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. 1994 Aug;102(8):656–667. doi: 10.1289/ehp.94102656

Inconsistencies and open questions regarding low-dose health effects of ionizing radiation.

R H Nussbaum 1, W Köhnlein 1
PMCID: PMC1567333  PMID: 7895705

Abstract

The effects on human health of exposures to ionizing radiation at low doses have long been the subject of dispute. In this paper we focus on open questions regarding the health effects of low-dose exposures that require further investigations. Seemingly contradictory findings of radiation health effects have been reported for the same exposed populations, or inconsistent estimates of radiation risks were found when different populations and exposure conditions were compared. Such discrepancies may be indicative of differences in sensitivities among the applied methods of epidemiological analysis or indicative of significant discrepancies in health consequences after comparable total exposures of different populations under varying conditions. We focus first on inconsistencies and contradictions in presentations of the state of knowledge by different authoritative experts. We then review studies that found positive associations between exposure and risks in dose ranges where traditional notions (generalized primarily from high-dose studies of A-bomb survivors or exposed animals) would have predicted negligible effects. One persistent notion in many reviews of low-dose effects is the hypothesis of reduced biological effectiveness of fractionated low-dose exposures, compared to that of the same acute dose. This assumption is not supported by data on human populations. From studies of populations that live in contaminated areas, more and more evidence is accumulating on unusual rates of various diseases other than radiation-induced malignancies, health effects that are suspected to be associated with relatively low levels of internal exposures originating from radioactive fallout. Such effects include congenital defects, neonatal mortality, stillbirths, and possibly genetically transmitted disease. A range of open questions challenges scientists to test imaginative hypotheses about induction of disease by radiation with novel research strategies.

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Selected References

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  1. Abrahamson S. Childhood leukemia at Sellafield. Radiat Res. 1990 Aug;123(2):237–238. [PubMed] [Google Scholar]
  2. Archer V. E. Association of nuclear fallout with leukemia in the United States. Arch Environ Health. 1987 Sep-Oct;42(5):263–271. doi: 10.1080/00039896.1987.9935819. [DOI] [PubMed] [Google Scholar]
  3. Band P. R., Spinelli J. J., Ng V. T., Moody J., Gallagher R. P. Mortality and cancer incidence in a cohort of commercial airline pilots. Aviat Space Environ Med. 1990 Apr;61(4):299–302. [PubMed] [Google Scholar]
  4. Barendsen G. W. Do fast neutrons at low dose rate enhance cell transformation in vitro? A basic problem of microdosimetry and interpretation. Int J Radiat Biol Relat Stud Phys Chem Med. 1985 Jun;47(6):731–734. doi: 10.1080/09553008514550971. [DOI] [PubMed] [Google Scholar]
  5. Barish R. J. Health physics concerns in commercial aviation. Health Phys. 1990 Aug;59(2):199–204. doi: 10.1097/00004032-199008000-00006. [DOI] [PubMed] [Google Scholar]
  6. Baverstock K., Egloff B., Pinchera A., Ruchti C., Williams D. Thyroid cancer after Chernobyl. Nature. 1992 Sep 3;359(6390):21–22. doi: 10.1038/359021b0. [DOI] [PubMed] [Google Scholar]
  7. Beral V., Fraser P., Carpenter L., Booth M., Brown A., Rose G. Mortality of employees of the Atomic Weapons Establishment, 1951-82. BMJ. 1988 Sep 24;297(6651):757–770. doi: 10.1136/bmj.297.6651.757. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Beral V., Inskip H., Fraser P., Booth M., Coleman D., Rose G. Mortality of employees of the United Kingdom Atomic Energy Authority, 1946-1979. Br Med J (Clin Res Ed) 1985 Aug 17;291(6493):440–447. doi: 10.1136/bmj.291.6493.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bithell J. F., Stiller C. A. A new calculation of the carcinogenic risk of obstetric X-raying. Stat Med. 1988 Aug;7(8):857–864. doi: 10.1002/sim.4780070804. [DOI] [PubMed] [Google Scholar]
  10. Bross I. D., Natarajan N. Cumulative genetic damage in children exposed to preconception and intrauterine radiation. Invest Radiol. 1980 Jan-Feb;15(1):52–64. doi: 10.1097/00004424-198001000-00009. [DOI] [PubMed] [Google Scholar]
  11. Checkoway H., Mathew R. M., Shy C. M., Watson J. E., Jr, Tankersley W. G., Wolf S. H., Smith J. C., Fry S. A. Radiation, work experience, and cause specific mortality among workers at an energy research laboratory. Br J Ind Med. 1985 Aug;42(8):525–533. doi: 10.1136/oem.42.8.525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Checkoway H., Pearce N., Crawford-Brown D. J., Cragle D. L. Radiation doses and cause-specific mortality among workers at a nuclear materials fabrication plant. Am J Epidemiol. 1988 Feb;127(2):255–266. doi: 10.1093/oxfordjournals.aje.a114801. [DOI] [PubMed] [Google Scholar]
  13. Clapp R. W., Cobb S., Chan, Walker B., Jr Leukaemia near Massachusetts nuclear power plant. Lancet. 1987 Dec 5;2(8571):1324–1325. doi: 10.1016/s0140-6736(87)91209-8. [DOI] [PubMed] [Google Scholar]
  14. Dieckmann H. Häufung von Leukämieerkrankungen in der Elbmarsch. Gesundheitswesen. 1992 Oct;54(10):592–596. [PubMed] [Google Scholar]
  15. Draper G. J., Stiller C. A., Cartwright R. A., Craft A. W., Vincent T. J. Cancer in Cumbria and in the vicinity of the Sellafield nuclear installation, 1963-90. BMJ. 1993 Jan 9;306(6870):89–94. doi: 10.1136/bmj.306.6870.89. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Frome E. L., Cragle D. L., McLain R. W. Poisson regression analysis of the mortality among a cohort of World War II nuclear industry workers. Radiat Res. 1990 Aug;123(2):138–152. [PubMed] [Google Scholar]
  17. Gardner M. J. Father's occupational exposure to radiation and the raised level of childhood leukemia near the Sellafield nuclear plant. Environ Health Perspect. 1991 Aug;94:5–7. doi: 10.1289/ehp.94-1567974. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Gardner M. J., Snee M. P., Hall A. J., Powell C. A., Downes S., Terrell J. D. Results of case-control study of leukaemia and lymphoma among young people near Sellafield nuclear plant in West Cumbria. BMJ. 1990 Feb 17;300(6722):423–429. doi: 10.1136/bmj.300.6722.423. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Gilbert E. S., Cragle D. L., Wiggs L. D. Updated analyses of combined mortality data for workers at the Hanford Site, Oak Ridge National Laboratory, and Rocky Flats Weapons Plant. Radiat Res. 1993 Dec;136(3):408–421. [PubMed] [Google Scholar]
  20. Gilbert E. S., Fry S. A., Wiggs L. D., Voelz G. L., Cragle D. L., Petersen G. R. Methods for analyzing combined data from studies of workers exposed to low doses of radiation. Am J Epidemiol. 1990 May;131(5):917–927. doi: 10.1093/oxfordjournals.aje.a115581. [DOI] [PubMed] [Google Scholar]
  21. Gilbert E. S., Omohundro E., Buchanan J. A., Holter N. A. Mortality of workers at the Hanford site: 1945-1986. Health Phys. 1993 Jun;64(6):577–590. doi: 10.1097/00004032-199306000-00001. [DOI] [PubMed] [Google Scholar]
  22. Gilbert E. S., Petersen G. R., Buchanan J. A. Mortality of workers at the Hanford site: 1945-1981. Health Phys. 1989 Jan;56(1):11–25. doi: 10.1097/00004032-198901000-00001. [DOI] [PubMed] [Google Scholar]
  23. Greenberg M. The evolution of attitudes to the human hazards of ionizing radiation and to its investigators. Am J Ind Med. 1991;20(6):717–721. doi: 10.1002/ajim.4700200602. [DOI] [PubMed] [Google Scholar]
  24. Hatch M., Susser M. Background gamma radiation and childhood cancers within ten miles of a US nuclear plant. Int J Epidemiol. 1990 Sep;19(3):546–552. doi: 10.1093/ije/19.3.546. [DOI] [PubMed] [Google Scholar]
  25. Hendee W. R. Estimation of radiation risks. BEIR V and its significance for medicine. JAMA. 1992 Aug 5;268(5):620–624. [PubMed] [Google Scholar]
  26. Hoel D. G. Questions about radiation and risk estimates that remain after BEIR V. Radiat Res. 1993 Oct;136(1):137–139. [PubMed] [Google Scholar]
  27. Inskip H., Beral V., Fraser P., Booth M., Coleman D., Brown A. Further assessment of the effects of occupational radiation exposure in the United Kingdom Atomic Energy Authority mortality study. Br J Ind Med. 1987 Mar;44(3):149–160. doi: 10.1136/oem.44.3.149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Jablon S., Hrubec Z., Boice J. D., Jr Cancer in populations living near nuclear facilities. A survey of mortality nationwide and incidence in two states. JAMA. 1991 Mar 20;265(11):1403–1408. [PubMed] [Google Scholar]
  29. Kazakov V. S., Demidchik E. P., Astakhova L. N. Thyroid cancer after Chernobyl. Nature. 1992 Sep 3;359(6390):21–21. doi: 10.1038/359021a0. [DOI] [PubMed] [Google Scholar]
  30. Kendall G. M., Muirhead C. R., MacGibbon B. H., O'Hagan J. A., Conquest A. J., Goodill A. A., Butland B. K., Fell T. P., Jackson D. A., Webb M. A. Mortality and occupational exposure to radiation: first analysis of the National Registry for Radiation Workers. BMJ. 1992 Jan 25;304(6821):220–225. doi: 10.1136/bmj.304.6821.220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Kerber R. A., Till J. E., Simon S. L., Lyon J. L., Thomas D. C., Preston-Martin S., Rallison M. L., Lloyd R. D., Stevens W. A cohort study of thyroid disease in relation to fallout from nuclear weapons testing. JAMA. 1993 Nov 3;270(17):2076–2082. [PubMed] [Google Scholar]
  32. Kerr G. D. Quality factors. Health Phys. 1988 Aug;55(2):241–249. doi: 10.1097/00004032-198808000-00016. [DOI] [PubMed] [Google Scholar]
  33. Kinlen L. J. Can paternal preconceptional radiation account for the increase of leukaemia and non-Hodgkin's lymphoma in Seascale? BMJ. 1993 Jun 26;306(6894):1718–1721. doi: 10.1136/bmj.306.6894.1718. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Kinlen L. J., Clarke K., Balkwill A. Paternal preconceptional radiation exposure in the nuclear industry and leukaemia and non-Hodgkin's lymphoma in young people in Scotland. BMJ. 1993 May 1;306(6886):1153–1158. doi: 10.1136/bmj.306.6886.1153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Kneale G. W. Comment on prenatal x rays and cancers. Health Phys. 1987 Aug;53(2):200–200. [PubMed] [Google Scholar]
  36. Kneale G. W., Mancuso T. F., Stewart A. M. Hanford radiation study III: a cohort study of the cancer risks from radiation to workers at Hanford (1944-77 deaths) by the method of regression models in life-tables. Br J Ind Med. 1981 May;38(2):156–166. doi: 10.1136/oem.38.2.156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Kneale G. W., Mancuso T. F., Stewart A. M. Job related mortality risks of Hanford workers and their relation to cancer effects of measured doses of external radiation. Br J Ind Med. 1984 Feb;41(1):9–14. doi: 10.1136/oem.41.1.9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Kneale G. W., Sorahan T., Stewart A. M. Evidence of biased recording of radiation doses of Hanford workers. Am J Ind Med. 1991;20(6):799–803. doi: 10.1002/ajim.4700200612. [DOI] [PubMed] [Google Scholar]
  39. Kneale G. W., Stewart A. M. Prenatal x rays and cancers: further tests of data from the Oxford Survey of Childhood Cancers. Health Phys. 1986 Sep;51(3):369–376. [PubMed] [Google Scholar]
  40. Kneale G. W., Stewart A. M. Reanalysis of Hanford data: 1944-1986 deaths. Am J Ind Med. 1993 Mar;23(3):371–389. doi: 10.1002/ajim.4700230302. [DOI] [PubMed] [Google Scholar]
  41. Krain L. S. Aviation, high altitude, cumulative radiation exposure and their associations with cancer. Med Hypotheses. 1991 Jan;34(1):33–40. doi: 10.1016/0306-9877(91)90062-4. [DOI] [PubMed] [Google Scholar]
  42. Kulakov V. I., Sokur T. N., Volobuev A. I., Tzibulskaya I. S., Malisheva V. A., Zikin B. I., Ezova L. C., Belyaeva L. A., Bonartzev P. D., Speranskaya N. V. Female reproductive function in areas affected by radiation after the Chernobyl power station accident. Environ Health Perspect. 1993 Jul;101 (Suppl 2):117–123. doi: 10.1289/ehp.93101s2117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Mancuso T. F., Stewart A., Kneale G. Radiation exposures of Hanford workers dying from cancer and other causes. Health Phys. 1977 Nov;33:369–385. doi: 10.1097/00004032-197711000-00002. [DOI] [PubMed] [Google Scholar]
  44. McKinney P. A., Alexander F. E., Cartwright R. A., Parker L. Parental occupations of children with leukaemia in west Cumbria, north Humberside, and Gateshead. BMJ. 1991 Mar 23;302(6778):681–687. doi: 10.1136/bmj.302.6778.681. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Messing K., Ferraris J., Bradley W. E., Swartz J., Seifert A. M. Mutant frequency of radiotherapy technicians appears to be associated with recent dose of ionizing radiation. Health Phys. 1989 Oct;57(4):537–544. doi: 10.1097/00004032-198910000-00003. [DOI] [PubMed] [Google Scholar]
  46. Modan B., Chetrit A., Alfandary E., Katz L. Increased risk of breast cancer after low-dose irradiation. Lancet. 1989 Mar 25;1(8639):629–631. doi: 10.1016/s0140-6736(89)92140-5. [DOI] [PubMed] [Google Scholar]
  47. Morgan K. Z. Changes in international radiation protection standards. Am J Ind Med. 1994 Feb;25(2):301–307. doi: 10.1002/ajim.4700250217. [DOI] [PubMed] [Google Scholar]
  48. Neel J. V., Awa A. A., Kodama Y., Nakano M., Mabuchi K. "Rogue" lymphocytes among Ukrainians not exposed to radioactive fall-out from the Chernobyl accident: the possible role of this phenomenon in oncogenesis, teratogenesis, and mutagenesis. Proc Natl Acad Sci U S A. 1992 Aug 1;89(15):6973–6977. doi: 10.1073/pnas.89.15.6973. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Neel J. V. Update on the genetic effects of ionizing radiation. JAMA. 1991 Aug 7;266(5):698–701. [PubMed] [Google Scholar]
  50. Nussbaum R. H., Köhnlein W., Belsey R. E. Die neueste Krebsstatistik der Hiroshima-Nagasaki-Uberlebenden. Eine unabhängige Analyse. Med Klin (Munich) 1991 Feb 15;86(2):99–108. [PubMed] [Google Scholar]
  51. Petkau A. Radiation carcinogenesis from a membrane perspective. Acta Physiol Scand Suppl. 1980;492:81–90. [PubMed] [Google Scholar]
  52. Pierce D. A., Vaeth M. The shape of the cancer mortality dose-response curve for the A-bomb survivors. Radiat Res. 1991 Apr;126(1):36–42. [PubMed] [Google Scholar]
  53. Preston D. L., Pierce D. A. The effect of changes in dosimetry on cancer mortality risk estimates in the atomic bomb survivors. Radiat Res. 1988 Jun;114(3):437–466. [PubMed] [Google Scholar]
  54. Rinsky R. A., Melius J. M., Hornung R. W., Zumwalde R. D., Waxweiler R. J., Landrigan P. J., Bierbaum P. J., Murray W. E., Jr Case-control study of lung cancer in civilian employees at the Portsmouth Naval Shipyard, Kittery, Maine. Am J Epidemiol. 1988 Jan;127(1):55–64. doi: 10.1093/oxfordjournals.aje.a114791. [DOI] [PubMed] [Google Scholar]
  55. Roberts L. British radiation study throws experts into tizzy. Science. 1990 Apr 6;248(4951):24–25. doi: 10.1126/science.2321023. [DOI] [PubMed] [Google Scholar]
  56. Roman E., Watson A., Beral V., Buckle S., Bull D., Baker K., Ryder H., Barton C. Case-control study of leukaemia and non-Hodgkin's lymphoma among children aged 0-4 years living in west Berkshire and north Hampshire health districts. BMJ. 1993 Mar 6;306(6878):615–621. doi: 10.1136/bmj.306.6878.615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Scheer J. Gould and Goldman: deadly deceit--a defense. Health Phys. 1991 Aug;61(2):279–280. [PubMed] [Google Scholar]
  58. Scheer J. Neonatal mortality in Germany since the Chernobyl explosion. BMJ. 1992 Mar 28;304(6830):843–843. doi: 10.1136/bmj.304.6830.843-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Scheid W., Weber J., Petrenko S., Traut H. Chromosome aberrations in human lymphocytes apparently induced by Chernobyl fallout. Health Phys. 1993 May;64(5):531–534. doi: 10.1097/00004032-199305000-00011. [DOI] [PubMed] [Google Scholar]
  60. Scheid W., Weber J., Traut H., Gabriel H. W. Chromosome aberrations induced in the lymphocytes of pilots and stewardesses. Naturwissenschaften. 1993 Nov;80(11):528–530. doi: 10.1007/BF01140813. [DOI] [PubMed] [Google Scholar]
  61. Sever L. E., Gilbert E. S., Hessol N. A., McIntyre J. M. A case-control study of congenital malformations and occupational exposure to low-level ionizing radiation. Am J Epidemiol. 1988 Feb;127(2):226–242. doi: 10.1093/oxfordjournals.aje.a114799. [DOI] [PubMed] [Google Scholar]
  62. Shleien B., Ruttenber A. J., Sage M. Epidemiologic studies of cancer in populations near nuclear facilities. Health Phys. 1991 Dec;61(6):699–713. doi: 10.1097/00004032-199112000-00001. [DOI] [PubMed] [Google Scholar]
  63. Smith P. G., Douglas A. J. Mortality of workers at the Sellafield plant of British Nuclear Fuels. Br Med J (Clin Res Ed) 1986 Oct 4;293(6551):845–854. doi: 10.1136/bmj.293.6551.845. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Smith R. J. Study of Atomic Veterans fuels controversy. Science. 1983 Aug 19;221(4612):733–734. doi: 10.1126/science.6879172. [DOI] [PubMed] [Google Scholar]
  65. Sorahan T., Roberts P. J. Childhood cancer and paternal exposure to ionizing radiation: preliminary findings from the Oxford Survey of Childhood Cancers. Am J Ind Med. 1993 Feb;23(2):343–354. doi: 10.1002/ajim.4700230211. [DOI] [PubMed] [Google Scholar]
  66. Sternglass E. J., Gould J. M. Breast cancer: evidence for a relation to fission products in the diet. Int J Health Serv. 1993;23(4):783–804. doi: 10.2190/MQ86-8R4W-BGJD-MJ80. [DOI] [PubMed] [Google Scholar]
  67. Stevens W., Thomas D. C., Lyon J. L., Till J. E., Kerber R. A., Simon S. L., Lloyd R. D., Elghany N. A., Preston-Martin S. Leukemia in Utah and radioactive fallout from the Nevada test site. A case-control study. JAMA. 1990 Aug 1;264(5):585–591. [PubMed] [Google Scholar]
  68. Stewart A. M., Kneale G. W. A-bomb radiation and evidence of late effects other than cancer. Health Phys. 1990 Jun;58(6):729–735. doi: 10.1097/00004032-199006000-00004. [DOI] [PubMed] [Google Scholar]
  69. Stewart A. M., Kneale G. W. A-bomb survivors: further evidence of late effects of early deaths. Health Phys. 1993 May;64(5):467–472. doi: 10.1097/00004032-199305000-00002. [DOI] [PubMed] [Google Scholar]
  70. Stewart A., Kneale G. Mortality of Hanford workers. Health Phys. 1989 Nov;57(5):839–841. [PubMed] [Google Scholar]
  71. Straume T., Egbert S. D., Woolson W. A., Finkel R. C., Kubik P. W., Gove H. E., Sharma P., Hoshi M. Neutron discrepancies in the DS86 Hiroshima dosimetry system. Health Phys. 1992 Oct;63(4):421–426. doi: 10.1097/00004032-199210000-00006. [DOI] [PubMed] [Google Scholar]
  72. Underbrink A. G., Kellerer A. M., Mills R. E., Sparrow A. H. Comparison of X-ray and gamma-ray dose-response curves for pink somatic mutations in Tradescantia clone 02. Radiat Environ Biophys. 1976 Dec 23;13(4):295–303. doi: 10.1007/BF01331174. [DOI] [PubMed] [Google Scholar]
  73. Upton A. C., Shore R. E., Harley N. H. The health effects of low-level ionizing radiation. Annu Rev Public Health. 1992;13:127–150. doi: 10.1146/annurev.pu.13.050192.001015. [DOI] [PubMed] [Google Scholar]
  74. Urquhart J. D., Black R. J., Muirhead M. J., Sharp L., Maxwell M., Eden O. B., Jones D. A. Case-control study of leukaemia and non-Hodgkin's lymphoma in children in Caithness near the Dounreay nuclear installation. BMJ. 1991 Mar 23;302(6778):687–692. doi: 10.1136/bmj.302.6778.687. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Verschaeve L., Domracheva E. V., Kuznetsov S. A., Nechai V. V. Chromosome aberrations in inhabitants of Byelorussia: consequence of the Chernobyl accident. Mutat Res. 1993 Jun;287(2):253–259. doi: 10.1016/0027-5107(93)90018-b. [DOI] [PubMed] [Google Scholar]
  76. Weinberg C. R., Brown K. G., Hoel D. G. Altitude, radiation, and mortality from cancer and heart disease. Radiat Res. 1987 Nov;112(2):381–390. [PubMed] [Google Scholar]
  77. Whyte R. K. First day neonatal mortality since 1935: re-examination of the Cross hypothesis. BMJ. 1992 Feb 8;304(6823):343–346. doi: 10.1136/bmj.304.6823.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  78. Wilkinson G. S., Dreyer N. A. Leukemia among nuclear workers with protracted exposure to low-dose ionizing radiation. Epidemiology. 1991 Jul;2(4):305–309. doi: 10.1097/00001648-199107000-00013. [DOI] [PubMed] [Google Scholar]
  79. Wing S., Shy C. M., Wood J. L., Wolf S., Cragle D. L., Frome E. L. Mortality among workers at Oak Ridge National Laboratory. Evidence of radiation effects in follow-up through 1984. JAMA. 1991 Mar 20;265(11):1397–1402. [PubMed] [Google Scholar]
  80. Yoshimoto Y., Kato H., Schull W. J. Risk of cancer among children exposed in utero to A-bomb radiations, 1950-84. Lancet. 1988 Sep 17;2(8612):665–669. doi: 10.1016/s0140-6736(88)90477-1. [DOI] [PubMed] [Google Scholar]

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