Brooklyn Community. SUNY Downstate Medical Center

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1 Brookly Commuity Health Report o Asthma SUNY Dowstate Medical Ceter

2 Cotets Itroductio... 2 Key Fidigs... 3 What Is Asthma?... 4 Types of Asthma... 4 Who Is at Risk for Asthma?... 5 Factors that Affect or Trigger Asthma... 5 Adolescets with Asthma... 6 Adults with Asthma... 8 Asthma Emergecy Room Visits Asthma Hospitalizatios Asthma Deaths Fightig Asthma Techical Notes... 15

3 Itroductio Asthma is oe of the fastest growig chroic diseases, affectig more tha 25 millio Americas. It causes adults to miss days from work ad childre to miss school. Whe medical bills are factored i, asthma costs are estimated to be more that $3,000 per perso each year. While overall asthma rates have more tha doubled sice the 1980s, childhood asthma has icreased more tha 160 percet; the greatest icrease is amog Africa America childre. Because of their smaller size ad developig lugs, childre are more vulerable to the allerges ad irritats that ca trigger asthma. The elderly, too, have a higher risk, especially those with other respiratory coditios, such as peumoia ad the flu. Recet studies poit to a strog coectio betwee high asthma rates ad socioecoomic status. I a cluster of eighborhoods kow as Asthma Alley i North-Cetral Brookly, the South Brox, Harlem, ad parts of Quees, asthma rates are uusually high. What may of these eighborhoods have i commo is that they are ear factories, saitatio trasfer statios, ad busy roadways that produce high levels of air pollutio. Poor housig coditios i stressed commuities also put residets at greater risk for asthma from ecouters with vermi, roaches, ad mold. As show i this Health Report o Asthma, several Brookly eighborhoods, especially three i North-Cetral Brookly Bedford Stuyvesat-Crow Heights, East New York, ad Williamsburg-Bushwick have far higher rates of emergecy room visits ad hospitalizatios for asthma tha the rest of the borough ad New York City. Asthma rates are highest amog the very youg ad the elderly. I Williamsburg-Bushwick, people over 65 were hospitalized for asthma at three times the rate of other Brookly residets their age. Such widespread eed for hospital ad emergecy care suggests that asthma is ot beig properly treated ad cotrolled i may parts of Brookly. Elimiatig asthma-related health disparities requires a cocerted effort amog may commuity parters. As a member of the New York City Asthma Partership, Dowstate is part of a coalitio of over 400 govermet agecies, medical ceters, schools, ad commuity groups who have joied together to provide research, educatio, ad improved access to healthcare, while workig to also address behavioral ad evirometal risk factors for asthma. Public health educatio has bee a effective tool for combatig asthma i homes ad schools. I have asthma but asthma does t have me, a advertisig campaig sposored by the NYC Childhood Asthma Iitiative i , helped lower the rate of childhood asthma hospitalizatios by more tha a third. Similarly, the Asthma Friedly Schools Campaig, begu i 2011, is makig strides i reducig abseteeism i city schools. Though it s ot yet possible to cure or prevet asthma, it ca be treated ad cotrolled so that commuities are ot burdeed by the disease ad people ca lead more active, purposeful lives. 2

4 key fidigs COMMUNITY HEALTH SURVEYS ON ASTHMA Amog adolescets: More high school studets livig i the orth-cetral eighborhoods of Brookly reported that they had asthma tha those from other eighborhoods. More Black ad Hispaic tha White ad Asia studets i Brookly ad New York City reported that they had asthma. More adolescet males tha females said they had asthma. Amog adults: More wome tha me i every locale reported they had asthma. A greater percetage of Blacks ad Hispaics tha Whites i Brookly ad New York City reported havig asthma. Williamsburg-Bushwick, Dowtow-Brookly Heights-Park Slope, Greepoit, East New York, Bedford Stuyvesat-Crow Heights, ad Caarsie-Flatlads had a higher percetage of residets who report that they had asthma tha the borough. ASTHMA EMERGENCY ROOM VISITS AND HOSPITALizatios The rate of emergecy room visits for asthma i Brookly was much higher tha for asthma hospitalizatios. While Childre had much higher ER rates tha adults, childre youger tha 5 ad adults over 65 had the most emergecy room visits ad hospitalizatios. Emergecy Room Visits Childre uder the age of 5 i Bedford Stuyvesat-Crow Heights, East New York, ad Williamsburg-Bushwick had much higher rates of emergecy room visits compared to childre i other Brookly eighborhoods, Brookly as a whole, ad the rest of New York City. Adults livig i Williamsburg-Bushwick, Bedford Stuyvesat-Crow Heights, ad East New York had higher rates of emergecy room visits tha residets i other Brookly eighborhoods, the borough, ad the rest of the city. Hospitalizatios Childre uder 5 i East Flatbush-Flatbush, Bedford Stuyvesat-Crow Heights, East New York, ad Williamsburg-Bushwick were hospitalized for asthma at higher rates tha those i Brookly as a whole ad the rest of the city. The commuities of Greepoit, East New York, Suset Park, Bedford Stuyvesat-Crow Heights, ad Williamsburg-Bushwick had higher asthma hospitalizatio rates for adults over 65 tha Brookly ad the rest of the city. The elderly i Williamsburg-Bushwick had hospitalizatios rates for asthma that were three times higher tha the rate for seiors i the borough. 3

5 what is asthma? Asthma is a disease that affects the airways of the lugs, causig them to become swolle, arrow, ad filled with mucus. Mucus build-up makes breathig difficult ad ca lead to a asthma attack. A very serious attack requires medical attetio. A asthma attack ca be triggered by cotact with substaces that irritate the lugs. Polle, mold, cockroaches, ad house dust mites ca cause a reactio i people who have allergic asthma about 60 percet of all asthma cases. Other types of asthma ca be triggered by tobacco smoke or exercise. A list of asthma triggers ca be foud o page 5. Normal Airway Trachea (widpipe) TYPES OF ASTHMA BY SEVERITY OF SYMPTOMS There are may types of asthma ad affect people differetly. Asthma that comes ad goes over time is kow as itermittet asthma. Asthma that occurs frequetly is kow as persistet asthma. Persistet asthma symptoms ca be mild, moderate or severe, ad these determie the type ad level of treatmet. Swolle liig Icreased mucus Airway Durig Asthma Episode Muscle costrictio TYPES OF ASTHMA BY FACTORS THAT PRODUCE SYMPTOMS Kowig the kid of asthma you have ad what triggers symptoms ca help you maage your asthma ad lesse its severity. Allergic asthma occurs after repeated exposure to allerges such as chemical fumes, dust, ad aimal dader. Cough-variat asthma whe a dry cough is the oly symptom. Occupatioal asthma occurs from exposure to irritats o the job or at the workplace. Exercise-iduced asthma occurs durig or followig exercise. SOME COMMON ASTHMA SYMPTOMS Wheezig (a whistlig soud whe you breathe) Tightess i the chest Shortess of breath Coughig Medicatio-iduced asthma occurs whe some medicatios take for other health coditios ca cause severe bouts or worseig of asthma. Noctural (ighttime) asthma occurs whe the amout of air you breathe durig sleep falls ad causes coughig, wheezig, ad shortess of breath that disrupt sleep. Source: Guidelies for the Diagosis ad Maagemet of Asthma. Natioal Heart, Lug, ad Blood Istitute,

6 what is asthma WHO IS AT RISK FOR ASTHMA? Asthma ofte starts i childhood but ca happe at ay age. It ca ru i families but may people with asthma may have o other family members with it. Persos who have peumoia ad iflueza or have other chroic pulmoary diseases are more likely to get asthma. Persos livig or workig ear the World Trade Ceter at the time ad immediate aftermath of the attack may be at greater risk for asthma ad other chroic respiratory diseases. FACTORS THAT AFFECT OR TRIGGER ASTHMA May thigs affect whether a perso has asthma ad how severe it will be. Family history or geetics may make a perso more likely to develop asthma. Idoor ad outdoor factors, such as tobacco smoke ad rapid chages i temperature may icrease the chaces of gettig asthma. I cities ad large urba areas like Brookly, dust mites, cockroaches ad chemicals used to kill or clea areas are probable factors. The diagram below shows the may differet factors that are associated with asthma. However, ot all factors that affect asthma are well uderstood. EVERY DAY IN THE UNITED STATES 40,000 people will miss school or work because of asthma; 30,000 people will have a asthma attack; 5,000 people will go to the ER because of their asthma; 1,000 people will be admitted to the hospital because of their asthma; ad 11 people will die due to asthma. Source: Asthma ad Allergy Foudatio of America, 2011 Idoor Factors Cockroaches ad Dust Mites Secod-had or Cigarette Smoke Cat ad Pet Hair Fugi ad Molds Fumes from Stoves ad Heaters Additives ad Preservatives Cleaig Products Outdoor Factors Smoke ad Dust Ozoe ad Sulphur Dioxide Automotive ad Factory Fumes Very Cold Temperatures Polle ad Grasses Other Factors Viruses & Bacteria Pai Medicatios: Aspiri, Ibuprofe, etc Beta-blockers Foods: Fish/Shellfish, Soy, Nuts, Eggs, Wheat Stress & Psychological Factors Work-Related or Occupatioal Hazards ASTHMA AND THE USE OF ACETAMINOPHEN Research published i Pediatrics (2011), Chest (2009), Lacet (2008), ad Aals of Allergy ad Asthma Immuology (1998) suggest that acetamiophe (Tyleol, etc.) may be liked to a icreased risk of asthma i childre ad adults. Util more research is completed o whether it is the dose or other factors, medical recommedatios are to cotiue the use of acetamiophe i asthma treatmet but uder the guidace of a doctor. 5

7 Adolescets with Asthma To fid out how commo asthma is amog adults ad childre, the New York City departmet of Health ad Metal Hygiee periodically coducts surveys askig, Have you ever be told that you have asthma? Roughly 20 percet of high school studets surveyed said they had bee told they have asthma. There was little differece betwee male ad female high school studets amog those surveyed. A slightly lower percetage of Brookly studets reported that they had asthma tha their couterparts i the city, state, ad atio. A greater percetage of studets i the orth-cetral part of Brookly reported havig asthma tha i the borough as a whole. Brookly compares favorably with other boroughs i New York City for the percetage of adolescets who said they had asthma. Adolescets Ever Told They Had Asthma, by Residece, percet of adolesets surveyed Brookly North & Cetral Brox Mahatta Quees State Islad Brookly Source: 2009 YRBS - Epiquery, NYCDOHMN, 2011 Adolescets Ever Told They Had Asthma, by Sex, 2009 BROOKLYN (%) New York City (%) New York State (%) Uited States (%) Ever Told Had Asthma Male Female

8 adolescets with asthma The racial ad ethic profile of high school studets who reported that they had asthma was differet for Brookly ad the city compared to the state ad atio More Black ad Hispaic adolescet studets i Brookly ad New York City said they had asthma those who were White or Asia. More White adolescets i New York State ad the atio reported beig told they had asthma tha those i Brookly or New York City. IN THE UNITED STATES Nearly 5 millio childre uder 18 have asthma. Asthma is the most commo childhood disease percet of childre have asthma compared to 3-5 percet of adults Asthma is the #1 cause of school abseteeism amog childre ages 5 to 17. Source: Asthma ad Allergy Foudatio of America, 2011 Adolescets Ever Told They Had Asthma, by Race/Ethicity, Brookly New York City New York State Uited States 25.0 percet of adolesets surveyed White No-Hispaic Black No-Hispaic Hispaic Asia Source: 2009 Youth Risk Behavior Survey, Epiquery - NYCDOHMH; Youth Risk Behavior Survey, Ceters for Disease Cotrol & Prevetio,

9 Adults with asthma A lower percetage of adults i Brookly reported that they had asthma compared to the city, state ad atio. A higher percetage of wome tha me reported beig told they had asthma. More Black ad Hispaic residets reported havig asthma tha whites. Lower proportios of Whites, Blacks, ad Hispaics i Brookly reported havig asthma tha those i the city, state, or atio. IN THE UNITED STATES Asthma is the 4th leadig cause of abseteeism ad preseteeism (goig to work sick). 15 millio missed or lost workdays each year are due to asthma. $8 billio i lost earigs due to illess or death aually is due to asthma. Source: Asthma ad Allergy Foudatio of America, 2011 Adults Ever Told They Had Asthma, by Sex, 2009 BROOKLYN (%) New York City (%) New York State (%) Uited States (%) Ever Told Had Asthma Male Female Adults Ever Told They Had Asthma, by Race/Ethicity, Brookly New York City New York State Uited States percet of adults surveyed White Black Hispaic Asia & Pacific Islader Source: 2009 CHS - Epiquery, NYCDOHMH; 2009 Behavioral Risk Factor Surveillace System, 2011 Note: Estimates for Brookly Asia & Pacific Isladers should be viewed with cautio due to low respose rate. Asia & Pacific Islader data ot available for NYS or US. 8

10 Adults with asthma I 2009, 1 out of 10 Brookly adults reported beig told they had asthma. However, the percetages varied by eighborhood. Two eighborhoods Williamsburg-Bushwick ad Dowtow-Heights-Slope reported much higher percetages of adults with asthma tha the borough or city. Williamsburg-Bushwick, Dowtow-Heights-Slope, Greepoit, East New York, Bedford Stuyvesat-Crow Heights, ad Caarsie-Flatlads had a higher percetage of adults who reported they ever had asthma tha the borough. Adults Ever Told They Had Asthma, by UHF Neighborhood, 2009 Borough Park 4.1 East Flatbush-Flatbush 4.9 Besohurst-Bay Ridge 6.6 Suset Park 8.4 Coey Islad-Sheepshead Bay 9.1 Caarsie-Flatlads 10.5 Bedford Stuyvesat-Crow Heights East New York Greepoit Williamsburg-Bushwick 16.1 Dowtow-Heights-Slope 19.1 Brookly 9.7 New York City 11.5 New York State Uited States percet of adults surveyed Source: 2009 CHS - Epiquery, NYCDOHMH; 2009 Behavioral Risk Factor Surveillace System,

11 Asthma emergecy room visits The rate of emergecy room visits for childre with asthma is far greater tha for adults, ad it is especially high for childre uder the age of 5. Childre uder 5 livig i three Brookly eighborhoods Williamsburg-Bushwick, East New York, ad Bedford Stuyvesat- Crow Heights had far higher rates of emergecy room visits tha childre i other Brookly eighborhoods, Brookly ad the rest of the city. Childre i most Brookly eighborhoods had higher rates of ER visits tha i the rest of the state. These higher rates may show that childre i these eighborhoods are ot receivig the care they eed to maage their asthma. Or it may be that these commuities have a greater burde of pollutats ad other factors (as show o page 6) that cotribute to asthma. Emergecy Room Visits for Childre with Asthma, Borough Park Besohurst-Bay Ridge Age 5-17 Age 0-4 Coey Islad-Sheepshead Bay Suset Park Greepoit Dowtow-Heights-Slope East Flatbush-Flatbush Caarsie-Flatlads Williamsburg-Bushwick East New York Bedford Stuyvesat-Crow Heights Brookly New York City exc Brookly New York State exc NYC Source: SPARCS Data, NYSDOH, Bureau of Biometrics, rate per 10,000 populatio 10

12 asthma emergecy room visits Adults have a lower rate of emergecy room visits for asthma tha childre. Williamsburg-Bushwick, Bedford Stuyvesat-Crow Heights, ad East New York had higher rates of emergecy room visits for adult asthma tha other Brookly eighborhoods, Brookly ad the rest of the city. Adults i most Brookly eighborhoods had higher ER visit rates tha the rest of the state. Higher rates may idicate that adult asthma is ot beig treated properly or that these commuities have a greater share of factors that worse asthma. Adults betwee the ages of 18 ad 64 years have higher ER asthma rates tha those over 65. This age group may ot have their asthma treated properly compared to those over 65. Emergecy Room Visits for Asthma i Adults, Borough Park Besohurst-Bay Ridge Coey Islad-Sheepshead Bay Greepoit Suset Park Caarsie-Flatlads Dowtow-Heights-Slope East Flatbush-Flatbush East New York Bedford Stuyvesat-Crow Heights Williamsburg-Bushwick Age 65+ Age Brookly New York City exc Brookly New York State exc NYC Source: SPARCS Data, NYSDOH, Bureau of Biometrics, rate per 10,000 populatio 11

13 Asthma hospitalizatios Childre usually have higher hospitalizatio rates for asthma tha adults. If their asthma were treated effectively or maaged cotiuously the eed for hospital care would be much lower ad less costly. Childre uder the age of 5 had far higher hospital discharge rates tha those betwee the ages of 5 ad 17. East Flatbush-Flatbush, Bedford Stuyvesat-Crow Heights, East New York, ad Williamsburg-Bushwick had higher asthma hospitalizatio rates for childre uder 5 compared to Brookly ad the rest of New York City. IN THE UNITED STATES Childre accout for early half (44 percet) of all asthma hospitalizatios. Asthma is the third leadig cause of hospitalizatios for childre. Source: Asthma ad Allergy Foudatio of America, 2011 Asthma Hospitalizatios for Childre, Borough Park Besohurst- Bay Ridge Age 5-17 Age 0-4 Coey Islad- Sheepshead Bay Greepoit Suset Park Caarsie-Flatlads Dowtow- Heights-Slope East Flatbush- Flatbush Bedford Stuyvesat- Crow Heights East New York Williamsburg- Bushwick Brookly New York City exc Brookly New York State exc NYC rate per 10,000 populatio Source: SPARCS Data, NYSDOH, Bureau of Biometrics,

14 asthma hospitalizatios Asthma hospitalizatio rates ted to be lower for people betwee the ages of 18 ad 64 tha for older adults over 65. I five Brookly eighborhoods Greepoit, East New York, Suset Park, Bedford Stuyvesat-Crow Heights, ad Williamsburg- Bushwick residets over the age of 65 had higher asthma hospitalizatio rates tha those for Brookly ad the rest of the city. The elderly i Williamsburg-Bushwick had rates three times the rate for the borough. This may suggest that asthma i this populatio is ot beig well maaged ad cotrolled. Adults, especially those over 65, also have a higher risk for other respiratory illesses, such as iflueza, peumoia, ad chroic obstructive pulmoary disease (COPD), which ca further complicate asthma. Asthma Hospitalizatios for Adults, Besohurst- Bay Ridge Borough Park Age Age 65+ Coey Islad- Sheepshead Bay Caarsie-Flatlads East Flatbush- Flatbush Dowtow- Heights-Slope Greepoit East New York Suset Park Bedford Stuyvesat- Crow Heights Williamsburg- Bushwick Brookly New York City exc Brookly New York State exc NYC rate per 10,000 populatio Source: SPARCS Data, NYSDOH, Bureau of Biometrics,

15 Asthma deaths Deaths due to asthma are ot as commo as for other respiratory coditios but serious complicatios ca occur i persos with severe asthma. Brookly had slightly higher age-adjusted death rates compared to the city, state, ad atio. IN THE UNITED STATES Persos over 65 accout for early half of deaths due to asthma. Africa Americas are three times more likely to die from asthma tha people of other races/ethicities. Source: Asthma ad Allergy Foudatio of America, 2011 Age-adjusted Death Rate for Asthma, Brookly New York City New York State Uited States* age-adjusted rates per 100,000 populatio Source: Vital Statistics Data, NYSDOH, 2011, Deaths: Fial Data for 2007; NVSS, May * US deaths reported for Death rates due to asthma icreased prior to the mid-1990s but have declied gradually for the past decade or more. Age-adjusted Asthma Death Rates i Brookly ad NYC, age-adjusted death rate per 100,000 populatio Brookly New York City exc Brookly Source: NYCDOHMH Note: 1998 ad 1999 death data adjusted by 2000 cesus 14

16 FIGHTING ASTHMA While there is o cure for asthma, over the past few decades major strides have bee made i treatig it. I 1999, the Departmets of Health for New York State ad New York City established the New York City Asthma Iitiative ad New York City Asthma Partership (NYCAP) to combat asthma through educatio, better access to care, research, ad reducig behavioral ad evirometal risk factors. The New York City Asthma Partership (NYCAP) is a city-wide coalitio of over 400 orgaizatios with represetatives from schools, health care istitutios, commuity based orgaizatios, persos with asthma ad their families, govermet, ad other groups committed to combatig the asthma epidemic i New York City. For more iformatio ad to get ivolved i your commuity s effort to elimiate asthma, cotact the partership at: New York City Asthma Partership New York City Departmet of Health ad Metal Hygiee East 110th Street New York, NY Tel: Fax: ycap@health.yc.gov Cotact the New York City Asthma Partership for the groups or orgaizatios i your commuity or Brookly that are ivolved i asthma prevetio, care ad services. Techical Notes Asthma mortality data for New York City ad Brookly come from the Epiquery: NYC Iteractive Health Data System Vital Statistics Mortality Data Sets, New York City Departmet of Health ad Metal Hygiee. Additioal mortality data was requested from the Bureau of Epidemiology Services, NYCDOHMH ad Bureau of Biometry, New York State Departmet of Health. Asthma mortality data for the Uited States come from Deaths: Fial Data for 2007, Natioal Vital Statistics System (NVSS), Ceters for Disease Cotrol & Prevetio, May Emergecy room visits ad hospitalizatios for asthma were geerated from the Statewide Plaig ad Research Cooperative System (SPARCS) ad provided by the Bureau of Biometry, New York State Departmet of Health. Defiitios for Asthma are based o the ICD 9 ad 10 codes used by the Office of Vital Statistics, New York City Departmet of Health ad Metal Hygiee, New York State Departmet of Health, ad the Ceters for Disease Cotrol ad Prevetio whe compilig ad reportig o disease hospitalizatios ad mortality. Survey data o asthma were obtaied olie from the 2009 Commuity Health Surveys (CHS) ad Youth Risk Behavior Survey located at Epiquery a iteractive health data system of the NYCDOHMH. Asthma survey data for the Uited States was obtaied from the 2009 Behavioral Risk Factor Surveillace System ad Youth Risk Behavior Survey at the Ceters for Disease Cotrol ad Prevetio. The CHS is a radomized, telephoe survey coducted aually by the Bureau of Epidemiology Services, Divisio of Epidemiology, NYCDOHMH that estimates a wide rage of chroic diseases ad behavioral risk factors. It is a cross-sectioal survey that samples approximately 10,000 adults age 18 ad older from all five boroughs of New York City. The survey data are self-reported by NYC residets ad provide isights ad better uderstadig of the health status ad behaviors of persos residig i the UHF eighborhoods. All results are age-adjusted ad restricted to persos over 50 years old. Specifics regardig the exact wordig ad explaatio for the CHS survey questios ca be foud at the Age-specific rates ad other demographic idicators were obtaied usig data from the 2000 U.S. Cesus. I istaces whe the hospitalizatio ad mortality couts are too small, the calculated rates are ustable ad should be viewed with cautio. These fidigs are highlighted ad oted i the documet. All disease outcomes are age-adjusted whe possible. A age-adjusted rate takes ito cosideratio the differeces i the distributio of age i a populatio ad the impact it may have o disease outcomes. This is importat whe comparig the prevalece of disease i differet geographic areas if the age distributio withi the areas is ot the same. 15

17 SUNY Dowstate Medical Ceter would like to thak the followig idividuals for their help i preparig the Report o Chroic Obstructive Pulmoary Disease: RESEARCH Steve D. Ritzel, MPH, MIA Director for Regioal Plaig ad Public Health Research, Office of Plaig, ad Cliical Assistat Professor, School of Public Health ADVISORY COMMITTEE Judith LaRosa, PhD, RN Professor of Policy ad Maagemet ad Vice Dea, School of Public Health Michael A. Joseph, PhD, MPH Assistat Professor of Epidemiology ad Biostatistics, School of Public Health Mira Grice Sheff, PhD Assistat Professor of Evirometal ad Occupatioal Health Scieces, School of Public Health Deise M. Bruo, MD, MPH Assistat Professor of Commuity Health Scieces, School of Public Health Maria E. Yomtov, RN MSN CDE Associate Director of Nursig ad Director, Ceter for Commuity Health Promotio ad Welless, SUNY Dowstate Patiet Educatio Departmet Michael Harrell, MPA Assistat Vice Presidet for Commuity ad Govermetal Relatios Doris Youdelma Seior Editor/Writer, Office of Istitutioal Advacemet REVIEWERS Pascal James Imperato, MD, MPH & TM SUNY Distiguished Service Professor ad Dea, School of Public Health Madu Rao, MD Professor Emeritus of Pediatrics Elle Watso Assistat Vice Presidet for Istitutioal Advacemet Desig: Bruce Kuo Cover Desig: Bruce Kuo Divisio of Biomedical Commuicatios Published by the Office of Istitutioal Advacemet ad the Office of Plaig SUNY Dowstate Medical Ceter, 2011 For other Health Reports i this series, go to:

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