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Two Thousand Auditors and a Quarterly Deadline: Inside America’s Biggest Healthcare Check-Up

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Healthcare Check-Up

There is a new growth industry in American healthcare, and it is not a drug, a device, or an app. It is checking. In the space of two years, the United States government has built one of the largest audit operations in its history, aimed squarely at the private insurers that deliver public health coverage to more than thirty million older Americans.

The numbers tell the story quickly. The federal audit workforce for this programme has grown from roughly forty reviewers to around two thousand certified medical coders. Audits that once trickled out have moved to a quarterly rhythm. Artificial intelligence now helps reviewers read medical records at speed, though humans make the final calls. And when auditors find errors in a sample of patient files, they no longer just correct the sample. They extrapolate the error rate across the entire contract and demand the difference back.

For British readers accustomed to NHS headlines, the scale takes a moment to absorb. This is a government checking whether it overpaid private companies, with hundreds of billions of dollars a year in play.

Why the checking became necessary

The programme under the microscope is called Medicare Advantage. Instead of the government paying doctors and hospitals directly, private insurers receive a monthly sum for each member they cover, adjusted for how ill that member is. A member whose records show diabetes, heart failure, and kidney disease brings a higher payment than a healthy one. The logic is sound: sicker people cost more to care for, and insurers should not be punished for covering them.

The vulnerability is equally clear. The payment follows what is recorded, not what is treated. Over fifteen years, an industry grew up around maximising the recording. Insurers hired teams and bought software to re-read years of old medical files, hunting for conditions that could be added to a member’s record. Every addition raised the member’s risk score, and the monthly payment with it.

Independent congressional advisers now estimate the resulting excess payments at tens of billions of dollars a year. In March 2026, government auditors published reviews of three insurance plans and found that between 81 and 91 percent of sampled high-risk diagnosis codes lacked proper supporting evidence in the medical records. The same month, the US Department of Justice concluded a 117.7 million dollar settlement with a major insurer whose chart-review programmes, prosecutors argued, added diagnoses by the thousand while almost never removing a wrong one.

The machinery of the response

The audit programme itself, known as RADV, for Risk Adjustment Data Validation, is where the government’s answer lives, and its recent expansion is the real news. A useful plain-language account of the Medicare Advantage audit expansion sets out what changed: audits of payment year 2020 began in February 2026, samples per contract now range from 35 to 200 members depending on plan size, insurers get a five-month window to produce the medical records behind each audited diagnosis, and the whole cycle repeats every quarter rather than every few years.

The genuinely novel element is extrapolation. Under the old regime, an insurer caught with unsupported codes repaid only the specific errors found. Under the new one, a 40 percent error rate in a sample becomes a 40 percent clawback across the contract. The change converts audits from a nuisance into an existential financial event, which is precisely the point.

Insurers have responded the way regulated industries always do when the referee starts counting properly: they are professionalising in a hurry. Compliance teams that once assembled audit responses from spreadsheets and email chains are buying purpose-built platforms. Review programmes that only ever added diagnoses are being rebuilt to remove unsupported ones too, because prosecutors made one-directional review the signature of bad faith.

The view from this side of the Atlantic

Britain does not run Medicare Advantage, but it is not a spectator to the underlying question. The NHS increasingly allocates funds using population-need formulas built on recorded data, and integrated care systems are experimenting with outcome-linked payment. Wherever documentation determines allocation, the American lesson applies: the data will drift toward the money unless verification keeps pace.

There is also a procurement lesson. British health bodies buying data and AI systems from an increasingly global vendor market can borrow the questions American auditors now ask. Can every automated conclusion be traced to its evidence? Does the system correct errors in both directions, or only the profitable one? Could a third party reconstruct the decision three years later?

The Americans learned to ask those questions after the money was gone. The audit army, the quarterly cadence, and the nine-figure settlements are what catching up looks like. The cheaper option, available to anyone still designing their systems, is to ask them at the start.

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Semen Testing Manchester: A Complete Guide to Male Fertility Testing

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Semen Testing Manchester

Being a parenting couple is one of the most personal experiences that a couple can go through. However, when they don’t conceive as soon as they want, many couples only think about the woman first. The truth is, male fertility is just as important. Male factors are involved in approximately 40 to 50 per cent of all conception issues. The most reliable test to begin with for male fertility testing is semen testing in Manchester. 

If you are in Manchester and want to seek real answers to your reproductive health, consider semen testing. This guide will go over everything you need to know about semen testing in Manchester, what the process entails. Why it is important, and how a male infertility specialist in Manchester can help you throughout the process.

Importance of Male Fertility Testing

Male infertility is a subject still much misunderstood. Many men delay getting tested for months or years, believing the issue is elsewhere or that it will resolve on its own. This delay can cause extra stress on the couple’s relationship. That’s why a male reproductive health checkup is equally important.

Male fertility is of critical importance. Several things can impact sperm health, including lifestyle, diet, stress, underlying medical conditions, and medications. These are all internal issues with no outward appearance. The only sure way of knowing what is really going on is to conduct a semen analysis.

Semen Analysis: What is it?

A semen analysis is a simple, non-invasive test performed in a clinical laboratory. It is a fundamental part of any male reproductive health examination. Providing a comprehensive overview of sperm quality across various parameters.

The semen testing Manchester laboratory will look at the following during a routine semen exam:

  • Sperm concentration: The number of sperm cells in the semen is called sperm concentration.
  • Sperm motility: It is measured by the total motile count (TMC). Which represents the number of sperm that are moving and able to reach the egg.
  • Progressive motility: The ability of sperm to move in a forward direction.
  • Morphology: the shape and structure of the sperm cells
  • Volume: amount of semen produced
  • pH levels: Which may signal problems with accessory glands that play a role in semen production
  • Vitaility: The number of sperm that are alive, even if they are not moving
  • Liquefaction time: The speed at which the semen turns from gel to liquid after it has been ejaculated

If the results are outside normal ranges, it does not necessarily mean that the male is infertile. But it does give your specialist the information they need to give you the right advice.

What will Happen When the Test is Performed? 

The Semen testing Manchester will try to make the process as simple and discreet as possible.

  • You will have to refrain from ejaculation 2-7 days before the appointment to get the most accurate results based on the international WHO guidelines.
  • You can produce your sample at home and drop it off at the clinic within 1 hour of production, or you can come to the clinic. Normally, the results can be obtained within a few working days.
  • Once you have your results, a subsequent consultation with a clinical embryologist or andrologist can assist you to understand the practical implications of each value and what you need to do next. They will also help you understand the importance of semen analysis and help you make lifestyle changes to improve your reproductive health.

Benefits of Seeing a Fertility Specialist

If you are having trouble conceiving, it is best to check with a fertility specialist.  A private male fertility clinic in Manchester can examine you within days and provide results in as short a span as 2-3 days.

The focus and expertise at specialist clinics are also greater than those in general practices, aside from speed. The team understands male reproductive health very well and can provide more than just a set of numbers. They’ll be able to interpret your results and make lifestyle change recommendations that could help you improve your sperm quality. If necessary, they can refer you to more advanced testing.

For men, a standard semen analysis doesn’t give the full picture, and there are advanced options available, including DNA fragmentation testing. This test focuses on the integrity of the gametes (sperm), which is especially important for couples who have had multiple miscarriages and/or multiple unsuccessful IVF attempts.

Tips to Naturally Boost Male Fertility

Semen Analysis results provide the facts; however, there is a lot men can do to enhance their fertility naturally over several months before conception. 

Some practical measures include keeping a healthy weight, limiting alcohol intake, quitting smoking, reducing processed foods, getting regular moderate exercise, managing stress, and getting a good night’s sleep. Clinical studies have also found that other nutrients are involved in sperm health, including zinc, folate, vitamin C, omega-3 fatty acids, and coenzyme Q10.

Conclusion

The only thing that matters about the importance of semen analysis is knowledge. Knowing where your fertility is in relation to time will give you the chance to make better choices.

The hardest thing about making a start is that very first step. After you know the results, it’s easier to see the way forward. Semen testing in Manchester is available, affordable and private. Whether you are trying to conceive, planning to conceive or simply would like a baseline checkup for your man’s health. Male Fertility Clinic provides flexible appointment times, no waiting periods and no added complexity, including evenings and weekends.

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What should parents look for in an ABA therapy program?

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My friend spent about four months researching all of the best ABA programs for her son. She made a spreadsheet. She compiled all of the information that programs provided to her in a folder that was color-coordinated and very beautifully organized.She even had up to 23 websites open in her browser at a time researching.Yet in the end, she confessed to me that even after all of that research, she wasn’t even really sure if she had been asking the right questions.

I still remember my friend describing the 4 months she spent researching for her 4 year old son with autism before entering a first ABA clinic.Four months of an in depth research of ABA programs, with an Excel spread sheet, a thick folder color coded by topic, and at times 23 browser tabs open on her computer. And even then, she would say she was not sure if she had asked the right questions.

So let’s cut through it.

Evaluating the therapy environment.

Take a walk through of the area before committing to a program would be ideal. Do a tour of the area and then sit down with a few families and have them give you a tour of their “clinic” or area where work takes place. Ask them to sit with you and explain how things work. Then sit in on a session with their lead therapist. Ask the staff members what they are doing at any given time while physically in the area with kids. Are they processing data and managing in the back or are they sitting right next to the kids working with them. How does a session deal with a crisis? Is there any warmth in the area or is it a processing area and kids and families just go there to have work done. There are still some really great clinical settings where kids and families feel really supported and at home and work is being done and there are other settings that feel sterile, cold and just like a “therapy” area where kids go to receive processing. Just because something looks different on the outside doesn’t mean it’s not great.

Here are a few things to pay attention to when looking at a therapeutic setting:

  • Low noise and visual clutter in core learning spaces (sensory overwhelm is real)
  • Natural light, or at minimum, lighting that doesn’t buzz
  • Clear zones for different types of activities, not one generic room where everything happens
  • Staff who make eye contact with the kids, not just the clipboards

That last one sounds small. It isn’t.

What’s the turnover rate?

Everyone asks whether therapists are BCBA-certified — and yes, that matters enormously, Board Certified Behavior Analysts have rigorous training requirements and any program worth considering should have BCBAs supervising the work — but I’ve watched parents spend twenty minutes asking about credentials without ever

What’s the turnover rate?

So here’s the follow-up question that nobody ever asks: What is the average amount of time that a therapist stays with a program before leaving for another job?This is a very important question for parents to ask because of how vital consistency is to a child’s progress in ABA therapy.ABA is a very relationship-driven process, and it takes a long time for a child to build up enough trust with a therapist in order to have a successful relationship.If a child is making great progress with a particular therapist, only to have that therapist leave for another job three months later, it can be very frustrating and even defeating for a child.So it is very important for parents to ask about turnover in a program before deciding whether or not to go with that program. A good program will not be embarrassed to tell you about how long their average therapist stays.

What are the credentials of the staff at the program? It is very important to have therapists, consultants and other supervisory staff that are BlockPlaceholderZZ3

  • BCBA or BCaBA certification for supervisors and lead therapists
  • Registered Behavior Technicians (RBTs) who have completed proper training (not just a weekend course)
  • Ongoing supervision hours, not just an initial sign-off
  • Experience specific to your child’s age group and needs

Individualized plans, not template therapy

However, I have found that there are many clinics that really do put the best practices of ABA to use, and really can change a child’s life for the better.As I mentioned before, every child with autism is different, and each will have their own individual way of communicating, their own individual sensory needs, and their own individual way of life.In the creation of the best plan for a child’s ABA goals, the therapist would use the best practices for the individual child, using the individual child’s methods of communication, and individual child’s ways to manage sensory issues.A truly effective ABA program would not use a single set of methods or protocol for all skills for all children.Instead, the most effective ABA programs for children with autism will be those that are tailored to the individual child, using a variety of different ABA methods, that best meet the child’s individual needs.An example of a less effective program, would be a clinic, that uses only one type of communication with all of the children, and has all of the children do all of their skills in one type of activity.This type of program could drag a child through life, having the child crawl to complete a skill, in order to complete his or her ABA therapy, and could be very dehumanizing to the child.

A good ABA program for your child should also have individually written goals that apply to your child’s actual life. For example, before starting ABA with your child, you should be able to view a detailed assessment of your child. In particular, your child’s goals for ABA should reflect his or her current situation and be relevant to his or her daily life.As a general rule, your child’s ABA goals for ABA should be to acquire a series of functional skills that any normally developing 2- to 6- year old child would acquire in order to interact with family and others in the community.These skills might include for example being able to cross the room, being able to stack blocks, being able to engage in cooperative play with others, and so on.Therefore, prior to starting a program of ABA with your child, you should view a detailed assessment of your child, and then review your child’s written goals for ABA in order to ensure that the goals of ABA are relevant to your child.

(One small indicator of this sort of program is if they can tell you within the first 5-10 minutes of your first intake meeting what your child’s goals will be. In reality, Individualized Programs take time to develop).

Here is a graphic to compare typical ‘individualized’ ABA programs and what ABA really should look like for children and their families.

Generic program approachIndividualized program approach
Same starting goals for most new clientsGoals built from a comprehensive intake assessment
Progress measured on a fixed scheduleData reviewed continuously and plans adjusted regularly
Family gets updates occasionallyFamily is part of the team from day one
Therapy stays in the clinicSkills are practiced across home and community settings too

Family involvement isn’t optional

The best ABA programs involve the families of the children with Autism Spectrum Disorders in the process of developing and implementing a treatment plan to help their child succeed. The staff of these ABA programs can equip the child’s therapists with strategies and tools that can be used at home by family members, in schools by teachers and other school staff, and in community settings by peer models and others. Families can learn new ways of communicating with children with Autism Spectrum Disorders, and tools to deal with difficult situations. Also, there are many things that children with Autism Spectrum Disorders can learn in their ABA sessions that will be very useful to their families.

However, if parent training is not included as a core component of treatment then this is an area that you should really push to get the program to acknowledge as a “gap” in their services.

The aba therapy bedford ma team at Bierman Autism Centers in the area for parents doing their research for a family-centered model of ABA for their child with autism is the model that comes to mind for staff to treat families with the respect and dignity that any family deserves.

16 One last thing — and I mean this one

Trust your gut. There are many things that can feel right or wrong to different people. We can’t always even explain to ourselves why we think a particular program would be good for our child. We may be misreading a program that is really good for our child because of our anxiety about our child. But, we can also trust our gut and know that a program does not feel right for our child. And, it is very important to pay attention to your gut if a program makes you feel like a nuisance for asking questions, if the answers to your questions sound rehearsed, and if you leave a meeting with a lot of confusion and uncertainty. These are all red flags and your gut is trying to tell you something. Pay attention to your gut. Your child deserves better.

A program can look great on paper and be a disaster. Don’t let a fancy intake process fool you. Your child deserves a program that earns your trust and has your child’s best interest at heart.

Your child needs a program that is worthy of your trust and does everything to earn it. An attractive intake packet does not equal a quality program.

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How to Maintain Hip Mobility as You Age

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Hip mobility plays an important role in daily movement. It helps you walk, climb stairs, get up from a chair, bend to wear shoes and stay active. As people age, the hips may become stiffer due to reduced activity, muscle weakness, arthritis, previous injuries or general joint changes.

Some stiffness is common, but it should not be ignored if it affects daily life. Keeping the hips mobile can support balance, comfort and independence. The key is to move regularly, strengthen the muscles around the hip and seek medical advice when pain or stiffness becomes persistent.

What Is Hip Mobility?

Hip mobility refers to how well the hip joint moves in different directions. The hip is a ball-and-socket joint, which allows the leg to move forward, backward, sideways and in rotation.

Good hip mobility helps with:

  • Walking
  • Climbing stairs
  • Standing up from a chair
  • Squatting
  • Bending to wear socks or shoes
  • Getting in and out of a car
  • Exercising
  • Maintaining balance

Hip mobility is supported by the joint, muscles, tendons, ligaments and surrounding soft tissues. When any of these become stiff, weak or painful, movement may feel harder.

Why Do Hips Become Stiffer With Age?

Hip stiffness can develop for many reasons. It may happen gradually, so some people do not notice it until daily tasks become more difficult.

Common reasons include:

  • Less physical activity
  • Muscle weakness
  • Tight hip flexors from prolonged sitting
  • Hip osteoarthritis
  • Previous falls or injuries
  • Reduced balance
  • Poor posture or movement habits
  • Weight gain placing more load on the joints
  • Pain that leads to avoiding movement

Avoiding movement may feel helpful at first, but too much rest can make stiffness and weakness worse over time.

What Are Signs of Reduced Hip Mobility?

Reduced hip mobility may feel like stiffness, tightness, aching or difficulty moving the leg freely.

You may notice:

  • Difficulty putting on socks or shoes
  • Pain or stiffness when standing up from a chair
  • Shorter walking distance
  • Trouble climbing stairs
  • Hip or groin discomfort
  • Limping
  • Reduced balance
  • Difficulty sitting cross-legged
  • Tightness at the front, side or back of the hip
  • Stiffness after sitting for a long time

If these symptoms persist or worsen, it may be useful to seek assessment.

Why Is Hip Mobility Important as You Age?

Hip mobility supports more than flexibility. It affects strength, balance, walking and fall prevention.

Maintaining hip mobility may help:

  • Support safer walking
  • Reduce stiffness after sitting
  • Improve confidence with stairs
  • Support balance
  • Reduce strain on the lower back and knees
  • Make daily tasks easier
  • Support exercise participation
  • Reduce the risk of movement-related pain

The goal is not to force extreme flexibility. For most adults, the goal is comfortable, safe and useful movement for daily life.

How Can You Maintain Hip Mobility Safely?

Maintaining hip mobility usually requires a mix of regular movement, strengthening, stretching and balance training. Exercises should be done within a comfortable range and adjusted for age, fitness level and medical conditions.

1. Keep Moving Regularly

Regular movement helps reduce stiffness and keeps the hips active. Long periods of sitting can make the hip flexors and surrounding muscles feel tight.

Helpful habits include:

  • Standing up and walking every 30 to 60 minutes
  • Taking short walks during the day
  • Using stairs when safe
  • Doing gentle movements after sitting
  • Avoiding long periods in one position

Small amounts of movement done consistently can be more useful than doing too much at once.

2. Add Gentle Hip Mobility Exercises

Gentle hip mobility exercises can help keep the joint moving. These should not cause sharp pain.

Examples may include:

  • Gentle hip circles
  • Seated marching
  • Standing leg swings while holding support
  • Heel slides while lying down
  • Side steps
  • Sit-to-stand practice
  • Gentle knee-to-chest movement, if comfortable

Start slowly. If an exercise causes pain, stop and seek advice before continuing.

3. Strengthen the Muscles Around the Hip

Hip mobility is not only about stretching. Strength is also important. Strong hip and thigh muscles help support the joint during walking, stairs and standing.

Strength exercises may include:

  • Sit-to-stand exercises
  • Glute bridges
  • Side-lying leg raises
  • Step-ups on a low step
  • Mini squats
  • Calf raises
  • Resistance band side steps

These exercises should be done with good control. Older adults or patients with pain should consider guidance from a physiotherapist before starting a new strengthening plan.

4. Improve Balance

Balance often changes with age. Hip strength and control are important for balance, especially when walking on uneven ground or climbing stairs.

Balance exercises may include:

  • Standing with feet close together
  • Heel-to-toe standing
  • Supported single-leg standing
  • Slow marching while holding a chair
  • Side stepping near a wall or support

Always perform balance exercises near something stable. Do not attempt challenging balance drills alone if you are at risk of falling.

5. Stretch Tight Muscles Gently

Tight muscles around the hip can limit movement. Gentle stretching may help, especially for people who sit for long periods.

Common areas to stretch include:

  • Hip flexors at the front of the hip
  • Glute muscles
  • Hamstrings
  • Quadriceps
  • Calves

Stretching should feel mild and controlled. Avoid bouncing, forcing the joint or pushing into sharp pain.

6. Choose Low-Impact Activities

Low-impact activities can help keep the hips moving without placing too much stress on the joints.

Options may include:

  • Walking
  • Swimming
  • Stationary cycling
  • Tai chi
  • Gentle yoga, if suitable
  • Water exercises
  • Strength training with proper guidance

People with hip arthritis or pain should avoid sudden increases in activity. Build up gradually.

What Daily Habits Can Help Hip Mobility?

Exercise matters, but daily habits also affect hip comfort and movement.

Helpful habits include:

  • Avoid sitting for too long without breaks
  • Use a chair that supports good posture
  • Wear supportive footwear
  • Keep walkways clear to reduce fall risk
  • Maintain a healthy weight where possible
  • Use handrails on stairs
  • Avoid rushing on wet or uneven surfaces
  • Warm up before exercise
  • Rest when pain increases
  • Stay consistent with safe activity

For many people, the best plan is one that fits into normal routines and can be continued long term.

What Should You Avoid If Your Hips Are Stiff or Painful?

Some movements may worsen symptoms, especially if there is hip arthritis, injury or inflammation.

Avoid or modify:

  • Deep squats if painful
  • Sudden twisting
  • High-impact exercise during flare-ups
  • Long walks when pain is already worsening
  • Sitting very low if it causes pain
  • Forcing stretches
  • Exercising through sharp pain
  • Returning to sport too quickly after injury

Pain is a signal. Mild muscle effort can be normal during exercise, but sharp joint pain, worsening pain or limping should not be ignored.

When Should You See a Doctor for Hip Stiffness or Pain?

Mild stiffness may improve with regular movement and gentle strengthening. However, persistent or worsening symptoms should be assessed.

You should consider seeing a doctor if you have:

  • Hip pain lasting more than a few days to weeks
  • Pain that affects walking
  • Pain that wakes you at night
  • Limping
  • Stiffness that limits daily tasks
  • Difficulty putting on socks or shoes
  • Hip pain after a fall
  • Groin pain with movement
  • Reduced ability to climb stairs
  • Pain that does not improve with rest
  • Sudden worsening of symptoms

Seek urgent care if you cannot bear weight, have severe pain after a fall, notice leg deformity or have fever with hip pain.

Where Can Patients Seek Hip Mobility Assessment in Singapore?

Patients with ongoing hip stiffness, pain or reduced walking confidence may start with a GP, physiotherapist or orthopaedic assessment. The right starting point depends on symptom severity, age, medical history and whether there was an injury.

Patients may consult an orthopaedic specialist at HC Orthopaedic Surgery if hip stiffness or pain affects walking, stairs, sleep, exercise or daily independence. A clinical assessment can help identify whether symptoms may be related to hip arthritis, muscle weakness, tendon irritation, injury or another condition.

How Is Hip Mobility Assessed?

A doctor or physiotherapist may assess how the hip moves and how symptoms affect daily life.

The assessment may include:

  • Discussion of symptoms
  • Walking pattern check
  • Hip range-of-motion testing
  • Strength testing
  • Balance assessment
  • Lower back screening, where needed
  • Review of previous injuries
  • Imaging tests if clinically needed

Possible Tests

Tests are not always required. If needed, they may include:

  • X-rays: To check for arthritis, joint space narrowing, bone changes or fracture
  • MRI scans: To assess soft tissues, early bone problems or certain hip conditions
  • Blood tests: If inflammation, infection or another medical condition is suspected

The doctor should explain why a test is needed and how it may guide treatment.

What If Hip Arthritis Is Causing Stiffness?

Hip osteoarthritis can cause pain, stiffness and reduced movement. It may become harder to walk, climb stairs or move the hip comfortably.

Treatment may include:

  • Activity changes
  • Physiotherapy
  • Strengthening exercises
  • Weight management advice, where relevant
  • Pain relief medication, if suitable
  • Walking aids in selected cases
  • Injections in selected cases
  • Hip surgery discussion for advanced cases

Surgery is usually considered only when symptoms are severe, daily function is affected and non-surgical care no longer provides enough relief.

Hip mobility can change with age due to stiffness, muscle weakness, arthritis, injury or reduced activity. Keeping the hips active through regular movement, strengthening, balance work and gentle stretching can help support daily function and confidence.

The goal is not extreme flexibility, but safe and comfortable movement. Persistent hip pain, stiffness, limping or difficulty with daily tasks should be assessed so that the cause can be identified and suitable treatment can be planned.

This article is for general information only and should not replace medical advice from a qualified healthcare professional.

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