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In the Wellness of All Things

By Amitabh Kant & Dr. Indu Bhushan

The sight of a family teetering on the brink of hope and despondency, surviving and falling into economic ruin on account of ill health is distressingly common. GoI’s health expenditure at 1.13% of its GDP is the lowest among the emerging developing countries. China’s expenditure is 2.45%, and Thailand’s 2.90% of its GDP.

Out-of-pocket expenses push nearly 66 lakh Indian households into poverty every year. About 24.9% of households in rural areas and 18.2% in urban areas meet medical expenditures through borrowings, and 17.3% of India’s population spend more than 10% of their household budget for accessing health services. The poorest of the poor are the worst impacted.

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Ayushman Bharat demonstrates GoI’s strong resolve to address this issue by ensuring primary healthcare through the establishment of 1,50,000 health and wellness centres, the first of which was launched in Bijapur, Chhattisgarh, in May. Digitally linked to district hospitals, these will provide comprehensive healthcare and will be responsible for providing essential drugs and diagnostic services. They will also have convergence with yoga and Ayurveda.

The second key component of Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojana (PMJAY) that will provide. Rs 5 lakh cover to around 50 crore economically weaker citizens and will be launched on September 25. This will be the world’s largest government-sponsored healthcare scheme covering a populationthe size of the US, Canada and Mexico.

 

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The mission will provide inpatient care in an empanelled network of healthcare providers (secondary and tertiary care) for more than 1,300 packages in specialties, ranging from general medical and surgical procedures to cardiovascular and oncological ones. The benefits shall be available to all those entitled and be cashless, paperless, portable, and backed by an IT infrastructure that will provide seamless service delivery at all points of care.

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PMJAY will leverage capacities available in both public and private sector hospitals, while providing standardised high-quality care, with strong fraud protection mechanisms and an efficient, service-driven architecture that will transform India’s healthcare systems in the years to come.

The National Health Agency (NHA) and the State Health Agencies (SHAs) are the keystone for the strategic purchasing of medical services at such a massive scale. NHA will be the instrumentality to expand coverage, benefits and financial protection.

As a substantive purchaser implementing PMJAY, NHA and SHAs will use the tools of pricing and incentives to drive down costs of services in the healthcare sector. The rates that have been fixed for the procedures have undergone a rigorous vetting mechanism in more than 50 cities in the country.

PMJAY will rely heavily on fraud detection and monitoring and building complex, intelligent systems that trigger and raise red flags on suspicious transactions, built upon extensive diagnostic guidelines and self-learning pattern-recognition algorithms.

The aim is to build a world-class intelligent system for fraud mitigation, grievance redressal, monitoring and evaluation, and research that allows the programme to scientifically evolve. Pre-authorisation protocols have been defined for 621fraud-prone and high-cost procedures for ensuring discipline in the provider network.

The states are the key partners in this alliance. The scheme architecture allows the states freedom for innovations and context-specific customisations. Till date, 29 of the 36 states and Union territories are on board. The states have been given flexibility to push for providing greater inpatient department (IPD) care through public institutions, as well as a framework for upgrading their infrastructure. The portability of services across a pan-India network provides beneficiaries in the migrant community to access services without hindrances.

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PMJAY will be a truly disruptive influence over India’s healthcare system. It presents India an opportunity to move towards a mature, data-driven, intelligent and predictive health systems built on top of individualised, secure and access-controlled health records, a verified provider registry and tech-enabled drugs and diagnostics supply chains.

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India, through health and wellness centres, is finally shifting the focus of healthcare provision towards providing primary healthcare to its citizens. The care on prevention and early management of healthcare will reduce the need for complicated specialist care and outof-pocket expenses.

While catering to 50 crore beneficiaries, PMJAY will leverage facilities in both private and public hospitals. This comprehensive healthcare system linking primary, secondary and tertiary care has the potential to transform the health delivery system in India.

Union Minister J P Nadda launches the official logo of Pradhan Mantri Jan Arogya Yojana, in New Delhi on August 27, 2018.

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*Amitabh Kant is CEO, NITI Aayog, and Dr. Indu Bhushan is CEO, Ayushman Bharat-National Health Protection Mission (AB-NHPM) and the National Health Agency (NHA).

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Demonetisation and its impact on Tax collection and Formalisation of the Economy – Arun Jaitley

 

The Reserve Bank has twice released its reports stating that the demonetised Notes of `500 and `1000 have been substantially deposited in the Banks.  A widely stated comment has been that just because most of the currency came back into the Banks, the object of Demonetisation has not succeeded.  Was the invalidation of the Non-deposited currency the only object of demonetisation?  Certainly Not.  The larger purpose of demonetisation was to move INDIA from a Tax Non-compliant society to a compliant society.  This necessarily involved the formalisation of the Economy and a blow to the black money.  How has this been achieved?

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  • WHEN cash is deposited in the Banks, the anonymity about the owner of the cash disappears.  The deposited cash is now identified with its owner giving rise to an inquiry, whether the amount deposited is in consonance with the depositor’s income.  Accordingly, post demonetisation about 1.8 million depositors have been identified for this enquiry.  Many of them are being fastened with Tax and Penalties.  Mere deposit of cash in a bank does not lead to a presumption that it is Tax paid Money.

  • In March 2014, the number of Income Tax returns filed was 3.8 crores.  In 2017-18, this figure has grown to 6.86 crores.  In the last two years, when the impact of demonetisation and other steps is analysed, the Income Tax returns have increased by 19% and 25%.  This is a phenomenal increase.

  • The number of New Returns filed post demonetisation increased in the past two years by 85.51 Lakhs and 1.07 crores.

  • For 2018-19, advance Tax in the first quarter has increased for personal Income Tax Assesses by 44.1% and in the Corporate Tax category by 17.4%.

  • The Income Tax collections have increased from the 2013-14 figure of `6.38 Lakh crores to the 2017-18 figure of `10.02 Lakh crores.

  • The growth of Income Tax collections in the Pre-demonetisation two years was 6.6% and 9%.  Post-demonetisation, the collections increased by 15% and 18% in the next two years.  The same trend is visible in the third year.

  • The GST was implemented from 1st July, 2017 i.e. Post demonetisation.  In the very first year, the number of registered assesses has increased by 72.5%.  The original 66.17 Lakh assesses has increased to 114.17 Lakhs.

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This is the positive impact of the Demonetisation.  More formalisation  of the Economy, More Money in the System, Higher Tax Revenue, Higher Expenditure, Higher Growth after the first two quarters.

 

Ayushman Bharat off to a good start

As many as 28 state governments have signed MoUs with the NHA to implement NHPM. Over 8,000 hospitals have offered to join the network of empanelled facilities that would provide inpatient care to the identified beneficiaries, and 1,350 medical packages—covering surgery, medical and daycare treatments—have already been identified.

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Nearly 3,000 years ago, one of ancient India’s great sages Yajnavalkya composed the Shanti Sukta: “Sarve bhavantu sukhinah; Sarve santu niramayah” (May all be happy, may everyone be free of diseases). What is striking is not only the prescience and universality of this invocation, but also the insight that happiness and health in a populace are inextricably intertwined.

Today, as we reflect upon the journey of India as an independent nation over the last seven decades, the achievements on the health front have not been insubstantial. The life expectancy has more than doubled, and infant and maternal mortality rates are a fraction of what prevailed in 1947. However, there can be no denying the fact that a lot of potential in this sector remains unharnessed—and ill-health is one of the leading causes of Indians falling into poverty. The government spends barely 1% of the GDP on health even as we are confronted with a two-front war—containing the rising burden of non-communicable diseases (NCD), even as we continue grappling with the control of communicable diseases and reproductive and child health issues. As a result, the citizens’ out-of-pocket (OOP) expenditure on health constitutes 62% of the total expenditure on health, placing India at 182nd position out of 191 countries on this indicator.

In fact, over 55% of this expenditure is on outpatient care, of which drugs constitute the biggest component. Expectedly, this structure of health financing places a disproportionate burden on the poor families and catastrophic health expenses have contributed to an increase in poverty levels in rural and urban areas by 3.6% and 2.9%, respectively.

Mindful of this reality and to plug the existing gaps in our health system, the government announced a new flagship scheme called the Ayushman Bharat in the Union Budget of 2018-19. One component of the scheme—the National Health Protection Mission (NHPM)—was to provide a financial cover of up to `5 lakh per family per annum to enable them increased access to secondary and tertiary healthcare, for the poor and lower middle class families, in a facility of their choice, irrespective of whether the ownership is public or private. As an initial measure, the plan is to cover 10.74 crore families, or about 50 crore individuals (roughly 40% of the total population), at the bottom of the pyramid as identified through a comprehensive Socio-Economic Caste Census (SECC) database.

The other component is to build a next-generation primary healthcare system, which would be publicly provided at locations close to the community. It sought to expand the reach and broaden the scope of our primary, preventive and promotive care through a network of 1.5 lakh Health & Wellness Centres (HWCs). It envisages population-level screening to detect diseases early and initiate timely treatment—which is especially critical in the context of India’s rising NCD burden. As an added measure, provision of free drug and diagnostics at these HWCs was expected to take care of that part of the OOP expenses borne by our poorest citizens for accessing outpatient care. The first of such HWCs has already been launched in the Bijapur district of Chhattisgarh, by the Prime Minister on April 14, and as we write this, work is going on in hundreds of others in the 117 ‘aspirational districts’ to provide meaningful and comprehensive primary care to our citizens.Image result for ayushman bharat pib

When the Ayushman Bharat was announced, critics argued that the scheme has been insufficiently imagined, that there was a lack of preparation, that it was not backed by adequate budgetary resources, and that the government lacked the techno-managerial wherewithal for its implementation. The Prime Minister, during his Independence Day address, gave a befitting response to the scepticism and to the naysayers by announcing the soft launch of NHPM, christened the Pradhan Mantri Jan Arogya Abhiyan. This clarion call from the ramparts of the Red Fort is a clear indication that the teams at the National Health Agency (NHA) and the ministry of health & family welfare (MoHFW) have been able to successfully surmount the significant challenges in terms of creating an IT backbone, cleaning up the beneficiary database, setting in place the guidelines and procedures, negotiating with state governments, while simultaneously building capacities for its implementation. The fact that all this has been achieved in a relatively short span of just six months is a glowing testimony to the hard work and speedy execution by Indu Bhushan and his team at the NHA.

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In addition, as many as 28 state governments have signed a memorandum of understanding with the NHA to implement NHPM, and are in the final stages of preparation for a formal launch. Over 8,000 hospitals have offered to join the network of empanelled facilities that would provide inpatient care to the identified beneficiaries. To ensure that no one is left out, there is no cap on family size or age. Similarly, there can be no exclusion on account of pre-existing disease conditions, among those who are eligible for benefits from day one of the roll-out of the scheme. As many as 1,350 medical packages—covering surgery, medical and daycare treatments—have been identified so that the coverage includes most of the common medical conditions. The software application driving the scheme is designed in such a way that an individual can avail of the benefits anywhere in the country irrespective of her place of origin, and it is cashless for the beneficiary and the claim settlement is paperless for the hospitals participating in the scheme.

 

The NITI Aayog’s Three-Year Action Agenda highlights the need for creating a wave of new institutions to build a 21st century health system that every citizen of the country would be proud of. Setting up of HWCs and the NHA are steps in the right direction, which were long overdue. The government’s active stewardship in leveraging the potential of the mixed health system is a very welcome development. It is all the more heartening to note the political commitment at the highest levels to transform India’s health system into an affordable, accessible, inclusive and efficient system.

The Ayushman Bharat has the potential to protect millions who are pushed into poverty every year due to catastrophic health expenses. Building a well-functioning health system is a work of decades—it took Germany, for example, 127 years to accomplish universal coverage. Thailand undertook reforms over a period of 30 years prior to announcing its universal health policy in 2002. Now that we have unprecedented political backing for the Pradhan Mantri Jan Arogya Abhiyan, the stage is set for its execution. Needless to say, in a country as large and complex as India, we will be faced with many implementation challenges. It is well worth recounting the Bhagavad Gita dictum of “Yogah Karmasu Kaushalam” (the path to redemption/salvation lies in the skilful execution of the job at hand). Thus, it is imperative we stay the course and pursue these ambitious initiatives with utmost vigour and determination.

4GG8U3jG_400x400.jpgAlok Kumar is Advisor and Vinod Paul is Member (Health), NITI Aayog.

Science City, Kolkata becomes the new insignia of Digital India with its state of the art hi-tech acquisitions

*Sh. Samrat Bandopadhyay

Nestled in the throbbing business arterial route of EM Bypass in Kolkata, the Science City of Kolkata is the largest science center of the Indian subcontinent and one of the finest in the world. Managed by National Council of Science Museums (NCSM), Ministry of Culture, Government of India, the first phase of the centre was thrown open to public in 1997 and the second phase in 2010. The sprawling green campus presenting Science and Technology in a stimulating and engaging manner to visitors of all age groups, including children, is actually built on a previous landfill area of the city. The environment conscious institute today is a place to experience and relive the living history and traditional culture of bygone days. The solid waste management here is also an example for building structures on an eco-friendly and environmentally sustainable basis.

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Science City is the place where visitors throng to cherish and relive the ambience of excitement of dinosaur era in the ‘Evolution Park’ as one walks through the evolutionary phases of life and has a glimpse of those gigantic extinct animals of the past.

The Age of Science and Technology has grown by leaps and bounds. Central Government’s tremendous efforts towards a ‘DIGITAL INDIA’ find a living example in this vibrant learning campus. The digital technology opens a plethora of opportunities for visitors to experience living moments, expositions and immersive images with extraordinary variety.

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The decision of the Culture Ministry to provide a facelift to the existing 2D theatre replacing it with a 3D full dome space theatre system with a particularly high resolution imagery and state-of-art LED dome lighting, sound system along with comfortable seating arrangement, will provide an enthralling and vivid experience that will be etched in visitors’ minds even after leaving the campus of Science City. Scientific phenomena explained through a narrative are set to appeal to the young minds of the country. The erstwhile Space Theatre was first of its kind facility in the country that attracted around 7.2 million footfalls during its operation for two decades. The Ministry of Culture’s plan to fund about 20 cr for the switch from existing 2D celluloid based film projection system to a 3D digital immersive projection system for the theatre will augment a new chapter in its modernization approach and capture the eyeballs of the visitors to a new unprecedented level. The fully built technologically advanced dome will have the scope to display wide range of topics from astronomy, geosciences to other natural scientific phenomena. The Facility which will be ready for visitors by December of 2018 will certainly be a milestone in the field of scientific explorations.

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The renovation of the Science City will be a value add-on to the learning experience for sightseers with a scientific temper and an enduring appreciation for the innovativeness of engineering marvels by architecture professionals and civil engineers of the region. A case in point is the ‘DYNAMOTION’ building architecture, which houses a plethora of interactive exhibits on physical science, along with a unique experience of walking on the floor piano and creating mesmerizing music as one walk past the space.

In the Science Park, people come close to nature with flora and fauna in an environment friendly surrounding and help learn and synergize the basic tenets of science in an all-inclusive manner. The Park’s interactive exhibits are simulative to that learning experience of our age old tradition and interactive kiosks with multimedia facility are an add-on to the learning experience.

Another striking section of Science City is the ‘Digital Panorama on Human Evolution’ which provides a 360 degree view of a narrative in a video format in a huge cylindrical screen. Started in 2016 it is the first of its kind in the country. The presentation hall presents exhibits and mannequins depicting pre-historic human species with varied flora and fauna of those times. There is an awe-inspiring feeling of moving in a space ship as one gazes at the screen unfolding all around. The Science and Technology Heritage of India exhibition gallery houses dioramas exhibiting emerging technologies over the ages with a special focus on mathematics, basic science and scientific development of Metallurgy, Information Technology, Medical Science and town planning of ancient India. The curator of this fascinating exhibition put special emphasis on the fact that the Indian Civilization dated back more than 7000 years while all other civilizations of the world are less than 5000 years old.

The Science City of Kolkata resembles a living architecture of a modern era, typifying a blend of ‘SMART CITY’ with ‘DIGITAL INDIA’ and ethos of ‘MAKE IN INDIA’ built and weaved on the fabric of culture and tradition of the rich and diverse heritage of modern ‘NEW INDIA’!!

*Sh. Samrat Bandopadhyay is Deputy Director (M&C), PIB, Kolkata

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Why I Pushed For The Passing of the Anti-Trafficking Bill 2018

B-A7Z8BM_400x400 Maneka Gandhi Union Minister for Women and Child Development

On 26th July 2018, the Lok Sabha successfully passed the landmark Trafficking of Persons (Prevention, Protection and Rehabilitation) Bill, 2018. There was an intensive debate on a wide range of issues around the subject of trafficking took place. I welcomed the debate wholeheartedly since it is representative of the priority we as Members of Parliament have placed on the issue of protection of vulnerable persons, especially the women and children of our country.

Every day, women and children are bought and sold in our villages and cities, as part of what is now the largest organised crime in the world- the trafficking of persons. They are mercilessly exploited for sex work, bonded labour, forced marriage, begging and other severe forms of violence. As per the National Crime Records Bureau, in 2016, a total of 15379 victims were trafficked for exploitative purposes, out of which 10150 were women and 6345 were children. And 63407 children went missing during the year. These numbers will be much higher in reality as many many cases go unreported.

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With eight children going missing every hour, and one woman being trafficked every hour, we are morally and constitutionally bound to act with utmost urgency. For the first time, the Trafficking of Persons (Prevention, Protection and Rehabilitation) Bill, 2018 responds to this urgent need with a comprehensive and structured solution through a robust, responsive and accountable institutional framework of prevention, protection and rehabilitation. The Bill seeks to combat trafficking at all levels through-

  1. A centralized body to oversee issues of inter-state and international trafficking of persons including matters of intelligence, investigation, capacity building and convergence.
  2. A survivor-centric protection mechanism that ensures the rescue of victims from places of exploitation and their immediate relief; while extending the choice of long-term rehabilitation to adults that is not contingent upon the status of prosecution.

iii. A guarantee to the right to statutory rehabilitation in the form of a dedicated rehabilitation fund, protection and rehabilitation homes along with psychological, social, and economic rehabilitation as well as education, skill development and infrastructure for social reintegration.

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Economic deterrence that targets the trafficking as an organised crime by attachment and forfeiture of property and freezing of bank account that are used for the purpose of trafficking. Any funds recovered hereunder, will be transferred to the rehabilitation fund to ultimately benefit survivors.

  1. Aggravated forms of trafficking that are more severe, complex and long-term in nature including trafficking for begging or by administering any chemical substance or hormones on a person for the purpose of early sexual maturity, by causing or exposing the person to a life-threatening illness including acquired immunodeficiency syndrome or human immunodeficiency virus or by causing serious injury resulting in grievous hurt or death of any person, amongst others. Additional offences include online trafficking, the disclosure of identity, abetment and offences by the media. Importantly, the Bill also establishes accountability of officers under the Act by criminalising an omission of duty of their behalf.
  2. It strengthens prosecution of offenders through designated courts, and special public prosecutors for speedy trial while protecting the identity and confidentiality of victims and witnesses through-camera trial, video conferencing and victim and witness protection.

These provisions have been carefully harmonized and synchronized with all existing and linked provisions of law and structures created thereunder. The Bill has been drafted after in-depth study and research and after extensive consultation with a range of stakeholders over a period of three years. We received hundreds of from civil society, representatives of sex workers as well as victims of trafficking, police organizations, state governments, labour unions. We also received valuable guidance from Members of Parliament and all this was incorporated to strengthen to provisions of the Bill.

The Bill was thus formulated with care, after thorough research, consultation and due diligence. I would like to clear the air around some of the concerns that are being expressed, which are primarily arising from the absence of a clear understanding of the provisions of the Bill. Firstly, there is an apprehension that the Bill will criminalise voluntary sex work. This is completely false. On the contrary, the Bill provides safeguards to voluntary sex workers against persecution and prosecution, while giving them the option to approach the Magistrate for long-term institutional, psychological, social and economic support if she wishes to discontinue. I urge those representing the rights of sex workers to recognize the value of this choice in the lives of the people they work so hard to defend.

Secondly, there are concerns that the Bill will raise a conflict with an existing set of legislation further confusing and complicating the delivery of justice. I would like to reiterate here, that the Bill clearly states that it is in addition to and not in derogation of any existing laws for the time being in force. The Bill will tie together various legislations through a single system of institutional framework dedicated to addressing trafficking of persons and related crimes. This will bring accountability and convergence within the overall trafficking response mechanism.

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Thirdly, many valuable suggestions regarding the strengthening of the enforcement of the law have been provided. These suggestions are wholeheartedly welcomed and I will ensure that each of the suggestion will be suitably incorporated in the Rules. Rules are the instruments through which the objectives and provisions of the Act get implemented. We have already started the process of drafting these rules and will again be taking inputs and guidance from stakeholders.

I am sure there will be many more lessons we will learn together as we roll out this law to protect the last woman, child, man and transgender from the most horrific forms of exploitation. And as we have arrived here today, we will continue to push the boundaries of justice to collaboratively protect and empower the most vulnerable persons of our society. But today, a child in sexual exploitation and a woman in slavery are looking up to us and questioning us on what we are doing as a civilized society and a welfare State. We need to take this step together because our children and women cannot wait.

 

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Happy and Healthy Pregnancy through Yoga

Smt. Maneka Sanjay Gandhi  mgandhui

Union Minister for Women and Child Development 

Pregnancy is an odd time for the mother. On the one hand one is filled with joy and anticipation, on the other there are worries about whether the baby will be normal and healthy.  As the mother’s body changes, there are mood swings, fatigue, cramps, difficult breathing.

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Being physically fit and emotionally strong directly affects the baby’s physical, neurological & psychological development. Practicing Prenatal Yoga during pregnancy gives you the ability to stay calm and eases most physical problems during these nine months.

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Prenatal yoga experts and medical professionals emphasise that prenatal yoga paired with cardiovascular exercises (such as walking) can ease the discomforts of pregnancy and help you prepare for the rigors of labour.

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Pranayama, or the group of several breathing exercises, have been found to have exceptional benefits during pregnancy. It must be incorporated in the daily regime all through the three trimesters as it helps release negative emotions.

Two most useful forms of pranayama or breathing exercises are: Ujjayi, a long, strong, deep breath that helps women redirect their concentration to the present moment and maintain calm; and Nadi Shodhana, (alternate nostril breathing), which helps to balance the body’s energy flows. However, avoid any kind of breath retention or hyperventilation that could limit the baby’s oxygen supply.  The postures and exercises differ for each of the three trimesters of pregnancy.

First Trimester (0 to 13 weeks)

The first trimester brings nausea and fatigue. Severe biological and musculoskeletal alterations take place in the body. Yoga experts advise that one must be extremely cautious while practicing yoga in this trimester as a wrong posture can obstruct the implantation of the fetus and placenta.

The following asanas are ideal for this trimester:

  • Marjariasana(cat stretch): Stretches the neck and shoulders, lessening body stiffness and keeps the spine flexible because the back has to support more body weight as the pregnancy advances.
  • Konasana(standing sideways bending arm): Keeps the spine flexible and helps alleviate constipation, a common symptom of pregnancy.
  • Badhakonasana(butterfly pose): Improves flexibility in the hip and groin region, stretches the thighs and knees, relieving pain, alleviates fatigue and helps facilitate smooth delivery when practiced until late pregnancy.
  • Yoga Nidra (yogic sleep): Reduces tension and anxiety, helps regulate blood pressure and relaxes every cell in the body.

Second Trimester (14 to 28 weeks)

During the second trimester, the volume of blood in the body expands 50-60% to support the fetus and placenta, the blood circulates faster, the rate of metabolism increases and heart rate rises. The body’s sugar gets used up faster and important reserves are used to support the placenta and fetus.

The following asanas are beneficial during this trimester:

  • Vajrasana(diamond pose) –Enhances digestion and can be done directly after meal.It also helps strengthen the pelvic muscles and assist women in labour too.
  • Kati Chakrasana(spinal twist pose) – Relieves physical and mental tension and tones waist, hip and back.
  • Tadasana (mountain pose)– Helps stretch and loosen the entire spine and also helps in developing mental and physical balance.
  • Uthanasana(standing forward fold)– Strengthens muscles of uterus, thighs, back and ankles.

Third Trimester (29 to 40 weeks)

By the third trimester, the body has already undergone drastic physical and biological changes and also the movement of the baby is strong now. The protruding belly and additional weight are likely to challenge one’s balance. Simple balancing postures can make women feel lighter and more aligned. It is advisable to practice yoga with a prenatal teacher at this stage. If you ever feel uncomfortable doing any posture, stop.

Basic balancing postures like Utthita Trikonasana (extended triangle pose), Utthita Parsvakonasana (extended side angle pose), Virabhadrasana (hero pose) and Vrksasana (tree pose) are ideal for building strength in the legs, for proper alignment in the spine and for easing blood circulation.

According to a review of recent research studies, prenatal yoga drastically lowers the chances of pregnancy complications, stress levels and pain, and possibly even the risk of the baby being small for her gestational age.

As we mark the 4th International Day of Yoga, I urge all expecting mothers to join prenatal yoga classes. Not only will you feel better but you will probably make friends with other soon-to–be mothers and your children can become friends!

Cherish this time.

Celebration of International Yoga Day 2018

Glimpses of  4th International Day of Yoga at FRI, Dehradun

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Development Trajectories and Wasted Plastics

Author: J R Bhatt and Ashish Chaturvedi

A cursory look at the history of development shows that economic growth invariably comes at the cost of environmental degradation. Beginning from the Industrial Revolution in England to the present day, most countries around the world have gained economic prosperity by putting an excessive burden on natural resources or ecosystems. These natural resources and ecosystems, either located in-country or abroad, served as a source of raw materials and sink for all kinds of environmentally burdensome effluents generated in pursuit of rapid growth.

The global experience also shows another trend – grow first and then manage the environmental degradation. For instance, the air quality in the already developed countries such as England and Germany suffered immensely in the pursuit of economic development. With sustained growth, there was enhanced economic space for investing in environmental policies and infrastructure to tackle degradation. Of course, citizens who had achieved the economic prosperity were also desirous of a better quality of life and put pressure on the policymakers to clean up the damages due to a single-minded pursuit of economic growth.

However, the experience of the already developed countries does not have to serve as the blueprint for countries that are still developing and trying to enhance the quality of life for their citizens. In fact, growth first and then clean-up later would be catastrophic for least-developed and developing countries for three reasons.

First, a majority of their citizens are dependent on natural resources for livelihoods and the opportunities in the manufacturing and service sector are still at a nascent stage. The costs of following models of growth of the already developed countries would be disproportionately borne by the most vulnerable and marginalized communities.

Second, the very idea of generating waste is antithetical to progress. It makes economic and ecological sense to not create waste. While this idea of not creating waste is currently gaining currency around the world under the broad rubric of “circular economy/ zero waste/ resource efficiency”, it has been a way of life for several generations in rural India.

Third, the experiences of the already developed countries are already before us. The same path does not have to be followed by the developing countries. Thus, sharing of experiences, institutional learning and technologies would be in the global best interest.

A case in point is the management of plastics in our life and environment. Plastics are symptomatic of a modern life. It is impossible to imagine life in any part of the world without plastics.

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We eat in plastics, drink in plastics, wear plastics and to a certain extent live in (or with) plastics. Part of the reason for the ubiquity of plastics is the versatility of the material – it can be molded into any shape, can be as thin as cling film or as sturdy as the bumper of a car. It is lightweight and above all, it is available in abundance because our economies are still fossil fuel dependent and plastics are an innocent by-product.

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However, there are significant challenges due to the widespread use of plastics. Our land, water, and even air are getting significantly polluted. Plastic waste is disposed of indiscriminately on land and water and often burnt in the uncontrolled environment leading to emissions of greenhouse gases as well as persistent organic pollutants. As the National Geographic points out, nearly 700 marine species, including endangered ones are affected by plastics in our oceans. Marine species of all sizes, from zooplankton to whales, now eat microplastics.

Global per capita consumption of plastics annually is 28kg. The Europeans consume more than double (65 kg) while the Indian consume less than half (11 kg) of the world average. One possibility would be to wait till the Indian consumption reaches the European levels before we start worrying about the challenges of plastic waste. The other would be to join hands with the global community to tackle the challenge of plastic waste management while consumption levels are low.

The latter is precisely the spirit with which India is hosting the World Environment Day. This year’s theme, Beat Plastic Pollution, gives a clarion call for collaboration amongst countries all over the globe to come together to arrive at solutions for plastic waste management.

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As we embark on this global challenge, we recommend following forms of cooperation at the global level. First, we must work together to regulate international flows of plastic waste. It is clear that significant flows of plastics happen from the global north to global south. Some of it is warranted by the relocation of plastic industry and the needs of raw materials. But at the same time, the flows of waste plastics also happen in the direction of least costs incurred – environment, social and economic.

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Second, we must create an international exchange platform for sharing of global experiences on policies, business models as well as citizen initiatives. A lot of action is already happening. Initiatives that have been successful in different parts of the world need to be upscaled rather than reinventing the wheel. The Ministry of Environment, Forest and Climate Change is documenting some of the best practices in India. Similar initiatives need to be documented and shared widely – there is no better incentive or nudge for good behavior.

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Third, we must establish global partnerships with the private sector which is also working across national boundaries. The innovations for recycling and disposing of plastics, finding substitutes for packaging material as well as developing innovative communication drives would necessarily require the skills of the private sector. For instance, a recent report by FICCI and Accenture points out that approximately 40% of India’s plastic waste goes uncollected (ending up in landfills). Diverting this to recyclers has the potential to create 1.4 million additional jobs in India’s recycling industry.

If we manage to do that successfully, we would be able to leave a planet worth living not only for our children but also for any form of life on our planet. Such resolve is crucial every day, not only on the World Environment Day.

At the national level, we must foster partnerships amongst actors that have hitherto not engaged closely together. That would be the only way for a transformative agenda for managing plastics. Further, we should celebrate successes and individual achievements, and there are already quite a few. From Afroz Shah cleaning the Versova Beach mobilising citizen participation, to Aditya Mukarji replacing 50,000 plastic straws, to Ukhrul in Manipur becoming a plastic-free district, to Vengurla taluka banning plastic bags and using plastics to make roads, to the start-up Banyan Nation helping global brands using more recycled plastic, to more than 5 million Bharat Scouts and Guides (BSG) pledging to give up their plastic woggles, a signature element of the BSG uniform, replacing it with more sustainable and eco-friendly options – the list is growing and rapidly. We need to celebrate these initiatives and spread the Good News from India.

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**J R Bhatt is Advisor in the Ministry of Environment, Forest and Climate Change. Ashish Chaturvedi is Director, Climate Change at the German Development Agency, GIZ. The views expressed are those of the authors and do not reflect those of their organizations.

Putting More Life Into The Lifeline

Author: Ashwani Lohani (Chairman Railway Board)  untitled-13.jpg

The preceding four years have indeed been an eventful period for the railways. A rapid move forward in consolidating existing operations and energizing various growth-oriented projects is being witnessed. The realization that railways needs to restructure, reform and revitalize has indeed dawned on the national carrier. The need to enhance infrastructure at a pace that blends with the rapidly growing national expectations in so far as passenger and freight traffic is concerned has also started getting addressed. With the tremendous emphasis being laid on safety, an effort that has already started giving results, the impetus is also being given to expediting the much-needed reforms – cultural, process and structural reforms becoming the order of the day. Perhaps for the first time ever in history, very major strides are being made in the process of bringing reforms in the railway system. Delivery is indeed the primary focus of the organization.

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With 73  train accidents, the year 2017-18 has indeed been the best year in the history of the railways in so far as its safety record is concerned. It is also the first year ever to log double-digit figure of accidents and it is definitely not a freak achievement, but an achievement that the entire organization has worked for. Renewal of overaged unsafe rail-track has touched an all-time record of 4405 km, sharply up from 2597 kms in 2016-17. The last four years also witnessed an unprecedented high removal of 5469 unmanned level crossings, that are inimical to safety. The Government has also recently and wisely decided to fill up a huge backlog of almost one lakh safety related posts besides creating a fund (RRSK) with a corpus of one lakh crores to be spent on safety items.

 

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The sharp focus of the Government towards capacity enhancement, primarily narrowing the huge backlog of infrastructure deficit has also started paying dividends. The average annual capital expenditure during the last four years at over 98,000 crores is more than double of the spending achieved in the previous five. Our achievements in commissioning 9528 kms of new broad gauge line in the last four years as against 7600 kms during the previous five is indicative of our commitment to enhance the pace of building of infrastructure. And electrification, easily the most widely recognized symbol of development has also witnessed a spike of 4300 kms during 2017-18, a pace that we indeed intend to accelerate further. Manufacture of coaches and locomotives at railway production units has also touched new highs in 2017-18 with ICF manufacturing 2397 coaches, CLW manufacturing 350 electric locomotives and DLW 321 locomotives.

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The 14th of September 2017 will go down in the annals of history as a giant leap for the railways in our country, for it is on this day this year that the nation took a major step forward towards displaying its intent of moving away from the era of slow speed trains to real high speed ones. As a citizen of this nation and more so as a railwaymen, I indeed feel more proud than ever. The very thought that the journey from the heart of Ahmedabad in Gujarat to the heart of Mumbai in Maharashtra would be covered in a time frame much shorter than what air travel would entail, and that this is just the beginning, is indeed extremely exciting. Prime Ministers Modi and Shinzo Abe on this day laid the foundation stone of the Mumbai – Ahmedabad High Speed Rail (MAHSR) project, popularly known as the Ahmedabad-Mumbai bullet train in Ahmedabad. And the next five years shall witness frentic activity in the states of Maharashtra and Gujarat to complete this project and position India and also its railway system in the illustrious list of nations that run high speed trains. This first route marks the beginning of a new journey for the railways as well as for the nation. This first route that shall be fully commissioned in 2023 will be the front runner of many more such routes. This project apart from triggering a paradigm shift in how people travel within India and therefore facilitate travel and tourism, would also have a significant impact on the nation’s economy as it scores high on the “Make in India” front. “Make in India” and “transfer of technology” rightly figure in the project agreement between India and Japan, thereby enabling India to make the bullet train a pivotal part of connecting our remotest corners to the epicentres of urbanisation. Called in Japan as ‘Shinkansen’ which means ‘new trunk line’, the bullet train is almost a wonder that will script the most memorable milestone in our journey towards a ‘New India’.

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Construction of dedicated freight corridors has also picked up speed. With many administrative, managerial, contractual and legal hurdles having been resolved, this project is going to see the light of the day in March 2020, when both the eastern and western corridors would stand fully commissioned. This would also be a giant leap forward for the railways as from a mixed traffic configuration on our tracks, we would start moving to lines dedicated for freight with its attendant benefits.

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Major strides have also been made in one of the most fundamental missions launched in recent times – mission cleanliness. While a lot yet needs to be done, considerable improvements have been achieved in cleanliness of stations and trains. Other passenger interface areas like catering, passenger information regarding delayed trains, e-ticketing and introduction of PoS machines are also being aggressively handled and taken forward. A variety of new designs of coaches and trains in the form of products like the Tejas, Antyodaya, Deendayalu, Humsafar, Anubhuti have also been launched to enhance passenger satisfaction levels. Our sensitivity towards the commuters experiencing dense loads in the suburban systems at Bangalore and Mumbai is also reflected in the sanction of projects for upgradation of Mumbai and Bangalore suburban systems at an overall cost of 51000 and 17000 crores respectively thereby benefitting millions of our passengers.

And our commitment and role in integrating the nation can never be underestimated. With 970 kms of gauge conversion done in the last four years, the North East is now fully integrated with the broad gauge network that covers the entire nation. Rail connectivity has now been established with the states of Meghalaya, Tripura and Mizoram and direct train connectivity has been made between Itanagar and Silchar to Delhi.

Indian Railways indeed provides the wheels on which the nation moves. It is also aptly called the economic lifeline of the nation and the primary and the most economical mode of transport for the masses. The onset of the new government in 2014 has indeed led to the beginning of the unleashing of this gigantic monolith and a lot of action has indeed begun in the right direction with reforms being at the core of them. Yet the fact remains that internal contradictions within the organization due to it being a business enterprise and also a ministry leads to inadequate exploitation of its true potential. A gigantic leap forward within the realm of possibility would entail a major structural reform at some point in time, the sooner the better.

Change is always painful, yet it is the only constant an organization must have, if it is to progress by leaps and bounds and for a long-term gain, paying a price in the short term is inevitable. While the progress made in the recent past is indeed noteworthy, the fact remains that we run short of the national expectations and would continue to do so with the gap increasing at a rapid pace, unless major structural reforms are undertaken to ultimately run the organization truly on professional lines. Yet the pace of improvement witnessed in recent times and the commitment to the reform process makes one confident that the railways would always be the key player in the economic development of the country in times to come.

 

 

 

 

Translating Basic Research towards the Development of Novel Malaria Vaccines & Drugs

Deepak Gaur*  deepak.jpg

Malaria remains one of the top killer diseases across the world accounting for around 200 million cases and half a million deaths primarily among young children, infants and pregnant women residing in some of the most impoverished countries of the world. Unfortunately, India is still endemic to this deadly disease that has plagued the human race for many centuries. The war against malaria has been fought on several fronts and while there have been some significant advancement in terms of developing novel malaria intervention strategies, it is crucial to continue these efforts with great vigor in order to counteract the different species of the highly complex malaria pathogen, Plasmodium.

Malaria control strategies have primarily involved the use of insecticide treated bed nets (ITNs), indoor residual spraying and therapy with anti-malarials such as chloroquine, artemisinin, which have led to a steady decline in malaria mortality during the past decade.

The discovery of Artemisinin was recognized in the award of the Nobel Prize for Medicine in 2015 to the Chinese chemist Youyou Tu. However, the continuous development of drug resistance by the parasite and insecticide resistance by the mosquito vector has proved to be a major challenge in achieving malaria elimination. It has been widely believed that an efficacious vaccine against malaria will be a major public health tool in combating the disease. However, the process of developing an efficacious malaria vaccine has been hindered by several obstacles that have thwarted its development. In fact, there is no successful vaccine available against any parasitic pathogen substantiating the complexity of these organisms and their ability to modulate human immunity. While, a successful malaria vaccine remains a big challenge, there have been several highly promising advancements in the recent past that provide hope for the development of a successful malaria vaccine.

The most advanced malaria vaccine, RTSS that targets the liver stage of the parasite life cycle has been developed through a three decade old association between the Walter Reed Army Institute of Research (WRAIR, US military) and Glaxo Smith Kline (GSK). The recent Phase III results have shown that the vaccine elicits a maximum protective efficacy of 50% against clinical malaria in young children (RTS,SClinical Trials Partnership 2015 Lancet). While, this is clearly not sufficient, the RTSS vaccine still does have the potential to save lives in Africa which carries most of the burden of global malaria mortality. The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive scientific opinion for RTS,S (July 2015).

The World Health Organization (WHO) has issued a position paper for RTS,S (also knownmosquirix.PNG as MosquirixTM)in which it recommends large-scale pilot implementations of RTS,S. Importantly, recent clinical trials with fractionalization of RTSS dosage has increased its efficacy to 80%, which is highly encouraging (Regules, JID 2016).RTS,S does serve as a significant platform to further build upon and produce a vaccine with the higher optimal efficacy.

The fact that individuals residing in malaria endemic regions develop natural immunity against the disease does suggest that it should be possible to develop malaria vaccines that mimic natural immunity. However, the challenge remains for us to advance our understanding of malaria immunity and identify the correlates of protective immunity. In parallel to RTSS, there have several efforts to characterize novel target antigens at all three stages (liver, blood and mosquito) of the parasite’s complex life cycle and evaluate their vaccine potential in human clinical trials. Recently, a whole organism approach based vaccine, PfSpz, comprising of sporozoites attenuated by irradiation have shown remarkable efficacy in naïve human volunteers and is being taken forward for field efficacy trials (Hoffman 2015 Am. J. Prev. Med.).

India has been at the centre of malaria research as the landmark discovery of Sir Ronald Ross in 1897 describing the whole sexual cycle of Plasmodium through the Culex mosquito was made during his posting in India. Malaria research in India has been funded primarily by the Indian government agencies, the Department of Biotechnology (DBT) and the Indian Council of Medical Research (ICMR). ICMR has developed a network of malaria field stations across the countries to study malaria epidemiology and vector biology. DBT has provided special attention to basic R&D that has improved our understanding of the parasite biology as well as on translational research aiming to develop novel anti-malarials and vaccines.

One of the biggest success stories has been DBT funded efforts of the ICGEB Malaria group to develop recombinant blood-stage experimental vaccine (JAIVAC-1) and conduct a Phase I human clinical trial. JAIVAC-1 was the first ever malaria vaccine trial against Plasmodium falciparum in India with recombinant molecules produced in an Indian laboratory (Chitnis 2015 PLOS One). It was funded jointly by DBT and the European Vaccine Initiative. JAIVAC-1 was the culmination a strong public-private partnership between ICGEB and Bharat Biotech, a Hyderabad based Biotech Company that has developed vaccines against several disease including the recent Rotavac that has come through the support of DBT. Another vaccine formaulation against P. falciparum, JAIVAC-2 has been developed by ICGEB along with Zydus Cadlia that is being taken forward for a Phase I trial. Human malaria is caused by both P. falciparum and P. vivax, and ICGEB has also developed a sub-unit recombinant vaccine (PvDBPII) against P. vivax malaria that has also been clinically evaluated in a Phase I trial.

Importantly, DBT was quick to recognize that vaccine development steps beyond the bench requires an expertise that is lacking in academically oriented scientists and thus DBT in partnership with the Bill & Melinda Gates Foundation created a separate entity with translational expertise known as the Malaria Vaccine Development Program (MVDP). ICGEB and MVDP have partnered in conducting the JAIVAC-1 and PvDBPII trials.

In a recent highly noted effort supported by DBT, scientists at the School of Biotechnology (SBT), JNU and ICGEB have discovered a novel multi-protein adhesion complex which is essential for the malaria parasite P. falciparum to invade human erythrocytes (Reddy 2015 PNAS; Du Toit 2015 Nature Reviews Microbiology). This complex comprises of three proteins (RH5, CyRPA, and Ripr) and facilitates the interaction between the essential PfRH5 parasite ligand to its red cell receptor, Basigin. Abrogation of this key protein complex has been demonstrated to neutralize the parasite, which provides a paradigm shift in the mechanism of action of parasite neutralizing antibodies that instead of inhibiting ligand-receptor interactions are impeding key protein-protein interactions between parasite molecules (Reddy 2015 PNAS). This discovery has laid the foundation for the development of a new generation blood-stage candidate vaccine, JAIVAC-3 targeting PfRH5 and CyRPA, which is being spearheaded by SBT, JNU with DBT support through their vaccine Grand Challenge Program.

DBT initiated a strong collaborative program between basic and clinical researchers known as GLUE through which JNU, ICGEB and an ICMR institute, NIRTH Jabalpur undertook a partnership aimed at studying Plasmodium vivax malaria in Central India. The collaboration identified the functional domains of P. vivax RBP proteins involved in specific host cell (reticulocyte) invasion and demonstrated that naturally acquired human antibodies against the PvRBP proteins were functionally binding-inhibitory, thus substantiating their promise as key vaccine candidates against P. vivax (Gupta 2017 JID).

Another translational malaria project being supported by DBT is the development of curcumin as an antimalarial. Studies in the Indian Institute of Science have shown that curcumin synergizes with ART as an antimalarial to potently kill the parasite as well as primes the immune system to protect against parasite recrudescence (Padmanaban 2012 Curr. Science). Further, nanocurcumin has been shown to be superior to native curcumin in preventing degenerative changes in experimental cerebral malaria (Dende 2017 Sci Rep). The results indicate a potential for the novel use of ART–curcumin combination against recrudescence/relapse in falciparum and vivax malaria. In addition, studies have also suggested the use of curcumin, as an adjunct therapy against cerebral malaria. Steps for the further clinical evaluation of the ART-curcumin combinations with DBT support are being undertaken.

In yet another significant project funded by DBT through their nanobiotechnology program, scientists at Jawaharlal Nehru University (Special Centre for Molecular Medicine and School of Biotechnology) and National Institute of Immunology (NII) are working on producing nanoparticle based formulations of the drug acriflavin and targeting it to the parasite through specific antibodies. JNU has a US patent for the antiparasitic activity of Acriflavine (Dana et al. ACS Chem Biol. 2014), which it wishes to harness in the development of a novel and highly efficacious antimalarial drug.

DBT’s support has produced a critical mass of Indian scientists involved in malaria research and some significant contributions in our basic understanding of parasite biology that have been undertaken by leading institutions and universities across India.

In spite of this optimism, we need to take bigger strides towards understanding the complexity of the Plasmodium pathogen and finally producing tools for successful intervention of the disease. The war against Malaria is a long drawn one comprising of several battles that have still yet to be won. In this regard, the support of DBT in this endeavor is highly appreciated and remains essential for our country to overcome this debilitating disease.

Rapid fire:

  • DBT funded efforts of the ICGEB Malaria group to develop recombinant blood-stage experimental vaccine (JAIVAC-1) and conduct a Phase I human clinical trial.
  • JAIVAC-1 was the first ever malaria vaccine trial against Plasmodium falciparum in India
  • Another vaccine formulation against P. falciparum, JAIVAC-2 has been developed by ICGEB along with Zydus Cadlia
  • Through DBT support, SBT, JNU and ICGEB have discovered a novel multi-protein adhesion complex, which is essential for the malaria parasite P. falciparum to invade human erythrocytes
  • This complex comprises of three proteins (RH5, CyRPA, Ripr), which form the basis of the new generation candidate vaccine , JAIVAC-3
  • Development of curcumin as an antimalarial supported by DBT.
  • In another DBT project. JNU & NII are working on producing nanoparticle based formulations of the drug acriflavin and targeting it to the parasite through specific antibodies.
  • DBT’s support has produced a critical mass of Indian scientists involved in malaria research.

* Author is Professor at School of Biotechnology, Jawaharlal Nehru University, New Delhi.

***

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