For one dizzying, schmooze and booze-filled week every January, thousands of tech execs, VCs, and investment bankers grind their way through a four-day slog of panel sessions, poster presentations, networking meetings, and cocktail-drenched after-hours parties in their industry’s premier orgiastic dealmaking event. And no, we’re not talking about CES.

On Monday, the Westin St. Francis hotel in downtown San Francisco opened its doors to the 36th annual J.P. Morgan Healthcare Conference, the country’s largest biotech convention. Everyone is there either to disrupt or to be disrupted. And while some companies were there to hawk the buzziest in far-future thinking—blockchain-based everything! fully robotic operating rooms!—others came to celebrate the very real, very current progress of a field 30 years in the making: gene therapy. And the promise of a much newer technology, Crispr, to propel the long-standing field forward with even greater momentum.

After decades of setbacks, gene therapy—a loosely defined umbrella term for any technique that uses genes to treat or prevent disease—is finally here. In December, the field got its very first FDA approval with Luxturna, which corrects a defective gene in a rare, inherited retinal disease. With a half dozen more treatments in late-stage trials and an unusually open-minded FDA commissioner in Washington, the industry is expecting a flurry of new approvals this year.

Which is going to throw a wrench in the health insurance industry. Because gene therapies are one-time, curative treatments, they break the traditional insurance model, which is designed to make multiple small payments over time. “We recognize that the products in this space create reimbursement challenges to the normal way of doing business,” said Janet Lambert, CEO of the Alliance for Regenerative Medicine, during her presentation Monday on the state of of the cell and gene therapy industry.

Lambert’s lobbying roadmap for 2018 includes helping insurance companies understand what to do with a new gene therapy like Luxturna, which cures blindness with a single, $850,000 injection into the eye. Ranked by sticker price, it’s the most expensive medicine in America. Spark Therapeutics, the company that makes Luxturna, argues that the six-figure price tag isn’t actually that unreasonable, if you factor in all the costs that patients with the inherited retinal disease would have racked up in a lifetime of seeking better care.

But because their clinical trial patients haven’t been followed long enough to determine if the treatment benefits are actually durable for a whole lifetime, Spark has received significant pushback from insurers. As a result, the company is already exploring a some creative new pricing models. It announced last week that it’s offering a rebate program based on the treatment’s effectiveness at 30 to 90 days and again at 30 months with one East Coast provider, and is in talks about expanding it to other insurers, Spark CEO Jeffrey Marrazzo said at JPM. He said Spark is also in discussions with the Centers for Medicare and Medicaid Services on a multi-year installment plan option. Either of these could soon serve as a model for how gene therapies might be made available to patients without cutting the legs out from under the healthcare system.

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That's a problem the Crispr companies in attendance at JPM don’t have to worry about yet. But they’re hoping gene therapy will have figured it out by the time Crispr-based medicines are patient-ready and FDA-approved. The first trial in humans isn’t expected to launch until later this year. But the Big Three—Editas Medicine, Intellia Therapeutics, and Crispr Therapeutics—had other hurdles to contend with.

Over the weekend, headlines metastasized across the internet about a new study suggesting Crispr might not work in humans at all. Published on pre-print server bioRxiv by a Stanford scientist who is also a scientific founder of Crispr Therapeutics, the non peer-reviewed study found that up to 79 percent of humans could already be immune to the most common forms of Crispr, called Crispr-Cas9, which come from two strains of Staphylococcus.

The timing was pretty terrible, and all three companies’ stocks took serious hits Monday morning, even as investors crowded into ballrooms to hear Crispr execs speak. The controversy made for one of the more tense moments of a gene therapy panel, when Sandy Macrae, CEO of rival gene editing tech company Sangamo, which uses zinc-finger nucleases, poked at Crispr Therapeutics chief scientific officer, Bill Lundberg. “That’s why we use human tools to edit humans,” he said.

The crowd of about a thousand swiftly inhaled. (This is what counts as maximum drama at JPM.) But the Crispr folks swiftly pushed back on the claims that immunity will present a barrier to their pipelines, since none of them use just plain old Cas9 like it’s found in nature. They’re all making proprietary tweaks to the enzyme system that they think will make the immunity issue, well, not an issue at all.

“We’ve actually done a lot of work ourselves on this specific topic and we don’t see this as a major issue to advancing Crispr-based medicines,” said Editas president and CEO Katrine Bosley. In a presentation to investors on Wednesday, the company revealed their plans to have five medicines in human testing within the next five years. The first diseases Editas is going after include a number of inherited eye disorders. The company is also pursuing a partnership with Juno Therapeutics to use Crispr to engineer T-cells to fight off incurable cancers.

Immunity to bacterial-based gene editors won’t be an issue for the current crop of gene therapies expected to get approvals in 2018. They represent the tail ends of a long and arduous development pipeline—one that Crispr is only just beginning to enter. It might be another 30 years before anyone is arguing about the insurance implications of one-time, cure-all Crispr meds. But at least by then, there should be some good options.

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Crispr Gene Editing Explained

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A wickedly fast fastball isn’t the anomaly it once was. A decade ago, Major League pitchers threw a grand total of just 196 triple-digit fastballs in a single season. Last year, 40 pitchers collectively threw 1,017.

But while baseball’s hallmark pitch has increased in popularity, it hasn’t increased in velocity.

Consider the confusion over the game’s fastest fastball ever. On paper, the honor goes to Yankees relief pitcher Aroldis Chapman, who clocked 105.1 miles per hour in 2010. But the record could have been set all the way back in 1974. Back then, Nolan Ryan was the first MLB pitcher to be tracked by radar during a game—and while his heater topped out at 100.8 miles per hour, the radar measured Ryan’s ball just before it crossed the plate. Had it eyed the pitch as it was leaving Ryan’s hand (as Chapman’s was), experts believe it might have registered at upwards of 108 miles per hour.

Similar retroactive estimates have put Cleveland Indians pitcher Bob Feller’s fastest fastball at 107.6 miles per hour—and that was all the way back in 1946. Walter Johnson, who played from 1907 to 1927, is also thought to have thrown pitches at 100 mph or more. All of which is to say: Pitchers have been throwing north of 100-mph for the past 100 years. Over the same time period, advances in training, technology, nutrition, and, yes, drugs, have fueled a dramatic upward trend in world-record athletic performances, from the marathon to the long jump to the 50 meter freestyle. But when it comes to hurling a five-ounce, leather-wrapped sphere as fast as possible, humans appear to have plateaued.

“I don’t see it going much higher,” says biomedical engineer Glenn Fleisig, research director of the American Sports Medicine Institute and an expert in the biomechanics of pitching. “I'm sorry to say that, but I don’t see it happening. Baseball isn’t like other sports, where we see people running faster or swimming harder or whatever, where today’s records are smashing the records from 10 years ago.”

That hasn’t prevented pitchers from pursuing the triple-digit barrier at the expense of their arms. A significant number of them undergo major medical procedures to correct injuries from competition. Like the “Tommy John” surgery: When the tendon in a pitcher’s elbow tears, surgeons can replace it with a fresh one from the player’s wrist, forearm, hamstring, or even their toe. Swapping in the relief tendon involves the surgeon drilling holes in the ulna and humerus bones and threading them in a figure-8 pattern with the healthy tissue.

A 2012 survey found that a quarter of Major League pitchers had undergone the Tommy John surgery at some point in their careers. And as the popularity of the fastball has increased, so has the surgery.

Fleisig thinks the rise in Tommy John surgeries has to do with the immense strain that hurling baseballs puts on a pitcher’s arm. By studying cadavers, he and his colleagues found that the force required to tear elbow ligaments is roughly the same as what a pitcher asks of his arm throwing at top speed. When the arm flings back, the shoulder ligaments experience about 100 Newton meters of torque. When it flings forward, the elbow ligaments suffer the same. “It’s the equivalent, at each point, of holding five 12-pound bowling balls,” Fleisig says. “So imagine I hang 60 pounds from your hand. That’s what it would feel like on your elbow or shoulder.” At those forces, he says, pitchers are effectively throwing their arms off. The odds of them throwing much faster seem pretty slim.

Which may actually be a good thing, as fastballs are already right at the limit of what batters can reliably hit.

A 100-mph fastball reaches home plate in under 400 milliseconds. The swing itself takes about 150 milliseconds. That leaves less than a quarter of a second for a batter to spot the pitch and decide whether and where to swing. That’s absurdly fast, which may explain why the swinging strike rate for triple-digit heaters is almost three times higher than it is for lesser fastballs.

But the tiny reaction window is only part of why batters struggle to connect. The other culprit: lack of practice. As popular as they’ve become, 100-mph fastballs are still pretty rare—rare enough that you’re not going to face off against them regularly at batting practice. Unless you’ve got a workaround.

The baseball team at Villanova University recently got access to a tireless pitcher who can throw fastballs all day long—even impossibly fast ones. Engineer Mark Jupina designed a virtual hitting simulator that allows batters to practice identifying and even hitting against any pitch in the MLB’s PITCHf/x database. (PITCHf/x is a tracking system installed in every MLB stadium that records the velocity, trajectory, release point, and spin of every pitch.) Players can either face off against the virtual pitcher in the university’s CAVE (an immersive, four-walled virtual reality environment equipped with infrared cameras), or by donning an Oculus Rift headset. “We have data sets that are appropriate for a high school level, all the way up beyond the pro level,” Jupina says. “We can even show you what, realistically, 120 mile an hour fastball would look like.”

I stood in the simulator and stared down a 120-mph pitch. It was ludicrous. The trip from the mound to the plate took just three tenths of a second; I felt like I needed to start my swing before the ball even left the pitcher’s hand.

Then a few members of Villanova’s baseball team took a crack at the simulator, and Jupina showed me how they planned to use it in training. Fastball practice was only part of the exercise. In one activity, he’d freeze the ball 150 milliseconds after leaving the pitcher’s hand, and ask the batter to ID the pitch. Was it coming in fast and straight, or was it a slow breaking ball? Would it cross the plate high and inside, or right down the middle?

Me, I couldn’t tell a fastball from a slider, but Villanova’s players took to it quickly, using things like the position of the pitcher’s arm and the spin of the ball to identify the pitch. It was impressive to watch, in part because it’s always impressive to witness someone exercise a sense you do not possess yourself. But also because the latency, the resolution, the sense of depth—they were all good enough to make reading an incoming pitch possible. All of which could make this a tremendous training tool.

“In the future, I could see every Major League baseball organization having this available to their hitters,” says Villanova’s head baseball coach Kevin Mulvey, a former pro pitcher himself. “If you could upload the pitcher that you're going to be facing to this virtual interface, in the stadium that you'll playing, at the time you'll be playing, and you can get in there and re-live an at-bat that you had against him, you're going to be better prepared to face this guy than if you were just taking batting practice off a generic lefty or generic righty."

After all, not many people can throw a triple digit pitch. But with a tool like Jupina's, a whole lot more could train to hit one.

On the first Saturday of March, Kristin Comella put on a white doctor’s coat and took the stage at the fourth annual conference for the Academy of Regenerative Practices. The founder and president of the academy, Comella also oversees an expanding empire of stem cell clinics that promise patients cures for most anything that ails them. None of those treatments—for everything from diabetes and asthma to multiple sclerosis and arthritis—have been approved by the US Food and Drug Administration.

The procedure—which costs a few thousand dollars—is always pretty much the same, regardless of its purported target. It involves sucking out some of a patient’s fat tissue with a liposuction needle, isolating the stem cells within, and reinjecting them into the patient’s body. The simplicity of the procedure is why people like Comella say it’s “insane” for the FDA to try to regulate stem cells.

So it was surprising when she announced onstage that her firm, US Stem Cell, had recently begun developing a radically new kind of treatment—this time, for cancer.

“Your stem cells are antigen-presenting cells,” Cormella told the audience, in a Facebook live video the company posted of the event. “We can make them express a protein from your specific cancer. So, it’s an individualized cancer vaccine, if you will.” US Stem Cell, a publicly traded firm that sells stem cell separation kits and operates one of the largest networks of clinics in the country, achieved this with something called an “electroporation protocol,” she said.

Electroporation is essentially zapping cells with electricity—a microbiology technique used to get drugs, proteins, or, most commonly, DNA into cells. “When I hear electroporation, that’s equal to genetic modification,” says Paul Knoepfler, a stem cell researcher at UC Davis. “That’s what we do when we want cells to permanently express a protein.”

Knoepfler writes a blog about stem cells, and that’s where he surfaced the video on May 9, after an acquaintance tipped him off. He’s sort of a watchdog for the industry. Since 2011, he’s tracked the proliferation of unregulated stem cell clinics and followed US Stem Cell’s cavalier approach to experimenting on its patients, sometimes to disastrous effect. In 2015, one of its clinics injected liposuction-derived stem cells directly into the eyeballs of three elderly women suffering from age-related macular degeneration. All three went blind, two sued, and US Stem Cell settled out of court.

But this, he says, might be the most dangerous thing he’s seen yet. “If my assumption is correct that they’re introducing DNA, this is up near the top of the riskiest things I’ve ever heard a stem cell clinic doing,” he says. “The big worry here is giving cancer patients another cancer, or a dangerous immune response."

US Stem Cell did not respond to WIRED’s questions about the procedure, so it’s still unclear if it does indeed involve genetic modification and whether any patients have actually been treated with it. In the video Comella only described it as one of the company’s “current protocols.”

What we do know is that the approach sounds similar to a powerful new class of anti-cancer medicines known as CAR-T therapies. They involve extracting a patient’s immune cells and genetically rewiring them to more effectively recognize and attack cancerous cells in the body. The FDA approved the first CAR-T, Kymriah, in late 2017 after scrutinizing years of data from animal studies and human clinical trials. Novartis claims it spent $1 billion to get the treatment to market.

Compare that with the $6,664 US Stem Cell reported having spent last year on research and development. The company—formerly named Bioheart—has nine clinical trials listed on the national registry ClinicalTrials.gov, none of which are actively recruiting and none of which are for cancer treatments. Though listed as the lead investigator on some of the trials, Comella isn’t a medical doctor. She received a three-year online PhD in stem cell biology from the Panama College of Cell Science—a non-accredited virtual university founded by stem cell evangelist Walter Drake, according to reporting by the LA Times. And she’s not afraid to spar with the federal government.

Last August the FDA sent a warning letter to US Stem Cell and to Comella, specifically, for “significant deviations” from good practices. And after Comella responded with a letter of her own, denying FDA has any jurisdiction to regulate her company’s activities, the agency followed up with a lawsuit.

On May 9, the FDA along with the Department of Justice filed a complaint seeking a permanent injunction against US Stem Cell and Comella, accusing them of endangering patient safety and failing to meet manufacturing standards for cell therapies. The federal officials also filed a similar lawsuit against another clinic—California Stem Cell Treatment Center—which was involved in giving patients an experimental cancer treatment made from a mix of stem cells and a smallpox vaccine inappropriately acquired from a Centers for Disease Control and Prevention stockpile under the auspices of research. When officials found out they were being administered to patients, US marshals raided the clinic and seized the remaining vials.

Both California Stem Cell Treatment Center and US Stem Cell said in public statements they plan to fight the injunctions, the most aggressive volley yet in the conflict surrounding direct-to-consumer stem cell treatments. At the heart of the clash is the phrase “minimally manipulated,” which the FDA uses to exempt therapies like bone marrow transplants. Both clinics will likely argue in court that their cell-based treatments fit that description. But Comella’s recent statements at the conference could undermine this claim. Electroporation is a tool designed explicitly for cellular manipulation, and there’s nothing minimal about it.

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Many people don't know too much about angular momentum—and that's fine. But what about figure skaters? Whether they understand the concept of angular momentum doesn't matter but they use it in one of the all time classic skating moves. You've seen it before. The skater starts off in a standing position and spins about the vertical axis. After a few rotations, the skater pulls both arm in closer to the body and spins faster. In physics, we call this conservation of angular momentum.

Just as an example, here is this same maneuver performed on a rotating platform instead of on ice.

Really, you can try something like this on your own. Sit on a nice spinning chair or stool. Start with your arms stretched out as you spin and then bring your arms in. Don't barf.

But what exactly is angular momentum? In short, it is something that we can calculate that can be conserved. That's a tough definition, so let me give an example of a conserved quantity—like mass (which only mostly conserved). Suppose you take add some baking soda to vinegar. If you've ever done this, you will see that the resulting mixture foams and produces some gas. But here's the cool part. If you measure the mass of the stuff you start with (vinegar and baking soda) it's the same as the mass of the stuff you end up with (carbon dioxide and water and sodium acetate). Boom, mass is conserved. It's the same before and after.

OK, I have to point out that mass isn't always conserved. n a nuclear reaction, the mass of the stuff before doesn't have to be equal to the mass of the stuff after. But if you look at energy (and include mass in the energy), then energy is conserved.

Now for angular momentum. The angular momentum is a quantity that we can calculate for rotating object. It's the product of the angular velocity (how fast it spins—represented with the symbol ω) and the moment of inertia (using the symbol I). I think most people are OK with the idea of the angular velocity—but the moment of inertia thing is a bit more complicated. Basically, the moment of inertia is a property of an object that depends on the distribution of the mass about the rotation axis. If you have more mass further away from the axis of rotation, the moment of inertia is larger than if that was was close to the axis.

Here is a super quick demo—and you can try this at home. I have two sticks with juice boxes taped to them such that both sticks (plus juice) have the same mass. However, there is a difference. One stick has the juice boxes at the ends of the stick (high moment of inertia) and one stick has them taped to the middle of the stick (low moment of inertia). Now look at what happens when you try to rotate these sticks back and forth (remember—they are the same mass). Oh, to make things more fun I gave the higher moment of inertia stick to the stronger girl. Also, here is a longer video version of this demo.

So let's review. The angular momentum depends on both the angular velocity and the mass distribution of the object. You can change this angular momentum by exerting a torque (a twisting force)—but with no external torque, the angular momentum is conserved.

Now getting back to the ice skater. In the vertical spinning position, there is very little torque exerted on the system (since ice is slippery and the skates are close to the axis of rotation). This means that the angular momentum should stay at a constant value. But what happens if you change something—like bringing your arms closer to your body? This would decrease the moment of inertia. Since the angular momentum has to stay constant, the angular velocity must increase. It's the only way to conserve angular momentum.

Here is another view (from the top) of this same move—just for fun.

Really, you could easily take some measurements from this. It wouldn't be too difficult to measure the angular velocity both before and after the arms being pulled in. From that, you could calculate the change in the moment of inertia. But still, I think this move is best left to professionals—the spinning would make me sick.

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You could be excused, when you first hear Dane Rudy describe his company, for thinking that he wants to use raccoons to send satellites into space. Trash pandas, though, are not the future that Rudy is talking about.

He's talking about rockoons—rockets launched from high-altitude balloons. Rockoons trace their trajectory back to the military, like the 1950s Air Force program called Farside. (Check out the news anchor's vintage intonations in this archival video about the program's fifth—and first successful—launch attempt.)

Rockoons, Rudy believes, deserve a reboot. Through his company, Leo Aerospace, he wants to balloon small satellites into the stratosphere, then shoot them to orbit with rockets. When launched from the ground, rockets require lots of fuel to push through the dense air of those first miles. If another vehicle floats them way up before they have to fire, they can use their fuel for what really matters—getting to space—rather than wasting it on leaving the ground. Right now, small satellites usually have to carpool on serious rockets, with names like Falcon, which is inconvenient, inefficient, expensive, slow—all the things small satellites are supposed to not be.

Last Wednesday, Rudy was in the LA Grand Hotel, surrounded by soft-jazz piano and spiral-arm chandeliers, to try to figure out what rockoons could maybe do for the military. Back in April, the Defense Advanced Research Projects Agency—Darpa—announced that it would hold a "Launch Challenge": To win, competitors have to launch something small into space two times in a span of weeks.

It's going to be a bit of a fire drill: Less than a month before the first launch, sometime in the last quarter of 2019, Darpa will tell competitors where it will take place. Then, less than two weeks before go-time, the agency will give them details about orbit, payload, and pad. And then they must rinse-repeat within weeks, with new requirements that they'll only receive after the first launch. The agency will give $10 million to the first-place winner, plus $400,000 to all who qualify to enter at all, and $2 million to everyone who nails the first launch.

At the Grand Hotel, Rudy was attending Darpa's "Competitors’ Day," an opportunity for would-be launchers to come together and get a read on the situation. It's kind of a PowerPoint-heavy Opening Ceremonies, minus musical numbers, and the ballroom is full of launch vehicle makers, propulsion companies, component constructors, New Space upstarts, Old Space stalwarts, spaceport representatives, and also the guy who sent the first hot dog toward space.

Everyone's name badge has the same graphic, which looks like a flat plain, edged by mountains. Four rockets launch at once from the landscape, which resembles classic aerospace-innovation geography. It's Edwards Air Force Base, or White Sands Missile Range. It's Area 51, or the Academy in Colorado Springs. And toward the end of 2019, Darpa may ask these competitors to launch from federal places like these, or from the commercial spaceports popping up around the country.

At the beginning of the meeting, Todd Master, the Launch Challenge program manager, steps up to a podium. "For a really long time, we’ve enjoyed and benefited from space being a sanctuary," he says. The guy next to me, who has a Sputnik tattoo on one forearm and an infinity symbol inked on the other, writes something in his notebook.

"That environment has been changing," he continues. "We’re in an environment now where we view ourselves as threatened in space."

Here’s part of what this means: More entities than ever can get to orbit. If you can get to orbit, it's no huge technological leap to trespass onto someone else’s space—by, say, slamming into their satellite. This problem has been part of the space race from the beginning. After all, the reason we invented rockets was to shoot each other with missiles, not because of the romantic human urge to explore the cosmos. And hackers could even target the software and signals satellites send, without shooting anything physical into space in the first place.

One ultra-satellite is vulnerable to take-down, physically or cyber-ly. But if you take that satellite's skills and disperse them across a network of hundreds or thousands of small, replaceable sats? The flock functions fine even if a few get destroyed or corrupted. And if a big one becomes compromised, you can quickly reestablish its capabilities in miniature. So Darpa hopes the DoD will pivot to constellations of small space objects, sent up so often that the citizenry simply shrugs its collective shoulders at every successful rocket launch. It doesn't even have to be a rocket. “I don’t care if FedEx is three trucks and two boats and an airplane,” says Master. "Get it there and I’ll pay you.”

The hosts set the crowd loose with an explicit mandate to network. Some attendees have vehicles in the works, while some make only vehicle parts. Some are the taker-carers of logistics. Some are from the spaceports. Few attendees, in other words, have the standalone resources to complete the Launch Challenge. I end up in a gaggle with Rudy. Nearby, someone from Northrop Grumman talks to the founder of Ruckus Composites, a company that mostly does carbon fiber work for the bike industry. But the founder, Shawn Small, is a space geek—he’s the one with the Sputnik tattoo.

Small also makes rockets sometimes, telescopes other times. He sent that first hot dog 22 miles up. Also chicken, on a mission called “A Pollo 13.” He wonders to me, at the end of the day, exactly why Darpa wants this responsive technology. “What do they know?” he asks. As in, what do they know that we don't.

A lot, probably, about all the things that could realistically go wrong in space. The military mindset is a strange thing, tasking itself with thinking constantly about how we are threatened, or could be. And for Darpa, right now, the way to shrink risk is to shrink satellites.

As I get ready to leave, I ask Rudy if it’s strange, for him, to be thinking about doing defense work (Rudy says he isn't sure whether Leo will enter the challenge). On Leo's website, the company describes using little satellites to track crop health, illegal fishing, port traffic. But like all launch technology, rockoons are dual-use. Most space companies—from the big SpaceXs and Boeings to the smaller Planets and Rocket Labs—do defense or intelligence work.

Partly for that reason, Leo Aerospace just went through a national-security-focused accelerator, MD5, to gain experience in navigating the byzantine bureaucratic processes involved in defense contracting. "You learn a lot of things you wouldn't expect," Rudy says, when you get into the defense world, but what he has learned has convinced him the sector is "trying to make the world a better, safer place."

And a more watched one, in which the US doesn't lose whatever shadow space race is going on. Darpa, in fact, was founded partly because of the surprise Soviet launch of Sputnik—the world's first (small) satellite. The US, henceforth, would be the surpris-er. So no matter what the agency publicly says about quick-launch and smallsat infrastructure, it surely is anticipating some surprises to come, and planning a few of its own.

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