TAG: "Health information technology"

Electronic health records can be used to predict sepsis risk, mortality

UC Davis study shows how EHRs can help identify best practices in medicine.

Tim Albertson, UC Davis

UC Davis researchers have found that routine information — blood pressure, respiratory rate, temperature and white blood cell count — from the electronic health records (EHRs) of hospitalized patients can be used to predict the early stages of sepsis, a leading cause of death and hospitalization in the U.S. Also, they determined that just three measures — lactate level, blood pressure and respiratory rate — can pinpoint the likelihood that a patient will die from the disease.

“EHRs have become essential resources for providing relevant information on patients’ medical histories and improving the quality of care,” said study co-author Tim Albertson, chair of UC Davis Department of Internal Medicine. “We have shown that they can also be powerful resources for identifying best practices in medicine and reducing patient mortality.”

Sepsis is an immune system response to infection that can damage organs and cause permanent physical and mental disabilities. It is associated with increased blood levels of lactate, an acid produced when organs receive too little oxygen.

Patients are rarely screened for blood lactate levels, because sepsis is very hard to distinguish in its early stages. The blood test also lacks specificity, as many patients with elevated lactate do not have sepsis.

While early treatment with broad-spectrum antibiotics and intravenous fluids is associated with better outcomes for those with sepsis, the potential harm from those treatments for low-risk patients far outweighs the benefits.

“Finding a precise and quick way to determine which patients are at high risk of developing the disease is critically important,” said study co-author Hien Nguyen, associate professor of internal medicine and medical director of electronic health records at UC Davis. “We wanted to see if EHRs could provide the foundation for knowing when aggressive diagnosis and treatment are needed and when they can be avoided.”

In conducting their investigation, the researchers analyzed data from the EHRs of 741 patients with sepsis at UC Davis Medical Center during 2010. They found that vital signs combined with serum white blood cell count — measures routinely taken for hospitalized patients — could accurately predict high lactate levels and sepsis. Also, they found that lactate level, blood pressure and respiratory rate could determine a patient’s risk of death from sepsis.

The research team is now working on a specific sepsis-risk algorithm that can be automatically calculated in the EHR.

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Nursing school hopes to improve care for cancer patients with social network

Participating patients will use a tablet device as part of UC Davis project.

Several chemotherapy patients at the UC Davis Comprehensive Cancer Center will be invited to use tablets with a unique social networking tool as part of their treatment plan. Researchers at the Betty Irene Moore School of Nursing at UC Davis hope to prove that mobile health technology improves the care experience for patients as well as the quality of care while also reducing cost.

The project is part of a two-year, $199,854 grant from the McKesson Foundation and its national Mobilizing for Health Initiative. Research on mobile health technology in cancer care is new, said Jill Joseph, the associate dean for research at the nursing school. Other cancer-related mobile applications are available, but are limited to education and awareness and don’t provide disease management tools or real-time communication.

“We have ample evidence that cancer patients often receive fragmented care, experience significant distress, and may needlessly require care in emergency departments or inpatient settings, particularly during chemotherapy,” Joseph said. “Little research and development has focused on providing novel technologies to support cancer care coordination.”

Participating patients will use a tablet device, such as a Google Nexus or iPad, to connect to their unique and private Personal Health Network that includes a nurse coordinator — who manages the their care — along with family, caregivers, clinicians and other desired partners. These people can connect with one another through real-time messaging, video and audio components as well as schedule appointments, assign tasks, store and track information and more.

A nurse coordinator is assigned to support each chemotherapy patient who uses the mobile application. This coordinator monitors the patient’s care plan, triages issues and communicates with caregivers. Unlike electronic health records and other information systems common in hospitals, the social networking platform allows patients, their families and caregivers to not only access information but communicate with another and make decisions about care and health management.

“This is a new tool designed with the patient and family at the center of care,” said Katherine Kim, a recent doctoral graduate of the UC Davis nursing school who is now a visiting faculty member and project director.

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UC Davis tests smartphone app to help patients with mental illness

Ginger.io enables individuals to actively record their symptoms on a daily and weekly basis.

Ginger.io app

Sacramento-area youth in the early stages of serious mental illness can receive a new smartphone app that helps them detect early warning signs of psychosis, through a one-year, $588,000 grant to the UC Davis Early Diagnosis and Preventive Treatment (EDAPT) Clinic from the Robert Wood Johnson Foundation, to study whether harnessing mobile technology improves patient care.

The app, called Ginger.io, enables individuals to actively record their symptoms on a daily and weekly basis, while information on their movements and daily social contacts, such as the number of incoming telephone calls and text messages, is gathered in the background.

“We are trying to identify the early warning signals that someone is struggling, so we can intervene earlier and hopefully prevent relapse,” said Tara Niendam, assistant professor in the Department of Psychiatry and Behavioral Sciences and director of operations for the EDAPT Clinic. “If an individual is having a bad week, we can reach out to them quickly, rather than waiting for them to call us or come in to the clinic for their next appointment.”

The early stages of psychotic illness, which affects an estimated 2 percent of Americans, represent critical periods for intervention. Eighty percent of individuals relapse within the first five years of receiving a diagnosis. Annual health care costs associated with psychosis are approximately $23 billion. Using Ginger.io, the UC Davis EDAPT clinic aims to improve early identification of symptom exacerbations, giving providers the ability to intervene early in the hope of preventing relapse.

Ginger.io’s three-part platform — patient app, behavioral analytics engine and provider dashboard — gives care providers a window into their patients’ health between office visits. The patient app and behavioral analytics use smartphone sensors to detect abnormalities in the patient’s sleep, communication and movement patterns. Any concerning changes in daily patterns are communicated to the provider via the dashboard, allowing clincians to deliver timely interventions. Ginger.io has offices in San Francisco and Cambridge, Mass.

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Grant will fund research in use of wireless technologies to manage health

Sensors to remotely monitor TB treatment.

Sara Browne, UC San Diego

Sara Browne, UC San Diego

The Alliance Healthcare Foundation has awarded the University of California, San Diego School of Medicine a $1 million Innovation Initiative (i2) Grant to support the work of Dr. Sara Browne, associate professor in the School of Medicine’s Division of Infectious Diseases. The grant is funding groundbreaking research in the use of wireless technologies in the management of personal and public health.

Browne is collaborating with colleagues at UC San Diego’s Anti-Viral Research Center, using technology developed by Proteus Digital Health, which has developed a system to track how and when individuals take medications. The system utilizes an ingestible and wearable sensor platform.

The ingestible sensor records time of medication ingestion and transmits the data to the wearable sensor in the form of a patch worn on the patient’s torso. The patch also collects activity and rest patterns and sends the information to a secure mobile application.

“The power of such a technology for physicians is that it reveals regular information on patients’ medication taking behavior and daily health patterns, enabling them to make better informed treatment decisions and to provide tailored support to their patients,” said Browne.

Browne and colleagues are using this technology to remotely monitor TB treatment, comparing it to directly observed therapy (DOT), where a health care worker personally witnesses the ingestion of medication by the patient. While DOT is the current gold standard for TB treatment monitoring, it is very time- and resource-intensive, making it unattainable for many developing countries, as well as too expensive for many domestic TB programs. Poor adherence to medication for TB is a major problem, one that exacerbates infection rates and boosts drug resistance.

“Wireless technologies have the potential to positively impact public health in San Diego and Imperial counties,” said Browne. “This technology can ultimately impact TB treatment globally, providing new methods of TB therapy monitoring and support to many more patients. This would mean better treatment completion rates, less drug resistance and, consequently, fewer cases of TB.”

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Apple honors UC Irvine’s iMedEd Initiative

Medical education iPad program named an Apple Distinguished Program.

With their iPads, UC Irvine medical students have at their fingertips all the information they need to read, study and participate in the classroom and in clinical training.

With their iPads, UC Irvine medical students have at their fingertips all the information they need to read, study and participate in the classroom and in clinical training.

The iMedEd Initiative – UC Irvine’s innovative medical education iPad program – has been recognized as a 2013-15 Apple Distinguished Program. The initiative joins a select group of exemplary learning environments being recognized nationwide. The Apple Distinguished Program designation is awarded for  innovation, leadership and educational excellence, and demonstration of  clear vision.

“The iMedEd Initiative is truly groundbreaking for its innovative, digital-based educational platform that conforms to the 21st century learning styles and needs of students throughout the world,” said Dr. Ralph V. Clayman, dean of the UC Irvine School of Medicine. “We’re honored that Apple has recognized our achievements for a second time.”

The iMedEd Initiative is reinventing the traditional medical school curriculum. It was the first to build a completely digital, interactive, tablet-based learning environment – which includes portable ultrasound clinical training – and continues to lead in adapting emerging technologies for all aspects of medical education. This academic year, the entire four-year curriculum has been placed on iPad, giving UC Irvine one of the first all-digital program medical schools in the nation.

Since 2010, when the initiative was launched, incoming UC Irvine medical students have received fully loaded iPads, putting at their fingertips all the information they need to read, study or review. This multimedia approach accommodates all modes of learning, especially small group sessions.

The iMedEd Initiative is fully supported by the John and Mary Tu Scholarship Fund, which finances the purchase of  iPads and a complete library of digital textbooks for all incoming UC Irvine medical students. The iMedEd Initiative was also recognized as a 2012-13 Apple Distinguished Program.

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New medical specialty aimed at harnessing data to improve patient care

Clinical informatics is first new board-certified specialty in 20 years.

Patient dataA new specialty in clinical informatics has been launched at UC San Francisco, addressing the growing need to harness the power of massive quantities of patient information in the era of precision medicine and health care reform.

This new board certification is designed to educate doctors on how to collect, synthesize and present data to deliver patient care more safely and effectively.

The select group of pioneering physicians who will receive the first national board certification in Clinical Informatics includes pediatric hospitalist Seth Bokser, M.D., medical director for information technology at UCSF Benioff Children’s Hospital. Awarded by the American Board of Preventive Medicine, the certification recognizes the increasingly vital role that the science and practice of informatics plays in health care.

Clinical informatics was recognized as a medical subspecialty in 2011 by the American Board of Medical Specialties, and is the first new board-certified medical specialty in 20 years.

“Health care is an information-management business,” said Bokser. “It has always been, but we have finally reached a new era where we are harnessing the power of IT to take in, organize, retrieve, analyze, reason and report on the data for individual patients and populations.”

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Research team enlists ‘citizen-sensors’ to improve world health

UC San Diego researchers and students seek crowdfunding support for project.

Researchers are going to deploy sensing devices in the field connected to mobile apps that allow them to track the health of individuals and the environment.

Researchers are going to deploy sensing devices in the field connected to mobile apps that allow them to track the health of individuals and the environment.

Enterprising researchers and students at UC San Diego are looking for funding to complete a “citizen-sensor” project that, they hope, will revolutionize global health and environmental monitoring – especially in remote and undeveloped areas of the planet.

They also hope to attract the faith and funding of people around the world through the open, global crowdfunding resource Indiegogo, the first partnership between UC San Diego and a funding platform.

The Indiegogo campaign, they stress, is more a call for widespread citizen participation in health monitoring than a simple appeal for funds.

“What if you could hold the power of modern medical equipment in the palm of your hand?” they ask. The device the students call “a cool gizmo” can also monitor your environment’s health by sampling the air, soil, and water for pollutants, then analyze and report the findings.

For non-Star Trek fans, the gizmo is much like the “tricorder” of the popular sci-fi series — a nifty handheld device used for scanning, analyzing, and recording data. Less evocatively named, but nearly as high-tech, the UC San Diego device is called the Open Health Stack.

It would beneficially alter the landscape of the medical economy, researchers say, first by changing how people sense and perceive their own health, and then by collecting enough data to enable changes to environmental practices or policies.

Making those ambitious goals a reality is the role of their Distributed Health Lab, a collaboration between UC San Diego’s School of Medicine and the Qualcomm Institute, the UC San Diego division of the California Institute for Telecommunications and Information Technology (Calit2).

Drs. Albert Yu-Min Lin and Eliah Aronoff-Spencer, co-directors of the lab, and co-principal investigators for the project, say that the multidisciplinary nature of the project will be key to its success. “We have a large number of truly talented collaborators in the School of Medicine as well in the School of Engineering,” says Lin. “Helping their different skills to coalesce, along with the amazing energy and imagination of our students, will be instrumental.”

The researchers and students – from such diverse fields as nanoengineering, medicine, machine-learning, cryptography, crowdsourced archaeology, citizen science, and human & computer ethnography – are building the Open Health Stack using cloud infrastructure, mobile apps and sensors that will collect and analyze data from individuals and the environment.

The first “layer” of the stack is SENSE, the heart of the gizmo, a health-and-environment sensor that tracks vital signs and measures, for example, heavy metals in water or cholera in streams. The pocket-size device enables users to learn more about their surroundings.

The next layer is MyOasis, a mobile app that interacts with the sensors and lets users monitor and report what the sensors discover. MyOasis visualizes data collected by SENSE, allowing users to “see” things invisible to the eye, such as heart rates.

The final layer is KEEP, a secure data-storage-and-analysis platform that detects large-scale trends, like flu outbreaks, with the help of machine-learning algorithms.

“Together,” Aronoff-Spencer says, “they provide an end-to-end solution for collecting and analyzing data at the individual, community, and global levels.”

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UCLA gets top honor in adopting electronic medical records

Hospitals join UC Davis, UC San Diego at Stage 7; UC Irvine, UCSF at Stage 6.

David Feinberg, UCLA

David Feinberg, UCLA

Three UCLA hospitals — Ronald Reagan UCLA Medical Center, the Resnick Neuropsychiatric Hospital and UCLA Medical Center, Santa Monica – received a top honor from HIMSS Analytics it was announced on Dec 10.

UCLA’s hospitals received HIMSS Analytics’ acute care Stage 7 award, an award that represents attainment of the highest level of electronic medical record progress at hospitals and health systems.  Most recently, only 2.2 percent of the more than 5,400 U.S. hospitals in the HIMSS Analytics Database have received this recognition. UC Davis and UC San Diego medical centers also have achieved Stage 7. UC Irvine and UC San Francisco medical centers have achieved Stage 6.

“UCLA Health System’s vision for ‘one patient, one record’ is integral to our progress and success so far. Our position to embrace opportunities in the coming years is fortified by building information around the patient experience. I’m grateful for the strong leadership of our clinical, operational and technology teams, enabling us to realize the achievement of Stage 7 designation,” said Dr. David T. Feinberg, president, UCLA Health System, CEO, UCLA Hospital System, associate vice chancellor, UCLA Health Sciences.

HIMSS Analytics developed the Electronics Medical Records Adoption Model in 2005 as a methodology for evaluating the progress and impact of electronic medical record systems for hospitals in the HIMSS Analytics Database. There are eight stages (0-7) that measure a hospital’s implementation and utilization of information technology applications. The final stage, Stage 7, represents an advanced patient record environment. The validation process to confirm a hospital has reached Stage 7 includes a site visit by an executive from HIMSS Analytics and former or current chief information officers to ensure an unbiased evaluation of the Stage 7 environments.

“UCLA Health System impressed the survey team with how thorough a job they did of preparing for our visit. Even though their EHR system has only been live for nine months, they have made great strides in using the data from their systems to improve patient care. We were also impressed with the culture that UCLA Health System CIO Virginia McFerran has built; they have a great team and a solid infrastructure from which to grow,” said John Hoyt, FACHE, FHIMSS, executive vice president, HIMSS Analytics.

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The science of nursing

UC Davis Ph.D. candidate shows how data improves patient care.

Rayne Soriano (standing) educates health care professionals in the field of health informatics.

Rayne Soriano (standing) educates health care professionals in the field of health informatics.

Rayne Soriano, nurse and doctoral student at the Betty Irene Moore School of Nursing at UC Davis, immerses himself in patient data — from fall rates to the number of hospital-acquired infections — which he analyzes to improve quality by updating hospital procedures or addressing staffing and resource needs. He also educates nurse managers in the field of health informatics.

“I love being a nurse, but I also love the technology — taking care of people through all methods. My work improves the way we interact with patients and deliver quality care,” Soriano said.

Soriano began his career in the emergency department where he learned the value of data — its capacity to help nurses and nurse managers prioritize and address problems. As he moved quickly through the ranks at Kaiser Permanente, Soriano led a team that introduced the use of a hospital-wide electronic health record system. The system helps health professionals, like Soriano, observe trends to maximize patient safety and quality of care.

As part of Soriano’s research toward his Nursing Science and Health-Care Leadership doctoral degree, he is examining a nurse manager’s role in leveraging technology to improve patient care. He found a gap in how nurse managers utilize these systems.

“How are nurse managers using data to allocate resources and get a pulse on the quality and safety of care?” Soriano asked. “If we get people inspired to use technology, and design it well, we can utilize the systems to build better outcomes.”

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High-tech health care services expanded for 3.5M Californians

Health information exchange improving coordination of care in 12 rural counties.

Kenneth Kizer, UC Davis

Kenneth Kizer, UC Davis

Communication of clinical information needed to provide safe and effective, high quality health care is now easier in 12 rural California counties as a result of an initiative launched earlier this year by the UC Davis Institute for Population Health Improvement (IPHI).

Through nearly $775,000 in grants awarded under IPHI’s California Health eQuality (CHeQ) program to four designated health information exchange (HIE) providers, the adoption of HIE is significantly accelerating in rural California. As a result of CHeQ’s Rural HIE Incentive program, HIE options for exchanging patient care-related information electronically have been created for more than 30 acute care and critical access hospitals, community clinics and behavioral health providers, serving nearly 3.5 million rural Californians. More than 700 physicians in these 12 counties will benefit from having better access to patient information.

CHeQ also is targeting an additional $200,000 to fund “Direct” accounts, a service much like secure email, to individual physician offices, small clinics, hospitals, and other providers in these rural counties that are not yet served by a health information organization or have HIE options. The Direct service will become available in early 2014.

Health information exchange refers to the secure electronic communication of health-related information among doctors, hospitals and other providers so that they have important patient-related information wherever and whenever it is needed to support patient care. Establishing HIE services to support electronic communication of health information in rural areas has proven to be particularly challenging, which is why IPHI launched the Rural HIE Incentive Program. HIE options for some areas were largely inaccessible or simply did not exist.

“Patients in rural areas often have to travel long distances to multiple different health care providers to get needed care — especially for medical specialist service — increasing the likelihood that some providers will not have all the information they need,” said Kenneth W. Kizer, IPHI’s director and a distinguished professor at UC Davis. “CHeQ’s rural HIE incentive initiative has provided a catalyst for developing these services in large areas of California. This will result in better coordination and higher quality patient care being provided in these areas.”

Redwood MedNet of Ukiah, one of the four Rural HIE Incentive Program awardees, knows how beneficial HIE is to their rural communities.

“The Rural HIE Incentive Program has been extremely useful for us,” said William Ross, Redwood MedNet program manager. It adds HIE functionality to low-resource facilities such as community clinics and critical access hospitals in historically underserved areas.”

In addition to Redwood MedNet, the three other service providers under the Rural HIE Incentive Program are Inland Empire HIE (Riverside), Orange County Partnership Regional Health Information Organization (OCPRHIO) (Orange) and Axesson (Santa Cruz).

The 12 counties benefitting from this initiative are Colusa, Fresno, Humboldt, Kings, Madera, Mendocino, Napa, San Luis Obispo, Solano, Sonoma, Tulare and Yolo.

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UC Davis institute funds state’s first ‘Blue Button’ project for Medi-Cal

Patients to have online access to their prescription data for improved patient safety.

Kenneth Kizer, UC Davis

Kenneth Kizer, UC Davis

As part of its mission to accelerate the adoption of health information exchange throughout California, the UC Davis Institute for Population Health Improvement’s California Health eQuality program awarded $400,000 to L.A. Care, the nation’s largest publicly operated health plan, to develop Blue Button functionality.

Blue Button will allow L.A. Care members to access their own prescription data online. The project is the first in California and among the first in the nation to develop the tool for Medicaid beneficiaries.

L.A. Care offers free or low-cost health insurance programs to more than one million Los Angeles County residents, giving members access to more than 10,000 physicians, specialists, hospitals and pharmacies.

The Blue Button initiative is a Web-based feature that allows patients to easily view and download their health information and share it with health care providers and caregivers. The U.S. Department of Veterans Affairs initiated Blue Button in 2010. In 2012, the Office of the National Coordinator for Health Information Technology began encouraging its broader use.

“Having a list of medications available through the Blue Button will help L.A. Care members take an active role in managing their care, increase effective communication with their providers and avoid potential prescription errors,” said Kenneth W. Kizer, distinguished professor and director of the Institute for Population Health Improvement at UC Davis. “The lessons learned from this project can serve as a model for all managed care health plans in the state to adopt the same Blue Button functionality to improve patients’ access to their data.”

L.A. Care expects to begin extending the Blue Button service to Medi-Cal Managed Care beneficiaries by early 2014.

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Global innovators to convene at ‘The Atlantic Meets the Pacific’ forum

UC San Diego co-hosts Oct. 2-4 event covering advances in technology, life sciences, health.

Calit2 Director Larry Smarr (right) at "The Atlantic Meets the Pacific" Forum at UC San Diego in 2012

Calit2 Director Larry Smarr (right) at "The Atlantic Meets the Pacific" Forum at UC San Diego in 2012

UC San Diego will again be the stage for globally important conversations about advances in technology, life sciences and health at the third annual “The Atlantic Meets the Pacific” innovation conference, set for Oct. 2 to 4.

Presented by UC San Diego in partnership with The Atlantic magazine, the acclaimed program brings together several dozen world-class innovators whose specialties range from advances in cancer treatments and longevity research to wireless health and brain mapping.

A limited number of one-day discount passes are available for as low as $50, including meals. To register for “The Atlantic Meets the Pacific,” please visit the registration site.

Among the more notable innovators who will participate are:

  • Deepak Chopra, best-selling author and founder, The Chopra Foundation
  • Craig Anderson, former editor of Wired and CEO of 3D Robotics
  • Roni Zeiger, former chief health strategist at Google, CEO of Smart Patients
  • Laurie Garrett, senior fellow for global health, Council on Foreign Relations
  • Siddhartha Mukherjee, Pulitzer Prize-winning author of “Emperor of All Maladies: A Biography of Cancer”
  • Clifton Leaf, Fortune magazine contributing editor and author of “The Truth in Small Doses: Why We’re Losing the War on Cancer (And How to Win It)”

Most of the conversations will take place at the Scripps Seaside Forum, the oceanfront conference center at Scripps Institution of Oceanography, and also at Qualcomm Institute.

Presiding over a number of panel sessions will be The Atlantic’s leading editorial voices, led by  James Bennet, editor in chief; James Fallows, national correspondent; and Steve Clemons, Washington editor at large.

Also joining the conversations will be internationally recognized experts from UCSD, led by:

  • Clark Gibson, professor, UC San Diego Department of Political Science;
  • Scott Lippman, professor of Medicine, UC San Diego School of Medicine, and director of the Moores Cancer Center; and
  • Jacopo Annese, director of The Brain Observatory, UC San Diego School of Medicine

Open to the public, the series of thought-provoking presentations and panel discussions include:

  • What’s next in Medical IT: Wireless Health and Wearable Trends
  • Chronic Diseases: How Technology is Changing the Patient Experience
  • How Far Away is a Cure for Cancer?
  • Future Trends in Technology
  • Innovations in Longevity Research
  • Brain Visualization
  • Publishing the Frontiers of Neurology
  • The future of neurology and brain mapping

In addition, the event will include a day at the California Institute for Telecommunications and Information Technologies (Calit2), as well as behind-the-scenes tours at Scripps Oceanography, the Sanford-Burnham Medical Research Institute, Sanford Consortium, The Scripps Research Institute and the La Jolla Playhouse, bringing attendees and some of the world’s most creative scientists and artists together.

General admission, which includes access to all main-stage programming, a choice of lab tours, and a welcome dinner and subsequent meals, is $495.

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