Return to Traditional Diet and Environmental Stewardship



Alaska Native Return to Traditional Diet and Environmental Stewardship

Kathryn Koller

Walden University

PUBH – 8165 – 02

Instructor: Dr. Steve Arnold

Alaska Native Return to Traditional Diet and Environmental Stewardship

Native American cultures have incurred radical change since first contact with non-Native cultures (Kuhnlein & Chan, 2000). In Alaska, long-established intimate ties to the land have been disrupted by socio-political and economic factors which have forced divergence from traditional diets and lifestyle (Barnhardt & Kawagley, 2003; Redwood et al., 2009). As a result, American Indian and Alaska Native health has been adversely affected, evidenced by increased health disparities (Slattery, 2005; Warne, 2007; Lanier, Day, Kelly, & Provost, 2008). More recently, evidence of distant sources of industrial and agricultural pollution contaminating Arctic water and wildlife has served to discourage consumption of traditional food sources by Native people who would benefit from them (Kuhnlein & Chan, 2000 and Mos et al., 2004).

Western culture has also undergone significant change with rapid developments in industry, science, and technology, and until recently, focus on environmental interrelationships with human health has not been a primary concern (Moeller, 2005). Hence, environmental stewardship has evolved as a modern scientific model. However, I submit this is an ancient, rather than a new, concept and science would do well to listen and learn from the Arctic’s first inhabitants. Alaska Native (AN) people have long recognized the interconnections between the environment and human biological, psychological, social, and spiritual wellbeing, and the need to be good stewards of the land (Kuhnlein & Chan, 2000; Milburn, 2004; The Alaska Native People et al, 2008).

The purpose of this position paper is to support two interrelated positions with evidence from the literature. First, AN people will benefit greatly by increased reliance on healthy traditional foods and far less reliance on unhealthy store-bought foods. Second, Arctic studies and surveillance conducted in Alaska must proactively partner with the AN people who possess traditional knowledge of the land to thoroughly examine interrelationships between environment and man.

Traditional Lifestyle

AN people are a diverse group of 16 linguistically and culturally distinct groups whose ancestors inhabited the Alaska region for centuries prior to contact with non-Native people (Barnhardt & Kawagley, 2005). The current estimated 130,000 AN residents (Indian Health Service [IHS], 2008) of the state each claim membership in one of Alaska’s 228 federally-recognized tribes (IHS, 2007b). In the literature, AN people are frequently segmented into three ethnic groups: Eskimo (50%), Indian (39%), and Aleut (11%) people (IHS, n.d.).

Traditional diet

Traditional diet is one component of traditional lifestyle which emerges from a collection of accumulated knowledge passed down through generations of a defined cultural group (Milburn, 2004 and Hensley, 2009). Although traditional diet is only one component of Native American culture, it is the primary component for many, including AN people (The Alaska Native People et al., 2008). In the Arctic and sub-Arctic regions, food sources are plentiful, yet challenging to acquire and preserve given the short warm season and long harsh winter. Nevertheless, as a testament to their resilience and ingenuity, AN people have adapted to this region and have survived thousands of years living off the land.

Access to the sea has provided coastal people with access to fish, birds and their eggs, and marine mammals, including walrus, whale, seal and sea lion (The Alaska Native People et al., 2008 and Hensley, 2009). Inland areas are abundant with caribou, moose, musk ox, deer, and smaller game and wild birds. Plant life is also abundant and varied throughout the state, and is gathered from both the land and the sea. Berries preserved in seal or fish oil, moose or caribou fat, provide a recipe for Eskimo or Indian ice cream (akutaq). All regions are well endowed with summer runs of various salmon species, all of which are a mainstay for AN people. The AN traditional diet is high in protein and fat, while low in carbohydrate (The Alaska Native People et al., 2008).

Milburn (2004) characterizes traditional diet in terms of indigenous nutrition as “culturally and bioregionally specific food-related knowledge that results in a dietary pattern meeting basic nutritional needs while avoiding Western diseases” (p. 421). In a state which encompasses one-fifth the land mass of the 48-contiguous U.S. and a coastline equal in length to the eastern and western U.S. seaboards combined (IHS, 2007a), there are vast cultural and bioregional differences. Soaring mountain ranges, glaciers, vast stretches of tundra, treacherous river systems, and numerous islands further serve to isolate small Native communities. Thus, as described above, each Alaska region provides specific food sources from which individual Native communities have developed their distinctive dietary patterns. However, Milburn’s reference to “Western” diseases requires elaboration.

Milburn (2004) cites Dr. Denis Burkitt as one of the first medical doctors to recognize the “relationship between nutrition and the geographic distribution of disease” (p. 412). Noting the lack of chronic, degenerative disease in indigenous African people compared to those in industrialized nations, Burkitt was convinced dietary patterns played a major role and emphasized the importance of nutrition. Attributing most of these diseases, such as diabetes, atherosclerotic heart disease, stroke, and some cancers, to poor diet and lack of physical activity, he concluded these “Western” diseases were largely preventable with improved diet. Fortuine’s (1992) classic chronology of health and disease in AN people, beginning with Russian contact in the 1700s, observes hunger, starvation, and disease related to malnutrition primarily affected only AN people forced into captivity. Traditional diets including greens, berries, fresh fish and meat were sufficient to ward off vitamin-deficiency conditions such as scurvy and rickets.

Traditional knowledge

The physical activity required to hunt, gather, harvest, prepare, and preserve foods acquired from the land and sea requires energy (Redwood et al., 2008). In the physical sense, this means fewer calories contributing to overweight and obesity. In the traditional sense, this means close ties with the land, the family, and the community. Just as the accumulated knowledge of regionally available food sources are a culmination of wisdom generated from hundreds of years of subsistence in one region, so too are the physical and cultural activities associated with these foods. “Food is more than sustenance to put into the body. For indigenous people, it is intricately tied to land, ceremony, family, and spirituality” (Edwards & Patchell, 2009).

When describing traditional activities related to traditional diet and lifestyle (net mending, kayak building, harpoon making, snowshoe and sled building, sewing and fitting dry- and warm-weather gear, and basket weaving) it is clear that many of these activities are not applicable today. Most individuals and communities take full advantage of advancements in mechanization and technology, opting for motorized boats, all-terrain vehicles, and firearms (IHS, 2007a). Yet equipment maintenance activities and diet do not total traditional lifestyle. Ties to place and the connections between man and nature are the foundation for the wisdom passed down by elders through storytelling, ceremonies and festivities, family and community values, and a holistic perspective of the world in which one lives. These are encompassed in a body of traditional knowledge which is facing slow erosion due in part to modern technology and mechanization, as well as reliance on store-bought foods (Milburn, 2004; Barnhardt & Kawagley, 2005; Carmack & MacDonald, 2008; and The Alaska Native People, 2008).

“There is a tradition of respect for these [traditional] foods” and “participating in harvesting, preparing, sharing and eating of the foods along with others contributes to our spiritual well-being” (The Alaska Native People, 2008). With so much of the traditional Native lifestyle dependent on the accumulated wisdom necessary to procure food for survival, Native language was “developed to encode information needed for survival” (Carmack & MacDonald, 2008, p. 278). A sense of belonging to the land, being a part of that land and relying on that land to meet their needs, provides Native people meaning in life, their lifestyle, and their identity (Barnhardt & Kawagley, 2005 and Carmack & MacDonald, 2008).

Impact of lifestyle changes

Recent changes in AN diet and lifestyle, documented by Native elders and researchers (Milburn, 2004, Barnhardt & Kawagley, 2005; and Slattery, 2005), point to urbanization, mechanization, and advances in technology responsible for disrupting historically vital connections and interdependencies between man and the land (Barnhardt & Kawagley, 2005). Social and economic changes accompanying urbanization have contributed to this disruption, with concurrent and notable increases in AN health disparities (Milburn, 2004; Slattery, 2005; and Redwood, 2008). In AN communities, reliance on traditional lifestyle has declined while chronic disease and its risk factors have risen (Redwood, 2008).

Reports of AN mortality in the mid-1950s cited infection as the leading cause of death (Day, Provost, & Lanier, 2009). With the arrival of antibiotics, vaccinations, and healthcare, life expectancy increased from 46 years in 1954 to 69.5 years in 2007. However, the rise in life expectancy was accompanied by a steep increase in chronic disease. Cancer, which was reported as under 5% in this population prior to 1954, is now the leading cause of death (21% of all deaths) for AN people (Lanier, Kelly, Maxwell, McEvoy, & Homan, 2006). Between 2004 and 2007, chronic diseases, including heart disease (14%), cerebrovascular disease (4%), chronic obstructive lung disease (4%), chronic liver disease (2%), and diabetes (2%), accounted for 45% of all deaths in AN people, while only 2% were attributed to influenza and pneumonia (Alaska Native Epidemiology Center [ANEC], 2009).

Mahoney and Michalek (1999) attribute increased Native American chronic disease rates to increased life expectancy, while Slattery (2005) points to migrant groups who adopted Western diet and lifestyle patterns only to assume Western chronic disease patterns as well. Slattery uses “reverse migration” (p. 94) to describe Native American assimilation of Western diet and sedentary lifestyle patterns resulting in less reliance on traditional diet and essentially eliminating the physical activity required to sustain it. The most recent published Alaska Behavioral Risk Factor Survey 2007 Report appears to support this effect, reporting 37% Alaskans overweight and 28% obese, noting no significant differences between AN and non-Native people living in Alaska (State of Alaska [SOA], 2007).

Understanding the interconnectedness of biological and chemical pathways in human systems is basic to the application of research findings to healthcare. As observed by Slattery (2005), nutritional science has had little success in determining the relationship of individual nutrients to chronic disease. The study of diet and physical activity patterns within communities in relation to chronic disease, rather than the effects of individual nutrients in body systems, may prove more beneficial to AN communities. These communities, which operate as family systems, may be more accepting of Western knowledge that supports cultural practices and relates directly to circumstances in daily life.

More drastic examples of self-destructive behavior are noted in AN young adults, where suicide rates in 20-29 year olds have soared within the last decade (Alaska Native Epidemiology Center, 2009). AN suicide rates are more than 3.5 times the rate of U.S. Whites and 2.5 times that of Alaska Whites. It would be an error of gross oversimplification to conclude that revisions in diet and physical activity alone would necessarily improve these disturbing statistics. However, in examining the interrelationship of cultural practices and connection to place, research has demonstrated youth with a strong sense of cultural identity possess greater self-esteem (Boeckmann, Morales, Smith, & Jordan, 2009). Greater self-esteem is associated with close ties to AN elder role models and cultural identity. Native identity has been positively associated with self-esteem which in turn serves to protect against behavioral health problems such as alcoholism, depression, and suicide. “The findings suggest that Native language, storytelling, and local subsistence activities are some of the more important cultural practices to encourage and strengthen Native identity” (Boeckmann et al., 2009, slide #6).

Environmental Stewardship

Conventional environmental management has operated under the assumption that users of common resources require regulatory systems to control access and use of the resources. (Ostrom, 2005). Frequently, however, regulations were generated by external agents who lacked understanding and appreciation of the complex interrelationships within the environment. Ostrom supplies evidence that supports community-based management programs that protect and preserve common-pooled resources and yield results superior to regulation by external forces. Central to her argument is the in-depth knowledge of the environment shared by community members who have relied upon the resources and will benefit from the efforts required to sustain them.

Modern environmental management promotes environmental stewardship which advocates responsible use of natural systems through a conservational approach to the development and management of resources (Moeller, 2005 and Carmack & MacDonald, 2008). This approach ties in closely to Native traditional beliefs that man is part of the natural universe which is to be respected. It is this spiritual connection between man and environment which Carmack and MacDonald (2008) conclude is missing in the environmental stewardship model. As early custodians of this region, waste and overuse were unacceptable (The Alaska Native People, 2008 and Hensley, 2009), while close ties to place and land reinforced the need to understand and behave responsibly in relation to the environment (Carmack & MacDonald, 2008). Adaptation to the environment was achieved through patient observation, trial, and error (Hensley, 2009).

Environmental science focuses on understanding the environment, the natural pathways by which chemicals and stresses are distributed, and the impact these have on environmental systems (Moeller, 2005). Study of the individual components of environmental chemicals, such as persistent organic pollutants (POPs), has proven difficult and produced confounding and conflicting results (Moeller, 2005 and Zhang, 2008). Recent efforts have focused on studying arrays of these compounds in the environment to identify and map contamination distribution patterns (Fitzgerald et al., 2007). Incorporating AN traditional perspectives of Arctic environmental interrelationships could greatly assist science in this context.

Barnhardt and Kawagley (2005) share “a growing appreciation of the contributions that indigenous knowledge can make to our contemporary understanding of medicine, resource management, meteorology, biology, human behavior, and educational practices” (p. 13). AN perspective has shed light on natural Arctic phenomena including observations of the aurora, the effects of climate change and contaminants in subsistence foods, and alternative technology for waste disposal. Carmack and MacDonald (2008) relate how the sage insights of their seasoned Inuit guide enabled successful scientific exploration of Arctic ice and environmental systems, proving invaluable to their work. They maintain traditional knowledge is a valid form of true science based on keen observation, trial, error, and success, passed down through generations and expanded upon by individual experience.

Impact of Polychlorinated Biphenyls (PCBs)

Properties and distribution

PCBs are a subset of manmade POPs primarily used for insulating electrical power units, such as transformers and capacitors (State of Alaska, 2004). Other uses include plasticizers, hydraulic fluid, flame retardants, and adhesives. Currently banned from U.S. production, these chemicals were once produced in massive quantities by many developed countries, including the U.S. and Canada. Their multiple chlorinated bonds make them insoluble in water, persistent in the environment, and resistant to metabolic detoxification in most living organisms (Bentzen et al., 2008). PCB products vary by chemical composition, i.e., their individual congeners. PCB congeners possess chemical names, but are most commonly referred to by number. The most prevalent congeners include PCB-118, -138, -153, -158, -170, and -180, are frequently used as indicator congeners for environmental monitoring (Maervoet et al., 2007 and Koller et al., 2009).

Uncertainty about potential environmental impacts of PCBs led to numerous studies over the past 40 years, with increasing speculation over their hazards. In 1972, the U.S. banned PCB production and over the following decade most other developed countries followed the lead. Under the World Health Organization (WHO) the 2001 Stockholm Convention (2009) convened to limit worldwide production of PCBs. Advocating for the ban, Arctic peoples sought to protect the land and its inhabitants which had been identified as the region with the highest PCB contaminant levels worldwide (Selin & Selin, 2008).

Three distinct properties are responsible for PCB distribution and potential impact: bioavailability, bioaccumulation, and biomagnification (Kuhnlein & Chan, 2000). Bioavailability stems from atmospheric release. Incineration of used products containing these chemicals, or emissions from the few world sources which continue production, results in volatilization (SOA, 2004). Atmospheric transport provides movement of these chemicals to locations distant to their source, while condensation and precipitation provides the mechanism by which they disperse over land and sea (Selin & Selin, 2008). Both atmospheric and oceanic currents pull these chemicals northward toward the Arctic where plant and animal species are directly exposed.

Bioaccumulation results as lower trophic order species ingest and absorb these chemicals (Wang & Needham, 2007 and Selin & Selin, 2008). Because these compounds are soluble in lipids (fat), but not in water, they accumulate in the fat tissues of animals and, since they are not easily metabolized or detoxified, they remain there until consumed by higher order predators. Each step in the food chain increases the concentration of these chemicals within larger hosts resulting in biomagnification (Wang & Needham, 2007). Large Arctic marine mammals with high fat content thus contain the highest concentrations of these chemicals. Bioavailability, bioaccumulation, and biomagnification, combined with traditional AN diet preferences, place AN people who consume traditional foods at risk for exposure (Rubin et al., 2001).

Research and surveillance

Numerous studies assessing PCB exposure have produced conflicting results as to their potential harmful effects to wildlife and humans (Agency for Toxic Substances and Disease Registry [ATSDR], 2000; SOA, 2004; and Koller et al., 2009). To date, there are no definitive pathological associations made between human exposure and PCBs (SOA, 2004). Animal studies demonstrating harmful effects have been confined to the laboratory where animals have been subjected to exposures far greater than those observed in the environment. Nevertheless, the unknown effect of long-term, low-dose exposure remains to be seen, suggesting the need for long-term monitoring and surveillance.

The SOA Department of Environmental Conservation Fish Monitoring Program collects fish samples statewide for analysis. Analysis includes the12 POPs designated by the WHO, 14 monitored by the multinational Arctic Monitoring and Assessment Program (AMAP), and 26 considered important by the US Federal Drug Administration (SOA, 2008). The 2008 SOA report detailing the number and types of fish sampled states that “[l]evels of PCBs measured in Alaska fish are far below those measured in fish from other parts of the world” (p. 12).

In addition to monitoring fish, the 2004 SOA bulletin on use of traditional foods recommended further studies to include baseline assessment and monitoring of marine mammal species specific to AN traditional diet, including beluga whale; ringed, harbor, fur and bearded seal; Pacific walrus; and the Stellar sea lion. In the absence of new source contamination, some scientists propose interactions between PCBs and other potentially toxic chemicals may be affected by changes in Arctic climate due to global warming (Couillard, MacDonald, Courtenay, & Palace, 2008). Recent studies demonstrate baseline levels are low in Alaska seafood and wildlife, and the levels worldwide are decreasing (Neale, Small, Schmelzer, & Tjeerdema, 2007; Bentzen et al., 2008; Wolkers et al., 2008; and Pollock et al., 2009).

Neale et al. (2004) analyzed blood from spotted seals captured in Bristol Bay, Alaska. PCB congeners were detected, however levels of many were too low to be quantified (less than 1 ppb wet weight). Ringed seals off the coast of Norway were also analyzed that year showing a 50-90% drop in PCB levels since first tested in 1996 (Wolkers et al., 2008). Pollock et al. (2009) examined, then sampled and analyzed caribou killed by Canadian Inuit hunters in 2001 for 20 organochlorine pesticides and 24 PCB congeners. Examination revealed no significant abnormalities and “in general, contaminant levels were relatively low” (p. 1). In a study of Alaska polar bears, Bentzen et al. (2008) found that organochlorine levels varied greatly by sex, age, and trophic level at which they fed. This would be consistent with other marine mammals with one exception. In polar bears, increased age was negatively associated with PCB levels. This species is noted to be one of the few possessing a natural ability to biotransform and excrete many organochlorine compounds, the process of which is not understood. As a result, the researchers note this ability makes the polar bear a poor species for study of Arctic levels of PCBs in the food web.

Studies of human exposure and impact on AN people are limited (SOA, 2004). In 2001, Rubin et al. confirmed PCB exposure among AN women living in Alaska. Researchers analyzed human sera drawn in the mid-1980s, frozen, and stored at the CDC Arctic Investigations Program. All sera contained PCB congeners, supporting ubiquitous distribution, and levels detected were comparable to levels detected in New York women during the same time period. An ensuing pilot study examined pre-drawn sera belonging to AN women with and without a subsequent breast cancer (Rubin et al., 2006). Breast cancer in AN women is the most frequently diagnosed cancer and the third leading cause of cancer mortality in this population (Lanier et al., 2006). The study hypothesized increased exposure of AN women was due to PCB exposure through traditional food sources and the possibility of breast tissue, which is primarily adipose, serving as a reservoir for PCBs (Rubin et al., 2006). The results served to reconfirm PCB exposure, however no statistically significant PCB level differences were detected and no association could be made between exposure and breast carcinogenesis. Because this study used serum samples drawn three to 10 years prior to diagnosis, a follow-up case-control study was conducted to include analysis of current serum in AN women at the time of pathology-determined breast cancer diagnosis (Koller et al., 2009). Controls included women with benign breast abnormalities. Again, no statistically significant associations could be made, as PCB levels in both groups were similar.

Studies involving human subjects outside Alaska have been pursued potential hormone-disrupting affects of PCBs with similar inconclusive results (Maervoet et al., 2007; Bonde et al., 2008). From a comparison study of Inuit and Belgian men, Bonde et al (2008) concluded that while POPs may appear to have some hormonal affects, no major impact on male fertility could be attributed to exposure. Maervoet et al. (2007) analyzed infant cord blood samples for PCB levels in relation to thyroid hormone levels. Thyroid hormones are responsible for brain development, thus it was postulated that higher PCB levels may interfere with brain development in neonates. The authors reported lower levels of free triiodothyronine (T3) and free thryoxine (T4) hormones, but higher levels of thyroid stimulating hormone (TSH) in relation to higher PCB levels. While level differences were observed, no infant developmental assessment was reported and the authors admit previous studies on the affects of PCBs associated with infant development have been conflicting.

In considering humans at the highest trophic level, it is difficult to imagine infants at the highest level of the human food chain. However, as Wang and Needham (2007) explain, this is undoubtedly true for nursing infants. Aside from significant weight reduction, lactation is the only natural way in which contents of human fat are released and excreted. Bearing this in mind, pregnant and nursing mothers whose diet includes traditional foods have reason to be concerned about transferring these and other chemicals to their nursing infants. The SOA has produced a set of guidelines which limit intake of certain seafood specifically for this group (SOA, 2004). As an added precaution, children under 12 are also included in the limited group to prevent possible but unconfirmed long-term affects. No limits are suggested or implied for teenage boys, adult males, or women unable to conceive. The SOA goes one step further, recommending traditional diet over refined and processed store-bought foods, whenever possible.

Position Statement

Given the evidence, I contend that traditional AN diet is physically, emotionally, socio-culturally, and economically healthier for AN people. Traditional foods provide balanced diets, physical activity, and protective factors which minimize chronic and degenerative disease. With current dietary and physical activity patterns, prevalence of these diseases has increased in AN people. While traditional diet and lifestyle remain important to Native culture, younger members of the population report lower traditional food intake and less traditional physical activities. This may in part explain why obesity and overweight are increasing among these age groups. In light of the increasing burden of chronic disease in this population, return to more traditional food and activity patterns is an appropriate healthy behavioral choice to make and an important investment in their future.

Fear of POPs contamination in traditional foods has been introduced, which may contribute to a suspicion that these foods are no longer healthy. However, the literature does not suggest current levels of exposure are threatening. While PCB exposure is widespread worldwide, no data confirms PCB exposure is harmful. Furthermore, PCB levels in wild foods are declining. What is confirmed is that store-bought processed foods are energy-dense and nutrient-sparse, making them poor in nutritional value. Nutrient-packed, lower energy traditional foods provide nutrition, promote physical activity, and offer protection from “Western” diseases. The benefits of traditional foods in supporting physical, mental, and emotional development have been presented. The interrelationship of traditional diet, physical activity, and health support the holistic principles and values which are embodied in AN culture.

In supporting traditional diet, I do not minimize concerns about PCBs and other contaminants. I support the SOA (2004) recommendations for continued surveillance. Key to this position is the integration of traditional knowledge which AN people possess as a hallmark of their survival and a testament to their wisdom, strength, resilience, and ingenuity. No modern Western science can replace this traditional science, which Carmack and MacDonald (2008) so appropriately expressed. Just as the two intimately interrelated concepts of traditional diet and traditional lifestyle cannot be separated, I contend that traditional knowledge and environmental stewardship are equally interrelated. Retaining the knowledge “of the old world” while adapting to the ever-changing environment is a practiced art among Arctic people for time in memoriam (Hensley, 2009, p. 220). AN youth eager to accept modern scientific principles should be equally eager to gain indigenous knowledge and wisdom from their AN elders. Acquisition of indigenous knowledge and the incorporation of western science will not only benefit the environment, but holds the keys to the health and survival of Arctic people (Zobel, 2009). Researchers who lack traditional knowledge of the land must recognize its importance and seek guidance from the people indigenous to the region. In sharing the bounty of this land, non-Native inhabitants and researchers must incorporate the respect and responsibility of environmental stewardship demonstrated by AN people.

The right to protect family, home, and property extends to AN people as citizens of this country. In participating in research in their communities, they also exercise their right to self-determination, ownership of their land, and control of their future (Public Law 93-638, amended 2000). As masters of survival in this harsh environment, AN people have defied conventional environmental management theory by demonstrating that solutions produced through self-governance provide superior outcomes to those produced by outside authorities and experts with little vested interest (Ostrom, 2005). Investigators who fail to seek and incorporate traditional AN insights deprive themselves of the tools necessary to acquire a comprehensive understanding of the Arctic environment. In terms of research, I wholeheartedly support

“… a type of ‘co-science’ in which natural phenomena are examined through both indigenous and Western methods; each approach is assumed valid within its own set of rules, and neither replaces the other. If we accept a definition of scientist as someone who uses observation, experimentation, and theory to learn about a subject, then the term “scientist” can be applied to an elder: here observation becomes experience; experimentation becomes replication, or what works for survival and what doesn’t work; and theory becomes the legends and teaching stories passed from generation to generation” (Carmack & MacDonald, 2008, p. 266).

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