I’ve always been fascinated by the concept of time. This fascination began when the legend, Mohamed Ali, broke down in an interview exactly how he would spend his retirement – after accounting for the time he would need for sleep, travel and entertainment, he arrived at what he labelled as ‘productive years’ left to live. To his audience’s amazement, it was only 16 years (he was only 35 years old at the time). Forty-two years later, we developed the Plano Time Machine – a platform that uses smart algorithms to compute your productive years. But unlike 26 years ago, before the dawn of the smartphone revolution, we now have to factor in the amount of time we will spend staring at our tiny screens.

In less than 2 months, Time Machine has collected data from thousands of people from 43 countries worldwide, and this represents the first time such data have been collected across the world through an online platform. Insights gleaned from the Time Machine are absolutely alarming.

A subgroup analysis of our cohort of teenagers aged 13 to 19 years old revealed that in countries such as India, Bangladesh, Singapore and Malaysia, the amount of time spent on smart devices is between 6 and 9 hours per day, and this does not even factor in the possibility of individuals’ tendency to underestimate their screen time. Over a lifetime, this accumulates to tens of years spent staring at tiny screens. For example, here in Singapore, teens on average spend close to 15 years (8 hours a day), or 33% of their productive waking years – assuming 7 to 8 hours of sleep per day – on their devices.

These findings are dauntingly consistent with existing research. One study found that American teenagers spend more than 7 hours a day on their smart devices. The age at which smart devices are being used is also getting younger – as many as 97% of children aged 4 years and three-quarters of children as young as 1 year use devices every day. Unfortunately, the increasing rate of integration of mobile technology into almost every aspect of human life will continue to perpetuate these worrying trends.

plano Time Machine’s findings indicate that teenagers worldwide are putting themselves at major risk of adverse health outcomes associated with excessive screen time. These include, a significantly increased risk of anxiety and depression, serious eye conditions including myopia, and a range of potentially fatal systemic illnesses including cardiovascular disease, diabetes and cancer.

Beyond this, the personal trade-offs of excessive screen time are vast. Time flows in one direction, and young people the world over who live on a digital diet will never get back those 8 hours that they spend on devices every day.

And at what cost? What are they sacrificing to stay connected? Time lost to devices could have been spent with loved ones, socialising and forming new beautiful relationships with others, experiencing the vast outdoors, travelling the world, learning a language, an instrument or another skill; and the list goes on.

At the end of the day, will they be able to answer one of life’s most fundamental questions – How did I spend my time on Earth? – with no regrets? It is blatantly clear from our results that for many, the answer will be a resounding no.

This demonstrates unequivocally that we need to stimulate behaviour change among young people at a global level with regards to their relationship with their devices. Individuals need to internalise the consequences of their actions and confront the uncomfortable reality that their screen time is interfering with leading a more fulfilling, meaningful life. At a societal level, better management of screen time will reduce the public health and economic burden we are seeing with the epidemic of adverse health outcomes associated with excessive use devices. Let’s use smart devices as the tools they are, and not allow them to make tools of us.

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More outdoor play prescribed for kids eye health.

Look up, and look around you: How many people wearing glasses do you see? Spectacles may be making a comeback as a fashion statement, but myopia (short-sightedness) is a growing global problem. In Asia today, the figures are startling – up to 80% of Singaporean teenagers, 90% of Chinese adults, and 97% of young South Koreans are reported to have myopia.

How did this condition become so prevalent? Is there any way to prevent the development of myopia, or stop its progression? Recent research has begun shedding light on the answers to these questions. I have dedicated my life to the study of myopia and have investigated the environmental and genetic risk factors of myopia.

When exactly does myopia start developing? Myopia usually develops in childhood, when the eye is still growing. As the child grows, the length of the eyeball may change. If it becomes too long, light will focus short of the retina, and result in blurred vision.

Genetics is understood to play a role in the development of myopia – if both parents have myopia, you’re 8 times more likely to develop the condition. In fact, mounting research has shown that myopia is also largely explained by environmental factors. These include excessive near work, how close you hold your reading materials and the lack of time spent outdoors. Some experts suggest that the high value placed on education and technology in many Asian countries has resulted in children spending more time indoors fixating on their books, computers and smart devices.

It has been found that children who spend at least two hours outside every day have a reduced risk of developing myopia. Bright natural light, physical activity and looking into the distance rather than at close objects are believed to be important protective factors.

The most well-known method of correcting short-sightedness is to wear a pair of spectacles or contact lenses, and in some cases, adults opt to have laser surgery. Unfortunately, there is no cure to myopia. About 20% of people with myopia are at risk of developing a severe form of the condition that may lead to irreversible blindness.

Is there a way we can prevent or slow the development of myopia? Increasing outdoor activity might just be the answer.

The UV light exposure from outdoor activity releases a chemical called dopamine, which is said to inhibit eye length growth. When we’re outdoors, we also look into the distance more, instead of being glued onto our phone screens.

Schools have taken action in ensuring kids get their dose of sunshine by including mandatory outdoor education in their curriculum. Some have even extended break times to increase the amount of time children spend outside. Taking it one step further are schools in China, by building transparent glass classrooms so that children can be exposed to natural light.

To play our part in the fight against screen addiction, our Singapore-based health tech company, Plano Pte Ltd has partnered with the Health Promotion Board to tackle myopia in school children in Singapore. We present the basic optics and anatomy of the eye, myopia and its risk factors, responsible smart device use and teach our kids the ‘clear vision recipe’. The recipe is a key component of our international bestselling book series, The Plano Adventures, and includes going outdoors as a means of protection against the onset and progression of myopia. Having this platform to share my knowledge on myopia to hundreds of thousands of primary school children is truly a privilege. However, our collective efforts are required to empower our children to establish healthy relationships with technology.

To be truly sustainable, a cultural change is needed. Children need to learn from a very young age, that they should spend more time outdoors and less time on their phones. There are simple ways to encourage such behaviour, like using an egg timer to regulate breaks, or a parental control app that encourages healthy device usage. Starting young is most important – myopia is irreversible. Prevention and slowing its progression is the key to managing myopia! 

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Kids are are still on their enviable, long winter break, and most of them will end up spending some extra time in front of screens.

This raises the question: How much screen time is too much? I cover this topic in the most recent episode of Tech Happy Life on my YouTube channel (below) and will tackle it here for those who prefer the written word. The irony that I blog and have a YouTube channel doesn’t escape me. Just to be clear, I’m not against screens or tech, I just want to promote that elusive healthy balance. So just where do we need to draw the line? Or do we need to even bother?

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The economic and health consequences of the global myopia epidemic have truly come to bear in recent years. Myopia, which affects more than 2 billion people worldwide, costs the global economy $250 billion in lost productivity every year, and that does not even factor in the cost to healthcare systems of treating the condition.

The prevalence and severity of myopia are increasing, with an estimated 80% of young people in developed parts of Asia now suffering from the condition and as many as 10% having sight-threatening high myopia. However, the good news is that awareness is rapidly growing around the role that excessive screen time plays in the onset and progression of myopia and governments are starting to take notice and implement policy to combat screen addiction in the hope that it will protect children’s eyes in the future.

Last year the Chinese Government announced that it would be implementing a framework to curb the rise in myopia, which affects more than half of young people in China. One of the major targets of the new scheme is the video game industry, which Chinese authorities have blamed for much of the worsening myopia crisis, partly because of the addictive nature of many games and the unhealthy periods of time children spend playing them without taking breaks and spending time outdoors. 

Amongst a range of other measures, the framework will reduce the number of video games that the Government approves each year and will require game developers to implement anti-addiction systems, particularly in the development of mobile games. The Government hopes that these new measures will keep the rates of myopia below 38%, 60% and 70% among primary, junior and senior school children, respectively. 

The Chinese Government’s announcement sent shockwaves through the gaming industry, and not just in China. Overnight, the market price of China’s biggest games developer, Tencent, plummeted by more than $20 billion and the share prices of Japanese developers also dropped. As a result, Tencent has taken important steps to reduce game addiction in minors, requiring players of their games to verify their age and imposing anti-addiction restrictions on young gamers. The company has embraced the opportunity and is even trialling new facial recognition technology for age verification.

This situation with a video games giant as important as Tencent shows us that not even the biggest corporations are immune to regulatory changes. It is encouraging to see that Tencent has taken steps to protect the health of young gamers, but other game developers must follow suit, and quickly, if they hope to stay on the right side of policy and industry regulations. 

Now is the time to stop playing games with our children’s eyes. The world is waking up to the problem of screen addiction, and governments around the world will soon start to legislate to protect vulnerable young people from its effects. This change will be inevitable as we begin to see the societal consequences of this problem grow out of control. 

There is already an increasing expectation by the public for companies to behave ethically, and the video game industry must work to address video game addiction if it wishes to conform to these social expectations. This will require game developers to work closely with governments, researchers and industry to develop evidence-based and scalable solutions that protect children without diminishing the quality of the gaming experience. 

At Plano, our core mission is to empower people to achieve their best vision and eye health through education and science driven technological solutions, and we welcome any opportunities to collaborate directly with game developers, to help young people to enjoy gaming responsibly while protecting them from the harmful effects of too much screen time.

Written by Mo Dirani and Joshua Foreman

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“Don’t watch too much television, or your eyes will become square!”

Most of us may have heard this refrain while growing up, and may even be the ones nagging our own children to stop watching television shows now. Younger children would fear that this meant their eyes would forever be irreversibly shaped like TV-sets, while those of us less predisposed to gullibility knew that this odd turn of phrase was a scare tactic designed to terrify children from watching TV for too long.

The rise of devices

However, the days of just staring at TVs for a few hours a week are long gone with the plethora of options available nowadays.

In highly technological societies like the United States and East Asia, more than 80% of households have tablet computers and 77% have smartphones. Arguably, what is truly terrifying is the age at which children are starting to use devices these days. Over half of children below the age of one  use mobile devices daily, and the amount of time children spend on smart devices is increasing all the time.

If the detrimental effects of television on eyesight are already well-known, what might children’s constant and excessive use of smart devices be doing to their eyes?

Beyond “square-eyes”: What are the real effects of unhealthy device usage?

Decreased and blurred vision. Inflammation and redness. Watering and dryness of the eye. These effects are known and have been proven by numerous studies to be connected with excessive device usage.

Health concerns related to device usage is a widespread issue and can affect virtually anyone who uses technology. As many as 50-90% of people who work at computer screens develop eye strain, which can make the above described symptoms even more severe. Eye strain can also cause headaches, double vision and an inability to focus properly on objects.

These negative effects are particularly problematic for children and adolescents, whose still-developing eyes make them exceptionally vulnerable.

If Saturday morning cartoons were making children’s eyes a little inflamed, then persistent and excessive device use in the modern age is certainly setting their eyes on fire.

Who is at fault here?

Before you are tempted to throw out your handphones and tablets, take a pause and think: what is the real source of these concerns? Owning and using a smart device in itself is not the problem. The issue arises when devices are used unhealthily – for too long without breaks and at an improper distance.

With proper monitoring and control that allows for regular breaks, these symptoms can be reduced, or even prevented if good behaviour is practiced from young. A parental control app can give you peace of mind that your child is not being glued to the screen all day. Taking pre-emptive action for your children from a young age can go a long way in ensuring that they do not grow up with “square eyes”.

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Singapore is the smallest country in Southeast Asia, being dwarfed in size and population compared to neighbours Malaysia and Indonesia. In terms of defence, however, Singapore thinks big.

Almost 20% of the annual budget is spent on keeping the nation safe. In fact, Singapore boasts the biggest and most well-trained air force in Southeast Asia, with more than 13,000 people enlisted.

Singapore’s powerful military capabilities are renowned all over the world. However, the Singapore Air Force (SAF) is facing a serious threat – not from a foreign military attack, but from a home-grown source.

The Myopia Epidemic

The epidemic of myopia, or short-sightedness, is a growing problem which potentially places the future of their air force in peril.

Pilots need good vision to fly planes safely and spot enemy targets from a distance. However, more than 80% of SAF enlistees each year are short-sighted. The lack of enlistees with good visual performance spells trouble for maintaining a ready pool of pilots.

The issue has become so pronounced that the SAF has developed the Vision Performance Centre, which provides free laser surgery to correct short-sightedness of new enlistees.

However, with the increasing myopia epidemic, more and more surgeries have to be conducted each year. Those suffering from high myopia, a severe form of short-sightedness, still have a risk of developing blindness even after laser surgery.

Tackling the problem at its root

People are at greater risk of developing high myopia if they begin to develop myopia when they are of young age. In fact, research has shown that 55% of children who develop myopia before age 7 develop high myopia.

A major contributing factor to this problem is unhealthy use of technology. With the technological revolution, children are starting to use computers and smart devices from a younger age. Unhealthy device exposure directly increases the risk of developing myopia early in life and irreversible blindness later in life.

Ironically, focusing solely on individual concerns may be myopic as well. It may not be as thought about, but myopia has implications on a nationwide level as well. With the widespread myopia epidemic, fewer people will be eligible to work in the air force due to failing eyesight requirements. This is detrimental to sustaining armed forces of countries with a high myopia rate.

Securing our future, starting today

For countries like Singapore to be well-protected for future generations to come, it’s essential to protect our children’s eyesight. No one should have to give up on their dreams of becoming a pilot because of poor eyesight, and this can be done through fostering good eye care habits from young.

Monitoring children’s smart device usage is a good place to start. By having a parental control app that allows you to control your child’s screen time even when you are physically apart, you can take the first step to managing the onset of myopia in your child.

Changing children’s behaviour from a young age will ensure that we have fewer people with sight-threatening conditions, as well as a generation of sharp army pilots to continue protecting the skies.

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Our Cultural Emphasis on Education

The cornerstone of the traditional Singaporean route to success has typically been education, as parents instill the value of studying hard in their children. Generations of parents, influenced by their own families, have cultivated a mindset of success defined by studies. It sounds like a good thing, but there’s a flipside – overly competitive environments. Children are pressured to work hard, and spend more time on homework and in front of devices and computers. The benefits of this hard work to our children and to our society are clear, but is there a negative impact of these long hours spent studying?

The Myopia Epidemic

The answer is most likely a yes. Excessive nearwork is a well defined risk factor for the development of Myopia, or short-sightedness, and the problem is bigger than you may think. Myopia has become a global epidemic, affecting more than 2 billion people, and in Singapore, more than 10% of children already have myopia by the time they leave pre-school. Rates reach 50% by primary school, and soar to 80% by the end of secondary school.  

With the high prevalence of myopia in our schooling children, parents should be majorly concerned. Yet, many easily treat short-sightedness as an almost inevitable effect of working hard in our education. However, experts say that this problem is caused by the environment that our children grow up in. Urbanisation and education pressures force our children to spend too much time indoors on books and technological devices like smartphones and computers. This takes away precious time kids spend outdoors playing.

Starting Young, Saving Vision

It’s possible to manage and even slow the onset of myopia in children, even as they excel in their studies. One of the ways to do this is exceedingly simple – by obtaining a healthy balance between near work and outdoor time.

The government has made some efforts to tackle the problem with programs like Kids for Nature, the Programme for Active Learning, and the National Myopia Prevention Programme. However, as parents, we can do more. We are integral in preventing or stalling the development of myopia in children as early as possible. Ensuring healthy device usage is paramount to protecting children’s eyesight.

It’s almost impossible, however, to be able to monitor your child’s device usage all the time. A parental control app comes in very handy, as you can ensure that your child takes regular eye breaks without having to be physically present. Your child can also be empowered to take active steps to protect his or her own eyes.

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What comes to mind when you think of a ‘nerd’? The stereotypical image of an awkward whiz pushing up a pair of spectacles sliding down his or her nose, buried in a book may arise. It’s hard to imagine a nerd without glasses. The perception played out in TV shows and movies for years that spectacle wearers are bookish and introverted has carried over to real life. But are people who wear glasses really more likely to be nerds or is this just a myth?

It turns out that this idea may have some basis in science. Glasses are often worn to correct a condition called myopia, or short-sightedness. Myopia can be blamed on the fact that people are spending less time outside and more time reading, writing and using technology, which is viewed as typical nerd behaviour. And there is some consolation for glasses-wearers – myopia has been linked to higher intelligence or IQ, according to at least ten studies done.

The link between myopia and nerdiness seems to be well-established, until personality factors are brought into the picture. In a study conducted by Dr. Mohamed Dirani in Melbourne, findings showed no link between myopia and typical nerdy personality traits like introversion and conscientiousness. Intelligence is not equitable with introversion and shyness. In fact, it’s suggested that the common misperception that intelligent people have nerdy personalities results in the perception that people with glasses are geeky.

But in Singapore, where myopia rates are sky high, wearing spectacles is often viewed as an indicator of how hardworking you are! It is normal for glasses-wearing students to be deemed as “bookish” or “studious”. The tradeoff between clear vision and working hard in school seems to be an accepted fact of life – the strain you put on your eyes is a result of the countless hours spent on your books and work.

However, our health is of utmost importance. The development of myopia should be of high concern and not viewed as a “normal side-effect” of working hard. By 2050, almost half of the world’s population, or 5 billion people, will have myopia. Approximately 1 in 5 of those with myopia will develop high myopia, which can lead to sight-threatening conditions such as retinal detachments and glaucoma. Failing to address this problem early, can increase your risk of developing this more severe form of myopia.

This may not even be necessary if the onset of myopia is slowed. To manage myopia, children need to spend more time outside from an early age, and have regular and timely comprehensive eye tests by trained eye professionals. To encourage this, a parental control app that manages a child’s screen time would be really useful. Outdoor activity can be encouraged during family bonding time, by keeping track and controlling your child’s device usage, whether they are “nerds” or not.

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A silent epidemic has been sweeping the world, affecting the health of millions. We may not be aware of it yet, but we should be – 2 billion people worldwide have already been affected.

We’re talking about myopia, or short-sightedness, a condition where people have difficulty seeing objects at a distance. It may seem insignificant, but half of the world’s population, or 5 billion people, is expected to be short-sighted by 2050.

If that doesn’t concern you enough, by 2050, about 1 billion, or one-fifth of those with myopia, are likely to develop high myopia, a form of severe short-sightedness. This condition greatly increases the risk of developing other eye diseases such as cataracts, glaucoma and retinal detachment, and can even lead to blindness.

Blindness is irreversible. While silent, the onset of myopia takes away one of the fundamental human senses: to see.  

What fuels the Myopia Epidemic?

So what contributes to the development of myopia? Some of the contributing factors include lifestyle factors, according to experts. Technologies, such as smartphones, tablet computers and laptops are becoming increasingly important in our daily lives.

Barely an hour goes by before you need to use your device for school, work or leisure. Focusing on near work and looking at screens for hours each day while not spending sufficient time outdoors, are considered to be major contributors to the myopia problem.

So all those hours your children spend on their devices without taking breaks to go outside are actually damaging your children’s eyes. Not monitoring your child’s device usage can result in greater vulnerability in developing myopia.

Stopping the epidemic in its tracks

The scenario may seem dire, but there are ways to manage myopia in children.

An effective way would be changing your children’s lifestyle habits. Reducing children’s screen time and ensuring they get 2 hours of outdoor activity every day is particularly important in early childhood. Good strategies also include ensuring your children do not hold their devices too close to their faces, and increasing their outdoor time where they can look at objects that are further away. A parental control app that allows you to keep track of your children’s screen time is also a good investment that can give you peace of mind even when you are away from your child. 

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Without a doubt, the integration of smart devices and mobile internet technology into virtually every aspect of our lives has resulted in an amazing array of benefits to each and every one of us. I, for one, am pro-technology and can often be seen using my smartphone to get work done and to capture important moments. And I’m not the only one! In Singapore alone, there are three times as many internet-connected smart devices as there are people.

The improvements to our communication and productivity that have resulted from this hyper-connected world cannot be overstated but, as many of us are starting to notice, the benefits of the smart device revolution have come at a price.

That price is the well-being of our children. If you are in a public place, a quick glance around you should be enough to see what I mean. Children everywhere are glued to their devices, and research shows that they are adopting devices at progressively younger ages and using them for longer periods of time.

For example, Singapore’s largest study that has tracked the health of children from birth, the GUSTO study, has shown that children who are just 2 years old are spending 2 hours per day on digital screens, and our 9-year-olds are spending the equivalent of a full-time working week on their device screens every single week.

As I try to comprehend these staggering statistics, the memories from my childhood of the days spent outdoors playing games with my siblings, chatting to my neighbours, and eating together with my family at the dinner table, truly engaged with each other and enjoying each other’s company, play over in my mind in stark contrast to what is happening around us now.

Kids these days are no longer talking to each other face-to-face, they no longer spend time building relationships, and they are perpetually addicted to their screens. If this is the case now, what might the situation be in 10 years, as mobile devices become more captivating and addicting? Unless we do something, I worry about the direction this situation is going.

Nostalgia and the social consequences of excessive device use aside, there’s also an emergence of research studies linking excessive screen time with several serious adverse health outcomes, including diabetes, heart disease, and mental illness. In fact, the World Health Organization recently declared that gaming disorder and internet addiction syndrome are real and serious mental health conditions.

There has been a lot of media coverage on some of the negative health consequences of too much screen time, but one particular disorder – myopia, commonly known as short-sightedness – seems to be flying under the radar. Because of how common it is, most people simply think of myopia as an inconvenience rather than a disease. But it is a disease. In fact, myopia has been labelled as a global epidemic that is out of control. Half of the world’s population is expected to have this disease by the year 2050. In Singapore, the prevalence of myopia is already as high as 11% in pre-schoolers aged less than 6 years, reaching up to over 80% in teenagers, and this high prevalence is reflected in other developed countries in Asia. As the myopia epidemic worsens, up to a billion people are predicted to have a severe form of myopia that increases the risk of irreversible blindness from complications such as retinal detachment or macular degeneration.

The parallel increase in device use among children and the prevalence of myopia is no coincidence, with several population-based studies from India, Taiwan, Japan and China reporting a significant association between device use and the development of myopia. For instance, a 2015 study from India that examined almost 10,000 children aged 5 to 15 years reported that 2 hours or more of television time and playing mobile games significantly increased the risk of developing myopia. However, the nature of the relationship between screen time and myopia is still unclear, and more research is needed.

The devices tsunami doesn’t look like it will be stopping anytime soon, so it is important to take steps to ensure that we manage the health implications so that our children have happy and healthy futures. The truth is that no one wants to go back to the stone age. So, rather than going on a witch-hunt against technology, the best strategy is to embrace our devices and to help our children (and ourselves) to build healthy relationships with them. And it has to start now.

To play our part in the fight against screen addiction, our Singapore-based health tech company has developed plano, a health application that runs in the background of devices to flip the ‘problem’ into the solution. plano was developed with governmental support and backing from reputable scientific research institutes. plano provides evidence-based live interventions to nudge users to use devices in a healthy manner. The app helps users to hold their devices at an appropriate distance and with correct posture, to better control their time on devices, and to screen for and manage myopia. plano uses a clever reward system to empower device-free activity as well as monthly parental reports to inform parents on what they can’t always see or monitor.

Recognising its potential to enhance Singapore’s existing National Myopia Prevention Program, the Health Promotion Board of the Singaporean Government has taken swift action to promote the use of the plano app to over 320,000 children over the next 12 months. Besides the plano app, to deliver key science-based messages to children, I had the privilege of being part of a unique collaboration of the sciences and arts. Best-seller children’s book author Hwee Goh, award-winning illustrator David Liew and I have come together to develop a children’s fantasy book series. The Plano Adventures seeks to create an actual societal shift, empowering the next generation to build a healthy relationship with their devices. The first of the five books, Trouble in Murktown, that focuses on device use and myopia is now available in all bookstores in Singapore and will be available globally in the coming months.

But our efforts at Plano are just the beginning. Government, industry and medical institutes must also work together to formulate preventative strategies to reduce excessive smart device use, particularly among children.

And if we collectively as a society do not take action now, then it’s not just a question of whether our children are losing their sight to technology; with the consequences to our relationships and our well-being, we will lose the things that truly matter most, and no glasses, contact lenses or laser surgeries will bring those things back.

This article was originally posted on July 18 2019 here.

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