work is no residency - it is necessary just to let you take Polish 'USMLE' (Lekarski Egzamin Panstwowy) and to apply for real residency (internal medicine takes 5 years in Poland) if you succeed.
It is such an absurd that I decided to try to take USMLE to get residency in USA and to become specialist after 3 yrs. of residency (instead of 5 in Poland).
Well, and they pay quite nice in comparison with my country (my wife, resident in Poland, gets 200 USD per month...  ).
So...
I start today with the subject changing rapidly over the past 10+ yrs: immunology (just 150 pages in KN and abt. 70 in Robbins). I know little about it.
I made deal with my wife: if I learn it in 4 days so that she's not able to ask me a question I can't answer - she says 'OK, we can spend money on THIS' 
Some days ago I decided to invest a few: I bought mp3 player (meg, thanks for your diary - you was listening to lectures all the time, so I decided to do the same), and I ordered books.
I've just received books. Much material to repeat. I decided to use just 5 sources:
1 - Kaplan Notes 2002 (2.5 kpages) (one can find many on e-bay)
2 - audio lectures; obviously Goljan audio (full mp3 player: 40 hrs, downloaded from the net...), BUT I decided to use also pathophysiology by dr Cizadlo:
http://faculty.css.edu/gcizadlo/Patho2004/index.h...
For me, these are high quality recorded = easier to understand (compared to Goljan) and motivating, and perhaps more 'official' than dr Goljan. I don't use any podcasts - I found nothing interesting here.
3 - Biochemistry (Lippincott Illustrated Review) - it's been my weakest point during medical studies, and I feel almost pain when I try to remind anything... 
4 - Robbins 'Pathology' 7th. edition (nice book - absolutely nice, and it's only 1500 pages, but I prefer to read this one than to read anything else including daily newspapers and things like that). It is not very cheap so I decided just to learn it by heart to get the best return on investment.
I like this book. I like online access to it and the way of explaining things. It goes very nice with Kaplan Notes and with Goljan audio.
And, during my medical studies I was engaged in pathology very much. This subject was my strongest point. So I think I can do Robbins with pleasure.
5 - all of my old textbooks, which are in my library - just as the reference books if I need it to understand KN: pathology, physiology, microbiology (Polish translation of Jawetz), histology, 7-volume 'Internal Medicine', 5-volume 'Bochenek' anatomy (just for outlines and neuroanatomy) and of course big 3-volume Sinelnikov 'Anatomy Atlas' in Russian  (my 2-yrs.old daughter likes especially vol. I, pages 50n. of this impressive book, it's a skull).
I don't know if I will be motivated enough to take the exam (it is more like hobby than necessity for me).
I don't know if it is possile to get a residency position for sb. 10+ yrs. after graduation, >40 yrs.old...
But anyway, according to the research results, chance for Alzheimer is at least 40% reduced if I learn as much as I plan to   
And knowing behavioral sciences, 40 yrs. is excellent age to try to make a change...
I'll inform you about any progress.
Bartek
Edited by Bartek on 05/09/06 - 08:27 AM
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| malinda
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You have made an excellene decision to join this forum.You will find great help here.Just keep up the spirits.All of us are struggling with our own stories for this usmle.Welcome to the family
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| Bartek
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Well, I am on my way towards Step 1.
The decision is made: I can invest some money. I will buy some books and I can think abt. spending up to 1 k bucks for my new hobby.
I read not only KN but also some more material... As my wife is psychiatry resident she decided to invite her friend, oncologist. She asked me just a few questions concerning immunology. We had a nice coversation
Tomorrow I start with anatomy, on March 2nd. I finish 1 reading and I go to physiology and then microbiology. When I finish these I will start patho/pharma/bs...
I ordered Robbins pathology and I will focus on it (according to advices for 'old graduates' written at usmle.strona.pl). This gonna be the only 'big' book I will learn.
Regards
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| Bartek
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Not good.
I tried to read some additional material... (biochemistry, microbiology, pathology) in addition to anatomy.
And i have to admit that I do not remember so many basic facts!
I had to take my 15 y.old son's textbook of biology (Villee) for quick-reading (only first 400 pages). So I have delay: 2 days.
But on the other hand, Goljan lectures seem so nice and obvious, and Robbins 'Pathology' (I have this impressive book, really excellent) is indeed interesting. I will finish first reading in 2 weeks (+1500 pages). I ordered Goljan 'rapid review'.
It seems that my weak points are biochemistry and microbiology, surely not pathology nor behavioral sciences (this I simply know, it is funny - all I read in Kaplan Notes seems to be well known, maybe 'cause I've been working in research for 10 yrs.?).
Anatomy and pharmacology, these just have to be memorized. OK, 30 minutes/ day for each of it.
God, why didn't I decide to repeat all this stuff 10 yrs. ago?
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| Bartek
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Not good, last week... Almost wasted time.
I was able to learn 1-2 hours daily plus 1 hour of Goljan audio (I did not have any accident by far. I digged out all my high school knowledge (biology, chemistry etc.) and almost finished anatomy (using BRS for gross anatomy, HY for neuroscience and Kaplan Notes for histology and early embryology plus one old histo/embryo atlas in my native language). On Sunday I start physiology.
I was so busy at work, and 2 of my children have flu. The elder has been listening to me with interest when I was talking about microbiology etc., but this is not good way to repeat material.
I have to follow my schedule tightly and to strengthen my motivation.
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Whatever you can do, or dream you can, begin it. Boldness has genius, power, magic in it. (Goethe)
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| Bartek
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I have just been working upon my motivation
After short reading of some prep journals here (just in the lunch time, I ordered 'chicken in 5 spices' in the nearby chinese bar and I ate it before my computer) - I have realized that in virtually every minute, day by day, someone on this planet is working really hard in order to pass Step 1. One should sacrifice 10% of time at minimum to progress.
It sounds like a kind of religion!
Or (this sounds better): fulfillment of the vocation. Changing dreams to reality.
OK, back to work.
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| malinda
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..hey I do that to my son all the time.I am sure when he is 3 years old,he will be talking microbiology instaed of"why is the sky blue"?you are doing good.bit by bit a day pal.
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| kk21
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Hi Bartek,
Its great that you joined the fourm... I myself just joined yesterday. I think it really puts down what we have achieved and what we haven't. Just keep going you are doing great... Just keep on working hard... and you're dreams are right around the corner...
I've gotta get to work too now!!
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| Bartek
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Thank You, Friends, for warm words. Except of you - I am quite alone.
Today I am almost sure that THIS will take me more time than I've expected. I have serious gaps in my knowledge. So maybe this will be 2008 match, not 2007. I will decide in May/June. I do not want to consider how old am I (what difference between 41 and 42?) - what matters is: Step 1 score. I have to be well prepared.
I've just took one week leave. I have abt. 10 hrs. per day for learning (my wife agreed and 2 major subjects to repeat: physiology and microbiology. I started today. My children are in schools before 8:15 a.m. and I go to the library (I don't even try to do it at home). I use Kaplan Notes - and Costanzo (physiology), NMS Physiology (we have translation with SERIOUS mistakes! e.g. in formulas like Nernst equation, really big things - NEVER use tranlations!) and BRS (microbioloogy and immunology).
- - -
My 14-years old son told me today afternoon that he got "A" for his English lesson at school: he had a speech about English in everyday life and he told about Goljan lectures and his father listening to them every morning (in the car, on our way to school - but of course I listen to it more often, and I make notes; lectures are easy, in the matter of fact, but the language makes them really valuable).
Well, I think that maybe I've exagerrated a bit))
And on the other hand - if I succeed and if my son will also be a doc one day, it's good to give him such rememberings.
OK. I go to Costanzo page 127: Respiratory pathology. Just 2 hrs. and I go to bed.
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| drbin
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dear Bartek it is really a nice push on my back reading ur journals. u r quite a nice father and a husband and an ambitious student all wrapped in one package. definitely when ur children grow up they will have very nice example of u infront to follow on. well i also recite everything i learn to my 2 yr old daughter whenever she comes to me in between her playing. when i see her eyes open wide in curiosity, what is this foreign thing my mother talking to me, i laugh and hug her and u know that moment eases all my tensions and anxieties. this is indeed a hard thing and a lot of us are really working hard on it investing all our energy, spirits and time sacrificing even precious moments of lives.
i wish all luck for u.
as for me im also planning the test in july and i started studying in feb only. i dont know whether i can make it in july or not. but im giving it a try.
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| Bartek
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I've just finished physiology.
I can consider it memorized. Incredible - it took me 12 days (and I expected one week...). I was using only BRS (Costanzo), Kaplan Notes and FA. Sometimes I had to look for proper understanding of some "whys" in NMS or in the net. All those books are now seriously damaged, I've always been doing it, using markers (thin and thick, at least 4 colours) and pencil. BRS is especially fragile, I went asleep with it taking bath after hard day at work and it was very difficult to dry it, paper became rough and I had to use iron to make it look like a book again.
So physiology is the first subject completed. I will yet review physiology questions for 2 days (weekend) to consolidate my knowledge. I still can't believe that I was able to go through it (anyway, with this subject I was never asking 'why do I have to know THIS?')
On Monday I shall start two next subjects: microbiology (immuno is already done) and biochemistry. And I will go on 2nd. reading of anatomy (BRS Chung for clinical corelations, HY for embryo and neuro - these 2 are difficult for me, knowledge that I did not use for over 10 yrs., now it is very difficult to memorize it). It is more easy for me to work in 2 different fields: tired of one, I switch to another. I hope it will work.
My learning schedule had to be seriously revised. I have to be more realistic. I have very limited time for study, and all I need for Step 1 is possibly high score. I didn't make final decision yet but most probably 2007 match would not be my goal. No need to hurry. I will work up new schedule just after cramming bioch.µb., as now I have no idea how much time will these two subjects consume...
After reviewing KN and thin BRS books I realized that I need more comprehensive resources and I decided to use Katzung for microb. and Lippincott Illustrated Review for biochemistry. I can't recommend this approach as most people remember these things better than I do. I went through it 10+ years ago and did not deal with it in my research, except of some really basic concepts.
- - -
Funny thing, for the last month I did not read any single newspaper, I did not watch TV (oops... I watched "Connecticut Tutorials" for Step 2 CS and one very old film "Runaway Train" - to remind myself what it means to be determined). And I don't miss it.
My wife says that finding answers to all those test questions must have sth. to do with endorphins and that I developed kind of addiction .
Have a nice weekend!
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| Bartek
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Bartek wrote:
Katzung for microb.
I meant: Levinson, of course.
I do not plan to use Katzung (which is for pharma).
Regards
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| Bartek
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Just finished 1st. reading biochemistry and microbiology.
Again I was too optimistic: I planned 2nd. reading of 'anatomy' but had no time for it. Anyway, 4 of 7 major subjects are 'done', I have to admit it.
I think it was good to start with things like anatomy and biochemistry which seemed most dull to me: if I started with pathology (which is simply interesting), I would be bored to death now.
So I have to either go on with pathology, BS and pharma - or repeat anat., microbs, biochemistry and physiology (= 2 nd.reading, all difficult 'memorizations' + q-banks). For next week I am completely busy doing other things in my work (but I take FA with me), then we have Easter: good time to take some tests and decide further schedule.
A am missing my initial enthusiasm and have to force myself to study. Every morning I start my day and say "I must be more enthusiastic, if I am not, it will be the same with my work in US, and my residency will finish after 1st year". It works, not very good, but it works.
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| tolito
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you have been doing great. so keep it up. teh only one who can encourage you is yourself. since you have decided to go for the exam, do not look back but instead look forward at the success you will have and the life you will lead after. ( a friend of mine on the forum gave me teh same advice) this shuld keep us going.
have you done qbank? especially sine you plan to go in june?
GOOD LUCK
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| Bartek
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Thanks, tolito
I'm just starting with q-banks.
This is also strong recommendation of friends who were passing USMLE over last 2 yrs. They simply say 'read books once but carefully like before seminars - and go to questions + questions + questions'. And I can see that it is the best way to make my knowledge 'operational' - to be able to use it.
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| Bartek
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I've done 5 of 7 subjects, 2 of them need second reading (biochemistry and pharmacology).
BS and pathology are still before me.
In a great hurry I found some time to take NBME. I am very disappointed. My result is very poor.
I have to be realistic: for me it is better to sacrifice more time for sound prep to step 1. I expect similar difficulties before step 2. I don't have enough time for learning, that's my weakest side now. I have to forget about 2007 match (this is not my recommendation for anyone, it is just the result of my realistic self-assessment supported by many additional pros). But if USMLE could have been waiting for so long, it can wait a bit longer. The longer the break after graduation and exam, the smaller the relative one year difference. No difference between 50 and 51 yrs. after graduation, ain't it? Of course there is more difference between 13 and 14 yrs. (my case ) but it is still not very big. Fighting for one year earlier match and neglecting possibly high score would be a big big mistake in my case. Poor result would be bigger handicap than one more year after graduation.
I decided to set 5 rules for myself:
1. go through questions for one hour each day (even if it has to be the only one)
2. understand all mechanisms and don't leave any 'why' question unanswered
3. aim at possibly high score for both steps
4. care for strong family and friends support and ban all kinds of defeatist croakers
5. strictly follow the schedule (last but not least!)
Well, according to my updated schedule, my step-1 prep has to be as long as pregnancy I need 4 months more than I expected: not June, but October.
So I am on my long distance run now with biochemistry second reading.
Edited by Bartek on 05/09/06 - 06:15 AM
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| Bartek
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I feel so fed up with learnig 
When I left my work yesterday I noticed that we have such a nice weather... I decided to go to the park just to smell flowers. And today on my way to the library I went to the cinema and spent 130 minutes of my precious time watching 'mission impossible 3'. It is crazy and I do not like it (I mean, idea of wasting time this way, not the film). Today I studied tolito's journal and it helped me a bit. I realized that I often find motivation here, reading opinions and views that we decide to share.
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| tolito
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well bartek, i am also going thro that phase of postponing my exam and match too. but i learnt something from a post someone mailed to me which i put in my diary. in our quest for both high scores ( which we need cos of the long years since grad) and our quest for knowledge ( which makes us study so hard and wide) we may miss the very essence of USMLE. i like the 5 things you wrote and i am going to copy them just to keep me in focus. try august or september for step 1 and aim high, 99. my friend tells me that a 99 score at only step 1 attempted will get us interviews so we should nto lose hope for 2007 match. then we make sure to have done all exams by december. of course, we will go for the exam only when objective tests like NBME says we are where we want to be. remember you need to pay for step 2cs before july 1 if you intend to match for 2007.
GL.
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| Bartek
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Thanks tolito
Today I finished comprehensive listening to Goljan. It took me more time than I expected, again. Poeple always say I am optimist. It was not easy to focus on the subject driving car. Now I start second time, making short outlines ('minutes') for every lecture.
I've been thinking about my new strategy. I shall try tests in June, at least twice. If I score over 75 - I take Step 1 in September and make an appointment for Step 2CS. If I don't score 75, I don't take care of Step 2 yet.
I found some interesting data concerning time of sleep:
They studied over a million adults of all ages to determine the relationship between sleep duration and mortality. Their results (which have recently been replicated by researchers at Harvard Medical School) showed that people who slept seven hours per night had the lowest death rates over a six-year period, while people who slept eight or more hours had a greater risk of dying over the same period. In fact, the greater the sleep duration beyond eight hours per night, the greater the death rate and people who only slept five hours per night lived longer than those who slept eight or more.
( source )
Five hours - no, thanks but I decided to slighly change my wake-up time by setting my alarm clock to six a.m. It is exactly 00:00 american EST and this will be my daily time for reading pathology. I started today. Just 60 minuts, 00:00-01:00 EST, for very quick reading of a very big book. No more time for this subject untill I finish biochemistry and then pharma 2nd. reading.
Let's have a look how it will work for 2 weeks...
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| Bartek
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Pathology is cool
Having one-week experience I must say that my 'morning pathology hour' is one of the best and most effective hours of day. My children are still asleep, telephone is switched off, no one disturbs me, and the textbook is easy to read (although huge). And the subject is really interesting.
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| Bartek
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I am going on with pathology. One morning hour is a very short time really, but I can't afford more right now.
Q-banks make another one hour of every day, according to the rules I accepted. Yesterday I started physiology 'pre test self-assessment and review': 500 questions. It will take few days, I hope (maybe I find some extra time for it during the weekend). Questions are really difficult for me, and my performance is poor (abt. 75% - after 2 readings of physiology! I considered BRS really memorized, but those 'pre test' questions are not based on memorization, but on the sound knowledge of mechanisms). Aiming at 99 score and not hurrying for 2007 match I simply have to be able to answer every single physio question.
And the rest of my daily 'free time' is for biochemistry 2nd. reading. First one was for understanding, this one is for memorizing things and making my knowledge 'operational'. Biochemistry was my weakness during studies (I was amazed with the rule 'cram - pass exam - forget', we called it 'CPF rule', 3 Zs' in Polish, it was very popular at my university...). So now I have to work hard. Kaplan Notes are nice, but my favorable book is Lippincott illustrated review. So some days I can read it for just 30 minutes, some days I have a couple of hours for it.
I June I plan to take test exams and… and I think that I will not score high. So many people around me who have relatively fresh knowledge are able to work really fast. I feel a bit handicapped with my very elementary knowledge and with my limited time. Anyway, I will rely on test exams scores planning real test exact date. And for sure I will pass Step 1, for this is exactly as dr Goljan likes to say 'the more you read, the higher the score', and I will not leave a single subject untouched.
And there are other activities which may help me a bit. I mean English. Once a week I meet native speaker to improve my communication skills. Plus, every morning I spend abt. 15 minutes in the car with my son and we continue speaking English (he prepares topics and we try to discuss). It is funny for him as we can communicate more and more fluently. I hope this will pay off one day. What is important for me (and perhaps the most difficult) is to find a proper balance among my engagement in learning, my work and my family. Family support is one of my rules. And making English with my son helps a bit.
So, in summary: after having started my prep, I am missing time every day and it is awful. But on the other hand, I feel that I am on the way towards the most interesting adventure that could ever happen to me, the one that can definitely change my life 
Edited by Bartek on 05/26/06 - 03:22 AM
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| tolito
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keep on trucking barteck. i can empathise with you especially since you are re-learning medicine in another language. i also have the handicap of too many years between when i first learnt all this stuff and now. so my studies are going pretty slowly. my worst subj remains bioch. i am enjoying path and like you, i have had to read big robbins, no brs shortcut there. could not even undestand the basics of cell receptors and cytokines so i had to use the big book. it is tedious but it will pay off. there is a guy who just started posting in this forum, askdoc, he is also an old img and i believe he will score a 99. so there si hope for us.
your written english is perfect!!!!
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| Researchsurvivor
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Keep on going
You'll make it and your family will be happy for you - better later than never!
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| EYDavis
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Dear Fellow Collegues,
How inspirational to read so many stories of determination and dedication. When we chose to become physicians, whenever that moment came to each of us, it was a turning point in our lives. To be a physician is to be true to a calling that is filled with much work and sacrifice. However, there is no other calling that encompasses so many aspects of a fullfilling life.
In times of trials and challenges I remember Osler's reminder: "The Master Word in Medicine is WORK."
I look foward to participating in this most useful website/forum in the coming months.
Yours sincerely,
E.Y. Davis, M.D.
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| rouadefoc
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Welcome to the right decision.Take step 1 and begin a new but deserved path.
I'm studyng for s1 basically from the same reason (i'm from roumania).
So good luck.
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