nep-hea New Economics Papers
on Health Economics
Issue of 2023‒10‒30
twenty-one papers chosen by
Nicolas R. Ziebarth, Cornell University

  1. The Long-Term Effects of Income for At-Risk Infants: Evidence from Supplemental Security Income By Amelia A. Hawkins; Christopher A. Hollrah; Sarah Miller; Laura R. Wherry; Gloria Aldana; Mitchell D. Wong
  2. The Effects of Adverse Childhood Experiences on Adults' Subjective Wellbeing By Blanchflower, David G.; Bryson, Alex
  3. Effects of Universal and Unconditional Cash Transfers on Child Abuse and Neglect By Lindsey R. Bullinger; Analisa Packham; Kerri M. Raissian
  4. The Parenthood Penalty in Mental Health: Evidence from Austria and Denmark By Ahammer, Alexander; Glogowsky, Ulrich; Halla, Martin; Hener, Timo
  5. The Demand Elasticity of Health Care Spending for Low-Income Individuals By Acquatella, Angélique
  6. Artificial Intelligence and Workers' Well-Being By Giuntella, Osea; König, Johannes; Stella, Luca
  7. Private Actions in the Presence of Externalities: The Health Impacts of Reducing Air Pollution Peaks but not Ambient Exposure By Susanna B. Berkouwer; Joshua T. Dean
  8. Diagnostic Uncertainty and Insurance Coverage in Credence Goods Markets By Loukas Balafoutas; Helena Fornwagner; Rudolf Kerschbamer; Matthias Sutter; Maryna Tverdostup
  9. Mitigating Coercive Parenting through Home Visitations: The Impacts of a Parenting Program Targeted at Vulnerable Communities in Jamaica By De Simone, Francesco; Mejia, Camila; Martinez-Carrasco, José; Perez-Vincent, Santiago M.; Villalba, Harold
  10. Navigating Ambiguity: Imprecise Probabilities and the Updating of Disease Risk Beliefs By Kerwin, Jason; Pandey, Divya
  11. The Effects of Maria Migrants on the Financial Health of the Residents of Central Florida By Braga, Breno; Elliott, Diana
  12. Life Expectancy, Income and Long-Term Care: The Preston Curve Reexamined By Thibault, Emmanuel; Ponthieres, Grégory
  13. The Role of Disability Insurance on the Labour Market Trajectories of Europeans By Agar Brugiavini; Petru Crudu
  14. Temperature and the Timing of Work By Cosaert, Sam; Nieto Castro, Adrian; Tatsiramos, Konstantinos
  15. Investigator Racial Diversity and Clinical Trial Participation By Marcella Alsan; Romaine A. Campbell; Lukas Leister; Ayotomiwa Ojo
  16. More Information, Lower Price? Access Market-based Reference Prices and Gains in Public Procurement Efficiency By Martinez-Carrasco, José; ConceiçaÞo, Otavio; Dezolt, Ana Lúcia
  17. Weeding out the Dealers? The Economics of Cannabis Legalization By Auriol, Emmanuelle; Mesnard, Alice; Tiffanie Perrault,
  18. The Impact of Expanding Worker Rights to Informal Workers Evidence from Child Labor Legislation By Lakdawala, Leah K.; Martínez Heredia, Diana; Vera-Cossio, Diego A.
  19. Access to water and COVID-19: a regression discontinuity analysis for the peri-urban areas of Metropolitan Lima, Peru By Gómez-Lobo, Andrés; Gutiérrez, Mauro; Huamaní, Sandro; Marino, Diego; Serebrisky, Tomás; Solís, Ben
  20. The Impact of the COVID-19 Pandemic on the Future Pensions of the Peruvian Pension System By Olivera, Javier; Valderrama, José A.
  21. Long-term effects of early adverse labour market conditions: A Causal Machine Learning approach By Petru Crudu

  1. By: Amelia A. Hawkins; Christopher A. Hollrah; Sarah Miller; Laura R. Wherry; Gloria Aldana; Mitchell D. Wong
    Abstract: This paper examines whether a generous cash intervention early in life can "undo" some of the long-term disadvantage associated with poor health at birth. We use new linkages between several large-scale administrative datasets to examine the short-, medium-, and long-term effects of providing low-income families with low birthweight infants support through the Supplemental Security Income (SSI) program. This program uses a birthweight cutoff at 1200 grams to determine eligibility. We find that families of infants born just below this cutoff experience a large increase in cash benefits totaling about 27% of family income in the first three years of the infant's life. These cash benefits persist at lower amounts through age 10. Eligible infants also experience a small but statistically significant increase in Medicaid enrollment during childhood. We examine whether this support affects health care use and mortality in infancy, educational performance in high school, post-secondary school attendance and college degree attainment, and earnings, public assistance use, and mortality in young adulthood for all infants born in California to low-income families whose birthweight puts them near the cutoff. We also examine whether these payments had spillover effects onto the older siblings of these infants who may have also benefited from the increase in family resources. Despite the comprehensive nature of this early life intervention, we detect no improvements in any of the study outcomes, nor do we find improvements among the older siblings of these infants. These null effects persist across several subgroups and alternative model specifications, and, for some outcomes, our estimates are precise enough to rule out published estimates of the effect of early life cash transfers in other settings.
    JEL: H0 H53
    Date: 2023–09
  2. By: Blanchflower, David G. (Dartmouth College); Bryson, Alex (University College London)
    Abstract: Using four cross-sectional data files for the United States and Europe we show that Adverse Childhood Experiences (ACE) have a significant impact on subjective wellbeing (SWB) in adulthood. Death of a parent, parental separation or divorce, financial difficulties, the prolonged absence of a parent, quarreling between parents, parental unemployment, sexual assault, experiencing long-term health problems, being bullied at school and being beaten or punched as a child all have long-term impacts on wellbeing. These experiences impact a wide range of wellbeing measures in adulthood including satisfaction with many aspects of everyday life, happiness and life satisfaction, self-assessed health, and are positively linked to measures of negative affect including the GHQ6. The evidence linking ACEs to lower SWB in adulthood is consistent across fifty different measures including sixteen positive affect and twenty-six negative affect measures relating to assessments of one's one life, and eight variables capturing how the individual feels about the area she lives in, including unemployment, drugs, violence and vandalism plus democracy in their country. Trauma in childhood is long lasting.
    Keywords: childhood, neglect, abuse, family circumstances, bullying, subjective wellbeing
    JEL: I31 I10 J12
    Date: 2023–09
  3. By: Lindsey R. Bullinger; Analisa Packham; Kerri M. Raissian
    Abstract: We estimate the effects of cash transfers on a severe measure of child welfare: maltreatment. To do so, we leverage year-to-year household variation from a universal and unconditional cash transfer, the Alaska Permanent Fund Dividend (PFD). Using linked individual-level administrative data on PFD payments and child maltreatment referrals, we show that an additional $1, 000 to families in the first few months of a child's life reduces the likelihood that a child is referred to Child Protective Services by age three by 2.0 percentage points, or 10 percent, on average. Estimates indicate that additional cash transfers also reduce child mortality.
    JEL: I18 I38 K42
    Date: 2023–09
  4. By: Ahammer, Alexander (University of Linz); Glogowsky, Ulrich (Johannes Kepler University Linz); Halla, Martin (University of Linz); Hener, Timo (Aarhus University)
    Abstract: Using Austrian and Danish administrative data, we examine the impacts of parenthood on mental health. Parenthood imposes a greater mental health burden on mothers than on fathers. It creates a long-run gender gap in antidepressant prescriptions of about 93.2% (Austria) and 64.8% (Denmark). These parenthood penalties in mental health are unlikely to reflect differential help-seeking behavior across the sexes or postpartum depression. Instead, they are related to mothers' higher investments in childcare: Mothers who take extended maternity leave in quasi-experimental settings are more likely to face mental health problems.
    Keywords: gender equality, fertility, parenthood, motherhood, mental health, parental leave
    JEL: D63 J13 I10 J16 J22
    Date: 2023–09
  5. By: Acquatella, Angélique
    Abstract: Low-income individuals are typically the most price sensitive segment of the mar-ket, but this is not true in the market for health care services. I show that low-income individuals have a smaller demand elasticity of medical spending with re-spect to coinsurance, relative to their higher income counterparts, using data from the RAND Health Insurance experiment. The null effect is driven by disproportion-ate share of low-income individuals who consume zero health care. The key insight is that low-income individuals may optimally consume zero health care because, when marginal utility of consumption is high, forgoing non-medical consumption becomes very costly.
    Keywords: income effects; health care demand elasticity; corner solution
    JEL: I12 I14 D11
    Date: 2023–10–03
  6. By: Giuntella, Osea (University of Pittsburgh); König, Johannes (DIW Berlin); Stella, Luca (Free University of Berlin)
    Abstract: This study explores the relationship between artificial intelligence (AI) and workers' well-being and mental health using longitudinal survey data from Germany (2000-2020). We construct a measure of individual exposure to AI technology based on the occupation in which workers in our sample were first employed and explore an event study design and a difference-in-differences approach to compare AI-exposed and non-exposed workers. Before AI became widely available, there is no evidence of differential pre-trends in workers' well-being and concerns about their economic futures. Since 2015, however, with the increasing adoption of AI in firms across Germany, we find that AI-exposed workers have become less satisfied with their life and job and more concerned about job security and their personal economic situation. However, we find no evidence of a significant impact of AI on workers' mental health, anxiety, or depression.
    Keywords: artificial intelligence, future of work, well-being, mental health
    JEL: I10 J28 O30
    Date: 2023–09
  7. By: Susanna B. Berkouwer; Joshua T. Dean
    Abstract: Extensive research has documented that elevated air pollution increases mortality and morbidity, with estimates reaching 8 million deaths per year. Many of the world’s one billion urban poor face both high ambient concentrations and even higher transient peaks. Should government interventions aimed at improving health prioritize reductions in ambient pollution—for example, regulating industrial emissions—or peak pollution? We conduct a field experiment studying the impacts of reducing a notorious source of peak air pollution exposure—biomass cooking—for three years in an urban environment with high ambient pollution. We collect personal, high-frequency particulate matter and carbon monoxide measurements and extensive quantitative and self-reported health measurements. Cooking increases peak PM2.5 exposure by 125 μg/m³ for the control group, but improved stove ownership reduces this by 52 μg/m³—a sizeable 42% reduction in peak cooking emissions. However, ambient pollution of 37.5 μg/m³ largely negates any impact on average air pollution exposure. The reduction in peak cooking emissions generates a 0.24 standard deviation reduction in short-term self-reported respiratory symptoms. However, we can rule out meaningful improvements in blood pressure, blood oxygen, and a wide array of self-reported diagnoses. Ambient air pollution dampens the health benefits from private technology adoption, and a government seeking to generate chronic health improvements will likely need to address negative externalities through environmental regulation. Still, despite the importance of ambient pollution, the $40 stove generates $86 in annual energy savings and reduces CO₂ emissions at $4.9 per ton when factoring in additionality rates, suggesting government subsidies would generate large societal benefits.
    JEL: I15 O12 Q53 Q56
    Date: 2023–09
  8. By: Loukas Balafoutas (University of Exeter, United Kingdom; University of Innsbruck, Austria); Helena Fornwagner (University of Exeter, United Kingdom; Austrian Institute of Economic Research (WIFO)); Rudolf Kerschbamer (University of Innsbruck, Austria); Matthias Sutter (University of Innsbruck, Austria; Max Planck Institute for Research on Collective Goods, IZA Bonn and CESifo Munich, Germany; University of Cologne, Germany); Maryna Tverdostup (Vienna Institute for International Economic Studies, Austria)
    Abstract: In markets for credence goods – such as health care or repair services – fraudulent behavior by better informed experts is a common problem. Our model studies how four common features shape experts’ provision behavior in credence goods markets: (i) diagnostic uncertainty of experts; (ii) insurance coverage of consumers; (iii) malpractice payments for treatment failure; and (vi) consumer-regarding preferences of experts. Diagnostic imprecision unambiguously leads to less efficient provision. Insurance coverage and malpractice payments have an ambiguous effect on efficient provision. The impact of consumer-regarding preferences on efficiency is positive without insurance but ambiguous in the presence of insurance.
    Keywords: Credence goods, diagnostic uncertainty, insurance coverage, social preferences
    JEL: D82 G22
    Date: 2023–10
  9. By: De Simone, Francesco; Mejia, Camila; Martinez-Carrasco, José; Perez-Vincent, Santiago M.; Villalba, Harold
    Abstract: Family violence is a critical development challenge in low- and middle-income countries (LMICs), carrying high health, social, and economic costs and increasing the risk of perpetuating the cycle of violence across generations. Parenting programs have improved parenting practices in high-income countries. However, evidence for LMICs is sparse. This study evaluates an intervention to reduce coercive parenting implemented by the Ministry of National Security of Jamaica, which targeted caregivers of children aged 6 to 15 in vulnerable communities in the country. Treated caregivers were visited by a parental trainer for six months and invited to three sessions of a group training workshop during that period. We conducted a randomized controlled trial (RCT) to evaluate the interventions impact. Using data from a follow-up survey completed six months after the intervention, we find robust evidence of reduced coercive parenting practices among treated caregivers compared to the control group. The improvement is due to a reduction in the reported likelihood of caregivers yelling and beating their children for misbehaving. The effect is greater for caregivers with higher pre-intervention levels of coercive parenting. The results provide evidence that parenting interventions can effectively reduce coercive parenting among caregivers of school-aged children in highly violent middle-income settings.
    Keywords: parenting;family violence;home visiting;randomized controlled trial;Jamaica;PAFAS;Alabama Parenting Questionnaire
    JEL: J12 J13
    Date: 2022–10
  10. By: Kerwin, Jason (University of Minnesota); Pandey, Divya (University of Minnesota)
    Abstract: Probabilistic risk beliefs are key drivers of economic and health decisions, but people are not always certain about their beliefs. We study these "imprecise probabilities", also known as ambiguous beliefs. We show that imprecision is measurable separately from the levels of risk beliefs. People with higher levels of imprecision update their beliefs more in response to a randomized information treatment, and new information also causes changes in imprecision levels. We show that we can map our data onto both a standard Bayesian model and a version that is designed to handle imprecise probabilities; these models can match some features of our data but not all of them. Imprecise probabilities have important implications for our understanding of decisionmaking and for the design of programs intended to change people's minds.
    Keywords: imprecise probabilities, ambiguity, ambiguous beliefs, epistemic uncertainty, Knightian uncertainty, uncertainty, risk beliefs, HIV / AIDS
    JEL: D81 D83 D84
    Date: 2023–09
  11. By: Braga, Breno (Urban Institute); Elliott, Diana (Population Reference Bureau)
    Abstract: The influx of climate migrants could challenge many communities in the coming decades. In this study, we estimate the effects of Puerto Rican migration on the financial health of residents in receiving communities after Hurricane Maria. On the one hand, migrants can compete for jobs or crowd out access to governmental safety net programs, contributing to declines in the financial health of residents of the hosting communities. On the other hand, migrants might fill labor market needs and increase the consumption of locally produced goods, helping to stimulate the community's economy. We find little evidence that Puerto Rican migrants negatively impacted the credit health outcomes – such as credit scores and delinquency rates - of residents in receiving communities, even three years after their arrival. On the contrary, existing homeowners in Hispanic communities in Central Florida improved their financial well-being after the arrival of migrants. To help explain this finding, we show suggestive evidence that homeowners might have financially benefited from an increase in their housing value after the arrival of migrants.
    Keywords: migration, financial health, housing markets
    JEL: G51 R23 I31
    Date: 2023–09
  12. By: Thibault, Emmanuel; Ponthieres, Grégory
    Abstract: The Preston Curve - the increasing relation between income per capita and life expectancy - cannot be observed in countries where old-age dependency is widespread (that is, where long-term care (LTC) spending per capita is high). The absence of the Preston Curve in countries with high old-age dependency can be related to two other stylized facts: (1) the inverted-U relation between LTC spending and life expectancy; (2) the inverted-U relation between LTC spending and preventive health investments. This paper develops a two-period OLG model where survival to the old age depends on preventive health spending chosen by individuals while anticipating (fixed) old-age LTC costs. In that model, anticipated LTC costs are shown to have a non-monotonic effect on preventive health investment, thus rationalizing stylized facts (1) and (2). This framework is shown to provide an explanation for the absence of the Preston Curve in countries where old-age dependency is more acute.
    Keywords: Preston Curve, ; life expectancy; OLG models, ; long-term care
    JEL: E13 E21 I15 J14
    Date: 2023–10–09
  13. By: Agar Brugiavini (Department of Economics, University Of Venice CÃ Foscari; Institute for Fiscal Studies); Petru Crudu (Department of Economics, University Of Venice CÃ Foscari)
    Abstract: This work documents the role played by disability insurance, typically part of a wider public pension provision package, on the labour market trajectories and retirement decisions. We will first employ a machine learning approach to estimate a Transition Probability Model able to uncover the most likely labour market histories and then evaluate the effects of policy reforms, including reforms to the eligibility for disability insurance benefits. The main contribution is the introduction of disability insurance programs within a framework, which models the entire life course of older Europeans. This requires the detailed administrative eligibility criteria prevailing in each of the 11 countries from 1970 to 2017. Results show that the disability route and early retirement are substitutes. In addition, tightening eligibility rules of disability programs crowd out disabled workers, whose reductions in working capacities are correctly assessed, towards other compensatory schemes (e.g., unemployment benefits or early pension) in which working is not expected. On the contrary, individuals with over-assessed reductions in working capacities are the most reactive to disability policy restrictions. In conclusion, efficient disability assessment procedures are crucial for incentivising labour market participation without hurting individuals most in need.
    Keywords: Retirement, Disability, Path Dependence, Simulation
    JEL: J14 J26 I38 H55
    Date: 2023
  14. By: Cosaert, Sam (University of Antwerp); Nieto Castro, Adrian (University of Luxembourg, LISER); Tatsiramos, Konstantinos (University of Luxembourg, LISER)
    Abstract: We leverage U.S. county-day temperature variation combined with daily time use data to examine the effect of temperature on the timing of work. We find that warmer (colder) temperatures increase (decrease) working time during the night and decrease (increase) working time in the morning. These effects are pronounced among workers with increased bargaining power, flexible work schedules, greater exposure to ambient temperature while at work, and fewer family-related constraints. Workers compensate for the shifts in the timing of work triggered by temperature fluctuations by adjusting their sleep time, without changing the timing of leisure and home production activities.
    Keywords: weather, time use, work schedule, labor supply, non-market activities, sleep
    JEL: J22 Q54 I31
    Date: 2023–09
  15. By: Marcella Alsan; Romaine A. Campbell; Lukas Leister; Ayotomiwa Ojo
    Abstract: We investigate whether increased racial diversity of clinical trial principal investigators could increase the enrollment of Black patients, which currently lags population and disease-burden shares. We conducted a survey experiment in which respondents were shown a photo of a current NIH investigator in which race (Black/White) was randomized. Sex was also randomized as a relevant benchmark. Black respondents reported 0.35 standard deviation units higher interest in participating in a clinical study led by a race concordant investigator (a 12.6% increase). Sex concordance had no effect. Further analyses indicate that perceived trustworthiness and attractiveness are the most important factors explaining these results.
    JEL: I14 I18
    Date: 2023–09
  16. By: Martinez-Carrasco, José; ConceiçaÞo, Otavio; Dezolt, Ana Lúcia
    Abstract: The paper examines the impact of providing market-based reference prices on public procurement efficiency in Brazil. Specifically, the study focuses on the State Secretariat of Health (SES) in Rio Grande do Sul and the algorithm developed by the local tax administration to calculate representative reference prices for pharmaceutical products. Unlike previous studies, reference prices are calculated based on the universe of local business-to-business transactions. The study finds that SES procurement officers access to this information caused a significant reduction in purchase unit prices, particularly for products characterized by a higher ex-ante unit price, a smaller number of suppliers, and purchased by a smaller number of public institutions. The gains in efficiency are attributed to the use of up-to-date market information, which is particularly useful for products where information asymmetry is more likely to exist between procurement officers and private providers.
    Keywords: public procurement;reference prices;electronic invoicing;Brazil
    JEL: D40 H51 H57
    Date: 2023–03
  17. By: Auriol, Emmanuelle; Mesnard, Alice; Tiffanie Perrault,
    Abstract: We model consumer choices for recreational cannabis in a risky environment and its supply under prohibition and legalization. While legalization reduces the profits of illegal providers, it increases cannabis consumption. This trade-off can be overcome by combining legalization with sanctions against the black market, and improvements to the quality of legal products. Numerical calibrations highlight how a policy mix can control the increase in cannabis consumption and throttle the illegal market. In the US, the eviction prices we predict to drive dealers out of business are much lower than the prices of legal cannabis in most of the states that opted for legalization, leaving room for the black market to flourish. Analyzing the compatibility of several policy goals sheds light on the less favorable outcomes of recent legalization reforms and suggests a new way forward.
    Keywords: recreational cannabis, ; legalization, ; crime; policy; regulation
    JEL: I18 K32 K42 L51
    Date: 2023–10–09
  18. By: Lakdawala, Leah K.; Martínez Heredia, Diana; Vera-Cossio, Diego A.
    Abstract: We study the effects of a Bolivian law that introduced benefits and protections for child workers (who are overwhelmingly informal workers) and lowered the de facto legal working age from 14 to 10. We employ a difference-in-discontinuity approach that exploits the variation in the laws application to different age groups. Work decreased for children under 14, whose work was newly legalized and regulated under the law, particularly in areas with a higher threat of inspections. The effects appear to be driven by a reduction in the most visible forms of child work, suggesting that firms may have reduced employment of young children to minimize the risk of being inspected. In contrast, we nd that more formal channels of adjustments - such as increased costs of hiring due to the costs of complying with the new law - are unlikely to explain the overall decline in the work of young children.
    JEL: K3 K31 J08 O12
    Date: 2023–01
  19. By: Gómez-Lobo, Andrés; Gutiérrez, Mauro; Huamaní, Sandro; Marino, Diego; Serebrisky, Tomás; Solís, Ben
    Abstract: This paper presents the results of a quasi-experimental study for which information was collected through a survey conducted in peri-urban areas of Metropolitan Lima between October and November 2021. The survey was conducted on households residing near and on both sides of the border of coverage of the public water network. Our work finds that access to networked water was associated with a reduction in the probability of infection by COVID-19. Likewise, an extension to the model, using heterogeneous effects, suggests that it is not enough for a home to be connected to the network, but that a minimum amount of consumption must also be guaranteed. The results should be interpreted taking into consideration the limitations in the information. These results highlight the need for investment in infrastructure to close access gaps, and the importance of ensuring quality and affordable services for the population.
    Keywords: water;COVID-19;health;regression discontinuity;Lima;Peru
    JEL: L95 I14 I15 I10 I18
    Date: 2022–09
  20. By: Olivera, Javier; Valderrama, José A.
    Abstract: We study the effects of the COVID-19 pandemic and the pension policy response on the private and public pension systems of Peru. We find that the policies allowing early withdrawals from the private pension balances imply a significant reduction in expected pension wealth by about 40 people, yet there are important heterogeneous effects: the losses are larger for males, for affiliates at the bottom of the distribution of income or pension wealth, and for older people as they have less time to rebuild their pension pots. We detect that the excess of mortality due to the pandemic will reduce the actuarial net liability of the public pension system by about 2.4 percent, even after accounting for new survival pensions and a drop in contributions. The effect is largely driven by savings due to the anticipated deaths of pensioners. Moreover, a new set of reduced pension benefits implemented in the public pension system during the pandemic could cost about 4 percent of the actuarial net reserve.
    Keywords: COVID-19;Old-age security
    JEL: D31 G28 H55 J14 J32
    Date: 2022–10
  21. By: Petru Crudu (Department of Economics, University Of Venice CÃ Foscari)
    Abstract: This study estimates the long-term causal effects of completing education during adverse labour market conditions, measuring outcomes 35 years post-education. To achieve this, the study combines historical regional unemployment rates with detailed SHARE microdata for European cohorts completing education between 1960 and 1990 in a novel database. A systematic heterogeneity analysis is conducted by leveraging the Causal Forest, a causal machine learning estimator that allows estimates at various aggregation levels. Furthermore, the causal link is validated using an instrumental variable approach. The main findings reveal that a one-percentage-point increase in the unemployment rate at the time of completing education leads to a significant decline in earnings (-5.2%) and self-perceived health (-2.23%) after 35 years. The heterogeneity analysis uncovers that the results are primarily driven by less educated individuals and highlights a permanent disadvantage for women in labour market participation. This study also provides evidence that systematic divergence in life trajectories can be explained by search theory and human capital models. Overall, the research suggests that the consequences of limited post-education opportunities can be permanent, underscoring the importance of identifying vulnerable groups for effective policy interventions.
    Keywords: Long-term Effects, Unemployment, Heterogeneous Effects, GRF
    JEL: J31 I1 J24 I24 E24
    Date: 2023

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