Protect Children,
Protect Our Future
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Children are 30% of the
world's population, but
100% of our future.
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Take Action to Protect
Children Where They Live,
Learn, and Play
Ixisks from environmental exposure at
home, school, and at play can be reduced if
care is taken to assure a healthy environment.
Governments, non-government organizations,
private industry, educational institutions, and
individuals can make a difference in protect-
ing children from environmental harm.
Through policy-making, research, and educa-
tion we can work together to protect our
children and our future.
Promote Policies that Protect Children
Communities, states, and the federal
government can create policies that protect
children from environmental risks and pro-
vide proper medical care to those children
exposed to such risks. Legislation, regulations,
and standards in areas such as housing, trans-
portation, education, agriculture, health, and
the environment, should explicitly consider
children's environmental exposures and
health effects.
Increase Scientific Knowledge about
Children's Environmental Health
Scientific evidence shows that children
are different from adults in terms of their
exposure and susceptibility to pollutants.
This evidence may explain the relationship
between environmental risks and some
childhood illnesses. Still, gaps exist in our
understanding of how, and to what extent,
environmental contaminants cause or exacer-
bate childhood diseases and developmental
disorders. Children's environmental health
research should be a priority.
Enhance Diagnosis and Treatment of
Environment-Related Illnesses
The public turns to health care profes-
sionals for environmental health informa-
tion. The health care community must be
trained in environmental health, and
equipped to share information about
environmental risks and children's health.
Educate the Next Generation
Youth involvement in recycling programs
created a cultural change in the way we man-
age our trash. Programs aimed at children and
youth will create a new generation of experts
on environmental health—a generation that
will be prepared to answer the new questions
that our ever-changing world poses.
Protect Children Beyond Our Borders
Children's environmental health issues
span the globe and transcend political bound-
aries. The priorities of developed countries may
not be the same as those in developing coun-
tries, but they are similar enough to warrant
international cooperation and collaboration
for technical, scientific, and economic reasons.
For more information about children's environmental health and ways you can
get involved, visit EPA's Office of Children's Health Protection Web site at
www.epa.gov/children or call toll-free 1-877-590-KIDS.
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Protecting children
from environmental
risks is fundamental
to the U.S. Environmental
Protection Agency's (EPA)
efforts to make the world
a healthier place,
now and for future
generations.
Children need clean air to breathe, clean
water to drink, safe food to eat, and a healthy
environment to learn, grow, and thrive. Yet
every day, children are exposed to environmental
risks that may stand in the way of these basic
necessities. They may even be more vulnerable
to some environmental risks than adults for
several reasons:
• Children's nervous, immune, digestive, and
other systems are still developing and their
ability to metabolize or inactivate toxicants
may be different than adults;
• Children eat more food, drink more fluids,
and breathe more air in proportion to their
body weight than adults; and
• Children's behavior—such as crawling and
placing objects in their mouths—may result
in greater exposure to environmental
contaminants.
Many of the health problems that result
from exposure to harmful environmental condi-
tions can be prevented, managed, and treated.
This is why EPA considers risks to children when
setting standards to control pollution. You can
play a role, too.
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Children Need
Protection Where They
Live, Learn, and Play
Each day, children may be exposed to a variety of environmental contami-
nants at home, school, and outdoors. These environmental exposures can have
harmful effects on children's health and behavior, and the amount and timing
of exposure can influence the magnitude of these effects. Children need our
protection. Learning about children's environmental health is the first step to
protecting them from environmental risks.
Children are often at risk of exposure to
indoor air pollution.
Poor indoor air quality can cause respiratory illness in children because their
respiratory systems are still developing. They also breathe more air than adults
in proportion to their body weight. Respiratory diseases, such as asthma, can
severely affect a child's ability to live an active life.
Exposure to allergens and irritants, including animal dander, cockroaches,
mold, and dust mites, plays a significant role in triggering asthma episodes in
children. Secondhand tobacco smoke is another asthma trigger that typically
occurs in the home. It may cause bronchitis, pneumonia, and ear infections,
and is believed to be associated with sudden infant death syndrome (SIDS). Since
children spend a lot of their time at home,
-^ day care, and school, reducing their
exposure to indoor environmen-
tal triggers in these places is
especially important.
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Outdoor air poii
ution may affect
children more than adults.
Outdoor activity is part of a healthy lifestyle,
but when air pollution levels are high, adverse
health effects may result. Outdoor air pollutants
that have been shown to be particularly harmful to
children include ozone and fine particulate matter.
Other air pollutants, such as sulfur dioxide (SO2),
nitrogen oxides (NOx), and toxic air pollutants, also
may affect children's health.
Ground-level ozone (a component of smog) is
formed when NOx and other air pollutants react in
the presence of heat and sunlight. Smog can cause
coughing, throat irritation, and chest pain. It can
reduce lung function, inflame the linings of the
lungs, and trigger asthma attacks, even the day
after ozone levels are high. Repeated inflammation
over time may permanently scar lung tissue.
Children and teenagers who are active
outdoors-especially those with asthma or other
respiratory illnesses-are particularly vulnerable
to smog.
Some fine particles are emitted directly into the
air from combustion sources such as cars, trucks, buses, construction and farming
equipment, and electric utilities. Fine particles in urban air also result from
chemical reactions of SO2 and NOx with other chemicals in the atmosphere.
Exposures to fine particles have been linked to a number of children's health
problems, including bronchitis and asthma. Diesel exhaust is a source of fine
particles and is also a likely human carcinogen.
SO2 is formed when fuel containing sulfur-mainly coal, oil, and diesel-is
burned, and during metal smelting and other industrial processes. The majority
of SO2 released into the air comes from electric utilities and refineries, particu-
larly those that burn coal. SO2 contributes to respiratory disease, and may
aggravate existing heart and lung disease.
NOx refers to a group of highly reactive gases emitted by motor vehicles,
electric utilities, and other fuel-burning industrial and commercial sources. NOx
gases can contribute to respiratory illnesses especially in children, and as noted
above, both SO2 and NOx can react to form harmful particles in the air.
Toxic air pollutants, also known as hazardous air pollutants, are emitted from
combustion sources, such as motor vehicles and power plants, and industrial
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activities. A number of commonly occurring toxic air pollutants, including
solvents, organic chemicals, and heavy metals, have been shown to harm the
developing nervous system, reproductive organs, and immune system-all of
which grow and develop rapidly during the first months and years of life.
Long-term exposure to some toxic air pollutants may cause cancer.
Lead
is a risk to children's physical and
mental development.
Removing lead from gasoline in the U.S. is considered by many to be one of
the great public health achievements of this generation. Lead levels in children's
blood dropped dramatically from the
1970s to the mid-1980s, as the use of
leaded gasoline was phased out.
However, lead still poses a risk.
Lead was a common ingredient
in household paint until it was
banned in 1978. Children
living in homes built before 1978
may be exposed to hazards from
deteriorated lead paint and lead
dust. Because children play
outside and frequently put their
hands in their mouths, contami-
nated soil near automobile repair
shops, abandoned mines, industrial sites, and
highways also may be a source of exposure. In addition, lead in drinking
water can contribute to overall lead exposure. Childhood exposure to lead may
result in damage to the nervous system leading to behavioral problems and
reduced intelligence, and may cause impaired growth and hearing.
is toxic during child development.
Children born to women with substantially elevated blood mercury levels are
at increased risk for nervous system and developmental effects, delayed onset of
walking and talking, and abnormalities in vision, hearing, and speech. At far lower
exposures, reduced neurological and developmental test scores occur. Children
exposed to mercury after birth may be sensitive to the toxic effects of
mercury because their nervous systems are still developing.
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Mercury is found in the environ-
ment in several forms, but coal-fired
power electric utilities are the
largest source of mercury emissions
in the U.S. Mercury emitted from
plants and other combustion
sources is deposited on surface
water and transformed into
methylmercury, which builds up
in fish. People are exposed to
methylmercury almost exclusively by eating
fish. Though fish is an important part of a balanced diet, federal and state fish
advisories guide consumers to limit their intake of certain fish that contain higher
levels of mercury.
Children may be exposed to contamination through
the water supply.
The U.S. has one of the safest water supplies in the world. Public water
systems test water for more than 90 chemical, microbial, and radiological
contaminants, and are required to treat water to remove harmful substances
under the Safe Drinking Water Act.
While actual events of serious drinking water contamination are infrequent
and usually of short duration, it is possible for children to ingest contaminated
water from a public water system or, more commonly, from a private well or by
swimming in polluted bodies of water. Microbial contaminants, such as bacteria
and viruses, are of special concern because they may cause immediate or acute
reactions, such as vomiting or diarrhea. Long-term exposure to some contami-
nants, including pesticides, minerals, and solvents, at levels above standards may
cause gastrointestinal problems, skin irritations, cancer, reproductive and develop-
mental problems, and other chronic health effects. High levels of nitrates in
drinking water can cause serious
illness in infants. If contamination
poses an immediate health threat,
water suppliers are required by law
to notify customers right away.
Individuals with private wells are
responsible for testing to assure
that the water is safe to drink.
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Children may be more sensitive and more exposed to
pesticides.
Children, due to their relative body size, may be more exposed to pesticides
because they drink more water, breathe more air, and eat more of certain foods
compared to adults. Young children
eat three to four times more food
than adults in proportion to their
body size, and they often eat greater
proportionate quantities of a more
limited variety of foods. Children
may be disproportionately exposed
to certain pesticide residues that
may be present in food. Still, for
children and adults alike, the
benefits of a diet that includes
fruits and vegetables far outweigh
the potential risks of pesticides.
Children's behavior, such as playing on lawns, floors, or carpeting recently
treated with pesticides, as well as putting their fingers or objects, including dirt
and toys that may be contaminated with pesticide residues, in their mouths, also
can lead to higher exposures. Access to containers of pesticides and other
chemicals in the house, garage, or storage sheds can result in dangerous exposures.
The dose, toxicity, and timing of exposure can have a significant impact on
the nature and severity of the resulting health effect. During early years of
development, children's bodies metabolize substances differently than adults.
In some cases, this may make a pesticide more toxic to a child. Too much
exposure to pesticides may lead to a variety of health effects, such as acute
poisoning, disruption of the hormone and immune systems, respiratory problems,
neurological damage, and cancer.
Elevated levels of
radon
in indoor air
may cause cancer.
Radon is an invisible, odorless, radioactive gas that comes from the natural
breakdown of uranium in soil, rock, and water. Radon can enter into basements
or crawl spaces through cracks and porous foundations, leading to high levels in
indoor air where children may sleep or play. In some locations, well water
containing dissolved radon also may affect children's health. Testing homes for
radon is simple and inexpensive, and if discovered, radon problems can usually
be fixed.
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Carbon monoxide
can be a risk
to fetuses, infants, and children.
Carbon monoxide (CO) is a colorless, odorless, tasteless gas produced
whenever any fuel such as gas, oil, kerosene, wood, or charcoal is burned.
If indoor and outdoor appliances that burn fuel are properly installed, vented,
maintained, and used, the amount of CO in the air we breathe is usually not
hazardous. However, dangerous levels of CO can accumulate where appliances
are not working with proper ventilation or are used incorrectly. If a pregnant
woman is exposed to elevated levels of CO, it may harm the fetus. Infants and
children are believed to be more susceptible to CO exposure than adults.
Exposure to very high levels of CO can result in severe injury or death.
Unprotected Sim
during childhood increases lifetime risk for skin cancer.
Children spend much of their time outdoors, exposed to the sun. Overexposure
to ultraviolet (UV) radiation from the sun can cause sunburns in the short term,
but also may lead to long term health problems such as skin cancer, cataracts, and
premature aging of the skin. Just one or two blistering childhood sunburns may
double the risk of some skin cancers as an adult. Artificial sources of UV light such
as sunbeds and sunlamps also can damage the skin and unprotected eyes.
Preliminary scientific research suggests that UV radiation also may harm the
immune system.
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ONLINE RESOURCES TO PROTECT CHILDRE,
The following is a list of online tools and resources provided by the U.S. Environmental Protection Agency
(EPA) to educate and encourage the public to protect children from environmental risks at home, at
school, and outdoors. EPA is working with many partners to protect children's environmental health and
links to non-EPA Web sites can be found at www.epa.gov/children.
LIVE
Indoor Air Quality - Provides information about indoor air quality topics, resources, and hotline
numbers.
www.epa.gov/iaq
A Brief Guide to Mold, Moisture, and Your Home - Provides information and guidance for
homeowners and renters on how to clean up residential mold problems and how to prevent mold
growth.
www.epa.gov/iaq/molds/moldguide.html
Lead Poisoning Prevention - Provides information about lead, lead hazards, and simple steps
to protect your family.
www.epa.gov/lead
Pesticides and Lead Poisoning - Offers simple tips to protect children from pesticides and lead
poisoning in the home.
www.epa.gov/oppfead1 /cb/10_tips
Ground Water and Drinking Water - Provides information about the quality and safety of
our drinking water.
www.epa.gov/safewater
Drinking Water from Household Wells - Gives private household well owners answers to the
most frequently asked questions, describes potential problems, and offers maintenance suggestions.
www.epa.gov/safewater/faq/faq/html1tfpwell
Asbestos Home Page - Provides information and resources about asbestos in the home.
www.epa.gov/asbestos
Pesticides and Food - Explains what your family needs to know about children's health risks
associated with pesticides and food.
www.epa.gov/pesticides/food
LEARN
Healthy School Environments - Serves as a gateway to EPA and other online resources to help
facility managers, school administrators, architects, design engineers, school nurses, parents, teachers,
and staff address environmental health issues in schools.
www.epa.gov/schools
Indoor Air Quality Tools for Schools' - Helps school personnel identify, solve, and prevent
indoor air quality problems in the school environment.
www.epa.gov/iaq/schools
Integrated Pest Management in Schools - Encourages school officials to adopt Integrated
Pest Management (IPM) practices to reduce children's exposure to pesticides.
www.epa.gov/pesticides/ipm
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Student Environmental Human Health Information - Explores ways in which students can
protect their health.
www.epa.gov/students/health.htm
Sunwise School Program - Focuses on children's health risks associated with overexposure to
the sun, UV radiation, and ozone depletion.
www.epa.gov/sunwise
Lead-Free Schools and Day Care Centers - Provides information on reducing the risk of lead
exposure from drinking water in educational facilities.
www.epa.gov/safewater/lead/schoolanddccs.htm
PLAY
Beach Watch - Describes EPA's goals of improving public health and environmental protection
programs for beach goers, and provides the public with information about the quality of their
beach water.
www.epa.gov/waterscience/beaches
Mercury Fish Advisories - Provides consumption advisories for commercial and non-commercial
fish, and information on the risks associated with mercury in freshwater fish.
www.epa.gov/ost/fish
www.epa.gov/mercury/fish.htm
Outdoor Air Quality - Offers information about air quality in your area and provides links to air
pollution data and maps.
www.epa.gov/air/urbanair/whappen.html
AIR NOW- Provides information on ozone maps, air quality forecasts, and health facts.
www.epa.gov/airnow
Diesel Exhaust and School BUS Idling - Encourages school districts to establish school bus
idling guidelines to protect children from exposure to diesel exhaust.
www.epa.gov/region01/eco/diesel/assets/pdfs/Diesel_Factsheet_Schoolbus.pdf
Chromated Copper Arsenate (CCA) Treated Wood - Provides information about wood
pressure treated with cromated copper arsenate (CCA), which is commonly used on playground
equipment.
www.epa.gov/pesticides/factsheets/chemicals/cca_qa.htm
Other useful tools and resources:
EPA's President's Task Force on Environmental Health Risks and Safety Risks to Children
http://yosemite.epa.gov/ochp/ochpweb.nsf/content/Whatwe_fedtask.htm
EPA's Strategy for Research on Environmental Risks to Children
www.epa.gov/ncea/pdfs/strat4resrch.pdf
Children's Environmental Health and Safety Inventory of Research (CHEHSIR)
www.oaspub.epa.gov/chehsir/chehsir.page
America's Children and the Environment: A First View of Available Measures
http://yosemite.epa.gov/ochp/ochpweb.nsf/content/pdf50.htm/$File/ACE-Report.pdf
Smart Growth Information
www.epa.gov/livablecommunities
*For links to additional online resources about children's environmental health, visit EPA's Office of
Children's Health Protection web site at www.epa.gov/children.
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THE FACTS ABOUT CHILDREN'S HEALTH
An estimated 6.3 million children (8.7 %) under 18 year of age had asthma in 2001. '
Hospitalizations for asthma increased from 21 per 10,000 children in 1980 to 29 per 10,000 children
in1999.2
In 1999, asthma was the fourth ranking cause of non-injury-related hospitalization among children
less than 1 5 years of age.3
In 2000, 233 children under 18 years of age died from asthma.4 The number of children ages 1-14
dying from asthma increased 180 % from 1979 to 1998.5
Asthma disproportionately affects children from lower-income families and children from different
racial and ethnic groups.6
Asthma is the most common chronic childhood disease in the United States.7
Economic Impact Of Asthma In 1994-1996, children with asthma missed approximately
14 million school days a year.8
The direct and indirect costs of asthma to the U.S. economy were estimated at $14 billion in 2002. 9
• About 1/3 of the costs are associated with children's asthma.10
• School absenteeism costs over $1 .5 billion each year in lost productivity.11
Asthmatic patients and their families pay a higher portion of their medical care costs than patients
with other diseases because of heavy reliance on prescription medication combined with lower
insurance coverage for prescription drugs.
• They pay about 25 % of the cost themselves compared to 10 % for other general medical care costs.12
About 430,000 American children (approximately 2 percent) ages 1-5
had elevated levels of lead in their blood (that is, levels at or greater than 10 ug/dL) in 1999-2000.
That number of lead poisoned children declined significantly from 4.7 million in 1978.13
Childhood lead poisoning reduces IQ, which can never be regained14.
The decline in blood lead levels is due largely to the phasing out of lead in gasoline between 1973
and 199515 and to the reduction in the number of homes with lead-based paint from 64 million in
1990 to 38 million in 2000.16
Today, elevated blood lead levels are due mostly to the ingestion of contaminated dust, paint, and soil.17
Blood lead levels are higher for children ages 1-5 from lower-income families and for certain racial
and ethnic groups.18
EPA, America's Children and the Environment, Second
Edition, 2003, p. 69. See http://yosemite.epa.gov/
ochp/ochpweb.nsf/content/pub I ications.htm.
2lbid, p. 75.
3lbid.
4CDC, http://www.cdc.gov/nchs/products/pubs/pubd/
hestats/asthma/asthma.htm.
American Lung Association, Trends in Asthma
Morbidity and Mortality, March 2003, Table 4. See
http://www2.lungusa.org/data/asthma/ASTHMAdt.pdf.
EPA, America's Children and the Environment, p. 71.
7National Academy of Science, Clearing the Air: Asthma
and Indoor Air Exposures, 2000, Executive Summary, p. 1.
Mannino, D,, D, Homa, L, Akinbami, J, Moorman, C, Gwynn,
and S, Redd, Surveillance for Asthma-United States, 1980-
1999, Morbidity and Mortality Weekly Report 51 (SS01), p, 5,
Seehttp://www,cdc,gov/mmwr/PDF/SS/SS5101,pdf
9NIH,rrttp://www,nhlbi,nih,gov/resources/docs/02_chtbk,pdf,
10EPA, National Costs of Asthma for 1997, pp, 21-22,
11 American Lung Association, Table 17,
1ZEPA, National Costs of Asthma for 1997, p, 24,
13EPA, America's Children and the Environment, Second
Edition, 2003, p, 53, See http://yosemite.epa.gov/ochp/
ochpweb.nsf/content/publ ications.htm,
ATS DP,, Case Studies in Environmental Medicine, Lead Toxicity,
revised September 1992, See http://wondercdc.gov/wonder/
prevguid/p0000017/p0000017,aip,
1SEPA, National Air Quality and Emissions Trends Report, 1998
(2000), p, 78, See http://www.epa,gov/oar/aqtrnd98/toc,html
16D, Jacobs, R, Clickner, J, Zhou, S, Viet, D, Marker, J, Rogers,
D, Zeldin, R Broene, and W, Friedmanm, 2002, The
Prevalence of Lead-based Paint Hazards in U.S. Housing,
Environmental Health Perspectives 110(10): 599-606 (2002),
17CDC, Screening Young Children for Lead Poisoning:
Guidance for State and Local Public Health Officials, 1997,
Seehttp://www,cdc,gov/nceh/lead/guide/guide97,htm,
18CDC,http://www,cdc,gov/nceh/lead/factsheets/
childhoodlead.htm.
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Economic Impact Of Lead Poisoning Reduced cognitive ability, as measured by IQ scores
and valued in terms of forgone earnings, is estimated to be about $9,600 per IQ point lost.19
The cost of not eliminating lead exposure to children between 2000-2010 is expected to be about
$22 billion in forgone earnings.20
In 199S, approximately 12,400 children younger than 20 years of age
were diagnosed with cancer and 2,500 died.21
Cancer is the leading cause of death by disease among children between 1 and 1 9 years of age in the
United States. It is the third most common overall cause of death, preceded only by intentional injuries
and accidents.22
Leukemia was the most common cancer diagnosis for children under age 20 from 1975-1995, followed
by central nervous system tumors, and lymphomas.23
The causes of childhood cancer are poorly understood, though in general it is thought that different
forms of cancer have different causes.24
Economic Impact of Childhood Cancer The total cost per case of childhood
cancer is estimated to be approximately $623,000 (in 1998 dollars).25
The estimated annualized cost of cancer for children under 15 years of age is $4.8 billion
(in 1998 dollars).26
Approximately 12 million children (17 percent)
under age 18 suffer from one or more developmental disabilities, which include physical, cognitive,
psychological, sensory, and speech impairments.27
In 1 997-2000 about 0.6 percent of children were reported to be diagnosed with mental retardation.28
Between 3 and 8 percent of the babies born each year will be affected by developmental disorders
such as attention-deficit/hyperactivity disorder or mental retardation.29
Mental retardation is more common for children from lower-income families and for certain racial and
ethnic groups.30
The causes of developmental disorders are generally unknown.31
Economic Impact Of Developmental Disorders State and federal education depart
ments spend about $36 billion each year on special education programs for individuals with develop-
mental disabilities who are 3-21 years of age.32
Although it is hard to estimate the costs of caring for children with more serious forms of mental
retardation, the costs may be as much as 10 times higher than caring for a child who does not have a
disability.33
"President's Task Force on Environmental Health Risks and zzlbid, Z7CDC, http://www.cdc.gov/ncbddd/dd,
Safety Risks to Children, Eliminating Childhood Lead Z3|b 2 zs ^^ Mdren and ^ Environmmt Smnd
Poisoning; A Federa Strategy Targeting Lead Paint Hazards, c.,., «rtrt, Or c ... „ ,. , . ,
February 2000, p. A-26, See http*psemiteepa,gov/ Z4EPA, America's Children and the Environment, Second E*°"'h „' P' , " "P/*0™'6'™0*^'
ochp/ochpweb,nsf/content/leadhaz,htm/$file/leadhaz,pdf. Edition, 2003, p, 76, See http://yosemite.epa.gov/ochp/ ochpweb.nsf/content/publications.htm,
zoih'ri A ?a ochpweb.nsf/content/publications.htm, B, Weiss and P, Landrigan, The Developing Brain and the
Ibid, p, A-^8, Environment: An Introduction, Environmental Health
s« ,Supp,,3,: 373, ,2000,,
rrir
G. Bumn, Cancer Incidence and Survival among Chi dren and A|mican Chi|dren; Estimate of Morbid| Morta|i and so ^^ Mdren and ^ Environmmt 85
E~£3sH£
Seehttp://seercancergov/publications
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