insight fertilization connected Back Pain and Chiropractic Care

Back pain is tasteless during pregnancy with research showing in the middle of 50-80% of pregnant patients reporting low back pain. It is good for expectant women to be informed about some of the options ready to alleviate pain as well as what they can do for themselves to ensure a wholesome pregnancy. Some women may feel anxious or unsure about seeking chiropractic care during pregnancy especially if they have never experienced chiropractic before - but they need not be. Let's recognize some of the frequently asked questions with regard to chiropractic care and pain during pregnancy...

Why is there back pain during pregnancy?
There are many mechanical, postural and hormonal changes that take place in a woman's body during pregnancy. Below are just a few examples of typical changes.

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Mechanical and postural changes:
- centre of gravity moves back therefore changing the mechanical stresses on joints, muscles and ligaments
- weight gain results in increased unabridged stress to joints and muscles
- muscles of low back must work more to counterbalance growing belly
- low back curve often becomes accentuated which pinches the joints of the low back and sacroiliac joints closer together resulting in joint irritation
- along with accentuation of the lumbar curve, the sacrum itself tilts transmit at its base
- increased breast size can result in mid-back pain as the muscles and joints of the mid-back must compensate
- often there is a turn in neck position with loss of the normal curvature of the neck
- women tend to adopt a wider based stance and gait which affects joint position of ankles, knees and hips resulting in joint/muscle/ligament irritation
- pressure may be exerted on nerves due to muscle tension and water retention resulting in tingling or numbing sensations

insight fertilization connected Back Pain and Chiropractic Care

Hormonal changes:
- hormonal changes in pregnancy also affect biomechanics of the spine and peripheral joints
- a hormone called relaxin is released which softens and elongates ligaments and other connective tissues which leads to greater joint request for retrial and inherent joint irritation

As one can see, there are verily myriad changes that occur. On top of this, minor pre-existing mechanical issues may be exacerbated during pregnancy due to the weight gain and hormonal effects.

How can chiropractic help?
Through a history and corporeal examination, chiropractic can identify specific problem areas in the spine and surrounding joints. Chiropractic adjustments help to restore allowable request for retrial and alignment of joints. In addition, specific corrective exercises are prescribed to help enhance posture such that tight muscles are stretched and relatively weaker muscles are strengthened. Beyond this, chiropractic helps by balancing the nervous law which allows the body to heal optimally. Most pregnant women who touch chiropractic care article relief of symptoms and related improved mood and sleep. Best of all, chiropractic is wholly natural and non-invasive. Chiropractors do not prescribe medications which can be of concern especially during pregnancy.

Is chiropractic medicine safe during pregnancy?
Chiropractic care is natural, non-invasive and very safe for both mom and the developing baby. Chiropractors are also trained to identify red flags related with high risk pregnancy and to refer accordingly.

What else can I do for relief and to ensure a wholesome pregnancy?
Maintaining corporeal fitness through practice is a great way to promote great condition and fewer complications. Quarterly cardiovascular practice leads to improved sleep, less pain, less stress, fewer delivery complications and has great birth outcomes for both mom and child. It also reduces the risk for gestational diabetes and pregnancy related hypertension and the related consequences for both mom and developing baby. A balanced and nutritious diet is also important, ensuring that the fetus has the needful building blocks for wholesome development and mom is wholesome too. Other ideas for pain relief include massage and acupuncture.

Following delivery, back pain normally resolves any way daily activities such as lifting one's child, bending down to their level, breast feeding and awkward postures related with raising a child may result in mechanical issues. Thus, some women may select to continue with chiropractic care during this phase as well to ensure optimal joint mechanics and unabridged wellness.

Stuber and Smith (2008). Chiropractic for back pain in pregnancy. Journal of Manipulative and Physiological Therapeutics; 31(6):447-454.
Jones, Housman & McAleese (2010). Exercise, nourishment and weight supervision during pregnancy. American Journal of condition Studies; 25(3):120-126.

insight fertilization connected Back Pain and Chiropractic Care

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Maternal health in India

'God could not be everywhere and therefore he made mothers' - A Jewish proverb summarizes the relevance of a mother. That should place mothers in a highly privileged position. But the irony is that every microscopic a woman dies in childbirth. 536,000 women continue to die needlessly each year at a time which should be joyous - just when they are bringing life into the world. A further 300 million suffer from avoidable illness and disability.

About 14 years have passed since the International consulation on citizen and development (Icpd) formulated a reproductive health program for the world, and about seven years remain for the Millennium development Goals (Mdg) to be achieved

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The fifth Millennium development Goal (Mdg) (Table 1) which aims to 'improve maternal health' - is desperately off-track.

Maternal health in India

Table 1 Mdg 5-Improve maternal health

Targets Indicators

Target 5A: cut by two-thirds, between 1990 and 2015,the maternal mortality ratio

1. Maternal mortality ratio
2. Proportion of birth attended by skilled health personnel

Target5B:Achieve, by 2015, universal entrance to reproductive health

1. Contraceptive prevalence rate
2. Juvenile birth rate
3. Antenatal care coverage
4. Unmet need of house Planning

Maternal mortality is an foremost indicator of the status of women in a community - a maternal death often represents the endpoint of a life of gender discrimination and deprivation 'inside' the household, and failure of the 'outside' (e.g., health system) to provide timely and effective care. Chronic conditions such as under nutrition, anaemia, diabetes and hypertension make women more susceptible to maternal death, but even healthy women can succumb to an unexpected complication while pregnancy or childbirth.

Only use of good health care can make maternal death a rarity, as it has in the industrialized world. Indeed, a stunning feature of maternal health in the world today is the vast difference in maternal mortality in industrialized and developing countries, the latter still alarmingly high. In 2000, 13 developing countries accounted for 70 percent of maternal deaths worldwide and South Asia for one-third. The country with the single largest amount of deaths was India, where an estimated 136,000 women died.

A amount of personel and household factors put women at high risk of death while pregnancy and delivery. These comprise age (too young or too old), high parity, poor nutritional status, low entrance to health services, low social status, illiteracy and poverty. As with other indicators of reproductive health, maternal mortality is higher in rural areas, among the economically worse-off, and those with microscopic or no education. Women who have received no antenatal care appear to be at greater risk of death (a cause or correlate), and those with unmet need for contraception are clearly at higher risk than they would be if they could avoid pregnancy.

A maternal death is a death like no other. The impact of a maternal death on families and communities is devastating - but is especially so for surviving children. A newborn baby is three to ten times more likely to die within its first two years without its mother. The health of women is indispensable to a country's social, economic and political development. The survival of women in childbirth reflects the comprehensive development of a country and either or not the health services are functioning. In reality, the survival of women reflects either or not women matter.

As per Nfhs-3 and Srs 2001-2003, discrete health indicators reflective of the current situation of Woman's health in India are

o Women in the reproductive age group constitute nearly 19% of the total citizen with 16% of women in the age group of 15-19 yrs. Are already child bearing.The midpoint age of child bearing in India is 19.8 years. (Urban area -20.9 yrs., Rural area - 19.3 yrs).

o 77% of the total pregnant mother received some form of Antenatal Care.( Urban area 91% , rural area 72%)

o Among women who received Anc, less than two-thirds had weight, blood, or urine taken or blood pressure measured, Three-fourths had their abdomen examined and 36% were told about pregnancy complications. 56% of married and 59% of pregnant women are anemic. 65% of the pregnant mother received or purchased Iron and folic Acid but only 23% consumed Ifa for 90 days. In urban Area the 76% pregnant women received or purchased Ifa and only 35% consumed Ifa for 90 days and in the rural area 61% received or purchased Ifa and 19% consumed the same for 90 days.

o 49% of all deliveries are institutional .Only about 1 in 7 home deliveries are assisted by a skilled provider.(urban-68%,rural-29%)

o 13% of the bottom indexed women delivered in an custom in difference to 84% of women in top indexed group.33% of pregnancies belonging to Sc caste delivered in the custom against 18% among Scheduled tribe.

o Only 42% of the postnatal mothers are receiving any forms of postnatal care. Maternal Mortality Rate has been slowly improving from 437 in 1992-1993 to 301/100000 live births .Maternal Mortality in India is not uniform. High maternal mortality is clustered among the Eag states of Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Rajasthan, Up, Uttaranchal, Assam & Orissa.

The comprehensive midpoint rate of Mmr decline while the duration 1997-2003 has been, of 16 points per year. At this rate of decline, Mdg of 109 by 2015 may be difficult to accomplish Under the prevailing conditions, the Mmr would be around 231 by 2012.

They give us the impression that though we are thoughprovoking in the right direction, the improve is slow and to prevent mothers from dying and living with problems associated to child birth, a lot still needs to be done and at a much faster pace

The major causes of maternal mortality are immoderate bleeding while childbirth (generally among home deliveries),(38%) obstructed and prolonged labour,(5%) infection/ sepsis (11%), unsafe abortion,(8%) disorders associated to high blood pressure(5%) and other health including anaemia.(34%).Forty seven per cent of maternal deaths in rural India are attributed to immoderate bleeding and anaemia resulting from poor nutritional practices. Intermediate causes, which are the first and second delays in care-seeking, comprise the low social status of women, lack of awareness and knowledge at the household level, inadequate resources to seek care, and poor entrance to capability health care. Causes of third delay are untimely analysis and treatment, poor skills and training of care providers, and prolonged waiting time at the installation due to lack of trained personnel, tool and blood. There are insufficient facilities for antenatal care and more than half of all deliveries are still conducted at home, very often by untrained helpers. The link between pregnancy-related care and maternal mortality is well established.

National programmes and plans have stressed the need for universal screening of pregnant women and operationalising indispensable and urgency obstetric care. Focused antenatal care, birth preparedness and complication readiness, skilled attendance at birth, care within the first seven days, and entrance to urgency obstetric care are factors that can help cut maternal mortality. One of the major goals of Government of India's agency of health and house Welfare is to cut maternal mortality and morbidity. The focus has shifted from individualized interventions to attentiveness to the reproductive health care, which includes skilled attendance at birth, operationalising Referral Units and 24 hours delivery services at primary health Centres. And initiation of Janani Suraksha Yojna (National Maternity benefit Scheme). The program to attend the same is Rural health Mission in Eag states and Rch Ii in the other states.

If India is to accomplish the Millennium development Goal 5 (Mdg 5) by 2015, besides providing universal urgency obstetrical care to each of the pregnant mother in need it will have to tackle indispensable social and economic factors, such as the low status of women, the poor understanding of many families about health care, the cost of such care, and also the low standard

Strategies which need to be adopted are

o enhance inclusion. Two foremost groups - poor women and adolescents -need to be brought squarely into the fold of reproductive health services straight through geographic and household targeting and clearly-directed outreach. social and gender sensitivity among providers, managers and policymakers is indispensable to accomplish this inclusion, as well as the provide and query improvements noted below.

o enhance supply. improving the provide of services for all stages of the reproductive life cycle, for which integrating the indispensable box and providing a client-centred continuum of care are good approaches. Four services have been particularly neglected and require further attentiveness in this context: combating unsafe abortion, food counselling and care, postnatal care, and Rti/ Sti analysis and treatment. improving the availability and capability of frontline female health workers straight through recruitment and/or contracting in, training, field reserve and performance-based incentives would help to fulfil many needs, while contracting out of services and other client/provider cost systems could growth the availability of care for poor women.

o growth demand. growth query for some services that are provided but underutilized, such as Anc, Ifa, institutional deliveries and house planning (although provide may be a constraint in some areas). In increasing to 'behaviour change communication,' demand-side financing is foremost to accomplish this.

o Reform the health sector for reproductive health. As reforms take place in the health sector, the delivery and financing of reproductive health services merit special attention. Reforms are especially indispensable in three areas to reserve the above approaches to improving reproductive health. Decentralized planning and resource allocations, human resource development, and financing improvements are foremost to implement targeting, integration of services, provide improvements, a client focus, query creation, and effective outreach.

Maternal health in India

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Lower Cholesterol simply - Alternatives to Statin Drugs

Huge topic. I can write a book on this but best not yet! Two more years of med school yet and by then I'll be even more versed in how to lower cholesterol naturally.

First: What is cholesterol?

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According to Stedman's healing Dictionary, cholesterol is "the most abundant steroid in animal tissues, especially in bile and gall stones, and gift in food, especially rich in animal fats, circulates in plasma complexed to proteins of varied densities and plays an foremost role in the pathogenesis of atheroma formation in arteries."

Lower Cholesterol simply - Alternatives to Statin Drugs

What is pathogenesis of atheroma? It is the starting stage of atherosclerosis which is the construction of lipid [cholesterol] plaques within the buildings of arteries. These plaques narrow the vessel wall thereby limiting the flow of blood. Limiting the flow of blood causes turbulence which causes supplementary deposition of plaque. The slowed speed of blood through the arteries helps lay down more plaque as well.

Ways to lower cholesterol naturally:

  1. Exercise: damn. How many times do you have to hear it - every person says it. Because it works best than any drug out there. Why does it work? straightforward biochemistry and physiology. Practice requires energy. Vigor comes from sugars, fats and proteins. When the sugars and proteins are burned, fats must be converted into useable forms of energy. The liver steps up by development good cholesterol, Hdl. Hdl goes nearby and picks up bad cholesterol, Ldl. It converts this into useable energy. So, by exercising, your Vigor requirements increase thereby lowering cholesterol naturally. Practice 30 minutes a day as often as you can in a week. Try one day a week and build up. You'll come to be addicted to it. best that than statins.
  2. Eat soluble fiber: Where can you find that? In beans and whole grains. Fruits and vegetables contain insoluble fiber. Soluble fiber honestly binds to cholesterol removing it from your body. Insoluble fiber adds bulk to your stools development you more regular - which is extremely vital as well.
  3. Limit animal fat foods: damn again. Even Stedman's healing Dictionary said cholesterol is the most abundant steroid in animal tissues. They didn't say plant tissues. I'm not saying avoid it completely. Just keep an eye on it - don't chomp down endless roast beef sandwhiches with mayo and four kinds of cheese.
  4. Inositol: This is time-released niacin in the no-flush form. Niacin is a main player in cellular metabolism. If one is low in niacin, then the Vigor reactions do not go forward. If they do not go forward, lipids secure which is directly tied to high levels of choleterol. A study on time-released niacin shows its effectiveness. The study I found used pharmaceutical time-released niacin but I believe these two are very similar - with the natural form being superior. The bottom line of the study: "The results show that niacin Er [extended release] produces a useful ensue on lipoprotein subclasses, specifically decreasing the more atherogenic small, dense Ldl particles and enhancing the cardioprotective large Hdl particles." Remember what I said about bad Ldl and good Hdl? The inositol sounds pretty good now doesn't it?
  5. Red Yeast Rice: This is what the pharmaceutical companies make some statin drugs from - directly! So why not take it in its natural state? It works quite well. It works by limiting the cholesterol reaction from going forward. This means that cholesterol's production is slowed down thereby lowering cholesterol naturally. I have found a great explore article on PubMed for Red Yeast Rice. The explore was done by the Center for Human cusine and is not biased by a natural supplement company. Here is another study about the cholesterol-lowering effects of a possession Chinese red-yeast-rice dietary supplement.
  6. Policosanol: This is sugar wax. Sound safe? It is. It does not turn off the cholesterol forming reaction as strongly as statin drugs. Our bodies need some cholesterol formed. Without it, numerous hormones would not be made and we would be dead. Thus, it is best to gently limit production rather than severely limit. Policosanol has also shown to increase the levels of Hdl. Do statin drugs do this? No. There is a good study on Policosanol that I found on PubMed. You'll consideration it is not a study made by a natural supplement firm or with biased interests. The title of the study is: Comparison of the efficacy and tolerability of policosanol with atorvastatin in elderly patients with type Ii hypercholesterolaemia.
  7. Bio Lipotrol: Bio-Lipotrol has been shown to simply lower cholesterol [http://www.healthegoods.com/product/bio-lipotrol-biogenesis-biolipotrol/natural-health-supplements]. Bio Lipotrol has Red Yeast Rice, Inositol, Policosanol and Guggal Gum extract. I have visited with physician after physician that have used Bio Lipotrol and the results are seen within a few weeks. Now this doesn't mean you can sit on your couch eating hamburgers and pizza while popping Bio Lipotrol capsules. I have already stated that Practice is the best medicine - along with the limitation of animal fats and an increase in soluble fiber. I did not know about Bio Lipotrol until a classmate kept buying it. I found her in the hall one day and asked her what it is. She told me it is working very well on her grandmother's high cholesterol levels. Then I became more interested. The benefits of being in med school - you find what works and what doesn't.

What are the dangers of Statin drugs?

I don't know all of the dangers but I know one that is not often addressed. Statin drugs give the false impression that the one taking them does not have to be proactive in lowering cholesterol. If a drug is lowering cholesterol without them doing anything, why not chomp on fatty foods? I'll tell you why. Statin drugs limit the production of cholesterol. They do not limit the intake of cholesterol. You do.

Also - statin drugs seriously limit the production of Coenzyme Q10. This is a major Vigor source for the human heart and electron vehicle chain. So if you are on statin drugs, take CoQ10. I believe statin drugs also limit the conversion of active Vitamin D. This I need to check on but it makes sense if following the reactions down from Hmg-CoA, which is the limiting step in cholesterol synthesis.

If you want to lower cholesterol naturally, these steps will no doubt help you. I recommend having a sit-down chat with your physician. Most docs will listen to you and be supportive and knowledgable about this arena. If not, find a licensed and suited naturopathic physician who will listen to you.

This facts is not telling you to stop taking your statin drugs. It is merely information. Do not stop your statin drugs without consulting with your physician. Only then, under their direction, stop the meds if you implement other means.

If you are not on statin drugs and you don't have money to see a doctor, these steps may help you lower cholestrol naturally. But as I am not a physician yet, I am not prescribing any of this facts to you. It is up to you.

I hope you are still awake. That is a ton of information. I know I'm wiped. I've got to get away from this computer now.

Lower Cholesterol simply - Alternatives to Statin Drugs

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How to Reverse Hardening of the Arteries - Honest Answers, straightforward Solutions

If you presume you may have hardening of the arteries you are truly not alone with over 40 million people being diagnosed with the condition and over twice that many silently walking colse to with some degree of arterial blockage.

But the fact of the matter is that as more people learn about the dangers of this condition, all of the sudden finding ways to reverse hardening of the arteries starts to move front and center in their lives. In this description we will walk through the basics of arterial hardening and then survey both lifestyle modification and the natural possibilities ready on the road to reverse hardening of the arteries and reducing the chances of heart assault or stroke.

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For many hardening of the arteries is a case of out of sight and out of mind. It tends to produce no symptoms until artery blockage reaches 70 percent and even then many of the symptoms may rapidly subside once a person is able to sit down for a few minutes. Such symptoms as shortness of breath, chest pain, chest tightness, deadness in the extremities, loss of mental clarity, dizziness, chronic fatigue, profuse sweating, and fluid accumulation colse to the ankles are all signs of hardening of the arteries and should be evaluated by a healing professional if noticed.

How to Reverse Hardening of the Arteries - Honest Answers, straightforward Solutions

Hardening of the arteries itself is a blockage in one or more arteries. The obstruction consists of cholesterol, dead cells and fibrous tissue with calcification occurring over time. So unless steps are taken to reverse hardening of the arteries the obstruction will most likely continue to build and place more pressure on the heart to pump enough oxygen and blood for the body to continue to run smoothly. Also, it is prominent to point out that as we age our heart plainly loses some of its pumping power so what might have be a symptomless case of hardening of the arteries at one time may at some point come to be a serious life threatening condition resulting in a heart assault or stroke.

What can be done to reverse hardening of the arteries?

Your doctor will likely tell you to make both diet and lifestyle changes including eating less saturated fat and cholesterol, keeping blood sugar under operate if diabetes is an issue, reducing or eliminating salt if high blood pressure is a concern, if you smoke insisting you quit immediately, keeping weight and body mass index in a salutary range, substituting baked fish for red meat a combine of times a week, and digging your walking shoes or pool fins out of the storage closet on your way to swimming or walking for 30 minutes or more, five days a week. If he/she fails to see a reduction in cholesterol levels in a 3 to 6 month period there likely will forceful advice for you to reconsider implementing a prescription medication for lowering cholesterol such as a statin medication, prescription vigor niacin, or one of the bile acid sequestrants.

Are there any natural remedies ready to reverse hardening of the arteries?

Yes, in fact there are quite a few natural remedies which may be able to help reverse hardening of the arteries. This list would include the omega 3 fatty acids Dha/Epa found in fish oil supplements; B6, B12, and folic acid to neutralize artery damaging homocysteine amino acid levels; herbs such as hawthorn, red yeast rice, garlic, and ginkgo; enzymes such as coenzyme Q10; and plant extracts such as policosanol, lecithin oil, and phytosterol all of which aid the body in disposing of excess blood fats such as cholesterol.

If you would like to learn more about heart and artery condition and/or natural cholesterol reduction supplements Click Here

How to Reverse Hardening of the Arteries - Honest Answers, straightforward Solutions

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Abdominal Plastic surgical operation Is Safe

Abdominal plastic surgical operation is convenient for those who have failed to lose extra fat and weight by dieting or work outs. It is a procedure in which excess fat is removed from the abdominal area. Liposuction and tummy tuck are the two kinds of abdominal plastic surgery.

In liposuction, the extra fats from separate body parts are vacuumed and tummy tuck is for the women who want their pre reproduction body back. The abdominal plastic surgical operation is getting popular rapidly because of its prosperous results and patients' delight after the treatment. Though it is expanding popularity, but there are some misconceptions about the abdominal plastic surgical operation among some people. If you are one of them, you should take all the doubts and misconceptions aside and learn about this surgery. Many people have experienced this kind of surgical operation and enjoying a safe bet convert in their lives. It gives not only the confidence of looking smart, but losing lots of weight from the body makes the patient's back comfortable and reduces backache. If abdominal plastic surgical operation was not safe, then the popularity of this medicine would not have been expanding rapidly. It is the delight of the patients that urges others to go straight through the procedure.

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Liposuction and tummy tuck are wholly safe for you if some points are followed.

Abdominal Plastic surgical operation Is Safe

The most leading thing is the surgeon should be well great in the field. The surgeon should be certified for the singular medicine by the authorities. If the surgeon you consider for your plastic surgical operation is certified, you can indubitably have a safe and prosperous plastic surgery. An authentic and great plastic surgeon will treat your body determined and give you satisfactory result.

Another thing to check is the place where you get your surgical operation done. The place you are getting the surgical operation from, should be fully adequate for the treatment. Make sure you are getting the medicine in accredited ambulatory centre or a hospital, not the doctor's office or the procedure room.

Make sure to take allowable rest for 24 to 48 hours the prescribed time by the doctor, after the surgery. Ask person to stay with you and sustain for the singular time unless you recover completely. Ask a sensible person who can cope the situation of crisis to sustain you during salvage period.

Your safety during the surgical operation depends on your extensive condition condition. You must tell your surgeon if you have diabetes, heart qoute or thyroid before getting the treatment. Once your condition is optimized, you can have a safe surgery.

Abdominal Plastic surgical operation Is Safe

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Chiropractic Treatments Can Help With Headaches

Often population searching for sick relief, reach for drugs or take a trip to the pharmacy in order to find relief. For many of these population it is routine. These days we are always looking for the quick fix. However, with headaches, prevention may be the best treatment. Licensed Chiropractors have techniques that can help population out of their pain, and then give them ways in which they can prevent time to come problems.

Headaches are a coarse question for many population in today's society. Many factors like stress, poor posture, and nourishment habits can lead to continuing headaches. Many headaches come from the basal vertebrae in the neck. Many times if these vertebrae are out of alignment or subluxated muscle spasms can occur and cause a subsequent headache.

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A chiropractic adjustment is a light, diplomatic manipulation targeted at specific vertebrae. The adjustment takes pressure off the vertebrae, soft tissue and nerves and reduces the muscle spasms that cause headaches. In chiropractic treatments adjustments reduce tension and reduce pain.

Chiropractic Treatments Can Help With Headaches

Not only does chiropractic ease a current sick but the chiropractic adjustment reduces the occurrence of time to come headaches by restoring permissible alignment and permissible function. The chiropractic rehabilitation is non intrusive and many patients get quick relief from the adjustment. There is no use of drugs, injections or surgical operation that may have complications connected with them.

Chiropractic Treatments Can Help With Headaches

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Walgreens, Cvs, and Rite Aid - What Re Investors Should Know

There are 3 major drugstore chains in the Us: Walgreens, Cvs, and Rite Aid. Below are some key statistics about the 3 major drugstore chains as of 2012:

1. Walgreens ranks first with shop cap of .51 Billion, .2 Billion in 2011 total revenue (.1B from designate revenues), and an S&P rating of A. According to Walgreens, 75% of the Us population lives within 3 miles from its stores. In April 2010, it acquired 258 Duane Reade drug shop in New York Metropolitan area which brings a total of 7841 drug shop Walgreens operates as of February 2012, together with 137 hospital on-site pharmacies.

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2. Cvs ranks second with shop cap of .56 Billion, 7.1 Billion in revenue (.5 Billion from Cvs designate revenues and .1B from its Caremark designate mail order revenue), and an S&P rating of Bbb+. As of December 31, 2011, Cvs operates 7404 drug stores.

Walgreens, Cvs, and Rite Aid - What Re Investors Should Know

3. Rite Aid ranks third (fourth, behind Walmart in terms of designate revenues) with shop cap of .49 Billion, .1 Billion in revenue (.1B from designate revenues), operates 4714 drug shop as of February 2011 and has an S&P rating of B-.

Investors purchase properties occupied by these drugstore chains for the following reasons:

1. The drugstore company is very recession-insensitive. population need treatment when they are sick, regardless of the state of the economy. Both rich and poor population in the Us have way to medicine. Some even argue that low-income population use more treatment due to free or low-cost drugs offered by government-assisted programs. So the tenants should do well while tough time and have money to pay rent to landlords.

2. The drugstore company has a good expectation in the Us:

· population are living longer and need more treatment to support longevity, e.g. Actonel for osteoporosis, Aricept for Alzheimer's symptoms. Older population tend to use more treatment than younger ones as they often have more medical problems. As the 78 million baby boomers are getting closer to retiring age starting from 2008, the drugstore chains anticipate the examine for treatment to increase in next 20 years.

· The drug shop continues to advance as the Us population continues to grow. More and more Americans suffer from discrete diseases. The whole of Americans suffers from seasonal allergies doubled in the last 15 years to 37 million population per Fortune magazine. They spent .4 Billion in 2009 for allergy drugs. As their waist lines balloon (75% of Americans are forecasted to be either overweight or obese by 2020), more Americans are diagnosed with diabetes, along with high cholesterol at younger and younger ages. In addition, doctors also recommend treating discrete diseases sooner than later due to best comprehension about the diseases. For example, doctors now designate antiretroviral drugs for patients soon after infected with Hiv virus instead of waiting for the infection to come to be Aids. More doctors join insulin with oral medicines to treat type-2 Diabetes instead of just oral medicines alone. All these factors increase the size of the drug market.

· advance in genetic engineering has introduced discrete new genetic Dna testing kits which allow the genetic pathology of vulnerabilities to inherited diseases and disorders. Genetic testing is currently the highest increase segment in the diagnostics industry. Some of these genetic tests will probably transform into direct-to-consumer testing kits available in drug shop in the near future.Upon Fda approval, these new products will potentially bring in added revenue for drug stores.

· Using a new method of tailoring molecules called structure-based design; drug associates come up with new medicines that they might not have discovered otherwise, e.g. Xalkori by Pfizer to treat lung cancer.

· The passage of health Care Reform Bill on March 23, 2010 provides insurance coverage to an estimated 33 million more American. This is a great gift to the drugstore industry.

· There are new drugs to treat previously untreatable illnesses, and new diseases, e.g. Viagra for men's unhappiness, Avastin for colon cancer, Herceptin for breast cancer,. The new medicines are very expensive, e.g. A year's furnish of Avastin costs about ,000. Eli Lilly has sold about .8 billion of Zyprexa in 2007 for schizophrenia and yet most population have never heard of this medicine.

· There are existing drugs now popular ,favorite to treat new illnesses and thus increase their sales revenue. For example, Lyrica was originally intended to treat pain caused by nerve damagein population with diabetes. It is now popular ,favorite by Fda to treat Fibromyalgia which affects 5.8 million Americans per WebMd.

· Big advances in genetics, biology and stem cells investigate are predicted to furnish a new class of drugs to treat diabetes, Parkinson's and discrete rare genetic disorders. For example the new drug Ilaris from Novartis targets genetic causes of an inherited disorder that there are only 7000 known cases worldwide. However, Novartis hopes to moderately broaden its drugs to a blockbuster drug to more tasteless disorders caused by similar genetics.

· Technology and modern life introduce and want new products, e.g. pregnancy test kits, Lamisil for stronger clearer toe nails, Latisse for longer & thicker eyelashes, Propecia for male hair loss, Premarin for menopausal symptoms, diabetic monitors, electronic toothbrushes, touch lenses, lenses cleaners, diet pills, vitamins, birth-control pills, Iuds, nourishment supplements and Cholesterol-lowering pills (Americans spent nearly B in 2006 on Cholesterol medications alone per Ims Health, a Connecticut-based consulting company that monitors pharmaceutical sales.)

· Before the customers can get to the treatment aisles or pharmacy counters, they have to pass by chocolates, sodas, digital cameras, watches, toys, dolls, beers and wines, cosmetics, video games, flowers, fragrances, and greeting cards. Drug shop hope you use the one-hour photos services there. The shop also carry seasonal items, e.g. Halloween costumes, and "As Seen on Tv" merchandise, e.g. Shamwow. As a result, customers buy more than their prescriptions and treatment in these drugstores. Cvs reported that non-pharmacy sales represented 30% of the company's total sales in January of 2007. The figure for Walgreens is 34% and 37% for Rite Aid. Many pharmacy locations are in consequent convenience shop especially ones that are in residential or rural areas. And so Walgreens hopes that customers also pick up Wd-40, and screwdrivers at its shop instead of at Home Depot; Thai Jasmine rice, and fish sauce to avoid a trip to Safeway or Kroger Supermarkets. while the recession, sales of these non-drug items are down as customers buy what they need and not what they want. Walgreens tries to sacrifice the whole of items by 4000. It also introduces its own secret label which has higher profit margins.

· There are more and more generic medications on the shop as a whole of enormously favorite brand-name blockbusters lose their 20-year long patents, e.g. Lipitor (best selling drug in the world to lower cholesterol) in 2010, Viagra (you know what it's for) in 2012. Drugstores prefer to sell generic drugs to customers due to higher profit margins than the brand-name medications.

· Many population are addicted to pain killers, e.g. Hydrocodone/Oxycodone. Per the Dea in 2012, there are 1.5 million American addicted to cocaine but 7 million addicted to designate drugs.

· This author estimates that at least 10% of the dispensed designate drugs are not used at all and sit idle in the treatment cabinets. They are ultimately expired and thrown away.

3. These associates sign very long-term Nnn leases, guaranteed by their corporate assets. This makes the investment in the basic property fairly low risk, especially for Walgreens with a S&P "A" rating. In fact, these properties are sometimes referred to as investment-grade properties. Once the drugstore chains sign the lease, they pay the rent abruptly and timely. This author is not aware of any properties leased by one of these drugstore chains in which the tenants failed to pay rents. Even when the shop are closed due to weak sales (Walgreens closed 119 shop in 2007), these associates may sublease the properties to other companies, e.g. advance Auto Parts and continue to pay rents on the scholar leases.

· A typical Walgreens lease consists of 20-25 year traditional term plus 8-10 five-year options. while traditional term and options, there will be no rent increases in most of the leases. This is the main disadvantage of investing in Walgreens drugstores.

· A typical Cvs lease consists of 20-25 year traditional term plus 4-5 five-year options. The rent is commonly flat while the traditional term and then there is a 2.5%-10% rent increase in each 5-year option.

· A typical Rite Aid lease consists of 20-25 year traditional term plus 4-8 five-year options. The lease often has a rent increase every 5-10 years.

Investment Risks

Although the pharmacy company in general is recession-insensitive, there are risks complex in your investment:

1) The main downside about investing in pharmacies is there is little or no rent bump for a long time, e.g. 20-50 years, especially for Walgreens. So the rent is effectively reduced after inflation is factored in. This is one of the main reasons these properties do not appeal to younger investors, especially when the cap rate is low.

2) The 3 drugstore chains now have a new formidable competitor, Walmart. Walmart sells designate drugs in more than 4000 Walmart, Sam's Club and Neighborhood shop shop in 49 states. As of 2012, Walmart is the third largest drug retailer with .4B in designate sales, just ahead of Rite Aid with .1B in designate sales. The retail giant is known for launching in 2006 a highly-publicized generic designate drug schedule which now sells 350 generic medications for a 30-day supply. The actual whole of medications is less as the medications with separate strengths are counted as separate medications. For example, Metformin 500 mg, 850 mg, and 1000 mg are counted as 3 medications. Walmart probably makes very little profits on these medications if any. However, the marketing campaign--created by Bill Simon, the President and Ceo of Walmart Us, generates a lot of publicity for Walmart. Walmart hopes to draw customers to its shop with other prescriptions where it has higher profit margins. In an unscientific examine with just one brand-name designate of Lyrica, this author finds the bottom price at Costco, the highest price at Walgreens and Walmart at the middle. Other drug chains try to counter Walmart in separate ways. Target now offers the same 350 generic medications for for a 30-day supply. Walgreens has a designate drugs club with membership fee which offers 1400 generic medications for as little as /week. Cvs says it will match any offers from its competitors.

3) Chief company Correspondent Rick Newman from Us World & News narrative predicted that Rite Aid might not survive in 2009. Rite Aid is still colse to in 2012. The prediction seems to go away in 2012 as Rite Aid as it was able to refinance the long terms debts and sales revenue has increased.

4) Drugs are also sold in thousands of supermarkets, Target stores, and Costco warehouses. However, there are no drive-through windows at these shop or Walmart to conveniently drop off the prescriptions and pick up medicines. Customers will not be able to pick up their prescriptions while lunch hour or after 7Pm at Target shop or supermarkets. They need to have membership to buy medicines at Costco. Others may not fill their prescriptions at Walmart because they don't want to mingle with typical Walmart customers who are in lower revenue brackets. And some baby boomers don't want their prescriptions filled at Target or Walmart because there are no comfortable chairs for them to sit down and wait for their medicines.

5) Drugs retail company to some degree is controlled by the Pharmacy Benefits Managers (Pbms). Customers commonly get designate coverage from their health insurance companies, e.g. Blue Cross. These Pbm conduct designate benefits on profit of the insurance companies. In 2012 Walgreens lost a ageement valued at over Billion with Express Scripts, a major Pbm. Walgreen revenue was immediately fallen in the first quarter of 2012 as Express Scripts customers cannot fill their prescriptions at Walgreens. The Pbms are also in the drugs retail company via mail orders which do not want leasing expensive retail spaces. The designate mail orders currently capture over 20% shop share of the total designate revenue. Should customers change their designate purchase habits to mail orders (there is no such evidence in 2012), it could have negative impact to the company of drugstore chains.

6) Many leases in areas with hurricanes and tornadoes are Nnn leases with the exception of roof and structure. So if the roof is damaged, you will have to pay for the expenses.

7) The tenant may move to a new location down the road or across the street when the lease expires. This risk is high when the property is located in small town where there is low barricade for entry, i.e. Lots of vacant & developable land.

8) The tenant may ask for rent concession to heighten its bottom line while tough times. The possibility is higher if the tenant is Rite Aid and if the store has low sales revenue and/or higher than shop rent.

9) More Americans are walking away from their prescriptions, especially the most expensive brand-name medicines. This may have negative impact on the sales revenue and profits of drug shop and consequently may cause drug store closures. According to Wolters Kluwer Pharma Solution, a health-care data company, nearly 1 in 10 new prescriptions for brand-name drugs were abandoned by population with commercial health plans in 2010. This is up 88% compared to 4 years ago just before the retreat began. This trend is driven in part by higher and higher co-pays for brand name drugs as employers are shifting more insurance costs to their employees.

Among 3 drugstore chains, Walgreens and Cvs pharmacies in general have the best locations-at major intersections while Rite Aid has less than premium locations. Walgreens tends to hire only the top graduates from pharmacy schools while Rite Aid settles with bottom graduates to save costs. When possible, all drugstore chains try to fill the prescriptions with generic medications which have higher profit margins.

1) Walgreens: the company was founded in 1901 by Charles Walgreen, Sr. In Chicago. While the company has existed for more than 100 years, most shop are only 5-10 years old. This is the best managed company among the three drugstore chains and also among the most admired group associates in the Us. The company has been run by executives with proven track records and hires the top graduates from universities. Due to its classic financial strength--S&P A rating-- and premium irreplaceable locations, properties with leases from Walgreens get the highest price per quadrilateral foot and/or the bottom cap rate among the 3 drugstore chains. In addition, Walgreens gets flat rent or very low rent increases for 20 to 60 years. The cap rate is often in the low 5% to 6.5% range in 2012. Investors who buy Walgreens tend to be more mature, i.e. Closer to retirement age. They are finding for a safe investment where it's more important to get the rent check than to get appreciation. They often correlate the returns on their Walgreens investment with the lower returns from Us treasury bonds or Certificate of Deposits from banks. Walgreens opened many new shop in 2008 and 2009 and thus you see many new Walgreens shop for sale. It will slow down this expansion in 2010 and beyond and focus on renewal of existing shop instead.

2) Cvs Pharmacy: Cvs Corporation was founded in 1963 in Lowell, Ma by Stanley Goldstein, Sidney Goldstein, and Ralph Hoagland. The name Cvs stands for "Consumer Value Stores". As of 2009, Cvs has about 6300 shop in the Us, mostly through acquisitions. In 2004, Cvs bought 1,200 Eckerd Drugstores mostly in Texas and Florida. In 2006, Cvs bought 700 Savon and Osco drugstores mostly in Southern California. And in 2008 Cvs acquired 521 Longs Drugs shop in California, Hawaii, Nevada and Arizona for .9B dollars. The acquisition of Long Drugs appears to be a good one as it Cvs did not have any shop in Northern Ca and Arizona. Besides, the price also included real estate. It is also bought Caremark, one of the largest Pbms and changed the corporation name to Cvs Caremark. When Cvs bought 1,200 Eckerd stores, it formed a single-entity Llc (Limited Liability Company) to own each Eckerd store. Each Llc signs the lease with the property owner. In the event of a default, the owner can only legally go after the assets of the Llc and not from any other Cvs-owned assets. Although the owner loses the guaranty security from Cvs corporate assets, this author is not aware of any incident where Cvs closes a store and does not pay rent.

3) Rite-Aid: Rite Aid was founded by Alex Grass (he just passed away on Aug 27, 2009 at the age of 82) and opened its first store in 1962 as "Thrif D allowance Center" in Scranton, Pennsylvania. It officially incorporated as Rite Aid Corporation and went group in 1968. By the time Alex Grassstepped down as the company's chairman and chief administrative officer in 1995, Rite Aid was the nation's largest drugstore chain in terms of total shop and No. 2 in terms of revenue. His son, Martin Grass, took over but was ousted in 1999 for overstatement of Rite Aid's revenue in the late 1990s. Rite Aid is now the weakest financially among the 3 drugstore chains. In 2007, Rite-Aid acquired about 1,850 Brooks and Eckerd drugstores, mostly along the East coast to catch up with Walgreens and Cvs. In the process, it added a huge long term debt and is the most leveraged drugstore chain based on its shop value. The integration of Brooks and Eckerd did not seem to go well. revenue from some of these shop went down as much as 20% after they change the sign to Rite Aid. In 2009, Rite-Aid had over 4900 shop and over Billion in revenues. The figures went down in 2010 to 4780 shop and .53 billion in revenue. On January 21, 2009 Moody's Investor Services downgraded Rite Aid from "Caa1" to "Caa2", eight notches below investment grade. Both ratings are "junk" which indicate very high credit risk. Rite Aid contacted a whole of its landlords in 2009 trying to get rent concession to heighten the bottom line. In June 2009, Rite Aid successfully completed refinancing .9 Billion of its debts. In 2012, Rite Aid benefits from Walgreens ageement question with Express Scripts. Same store sales increased 2.2%, 3.2%, and 3.6% for January, February and March of 2012, respectively. Rite Aid is still losing money in fiscal year 2012 which ended in March 3, 2012. However, it is losing less, .43 per share in 2012 versus .64 per share in fiscal year 2011. The company expects best outlook in fiscal year 2013.

Things to think when invested in a pharmacy

If you are interested in investing in a property leased by drugstore chains, here are a few things to consider:

1. If you want a low risk investment, go with Walgreens. In stable or growing areas, the degree of security is the same either the property is in California where you get a 5.5% cap or Texas where you may get a 6.5% cap. So, there is no vital advantage to spend in properties in California as the property value is based primarily on the cap rate. In 2012, the offered cap rate for Walgreens seems to come down from 7.5%-8.4% in 2009 to 5.5%-6.5% for new stores.

2. If you are willing to take more risk, then go with Rite-Aid. Some properties surface of California may offer up to 9% cap rate in 2012. However, among the 3 drug chains, Rite Aid has 10.5% chance of going under in 2010. Should it avow bankruptcy, Rite Aid has the option to pick and select which locations to keep open and which locations to quit the lease. To minimize the risk that the store is shuttered, select a location with strong sales and low rent to revenue ratio.

3. Financing should be an important consideration. While the cap rate is lower for Walgreens than Rite Aid, you will be able to get the best rates and terms for Walgreens.

4. If you are not a conservative investor or risk taker, you may want to think a Cvs pharmacy. It has Bbb+ S&P credit rating. Its cap rate is higher than Walgreens but lower than Rite Aid. Some leases may offer best rent bumps. On the other hand, some Cvs leases, especially for properties in hurricane areas, e.g. Florida are not truly Nnn leases where landlords are responsible for the roof and structure. So make sure you adjust the cap rate down accordingly. Some of the Cvs locations have onsite Minuteclinic staffed by registered nurses. Since this clinic idea was introduced recently, it's not clear having a clinic inside Cvs is a plus or minus to the bottom line of the store.

5. All 3 drugstore chains have similar requirements. They all want highly visible, standalone, rectangular property colse to 10,000 - 14,500 Sf on a 1.5 - 2 acre lot, preferably at a projection with about 75 - 80 parking spaces in a growing and high traffic location. They all want the property to have a drive-through. Hence, you should avoid purchasing an inline property, i.e. Not standalone and property with no drive-through windows. There is a chance that these drugstores may not want to renew the lease unless the property is located in a densely-populated area with no vacant land nearby. In addition, if you secure a property that does not meet the new requirements, for example a drive-through, you may have a question getting financing as lenders are aware of these requirements.

6. If the pharmacy is opened 24 hours a day, it is in a best location. Drugstore chains do not open the store 24 hours day unless the location draws customers.

7. Many properties may have a ration lease, i.e. The landlord can get added rent when the store's every year revenue exceeds a obvious figure, e.g. M. However, the revenue used to compute ration rent often excludes a page-long list of items, e.g. Wine and sodas, tobacco products, items sold after 10 Pm, drugs paid by governmental programs. The excluded sales revenue could list for as much as 70% of store's gross revenue. As a result, this author has seen only 2 shop in which the landlord is able to secure added ration rent. The store with a ration rent is required to narrative its every year sales to the landlord. As an investors, you want to spend in a store with strong gross sales, e.g. Over 0 per quadrilateral foot a year. In addition, you also want to check the rent to revenue ratio. If the figure is in the 2-4% range, the store is likely to be very profitable so the chance the store is shut down is low.

8. It does not matter how good the tenants are, avoid investing in declining, e.g. Detroit and/or low-income areas or small towns with less than 30,000 residents within 5 miles ring. In a small town, it may be the only drug store in town and captures most of the shop share. However, if a competitor opens a new location in the area, revenue may be severely affected. In addition, the tenant can all the time moves to a new location down the road when the lease expires since there is low barricade to entry in a small town. These properties are easy to buy now and hard to sell later. When the credit shop is tight, you may have problems finding a lender to finance these properties.

9. Many properties have an existing loan that the buyer must assume. If you have a 1031 exchange, think twice about buying this property. You should clearly understand loan assumption requirements of the lenders before challenging forward. Should you fail to assume the existing loan (assuming an existing loan is a lot more difficult than getting a new loan), you may run out of time for a 1031 exchange and may be liable to pay capital gain.

10. With few exceptions, drugstore chains do not own the shop they occupy for any reasons. Here are just a join of them:

- They know the pharmacy company but don't know real estate. Stock investors also don't want Walgreens to come to be a real estate investment company.

- Owning the real estate will want them to carry lots of long term debts which is not a great idea for a publicly-traded company.

11. About 10% of the drugstore properties for sale and typically Cvs pharmacies want very small whole of equity to acquire, e.g. 10% of the purchase price. However, you are required to assume an existing fully-amortized loan with zero cash flow. That is, all of the rent paid by the tenant must be used to pay down the loan. The cap rate may be in the 7-9% range, and the interest rate on the loan could be challenging in the 5.5% to 6% range. Hence, the investor pays off the loan in 10 to 20 years. However, you have no obvious cash flow. This requires you to come up with surface cash to pay revenue tax on the rental profits (the discrepancy in the middle of the rent and mortgage interest). The longer you own the property, the more surface cash you will need to pay revenue taxes as the mortgage interest will get less and less toward the end. So who would buy this kind of property?

- The investors who have big losses from other investment properties. By acquiring this zero cash flow property, they may offset the revenue from the drugstore tenant against the losses from other investment properties. For example, a property has 5,000 of rental profits a year, and the investor also has losses of 0,000 from other properties. As a result, the combined assessable profits are only ,000.

- The uninformed investors who fail to think that they have to raise added cash to pay revenue taxes.

Out of the Box Thinking

If you put too much weight on the S&P rating of the tenants, you may end up either taking a lot of risks or passing up good opportunities.

  1. A Good location should be the key in your decision on which drug store to spend in. It's often said a lousy company should do well at a great location while the best tenant will fail at a lousy location. A Walgreens store that is closed down later on (yes, Walgreens closed 119 shop in 2007) is still a bad investment even though Walgreens continues paying rent on time. So you don't want to blindly spend in a drug store simply because it has a Walgreens sign on the building.

  2. No company is crazy sufficient to close a profitable location. It does not take rocket science to understand that a financially-weak company like Rite Aid will make every endeavor to keep a profitable location open. On the other hand, a financially-strong Walgreens will need justifications to keep an unprofitable location open. So how do you decide if a drug store location is profitable or not if the tenant is not required to disclose its profit & loss statement? The answer is you cannot. However, you can make an educated guess based on the store's every year gross revenue which is often reported to the landlord as required by the ration clause in the lease. With the gross revenue, you can decide the rent to revenue ratio. The lower the ratio, the more likely the store is profitable. For example, if the every year base rent is 0,000 while the store's gross revenue is M then the rent to revenue ratio is 5%. As a rule of thumb, it's hard to make a profit if this ratio is more than 8%. So if you see a Rite Aid with 3% rent to revenue ratio then you know it's likely a very profitable location. In the event Rite Aid declares bankruptcy, it will keep this location open and continue paying rent. If you see a Rite Aid drug store with 3% rent to revenue ratio contribution 10% cap, chances are it's a low risk investment with good returns and the tenant will most likely to renew the lease. The weakness of corporate guaranty from Rite Aid is probably not as vital and the risk of having Rite Aid as a tenant is not de facto that significant.

  3. Drug shop with new 25 years leases tend to sell at lower cap, e.g. 6-7% cap on new shop versus 8.0-8.5% cap on established locations with 5-10 years remaining on the lease. This is because investors are afraid that the tenants may not renew the leases. Unfortunately, lenders also have the same fear! As a result, many lenders will not finance drug shop with 2-3 years left on the leases. The fact that drugstores with new leases have a premium on the price means they have inherent of 20% depreciation (buying new at 6% cap and selling at 7.5% cap when the leases have 8 year left). Some investors will not think investing in drug shop with 5-10 years left on the lease. They might simply ignore the fact that the established shop may be at irreplaceable locations with very strong sales. Tenants simply have no other choices other than renewing the lease.

Walgreens, Cvs, and Rite Aid - What Re Investors Should Know

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