Since the NuVal food-scoring system was introduced at all Hy-Vee stores in January 2009, my family - both consciously and subconsciously - has changed the way it buys and eats.

There are times when we've discussed whether to buy this yogurt or that yogurt, and the decision was based on nothing more than the higher NuVal score. (Sometimes, we look at the nutrition panel to try to figure out why a certain score was higher. Sometimes, we succeed.) And I'm certain there have been times when, without thinking about it, we've grabbed one food item instead of the lower-scoring version right next to it.

The funny thing is that until I began researching this article, we took it on faith that NuVal scores meaningfully and accurately reflected the nutritional content of the food we were buying.

Conceptually, the system is intuitively understood. It's a number from 1 to 100 (on top of NuVal's joined-hexagon logo) on the shelf tags of a vast majority of edible items in Hy-Vee. The higher the score, the better the food is nutritionally. Fresh blueberries get a 100, and nearly all fresh fruits and vegetables score in the 90s. Scores for hot dogs generally range from 6 to 16, while sugared sodas get a 1.

Of course, you already know that fresh fruits and vegetables are good for you, and hot dogs and sugared sodas aren't. Where NuVal is most instructive - and fascinating - is within a given food group. In its simplest form, NuVal is about deciding between two or three or 10 products jostling for your attention on the same supermarket shelf. As Dr. David L. Katz - the chief architect of NuVal and director of the Yale-Griffin Prevention Research Center - said in an interview last month: "Any aisle of the supermarket where you were already going to buy something, go ahead, but try to buy the most nutritious version that satisfies your wallet and your palate."

Hy-Vee still has work to do in terms of educating consumers about NuVal. Ruth Comer, an assistant vice president for media relations at Hy-Vee, said that in the company's most recent customer survey, a little more than half of those questioned knew about the system. That's a long way from universal.

And being aware that NuVal exists is different from using it, and using it is different from understanding it. Blindly trusting NuVal can be satisfying on a gut level, but the scoring system is most powerful if you take a look under the hood and get a sense of its origins, goals, and methods; what it is and isn't; and its strengths and weaknesses. While it was developed by a panel of scientists without the input of the food industry and takes into account roughly 30 nutritional factors, NuVal has its quirks, it's still being refined, and its reductive nature means that it can't replace careful consideration of a food's nutrition-fact panel.

So while the tool is easily grasped, its nuances are many and worth exploring. "It only takes one minute to explain NuVal to a customer who has never heard about it," wrote Hy-Vee dietitian Chrissy Mitzel in an e-mail. "Of course, I can also spend a one-hour presentation explaining the details of NuVal to a group. It is very versatile in the amount a customer can learn about it."

The Need for NuVal

The reference manual for ONQI - the engine that powers NuVal - sketches out the case for NuVal: "There are two ways to close the gap between how we eat at present and how we should eat for optimal health. One involves a fundamental shift in the pattern of the diet, as reflected in such advice as 'eat more fruits and vegetables.' Such advice is valid, and important, but subject to considerable resistance. ...

"There is another way to improve dietary patterns, and that is one food choice at a time. The range in nutritional quality for every food category represented on supermarket shelves - from greens to granola bars, sandwich meat to salad dressing, cookies to cooking oils, and even the proverbial soup to nuts - is vast. Choosing the most nutritious offerings in each category offers a powerful means to reduce intake of calories, sodium, added sugar, and harmful fats, while increasing intake of fiber, beneficial nutrients, vitamins, and minerals."

In other words, we know we need to eat more fruits and vegetables, but most of us don't heed that advice. NuVal, Katz summarized, offers as an alternative a "simple, elegant power. Improve your diet, improve your health - one easy, well-informed choice at a time. You want bread, buy a bread; just buy a better bread."

Or snacks. Look at the dried-fruit section of Hy-Vee, and you'll see a massive gulf between products that score in the 90s (raisins, dried peaches, dried apricots) and those coming in below 10 (dried cranberries and blueberries) - a function of whether they have added sugar.

Comer said that she used to buy reduced-fat peanut butter. And when saw the NuVal scores - with some reduced-fat products scoring significantly lower than their full-fat equivalents - she thought: "This doesn't make sense to me." But after she investigated and understood the scores, she changed what she bought. "I buy the regular peanut butter again," she said. "I'm not sacrificing nutritionally."

In this way, NuVal helps consumers understand that certain foods aren't by definition healthy - dried fruit, for instance - and claims by manufacturers are often not meaningful in terms of nutrition. Lower-fat foods often compensate for the lost fat with sugar, typically more than negating any nutritional gain. A vast majority of breakfast cereals are almost depressingly low-scoring, regardless of whether they're aimed at kids (Cap'n Crunch, which scores a 10) or pitched as wholesome (Wheaties, a 28).

"It's easy in a world where nobody knew what better nutrition actually meant for manufacturers to just make it up," Katz said. "With NuVal you can tell at a glance."

And NuVal helps overturn some long-held beliefs. "I scratched my head when iceberg lettuce received a score of 82, as did some of my customers," wrote Hy-Vee dietitian Janet Macon. "Iceberg has a reputation as a leaf with little to offer; 82 seemed like an unlikely high score. When looking into the score, I realized that the nutrients it provides, including potassium, folate, and carotenoids, come at a very low caloric cost (less than 10 calories per cup), which explains the high NuVal score."

The scoring system offers other benefits, too, as Hy-Vee dietitian Dawn Blocklinger listed in an e-mail:

"NuVal is very helpful for those individuals with language barriers or who are illiterate.

"NuVal is definitely kid-friendly. What kid doesn't want to score a 100?

"NuVal is available free and on most items in the store."

And it's even helpful to people who know their nutrition. Hy-Vee dietitian Kristen Decker wrote: "It has reinforced facts I know about nutrition but makes it easier to assess on a glance when comparing options."

"It Needed to Be Fixed; We Fixed It"

Katz says a 2003 event represents the obvious genesis of NuVal. But "the origins in my head go back much longer than that. As a preventive-medicine specialist who focuses on lifestyle in particular - food as medicine, if you will - I've really been wrestling with my patients' challenges in this area for many, many years, and recognizing that patients can get perfectly good advice about eating better and yet find it almost impossible to implement when the rubber hits the road - when they get out there and have to make food choices. ... They trip over all of the confusing marketing messages that stand between them and better health. ... The public at large - patients - needed better guidance in this area. ...

"It would be bad enough to miss out on the power of nutrition as medicine ... if it was because people didn't care," Katz added. "But you know what? People do care. ... They just don't feel empowered to do anything about it. And even the people who are really trying are getting lost on the way. And that's just wrong. It needed to be fixed; we fixed it."

Eight years ago, Katz said, he was among 15 researchers invited to speak to the Working Group on Obesity, under the federal Food & Drug Administration (FDA). He and his fellow scientists were given three minutes apiece to offer one idea that the FDA could implement.

Katz said he told a story about bread and his wife, who has Ph.D. in neuroscience from Princeton and shops for the family. (They've been married more than 20 years and have five kids.) "Even my wife ... - extremely intelligent, highly educated, lives with somebody whose nutrition bona fides are good enough to get him a seat at this table, takes care of all seven of us on a daily basis - even she comes home from the supermarket with smoke coming out of her ears at times.

"She's shopping for a loaf of bread, and one bread has the most fiber, but that's the one with the most sodium. And one, the fiber's good and the sodium's better, but that's the one with added sugar in the form of high-fructose corn syrup. And another one, the fiber's good, the sodium's not bad, it doesn't have added sugar, and it says zero grams trans fat on the front of the pack, but that's the one with partially hydrogenated oil in the ingredient list. And another one says 'multigrain' and looks like it's the most wholesome choice but actually has the least fiber of all and as far as she can tell doesn't contain any whole grain. And so she brings home all four, looks at me, and says, 'If you want the most nutritious one of these, you figure out which one it is.'"

He concluded his presentation by addressing Health & Human Services Secretary Tommy Thompson: "And I said, 'Mr. Secretary, with all due respect, if a Ph.D. in neuroscience from Princeton is not good enough to pick out a loaf of bread, I think we set the bar a little high.'"

He suggested that the FDA convene a panel to create "a tool that everybody can use, so that at a glance everybody can tell what's the most nutritious choice. ... Essentially like a GPS for the food supply: 'You want better nutrition, turn here now.' And let's make it completely simple."

Katz said the idea was dismissed. (The working group in 2004 made recommendations on changes to foods' nutrition labels that could charitably called minor: "increasing the font size for calories, including a percent-daily-value column for total calories, and eliminating the listing for calories from fat," and "encourag[ing]" manufacturers to stop the practice of dividing packages of food that most people consume in one sitting into unrealistically small serving sizes for nutrition-panel purposes - 20-ounce sodas, for example, claiming 2.5 servings per bottle.)

But in late 2005, Katz said, Griffin Hospital said it would financially support the development of the system he proposed. Katz and a team of scientists crafted the Overall Nutritional Quality Index (ONQI) algorithm. Katz then took that back to the FDA, but one official there advised him to pursue the project through the private sector rather than the federal government: "If you turn it over to our bureaucracy, I'm not sure you'll live long enough to see this in the hands of consumers ... ."

So Griffin Hospital partnered with grocery-chain co-op Topco Associates (of which Hy-Vee is a member/owner) to form the for-profit NuVal LLC. That company licenses the NuVal system, and Griffin and Topco share in the profits. NuVal is now in more than 1,100 stores nationwide.

While NuVal LLC is a for-profit venture, Katz said there's a clear separation between the algorithm and the marketing of its application. Griffin Hospital retains sole ownership of ONQI, "and the business side has nothing to say about it," Katz said. "We're at liberty to just keep this all about pure public-health science and then rely on NuVal LLC to get it out there where it can do some good."

Hy-Vee's Comer said NuVal was attractive to the chain for several reasons. It's "completely independent" and developed by scientists rather than the food industry, she said. "And it's also very simple to use and easy to understand."

Comer said Hy-Vee explored other nutrition-rating systems - such as those that break foods down into broader groupings - but thought they were "somewhat subjective." She gave the example of a stoplight system - with green, yellow, and red - and said there wasn't enough nuance; one product might be a high yellow and another a low green, and there was no way for consumers to know that they were more similar than different nutritionally.

The NuVal Algorithm

While NuVal is a proprietary rating system, its Web site (at offers a basic breakdown of what's measured and how it affects the score.

The system includes a calculation for "numerator nutrients," which are "considered to have generally favorable effects on health." These include fiber, folate, Vitamin A, Vitamin C, Vitamin D, Vitamin E, Vitamin B12, Vitamin B6, potassium, calcium, zinc, Omega-3 fatty acids, total bioflavonoids, total carotenoids, magnesium, and iron.

That number is then divided by the calculation for "denominator nutrients," considered to have "generally unfavorable effects on health": saturated fat, trans fat, sodium, sugar, and cholesterol.

Other factors considered in determining the final 1-to-100 score are protein quality, fat quality, glycemic load, and energy density.

The algorithm was built on and tested against "face validity," which Katz explained by way of a few questions: "What are the foods the most expert people think are most nutritious? What are the foods the most expert people think are less nutritious? You start there, and you build around that."

He admitted that face validity is "not a very high standard. But frankly we don't have a gold standard for measuring nutritional quality of an individual food. In some ways it's perfectly obvious; everybody agrees that spinach is a really nutritious food, and everybody agrees that marshmallows are not. But based on what? ... You really have to beat up on that to get people to figure out what's going on."

Since the algorithm was finalized, 90,000 foods have been scored - including more than 20,000 carried by Hy-Vee. This is done through the method of "imputation" - which involves analyzing data about the food rather than the physical food itself. "If you have the ingredients, and you have nutrition facts, there's only basically a very narrow, fixed way those ingredients can come together to produce those nutrition facts," Katz explained. "So you can reverse-engineer the rest ... ." Through that process, he added, one could generate as many as 150 nutrient entries for a food, but NuVal uses approximately 30.

It's also worth noting that the factors that determine a food's NuVal score are not all available on the nutrition panel - such as the biological quality of protein.

And there are labeling practices and regulations (and loopholes) that NuVal is designed to get around. Omega-3 fatty acids - considered good for your health - are not universally declared by manufacturers, for instance, but NuVal calculates them. On the negative side, there are rounding rules through which manufacturers claim foods have no trans fat because they've made the serving size small enough that trans fat is less than half a gram; NuVal includes that trans fat in its calculations.

"We have to go beyond the nutrition-fact panel ... ," Katz said.

"We're Not Telling You What to Eat"

NuVal isn't the only nutrition-rating system.

The Guiding Stars system ( is more widely used - in place at more than 1,600 grocery stores - and is more reductive, giving foods zero, one, two, or three stars based on nutritional content.

Jewel (with three stores on the Illinois side of the river) uses the Nutrition iQ system (, which is less reductive and uses colored labels to denote foods that have, for example, good fiber, good protein, low sodium, vitamins, minerals, or 100-percent juice.

And stores generally are focusing more on nutrition. Walmart earlier this year unveiled a new nutrition initiative - including reformulating products and "developing strong criteria for a simple front-of-package seal that will help consumers instantly identify truly healthier food options such as whole-grain cereal, whole-wheat pasta, or unsweetened canned fruit," according to a press release.

But because Hy-Vee dominates the Quad Cities market - and because no other local grocer outside of Jewel has a nutrition-rating system - NuVal is the focus here. (I visited Aldi, Fareway, Save-a-Lot, Schnucks, Target, and Walmart.)

The nature of NuVal makes it ideal for side-to-side comparisons of similar foods. Katz said NuVal allows consumers to make informed decisions about not just nutrition but also value. While many people think "better" foods cost significantly more, that's typically not the case. "There's the opportunity to trade up nutritionally" without paying much (if any) more, Katz said.

A longer-term goal, he said, is to get people to compare products across categories and not just within them. "NuVal is universal," Katz said. "It's the same scoring system from soup to nuts. So it also is pointing out: You probably should spend a little more time in the produce aisle, and you should maybe spend a little less time in the cookie aisle. ... We do hope that it will not only empower people to make better choices within a given aisle, but over time will also nudge them to spend more time in aisles that have the most nutritious choices."

If the gentleness of that statement isn't clear enough, part of the marketing genius of NuVal is that it doesn't impose itself. The shelf tags themselves are unobtrusive and easy to ignore when you're buying Chips Ahoy! (a 6, by the way), and Katz was careful to say that there's no number below which one shouldn't buy. (Anything below 10, he said, should be a "rare and occasional thing.")

He stressed that "people who use a GPS system don't want to be told where to go. They just want to be told how to get there. NuVal was really designed with that concept in mind. We're not the boss of you, and we're not telling you what to eat."

The aim, he said, is to choose a more nutritious food whenever possible - even if you're still buying candy and cookies: "In every category and whatever the range, you have the opportunity to trade up, even when you're indulging yourself."

This was echoed by Hy-Vee's Comer, who said the store doesn't want to prevent people from buying low-scoring foods. "We wanted to give our customers an easy way to evaluate products and make healthier choices," she said. "We think it's working."

Dietitian Macon gave some examples of how she uses NuVal: "I ... create cut-off points when I am shopping with my kids. It takes the pressure off of Mom; I'm not the bad guy for saying 'no' to a low-scoring food. My kids know that scores below a certain number are treats in our house, not everyday foods.

"NuVal makes it easier to see the value in making healthy choices for my family, even if those choices have a higher price tag. The food we eat is probably the biggest investment we make in our health most days. I divide the price by the NuVal score as I shop and realize that even if the price is higher, often I pay less for each nutrient in that food than I would if I chose a lower-scoring, lower-priced product."

What NuVal Can't Do

While NuVal is a godsend to many of us, it's important to understand what it can't do. Much of this is obvious, but the intentionally simple presentation of NuVal might make us lazy - we could use it instead of common sense.

For one thing, NuVal doesn't address portion sizes and Americans' tendency to overeat. Macon suggested that consumers use the U.S. Department of Agriculture's Choose My Plate system ( in concert with NuVal.

And NuVal shouldn't take the place of reading ingredient lists and nutrition panels. Comer said that consumers can (and should) consult the nutrition panel, but "NuVal's an acknowledgment of our human foibles and human nature, in that we don't always take the time ... to do all the research about all the products we're buying." found two related problems with NuVal and other nutrition-rating systems: "First, they set the nutritional priorities, not you." So if your sense of what you should and shouldn't eat diverges from conventional wisdom on nutrition, NuVal won't be of much use to you.

The Web site continued: "The other disadvantage is that crunching all the data into a single number obscures the various 'pluses' and 'minuses.' For example, a food that's high in sodium but low in sugar could end up with the same rating as a food that's just the opposite: low in sodium but high in sugar. But depending on whether I have diabetes or high blood pressure, the two choices are hardly comparable."

In other words, NuVal can't consider your particular health situation or dietary goals. As Macon wrote: "A customer concerned about heart health may consider NuVal when choosing a salad dressing, but still choose to look for saturated fat and sodium information on the nutrition-facts panel before making a decision. Similarly, NuVal may help a diabetic customer to narrow his search for a breakfast cereal; then he may make his choice based on the fiber content."

And NuVal doesn't address factors other than nutrition.

For instance, it gives no advantage to organic foods, even though that's important to many people. NuVal explains this on its Web site: "As yet, there is no widely validated evidence that organic foods have a higher nutritional value or greater nutrient density than food not grown organically. Obviously, consumers who choose organic foods may be doing so for reasons beyond nutrition - the fact that it is grown without using certain chemical controls, for example."

Similarly, Hy-Vee dietitian Blocklinger noted that "foods that may be processed and then enriched may score equally to a product that has the same nutrient profile but that is in its natural/original state."

The Wall Street Journal provided another example of how NuVal's system doesn't account for all the factors that go into consumer choice: "Kellogg Company's Kashi brand in a statement said it tries to provide minimally processed, organic-certified food free of artificial flavors and other additives. 'Many of the current nutrient-profiling systems don't take these values into account, which results in an incomplete picture,' it said."

A personal example: I'm hesitant to buy products with artificial sweeteners for my three-year-old daughter. My bias against them is admittedly based in ignorance rather than research - I fear that some of them might have adverse long-term health effects - but it's there nonetheless. (For the record: The National Cancer Institute says "there is no clear evidence that the artificial sweeteners available commercially in the United States are associated with cancer risk in humans.") The problem for me is that because of the penalty NuVal assigns to sugar, artificially sweetened products inevitably score higher than their sugared (or high-fructose-corn-syrup-ed) counterparts. (This can most easily be seen in soda: Coke gets gets a 1, and Diet Coke gets a 15. And that's an illustration, not an admission that we buy soda for our daughter.) So when it comes to special treats, do I buy ice cream (typically scoring in the teens and 20s) or Blue Bunny's Sweet Freedom Fudge Lites (artificially sweetened and scoring a miraculous 100)? NuVal's values are at odds with my own.

Hy-Vee dietitian Mitzel explained the fudge-bar score this way: "It made sense when I considered the ingredients - basically skim milk (which scores a 91 alone) and fiber (which drives scores up)."

And Macon expanded in an e-mail on why products with artificial sweeteners score higher: "NuVal incorporates into its complex algorithm only those nutrients and ingredients that have clear, current, high-quality data demonstrating their relationship - positive or negative - to human health."

She continued: "At this time, our extensive body of research on the safety of non-nutritive sweeteners demonstrates that they are safe and effective tools for weight-management. Excessive added sugar intake, on the other hand, contributes to a variety of health problems. In this example, the presence of non-nutritive sweeteners does not raise the score (non-nutritive sweeteners are neutral); the lack of added sugar prevents the score from dropping."

Katz and I discussed artificial sweeteners, and he gave insight into some of the challenges of developing the algorithm. While he doesn't like artificial sweeteners for taste reasons, he also said he has "a concern about them for which the science isn't fully developed. It's kind of an unanswered question in the world of science." (He mentioned how artificial sweeteners increase one's craving for sweetness.)

But, he said, ONQI and NuVal aren't reflections of his own beliefs. "Although I'm the chief engineer and the principal inventor, this level of sophistication took ... a village of experts," he said. "We really had to work by consensus." Some people involved in the development of ONQI thought artificial sweeteners helped people reduce calories and sugar in their diets, while others though the downside was greater than the upside. As a result, he said, "what we wound up doing is splitting the difference."

Katz said an adjustment to the algorithm "puts back" the calories that would have been present with sugar - a change that reduces the product's considered nutrient density. Products with artificial sweeteners, however, still score higher than sugared counterparts because of their energy density, and because they don't incur a penalty for added sugar. So the difference between their scores is smaller because of the algorithm adjustment. "NuVal essentially neutralizes that advantage," Katz said.

He added that ONQI's handling of artificial sweeteners might be adjusted in the next incarnation of the algorithm - which is currently in development.

ONQI 2.0, Katz said, will take into consideration new food ingredients (such as the sweetener Stevia) and new federal dietary guidelines - such as an increased recommendation for Vitamin D and recognition that different types of saturated fat have different health impacts. "We don't ever want to be at odds in any way with federal guidance," he said. "It's based on and perfectly consistent with dietary guidelines ... ."

But don't expect radical scoring changes. "The original engineering was pretty damned good," Katz said. "More will stay the same than change."

Still, it's worth emphasizing that NuVal isn't the be-all and end-all; it will evolve and be refined just like nutrition science and dietary guidelines. And as Katz readily admitted about artificial sweeteners, the science isn't always an exact science.

Does NuVal "Work"?

Shoppers might use NuVal to make buying decisions, and anecdotal evidence certainly suggests that they like it. NuVal, for me, almost makes shopping a game between my family and the manufacturers, to see if I can outsmart their marketing; I genuinely feel empowered by it.

That's great for shoppers' confidence, but if NuVal truly "works," three different but interrelated things should happen.

First, consumer buying patterns should change, and people should be buying healthier foods - both within and across categories. So customers would choose higher-scoring bread, but they'd also be buying more fresh fruit and fewer cookies.

Second, consumer health should improve. NuVal is premised on the idea that a single score is a valid basis on which one can make healthier food choices. Ultimately, Katz said, the test of NuVal is straightforward: "Do these scores actually predict health outcomes when you study large populations?" If health doesn't improve among people who use NuVal, then the system is built on false assumptions - or people aren't using it correctly.

Third, manufacturers should make their foods healthier. If people buy based at least in part on NuVal scores, the food industry has an incentive to improve its products nutritionally in the interest of maintaining or increasing sales.

While it's probably too early to say with certainty that all three of those things are happening, there's some evidence for each.

Consumer habits. Katz said stores that use NuVal are seeing changes in buying patterns. While NuVal hasn't published these findings yet, company spokesperson Robert Keane shared sales data from two grocery chains and three categories of food: cold cereal, fresh bread and rolls, and yogurt.

In one retailer from 2008 to 2009, "scores ranked 50 or greater outperformed products with NuVal Scores from 1 to 49. Those products with better overall nutrition grew more than lower-scoring products or all products (which includes products not yet rated). In cold cereal, products ranked 1-49 saw decreases in sales volume."

At the same retailer, "sales of cereals scoring 50 to 100 grew 5.2 percent, [while] the ROM [rest of market] volume sales change was negative 13.0 percent. These data show that the retailer with NuVal scores published on their shelf tags had stronger growth of more nutritious products."

Results from the second retailer - which compared pre-NuVal sales to post-NuVal sales - demonstrated a similar advantage for higher-scoring products.

"People are trading up their choices within categories," Katz summarized, but he hasn't yet seen data showing shifts from less-healthy categories to more-healthy ones. "That would be one of the next things we'd like to see."

Comer said Hy-Vee hasn't tracked sales by NuVal score to see if consumer behavior is changing. "We have not in a scientific way. [But] we have anecdotal evidence of that from dietitians ... . There's still a lot of opportunity for us there in the future to do more statistically valid or scientifically based surveys."

All the Hy-Vee dietitians contacted for this article said they have heard stories from customers about how they've changed what they buy.

Consumer health. A study in the May issue of the American Journal of Preventive Medicine concluded: "Consumption of foods that lead to a higher score for the ONQI scoring system is associated with modestly lower risk of chronic disease and all-cause mortality."

It's only one study, but it appears to confirm the basic scientific validity of ONQI and NuVal.

Yet it doesn't prove that NuVal shoppers are healthier. To do that, you'd need evidence that the overall diets of shoppers improve when they use NuVal, as well as evidence that they're actually healthier.

Healthier products. This is primarily anecdotal, but Katz said he's seeing food manufacturers change their products in response to NuVal. "It's forcing manufacturers to compete in a fishbowl," he said.

Citing the example of reduced-fat peanut butter, he said: "Either that product's going to go away, or manufacturers will have to make fat-reduced [peanut] butter that doesn't have significant additions of sugar and salt.

"And we're starting to see innumerable examples of reformulation to improve nutrition. And that requires nothing whatsoever of the consumer; NuVal [just] needs to be there, and consumers need to be interested in nutrition ... ."

This, he said, is a triumph of nutrition over marketing.

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