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Seanad Éireann díospóireacht -
Tuesday, 13 Dec 2011

Vol. 212 No. 5

Adjournment Matters

Vaccination Programme

I thank the Minister of State for coming to the House to respond to this matter which concerns Pandemrix, a vaccine given to many because of concerns about the effects of swine flu. There are some concerns that a number of children and adolescents have since developed narcolepsy, a neurological sleeping disorder caused by the brain's inability to regulate sleep and waking cycles in a normal fashion. There is no cure and symptoms include excessive daytime sleepiness, sudden loss of muscular and postural tone, vivid hallucinations during sleep or after waking and brief episodes of total paralysis at the beginning or end of sleep.

There has been some media coverage of this issue and I was concerned to hear yesterday that the Finnish Government had accepted there was a link between the vaccination and narcolepsy. Some 79 children and adolescents were affected in Finland, some 12 times the number expected to be affected. Has the attitude of the Government changed? There was an investigation and the matter is being examined. I acknowledge that the young people affected have been given medical cards, but a decision must be made on the support required. The investigation must reach a point where the level of support required by the children and young people concerned — as well as their families — should be established. While there have been meetings with officials from the Department of Education and Skills, there has been no provision of support since. Young people need education supports, particularly given the symptoms mentioned.

Having conducted some research on the Internet, some five months ago, on 21 July, the European Medicines Agency, given the circumstances, recommended the restricted use of Pandemrix. It is a major concern for healthy and high functioning children as, according to their parents, their lives have been completely changed following the administration of the vaccine. Any person in the country would be concerned about this issue. We must establish the facts and how the young people concerned can be supported, even leaving aside the link with the vaccine.

We all remember the swine flu scare. I acknowledge the response of the health service at the time in administering the vaccine. Nevertheless, there is a question mark over the vaccine. It is estimated that 35 young people have been diagnosed with narcolepsy since the scare. I do not know if it is connected with the vaccine, but for the sake of everybody in the country, particularly the children and young people concerned and their families, we must establish the facts and support these families in whatever way we possibly can.

I thank the Senator for raising this matter as it provides me with an opportunity to outline to the House its importance. Epidemiological studies in Finland and Sweden show an association between immunisation against H1N1 with Pandemrix and narcolepsy. Narcolepsy is a disabling chronic neurological disorder characterised by recurrent episodes of excessive daytime sleepiness. A multi-factorial aetiology has been suggested for narcolepsy, involving a genetic predisposition in combination with environmental risk factors. Researchers have proposed an autoimmune involvement. A Chinese study points to an upper respiratory tract infection as a possible determining factor.

The Health Protection and Surveillance Centre estimates that approximately 250,000 children and adolescents between the ages of five and 19 years received Pandemrix vaccine. The Department's chief medical officer's office and the Health Protection and Surveillance Centre are working with the Irish Medicines Board and clinical experts in narcolepsy to examine the Irish data. However, the number of cases in Ireland is relatively small and may not allow causality to be determined. The results of the study are expected in early 2012. We are also awaiting the outcome of a multi-country vaccine adverse events monitoring and communication, VAESCO, study undertaken in conjunction with the European Centre for Disease Control. Results from this study are expected in spring 2012.

The Health Protection and Surveillance Centre is investigating 32 cases that meet the case definition for narcolepsy which had onset of symptoms between April 2009 and December 2010 and in which people have consented to participate in the study. Of these 32 validated cases, 25 had received a vaccination before the recalled onset of the first narcolepsy symptom, 24 with Pandemrix and one with Celvapan. A small number of cases had received vaccination after the onset of the first symptom. Three cases did not receive any vaccination. The Health Protection Surveillance Centre is aware of a further 15 potential cases at varying stages of investigation. These may or may not meet the case definition, and one of them has declined to participate in the study.

Relevant health care professionals, including GPs, paediatricians, psychiatrists, clinical psychologists and public health nurses, have been advised on the possible association between Pandemrix vaccination and narcolepsy and the referral process for suspect cases for diagnosis. A group called Sufferers of Unique Narcolepsy Disorder, SOUND, has been set up by parents of those affected. The Minister has met the group which is actively engaged with the HSE through two representatives on the HSE serious incident alert group which is managing the issue.

Medical cards have been granted for diagnosed cases and expenses incurred by parents are being met by the HSE. Representatives of SOUND also met the Department of Education and Skills recently. The Department has advised on how educational support services available can be accessed to assist the children concerned in continuing their education. Everything possible will continue to be done by the health and education services to address the concerns of parents whose children have developed narcolepsy.

I am glad there will be a report next year. Is there a link between the studies ongoing in this country and those being undertaken across Europe? I raise the issue today because Finland yesterday acknowledged that there was a connection between the vaccine and narcolepsy in young people. The reasons should be available across the European Union.

I made reference to studies in Finland and Sweden, as well as other epidemiological studies and their findings, which are being considered by the public health specialists charged with examining the issue.

Employment Action Plan

I welcome the Minister to the House. The matter relates to the south-east employment action plan which has been launched by the Minister for Jobs, Enterprise and Innovation. The action plan was developed in response to serious job losses in Waterford city. In recent months and years there have been some high profile closures such as Waterford Crystal and more recently TalkTalk. Much was promised by the Minister. The Government indicated that an action plan would be put in place to help not just Waterford city but the south-east region. I welcome the publication of the plan and that the Minister has brought together stakeholders from across various enterprise agencies and boards, development boards, city and county managers and many others. However, the big problem with the plan is a lack of specifics and measurable elements. For example, there is reference in the document to the rate of unemployment in the south-east region being 18.2% while the national average is 14.5%. The gap is almost 4%. In parts of Waterford city the unemployment figure is more than 20%. The document does not specify whether the Government is going to set a target of reducing unemployment from 18.2% to at least bring the south east into line with the national average. That would still be unacceptable, but at least it would be a specific measurable action contained within the document but that is absent.

Reference is made in the document to IDA Ireland and Enterprise Ireland being committed to pursuing job opportunities. As they are doing that already, there is nothing new in that respect. The document also indicates that a strong, regional value proposition, a marketing strategy built around key regional strengths and areas of opportunity, should be developed by means of a co-ordinated approach involving the enterprise agencies, local authorities and other regional stakeholders. What does that mean? To be honest, it is a lot of waffle in terms of what is said and what is not said. The document indicates that there will be a review of the planning and land use and transport strategy, PLUTS. In terms of the enterprise agencies it states that IDA Ireland and Enterprise Ireland will continue to convene additional first flight workshops and initiate a marketing campaign. There are no measurable goals and few specific actions in the plan.

Reference is made in the plan to a number of areas where Waterford could potentially major in terms of job opportunities such as clean tech, life sciences and tourism. Clean tech and life sciences are two areas where it is suggested that the region could prosper. Another difficulty I have with the document is that it says the agencies will have a spotlight on Waterford. What does that mean? The Minister is saying that the region needs to perform better and the enterprise agencies need to deliver for the region, including IDA Ireland, but does that mean that when there are opportunities for IDA Ireland to attract foreign direct investment and other employment opportunities to this country that they will ring-fence those opportunities for the south east? That is what should be in the plan because if it is taken in isolation to the national plans of Enterprise Ireland and IDA Ireland then the plan is not worth anything. There needs to be measurable and specific goals and real, actionable points to which the people of Waterford can refer and say the Government is serious about job creation in Waterford and ensuring that in life sciences, clean tech and a number of other areas that have been identified, the enterprise agencies will respond accordingly.

The action plan is a regional plan. It is not about Waterford city but if the region is to succeed then Waterford city needs to succeed. One of the things the Government could do immediately is to designate Waterford Institute of Technology as a university for the region. That will not solve all of our problems but it would certainly lift Waterford city and the region. If the city does not perform economically and does not get the opportunities and jobs that we need then, unfortunately, the region will not perform either. The figures in the document prove that.

I thank the Senator for raising this issue. As outlined by the Minister for Jobs, Enterprise and Innovation, Deputy Bruton, during his visit to Waterford following the TalkTalk closure announcement, he decided to oversee the preparation and implementation of a south east employment action plan to investigate the causes of this problem in the city and its hinterland and outline a list of actions to be taken in the short and medium to long term to seek to address it.

The task the Minister set the agencies included: analysis of existing portfolio of activities by agencies and an assessment of their capacity to expand employment; an assessment of the region and Waterford as a gateway for the location of employment; and an assessment of sectoral strengths and emerging sectors that would have a good fit with the region. On receipt of the agencies' responses, an action plan for the south east was prepared by Forfás incorporating inputs from all agencies and those of relevant stakeholders in the region. The report contains specific actions to address the specific employment problems affecting the south east. The Minister launched the south-east action plan last Friday, 2 December, and it is his intention to meet regularly with a forum representing the agencies and stakeholders to progress the implementation of the plan.

The reality is that the structural challenges that the region faces have built up over many years and will not be reversed with a simple set of actions. What is required is to build a stronger enterprise base in the region as a whole. The report identifies many actions that can help deliver on the ambition of having a stronger local enterprise base, but it will only achieve so much. There are challenges for all agencies in the region to help build up the region's competitive advantage and then to promote it in a co-ordinated manner.

One of the key issues that no single agency or Department can hope to address is the overall coherence of the region's "value proposition" to investors from home or abroad. What has arisen again and again in consultation with all the relevant stakeholders and agencies in the region is the need for greater co-ordination of effort from all those with an interest in improving the enterprise potential of the region. This was brought to the fore when all the agencies, local authorities, CEBs, education institutions and other local representative groups met with the Minister on 24 November. That meeting was the first time that a group of that nature had met collectively with the focus solely on what could be done to improve the region's fortunes. The Minister intends for the coming year to facilitate a series of further meetings of the same group as a means of both monitoring the implementation of the proposals in this report but also as a means of helping to forge greater co-operation and collaboration between the various stakeholders across the region.

A full set of actions and further analysis is outlined in full in the report prepared by Forfás but it is worth noting a number of specific issues of importance. IDA Ireland will assign a clear priority to the region with a view to attracting additional investment to the area particularly in sectors such as life sciences, financial services and new areas such as clean tech. It will continue to work with local stakeholders to promote the Bellview site to a targeted set of international investors. It will work closely with local authorities and other agencies and will ensure that the region is optimally promoted and wins more site visits from prospective investors. It will continue an intensive process of promoting a replacement company for the existing TalkTalk facility and its qualified workforce through its extensive network of international offices.

In terms of Enterprise Ireland's action, an immediate competitive call for feasibility funding for new start-ups in the south-east region will be launched. Funding of up to €20,000 per project will be made available for ten proposals by Enterprise Ireland. Other Enterprise Ireland activities in the region will include the enterprise platform programme in a new format in the first quarter of 2012, and a first flight workshop, aimed at companies developing export markets for their products, will be convened in Waterford. IDA Ireland and Enterprise Ireland will work with other agencies to exploit the clear regional opportunities in life sciences, clean tech and food to build up the competitive strengths and establish the important linkages these sectors need to develop.

The enterprise agencies will also focus on stimulating increased linkages between firms. These actions can only do so much to improve the region's enterprise base, but it is just a start. A challenge that has built up over many years will not be turned around in a matter of months, but the Minister is determined that we should make a start with the measures proposed in the Forfás report. More than that, the Minister is keen in the coming 12 months, to see the agencies and the regional stakeholders come together and help drive the positive changes that are clearly overdue.

I thank the Senator for raising this matter.

Does the Minister of State agree that the Government and the Minister need to do three things with regard to the outworkings of this plan? The first is to set a real target for the reduction of the number of people who are unemployed. The figure could be 14%, for example. There should, at least, be a target. There is no target in the document.

Second, we need to identify the niche areas for Waterford. The document talks about agri-food, clean tech, life sciences and international trading services. I agree with all of that. Does the Minister accept that we now need to amend national plans to reflect that, in order that when IDA Ireland is looking at opportunities it positively discriminates in favour of Waterford and the south east?

Third, the plan should be kept under constant review in order that when we have established targets and we know our objectives we can measure progress against those targets. The big problem with the document is its lack of targets. I hope the Minister will revisit this matter and set clear targets.

The Government is very serious about job creation. There is a challenge throughout the country with regard to job creation. The Government also recognised that there are particular problems in the south east. Waterford has been especially hit, one could say devastated, by substantial job losses in recent years, most recently with the closure of TalkTalk.

There is a clear plan of action. The State agencies were brought into the picture as quickly as possible. They have identified the niche areas. I take the Senator's point regarding setting targets. That should be done. I will relay his views to the Minister in that regard.

The emphasis is on identifying the strengths of the area and of those areas that need to be strengthened further. We must identify those niche activities in the jobs market where there is most potential to benefit the south east.

Bringing the local stakeholders together is particularly important. It is regrettable that this has not been the case and that there has not been such a forum working and campaigning for the south east. I am glad this has come together. The work of the group now needs to be built upon and the group needs to meet on an ongoing basis and be in constant contact with the Department of Jobs, Enterprise and Innovation and the State agencies.

No one is suggesting this is easy. Much work needs to be done. Commitment has been demonstrated by the Minister and the State agencies involved. By working together the south east can be put on the map in terms of job creation. It has significant strengths which need to be built on. The area needs to be sold, and the local people and the local forum can best do that. I agree that they should be setting targets.

Diabetes Services

I raise the issue of diabetes facilities in Letterkenny General Hospital. In Ireland, there are approximately 4,000 children and young adults under the age of 16 with diabetes. Approximately 90% of patients under the age of 16 have type 1 diabetes but, unfortunately, an increasing number of young patients are developing type 2 diabetes. The incidence of type 1 diabetes is also increasing, by between 2% and 3% per year, and experts anticipate that the number will double by 2020.

Type 1 diabetes is a complex condition in children and young adults and it is recommended that care be delivered in multidisciplinary settings, with access to a consultant paediatric endocrinologist, a paediatric diabetes specialist nurse, a paediatric specialist dietician, a psychologist and a social worker. Because of the complexity of the condition and the significant dangers of hypoglycaemia, there can be a clinical advantage in having continuous insulin infusion therapy for children and young adults with type 1 diabetes.

I recently attended a meeting with the parents' support group in Donegal. They have major concerns regarding the future of services at Letterkenny General Hospital. In 2010, the Health Service Executive established a national clinical programme for diabetes with the aim of defining the way diabetes clinical services should be delivered, resourced and measured.

I understand there are two proposed models of care to improve the situation for paediatric diabetes care. The first model comes from the report of the HSE expert advisory group, chaired by Dr. Colm Costigan. This model proposes that care be centralised for each region in a dedicated paediatric adolescent diabetes centre looking after at least 150 children and adolescents. The second model comes from the Diabetes Federation of Ireland. It recommends the establishment of between eight and ten regional networks with three existing Dublin centres acting as territory reference centres and with one third of the national diabetes population being served in Dublin.

The parents of the 160 children with type 1 diabetes who attend Letterkenny General Hospital want to ensure that the services currently available at Letterkenny General Hospital are maintained and enhanced. I understand that discussions are taking place at a national level on the diabetic clinical care programme but no decision has yet been made.

A number of things are significant in the case of County Donegal. The county is geographically isolated. If services were to be withdrawn from Letterkenny General Hospital parents and children would have to make a return journey of at least six hours to get the care that is being provided in Letterkenny.

Some 21 hospitals in the country provide this level of care. It is essential that a consultant endocrinologist be appointed at Letterkenny General Hospital. I understand such an appointment is being considered for January 2012. I raise this issue because I seek some level of clarification as to whether or not that is the case and whether or not the HSE will give the go-ahead to employ a consultant endocrinologist.

Will the HSE approve the appointment of a clinical nurse specialist? Two clinical nurse specialists are employed at Letterkenny General Hospital, working with adults and paediatric patients. What is required is a dedicated nurse who would deal solely with children and adolescents with diabetes. This appointment would be vitally important.

Can the Minister give an indication that the service will be retained at Letterkenny General Hospital? The hospital has the excellence and the ability to provide this care. It deals with 160 children, more than the 150 recommended by the HSE expert advisory group. Given that national statistics predict that the number of children with type 1 diabetes will double between now and 2020, there will be more than 300 children with diabetes in the Donegal region by that date.

I hope progress can be made and that the Minister can give a commitment to the provision, retention and enhancement of the services available in Letterkenny General Hospital. I hope there will be a commitment to the provision, retention and enhancement of the services currently available at Letterkenny General Hospital

I thank the Senator for raising what is both a local and a national issue. There are no plans to remove or downgrade the existing paediatric diabetic service at Letterkenny General Hospital. There are two clinical nurse specialists at the hospital. These specialist nurses work with the adult and paediatric diabetic service and a consultant endocrinologist is scheduled to take up appointment in January 2012. Funding is not currently provided for a dedicated paediatric clinical nurse specialist.

The future development of diabetic services in the State and at each hospital site, including Letterkenny General Hospital, will be determined by the HSE national clinical programme for diabetes. This programme includes the care of children and adolescents with diabetes and was established within the clinical strategy and programmes directorate. The purpose of the national diabetes programme is to define the way diabetic clinical services should be delivered, resourced and measured. A clinician has been appointed to lead the development of the programme, which has as its central aim to save lives, eyes and limbs of patients with diabetes.

Improvements in the care of children and young adults with diabetes are required and, with this in mind, a number of models have been proposed. One such model is suggested by the recent Diabetes Federation of Ireland "Diabetes Action" campaign, chaired by Professor Hilary Hoey, retired professor of paediatric endocrinology in the National Children's Hospital in Tallaght. The second model is from the report of the expert advisory group, chaired by Dr. Colm Costigan, paediatric endocrinologist in Crumlin hospital.

In the context of the national clinical programme, the national clinical leads for diabetes and paediatrics have met to discuss the issues involved in the care of children and adolescents with diabetes. They have set up a working group to assess current services across the country, to agree a model of care and to standardise services across the country. This work will also include work on the provision of insulin pumps and work on policy for prevention and early detection of diabetes in young children and adolescents. The group's work is continuing and will determine the final shape of any model for service delivery.

I welcome what the Minister of State has said, particularly with regard to the endocrinologist who will be appointed in January and the fact there are no plans to remove or downgrade the existing services. She has stated that the work of the expert group is continuing and will determine the final shape of any model for service delivery. I hope that whatever decision or recommendation is made by that group, it will not involve any downgrading or removal of services at Lettterkenny General Hospital. I ask her to bear that in mind when decisions are being formulated, because the level of service delivery is vitally important to the families and children who use the service at the hospital. It is a hospital which is endeavouring to deal with the difficult financial constraints it is under but which provides an excellent level of care, which can only be enhanced by the decision to appoint an endocrinologist and specialist nurse. We appeal to the Minister of State to try to ensure that money is ring-fenced to provide the nurse specialist treatment that is required by the patients.

There are no plans to downgrade the excellent work being done in Letterkenny General Hospital. I am very hopeful that we will be able to roll out the clinical care programme for diabetes. As the Senator has said, the explosion in the number of cases in diabetes is probably the biggest threat facing the health service. It is a huge challenge to address that, to concentrate on prevention and to provide for management of chronic diseases, particularly diabetes, at primary care level. That is the way we want to go and I hope that if funding is provided, we can start on that important programme next year. We cannot afford not to, given the threat posed by the disease. Clearly, Letterkenny General Hospital will play a critical role in the roll-out of the programme.

Modern Languages Initiative

I thank the Minister of State, Deputy Ciarán Cannon, for waiting to take this final Adjournment matter. The modern languages initiative in primary schools is an issue that was brought to my attention this weekend, due to the plans introduced in the budget, unbeknownst to many people, to end the initiative.

This programme was introduced some time ago and has proven quite successful in fostering a knowledge and love of foreign languages among primary school children. As the Chair, the Minister of State and I are aware, the option was not available to us in primary school to learn French, German or Spanish, as happens in some schools in my area. As the Minister of State's constituency borders on my area, I know he is aware of the importance of ensuring that rural Ireland, in particular, has these opportunities. Looking at some of the jobs created in recent years, particularly in areas like Shannon and Galway, they have been in the telesales area for international companies. In the Shannon free zone, in particular, a number of companies provided specialist services through French, German, Chinese, Japanese and other languages. What has attracted these companies to the area has been the high quality second level education, particularly in the area of modern European languages.

Extending the modern language programme to primary schools was a great idea. Most other European countries teach at least one other language and most children leaving European primary schools have at least basic knowledge of two languages. In Ireland, students have Irish and English and that is all. While Irish is important for the formation of the character of students, the study of at least one European language is desirable. In my area of north Clare, there were two visiting teachers, visiting a myriad of schools in the west and east Clare areas. Those two teachers provided classes in Spanish, French, German, Italian and one other language. Not all kids blossomed in this area, but a number of them have shown enormous potential. I know of examples where kids have gone abroad with their families as a direct result of the knowledge and love of the language they learned.

I believe the axing of the initiative will save €2.5 million, but there are other ways this amount could be saved rather than eliminating the service with immediate effect, which is something about which I am concerned. Children who have been learning a language since September will no longer have their classes after Christmas as the programme will not even continue for the full academic year. This is most regrettable as is the fact that the teachers in question will be made redundant immediately. I call on the Minister to review this. I am aware that other elements of the budget, particularly with regard to disability, have been reviewed. There is nothing wrong with conducting an examination and realising that decisions should be tweaked. This is one area I sincerely hope the Minister will tweak.

I am taking this Adjournment matter on behalf of my colleague, Deputy Ruairí Quinn, Minister for Education and Skills.

I welcome the opportunity to outline to the House the decision taken by the Minister in the context of budget 2012 concerning the ending of the modern languages in primary schools initiative. As part of the budget 2012 decisions that have been announced, the modern languages in primary schools initiative will cease at the end of the 2011-12 school year. The savings from this measure will go towards the cost of implementing the new national literacy and numeracy strategy, which is a key commitment in the programme for Government.

Since becoming Minister for Education and Skills, the Minister has spoken repeatedly about the need to raise educational standards. In terms of curriculum reform, the priorities in the period ahead are to strengthen achievement in literacy and numeracy, to implement reforms in maths, Irish and science and to progress junior cycle reforms.

The modern languages initiative was a pilot scheme, involving approximately 500 schools, and had been operating since 1998. It has not been possible for other schools to join the pilot project for a number of years and the way in which it operated was not capable of being rolled out to all 3,200 primary schools. The decision to end the scheme from June 2012 was based in part on policy advice from a 2008 report by the National Council for Curriculum and Assessment, NCCA, which has identified serious issues with curricular overload at primary level. The NCCA's advice recommended that modern languages should not be part of the primary school curriculum as an additional and separate subject.

The primary curriculum is being reviewed by the National Council for Curriculum and Assessment in the context of the national literacy and numeracy strategy. The focus of the review will be on how best to enhance children's learning in these areas, providing for a clear delineation of the learning outcomes required and integrating into the infant cycle the learning experiences from Aistear, the curriculum framework for early childhood education.

At post-primary level, targeted support is provided for schools to enable them to diversify language provision, with a particular focus on Spanish, Japanese, Russian and Italian. Other languages taught at second level include French, German and Arabic. Participation in foreign languages, relative to other subjects, remains high at post-primary level. The majority of students are studying two languages, thereby developing core skills that will serve them well in future language learning. There are many opportunities outside the second level system for people to resume language learning.

Ending the scheme was not easy, but before the decision was taken the Minister gave careful consideration to the concerns about the teaching of languages. I again thank the Senator for affording me the opportunity to respond to the House on the matter.

I thank the Minister of State for his comprehensive reply. I am glad that I was wrong to state the scheme would be brought to an end immediately. It is welcome that it will continue until June 2012. However, I will continue to contend that the teaching of modern languages is important and that the earlier children are exposed to them, the better their chances will be of developing a love for them. Perhaps the Minister might review the decision. While I take on board the points and recommendations made to him and accept that he has a difficult job to do, perhaps the Minister of State might stress to him the importance of exposing children to modern languages at a young age. The Minister of State might also suggest to him that the teachers who find themselves out of a job at the end of this academic year should be redeployed in a support structure for second level students to broaden the church of languages available to them.

I thank the Senator for his contribution and highlighting this issue which is close to my heart. As he pointed out, we need to prioritise our use of limited resources and make difficult decisions that will have problematic outcomes for those who have been employed as teachers under this initiative. There was a certain degree of inequity in provision, in that we were only able to roll out the opportunity to 500 of the 3,200 primary schools. We also needed to take into consideration the strong opinion expressed by the NCCA to the effect that modern languages should not be part of the primary school curriculum as additional and separate subjects. Under the programme for Government, we are strongly determined to eliminate illiteracy and innumeracy at primary, post-primary and further education levels. There is no better time to do this than early in a young person's education. The resources saved through the cessation of this process will be targeted at dealing with this issue. It will be money well spent and we will see positive outcomes in the years to come.

The Seanad adjourned at 5.45 p.m. until 10.30 a.m. on Wednesday, 14 December 2011.
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