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New report reveals higher number of people with a brain injury in the criminal justice system

A new report has revealed that the number of people with a brain injury in the criminal justice system could be higher than those without.

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A man with acquired brain injury holding the bars of a cell. Close up on two hands holding the bars

A new report has revealed that the number of people with brain injuries is five times higher within the criminal justice system

NR Times speaks to Chloe Hayward, the UKABIF Director and Gemma Buckland, the Director of Do it Justice, about what the report means and what happens next.

The United Kingdom Acquired Brain Injury Forum (UKABIF) and the Criminal Justice Acquired Brain Injury Interest Group (CJABIIG) have welcomed a report by the Criminal Justice Inspectorates. The report examined their evidence of neurodiversity within the criminal justice system.

Revealing research

The research shows that the number of people with brain injuries is five times higher within the criminal justice system compared to those in the general population. There are many factors that can contribute to this for both adults and adolescents.

Gemma highlights that there can be difficulties with emotional regulation and impairments to cognitive functioning that means those with acquired brain injuries may struggle to moderate their behaviour.

“Young adults who are involved in the criminal justice system are still going through a distinct period of brain development. They are likely to have less emotional temperance where they are able to regulate their own behaviour. Those skills around emotional regulation come in at quite a late stage and can continue to the late 20s. If someone has an acquired brain injury then they are less likely to be able to modulate those behaviours.”

She adds: “Young adults with ABI may be more violent and have a higher risk of suicide. They may be more influenced by their peers at that age. Someone with a brain injury may be more susceptible to that because they cannot undertake the thinking processes that may need in order not to engage in that behaviour.”

Trauma in the form of violence, abuse, poor parental attachment, bereavement or siblings involved in the justice system can also compound the lack of maturity. Once they are in the system, it can be difficult to understand what is happening and also, adhere to the rules of conduct. Which can be distressing and also lead to further punishment or a return to the justice system post-release.

Read more: Mental health NHS Trust extends roll-out of Perfect Ward

Change

Both UKABIF and The Group hope that the report will lead to change in how neurodiversity is handled by the criminal justice system. Chloe outlines that among the most important changes that need to be instigated are training and screening.

“The key things we have been pressing for are screening and training. We don’t know how many people in the system have an acquired brain injury. There are a couple of questions that are asked to people when they enter the criminal justice system but that information is often not shared because of confidentiality,” she says.

“We need to make sure that all of the people across the justice system know what this is about. There are a lot of different parts to this like judges, police officers, magistrates who need to have an understanding because it’s a hidden disability. It’s something going on inside you that you have to deal with and often people don’t know themselves. It could be from a concussion you had as a teenager from an assault.”

Bright blue cell doors being unlocked by man with a gold set of keys to highlight the problems in the criminal justice system for those with a brain injury

It may not be from trauma or an injury sustained before young adults with ABI enter into the system. There is currently no research into how many brain injuries are acquired as a result of violence, assault or self-harm in prisons. Both Gemma and Chloe confirm that this is an area that could benefit from more research.

Criminal justice system resources

Gemma adds that an action plan is due but will depend on resources. “The Secretary of State is very keen on this agenda but there aren’t any resources yet to make it happen. An action plan will need to be produced within the next three months. There will need to be decisions made by the Treasury as to what to invest in so it may mean that in the short term, things need to happen with existing resources.”

“It would be easier to have a blanket approach or guidance across the criminal justice system as to what adjustments should be made for people who are known to have an acquired brain injury. This should include having more flexibility and understanding on the part of the practitioners involved that challenging behaviour may have an underlying reason for it.”

Read more: Long COVID cognitive impairment investigated in a new study

Interviews

HELP: Empowering people to live their best lives with pain

Think Therapy 1st discuss their pioneering results-based pain management programme

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Through the launch of the Holistic Education for Living with Pain (HELP) programme, Think Therapy 1st is helping to give new hope to people living with pain. NR Times learns more about the first-of-its-kind initiative which is set to change the lives of countless people who too often suffer in silence

 

While pain is something that is all too often dismissed, leaving people struggling to manage their daily lives with few places to turn for practical support, for Think Therapy 1st (TT1st) comes the opportunity to use their expertise to make a life-changing difference. 

As pioneers of a pain management programme which saw 100 per cent of participants report improved functioning as a result, and vast decreases in the level of pain in daily activities such as socialising – where the pain rating reduced from an average of 7.6/10 pre-programme to 2.6/10 afterwards – the team wanted to create an even more compelling offering for those in need of bespoke support. 

While the initial pain programme was an occupational therapy (OT) only project, now, with the launch of the Holistic Education for Living with Pain (HELP) programme, TT1st have extended their MDT to include psychologists and physiotherapists.

A HELP participant

A unique programme in the field of pain, HELP is delivered on a one-to-one basis over a four-to-six month period, and importantly is delivered in a person’s own everyday environments. 

Participants are empowered to live their lives through the power of education, with the onus on the activities and tasks they can do, rather than what their pain has restricted them from, re-opening the possibility of returning to leisure, work or the employment market. 

And while TT1st does not make any claims to reduce levels of pain through HELP, the vast majority of participants do experience a reduction in pain as a result of their involvement. 

For Helen Merfield, managing director of TT1st, the expansion of the initial pain programme is a welcome opportunity to tackle the issue of pain in new and impactful ways. 

“We got awesome results from the programme, but we could only help a small cohort. We felt we needed to reach out to more people with a wider spectrum of conditions, pain is something I feel very passionately about and people need support,” she says. 

“I’ve always felt that people with pain get a bad rap, they’re often just told it’s all in their mind. And while the mind might play a part, no one consciously chooses to be in pain, they don’t get up in the morning and decide ‘I’m going to have pain today’. 

“We want people to be living their best lives in spite of – or as I like to say ‘to spite’ – their pain. We HELP them to recover a life that has meaning and purpose.

“We wanted to help a wider population but wanted to test it on a smaller scale first. And because the results were so great, we have invested in making it even better – and hopefully the results will be even better too.”

Leading the HELP programme, which launched earlier this month, is Steph Fleet, a pain specialist OT who joined TT1st in 2020 and who Helen credits with “taking the bull by the horns” in breathing new life into the company’s pain offering. 

Through adding in psychology, with TT1st working alongside neuropsychology specialists at Sphere Rehab, HELP is bringing together experts in their field to deliver the best possible results to clients.

Dr Katherine Dawson, director at Sphere, said: “Partnering together in the development of a stepped care functional model to inform when therapy is indicated (as well as identifying different levels of intensity) is a great opportunity to deliver positive client experiences and outcomes.

Steph Fleet

“We are also really looking forward to exploring how technology can help with early interventions in the functional management of pain.”

Under Steph’s guidance, HELP has been created to be tailored to the needs of each client. If psychology input is required, their needs are determined through the use of a newly-developed algorithm by Sphere. 

Clients will be screened at the assessment to determine which mix of disciplines they require, OT only, OT and physiotherapy, OT and psychology or all three.

With a fixed fee pricing structure, HELP can be completed in a timescale to suit the needs of each individual client, with a specially-designed workbook and a raft of resources – including podcasts and video – to support them through the process. 

“Pain is something that doesn’t get talked about like it should, I feel really strongly for anyone experiencing any level of pain that unless you talk about it and develop some strategies, then it’s just going to keep continuing and holding you back,” says Steph, who won the rising star accolade at the Advancing Healthcare Awards 2022 in recognition of her client-focused work.

“They’re going to learn how to manage their pain, so that they’re able to do the things that they need to do, but also the things that they want to do, despite their pain experience. They will learn lots of techniques and develop tools to do that.

“We wanted to create a programme that was flexible and exactly what people want and need, and already, although HELP is new, we are seeing some brilliant results.

“I’ve got a client who’d been standing in an almost brace-like position, her knees and back have been bent, as if she’s about to run. 

“The physical reason for this position had resolved, so we talked about it in terms of her brain being hyper-alert to danger, therefore she was defaulting into this position essentially being ready to run. 

“I helped her see she no longer needed to be ready to run and the danger had passed and it was safe to straighten up.

“She has done that for a week and her pain experience has dropped massively, because she’s standing in the right position again and recognising that she’s not in imminent danger.  

“So that conversation, and the strategies we came up with, have enabled her to see positive change.”

The client, Juliet from Dorset, said: “The key thing I’ve been taking away to help me when Steph’s not with me is becoming aware of my standing position. 

A HELP participant

“I’m telling myself that I can stand up straight and I recognise that I’ve been locked in my traumatic experience. I’m now much more aware which has helped me to progress. 

“Improvements are being made and my perception of pain has reduced a lot”.

Helen continues: “It’s all about tailor-making it for everyone. 

“Although there are fixed components, there are more components than required because not everyone will need everything. Some people will need more of one type of support than another. 

“But what we see is that because it’s tailored, they start seeing improvement almost from day one, there’s so much education involved that we are teaching them to be their own therapist, putting them back in charge of their pain experience rather than it running their life.” 

One big difference to other pain management programmes is the delivery in a participant’s own environment, be that their home or places they spend time or need to access. 

“The majority of current programmes on offer are great, but they’re not delivered in an environment where people are actually living their lives, they’re often in a a completely different environment,” says Helen. 

“While people may get a solid two or three weeks to focus solely on education and therapy, they leave and have to come back to real life. The programme finishes and they just go home. They’ve learnt all of this information, but how do you actually apply that when you’ve got a family, kids, a dog running around?

“What you thought could transfer quite easily because it all made total sense when you were on the course now goes out of the window, and you find that within three or four months they’re back to where they were before.

“That’s why delivering it in a person’s own environment, with all of their daily routines and tasks around them, is so important. So that even after

A HELP participant

we leave them, when they have a new environment, whether it’s a new job, they’ve moved house or they’re just going to a different cafe, they’ve got the tools they need in their toolkit to keep them safe in that environment.”

Steph adds: “HELP is also unique when compared to others which are in a group setting. There’s nothing wrong with a group session, but this makes it so individualised and so accessible for the person.”

“And then we take the education and learning we have delivered and we put it into practice, with support from an OT, physio or psychologist, depending on what they need. We’re going to do it with them, in their environments with the world happening around them and model it with them, which is why we get such great results.”

And with such a pioneering programme to work with, Steph, who has a Masters in rehabilitation, is delighted to have the opportunity through TT1st to make a difference. 

“All the clients I’ve worked with over the years have experienced pain to some degree, whether that’s psychological pain or physical pain,” says Steph. 

“And I’ve always found it really interesting how it can really limit people’s abilities and last longer than many of the physical challenges they manage to overcome. 

“Rehabilitation is my absolute passion but pain kept on coming back as something that affected so many people and doesn’t get talked about. The individual often feels that it’s their fault – and then I came to TT1st and had the opportunity to really jump into helping them.” 

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Inpatient rehab

The secret of a successful rehab service? Happy, supported staff

Askham Rehab shares stories of progression and development from its team

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Meet Bonnie, Lisa, Shainy and Stacey from Askham Rehab, as they share their journeys to working for one of the leading neuro-rehab providers in East Anglia. 

One thing they share is that when they first started working with Askham, they did not think they would be working in rehab. 

However, over time and with the support of a management team committed to person-centered empowerment for staff as well as residents, they have flourished. Each of them now contribute directly to quality of life improvements of the rehab patients at Askham. 

Every member of the Askham team has a story to tell – one that involves self-development, professional ambition, and personal drive to be the best they can be, and in so doing bring this out in their rehab patients too. 

Askham is always looking for motivated individuals to join their team – if you could see yourself working alongside Bonnie, Lisa, Shainy, Stacey or their colleagues, get in touch with the Askham team.  

 

‘I moved from the kitchen into speech therapy’

For Bonnie Nelson, her 14-year career at Askham has been varied, and through her initial role as a kitchen assistant, she saw first-hand the impact speech therapy had. 

“I saw the speech therapists at work and thought that’s something I’d really like to do,” she says. 

“I loved working in the kitchen but wanted to be more involved with the residents and their rehab, so wondered whether I could be a speech therapy assistant. I started helping out at first, but it was too much to do alongside my job. 

“Askham were really supportive and gave me the option to choose – I jumped at the chance to work in speech therapy.”

Now, having made the move in 2013, Bonnie is loving her role as a speech therapy assistant. 

“It’s such a valuable and rewarding role, and of course it’s not just about speech, it’s about swallowing, eating and drinking, really vital parts of their lives,” she says. 

“There are some very special moments, such as when you work with someone and they regain the ability to say their children’s names, or someone is able to follow a normal diet after having to have pureed food. It’s lovely to share that with them. 

“It is lovely to feel like you’ve made a difference to people’s lives and to see their progress.”

She remains grateful to Askham for the opportunity to re-train and move to a rehab role. 

“Askham were great and supported me with training on the job, and giving me the opportunity to complete some courses in speech therapy, which I did in my own time,” says Bonnie. 

“I’m so pleased it’s a move I’ve made, and Askham is a lovely place to work.”

 

‘I became a carer during the COVID pandemic’

Having resumed her career at Askham after taking a break to raise her family, Lisa Keel took on a role as a weekend kitchen assistant in 2018. After realising the work/life balance worked for her, with Askham accommodating her need for childcare-friendly hours, she took on a role working Monday to Friday. 

But having already progressed at Askham through her kitchen role, Lisa realised she would love to move again during the COVID-19 pandemic. 

“I’d spent my time at Askham watching the carers at work and wishing I could do more to help,” she says. 

“I couldn’t mix two jobs, so I decided I wanted to challenge myself and move into care. 

“Although it was during a very difficult time, I was already working within a care home setting and just felt I wanted to support the care team, and especially the residents. I knew I wanted to put all I’ve got into it.”

So in September 2020, Lisa, with support and training from Askham – including specialist brain injury training – moved to become a carer. She recalls how difficult yet rewarding that challenging time was. 

“This was at a time when residents couldn’t see their families, which was heartbreaking, but we as the care team effectively became their families during that period,” says Lisa. 

“Just being there for them was so important, to support them with their physical and emotional needs. When a resident had COVID, I was put in the isolation team, which meant that one resident needed even more support during what was a particularly difficult time. 

“You were so conscious of that fact that you were the only people our residents were seeing and you wanted to do all you could. It’s your job to make sure they’re safe and happy, and that was never more important than during that time.”

Through the dedication of Lisa and her colleagues during the pandemic, Askham’s care and rehab regime was able to continue, and residents progressed despite the challenges. 

“We do get a lot of appreciation and ‘thank yous’ from residents, and their families too, many of whom we were able to keep in touch with their loved ones through using tablets and screens during isolation,” says Lisa. 

“It’s very hard to say goodbye, as much as you also want them to leave and move on in their lives, but you do establish a strong bond. It does make you feel very proud to be a carer and to know the contribution you have made.”

 

‘I was supported in relocating from India’

Shainy Mathew was living in India in 2011 when an opportunity to relocate to England and work in nursing came up. Initially working to complete her adaptation programme having moved from overseas, Shainy became a registered nurse around eight months later. 

Initially moving to Cambridgeshire alone, leaving her husband and baby in India, they joined her shortly afterwards, at which point Askham offered their assistance in supporting the family. 

“My husband had to work too, so I was able to do my hours around his, which worked well for our childcare. My flexible shifts meant we could organise this,” says Shainy. 

“If my son was ill or I had problems with childcare, I would call the lead nurse and was told not to worry, they would support me. Although we were here on our own with no family support, Askham felt like our extended family. 

“The transition process in moving to a new country for the first time was often challenging, but I have been supported in every way. I have never felt pressured or unsupported because of childcare and I’m so grateful for the help I have been given over the years. 

“The management and my colleagues were fantastic and so supportive. It made moving to a new country and being able to work a really good experience.”

Through Shainy’s dedication to her role in nursing, on the retirement of the long-serving lead nurse, she was offered the position. 

“I was delighted to be offered the role as lead nurse, it was the service I knew and loved working in, but just with more responsibility. It was a great opportunity for me,” she says. 

“Askham gave me the time to spend with the lead nurse before he retired, to work with him and learn more about the position I was about to take over. I was also given extra shifts to ensure I was fully prepared. That meant it was a very smooth transition for everyone. 

“I got the chance to speak with one of Askham’s directors, Aliyyah-Begum Nasser, and the management team about the promotion and they were all confident that I could do it – and I am really loving it.

“As lead nurse, you have two days where you work on the admin, which is very different, but is very responsible in reviewing care plans, medication records and funding matters. It is a vital role and one I really do enjoy – and I still get plenty of opportunity to be with the patients.”

And it is the interaction with the patients that continues to inspire Shainy as a nurse. 

“You see what they go through and the progress they make, and it is lovely to feel you play some role in that,” she says. 

“You feel very much valued, there is a lot of happiness and job satisfaction in what we do. This is a great environment and a very positive working environment, and I love my work with the patients. 

“I’m very grateful for the support I’ve had since I came here, and the opportunity for promotion. Askham is a great place to be.” 

 

‘A secondment made me want to pursue a rehab career’

Having joined Askham in November 2018, initially in a part-time care assistance role, Stacey Hawkins was keen to progress – particularly after seeing the power of rehab through a secondment opportunity. 

“I was offered a four-month secondment, where I worked with all four disciplines – physiotherapy, psychology, speech and language and occupational therapy,” she says. 

“I learned a lot from this and really enjoyed it. I got so much insight into the sessions. A position came up for a rehab assistant, and having seen how much I loved working in rehab, I decided that’s what I wanted to do.”

Stacey was successful in her rehab assistant application, which she took up in September 2021, being given full training on-site to equip her for her new role. 

“I read all the assignments for each Individual and look at what their goals are, we then work on these and build exercise plans and explain the treatment we feel is right for them,” she says. 

“This is different for everyone, as everyone will have different needs and outcomes, so we work on finding the best and safest equipment and ways to do it. We often have to demonstrate to patients what we would like them to try, and we have to be calm, understanding and always listen.”

And the role is giving Stacey new levels of job satisfaction. 

“I love being able to make a difference to people’s lives and seeing them achieve all they can in their rehab goals,” she says. 

“Seeing the gratitude on the people’s faces, and their family members too, is priceless. The feeling is unreal to see people progress in their own ways and give someone their independence back. 

“But while I absolutely love this role, I feel just as valued on the rehab team as I did when I was working on the care floor. Askham is one big family, and I’d say thank you to everyone here who has helped me on this journey.”

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Tech

Fourier Intelligence: ‘All eyes are on us now’

‘We are ready to lead, collaborate and change people’s lives,’ says Zen Koh

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Now firmly established as a leader in its field on an international scale, Fourier Intelligence has again captured the world’s attention through attracting a second major investor to support its pioneering work in rehab robotics.

Here, deputy chief executive Zen Koh tells NR Times how the business is now ready to unite and lead the sector, and be a force for good in global tech

 

Having emerged as a leader in the field of rehab robotics on a global scale, Fourier Intelligence continues to push the boundaries of what is possible in technology. 

With a track record of designing and creating robotics which truly redefine the outlook for patient rehabilitation – and its most recent launch of the ArmMotus™ EMU being hailed as being capable of redefining neurorehab as we know it – its latest creations are set to up the ante even further. 

ArmMotus EMU

With the impending launch of the MetaMotus™ system, and its fully immersive gait training Galileo model – its first to make use of its move into world-leading standards of VR technology – Fourier is moving forward day by day in its quest to improve patients’ lives; an ambition the business has had as its focus from day one. 

And to accompany the unveiling of its latest technology, Fourier is set to leave the world in no doubt of its capability by creating the world’s first bionic robot. 

The globally sought-after ability to create a ‘virtual human’ – which tech powerhouses and entrepreneurs, including Elon Musk, believe lies at the future of human operation – would show the scale of Fourier’s innovation and underline its ability to create cutting-edge technology beyond the world of rehab and healthcare. 

 

Attracting investment to the sector

But within the healthcare sector, where it has become established as a true pioneer, Fourier is now known as a force to be reckoned with, having become the first rehab robotics business to attract two major mainstream investors – Saudi Aramco, which made a significant investment last year, and SoftBank, which led a RMB 400million in a Series D funding round in early 2022. 

For Zen Koh, deputy chief executive and co-founder of Fourier Intelligence, this investment will help unlock the next stage of growth for the business, which includes ongoing international collaborations, and is set to include its first acquisitions.  

“The investment will definitely speed up the whole process and accelerate the pace of expansion,” says Zen. 

“We have grown organically and steadily and this is a great boost. It is more ammunition for our plans and also gives us the option to look at more options. 

“We are recruiting many new people to set up and grow teams in Europe, Australia and the US, and are also looking at acquiring companies. We are already talking to a few companies across North America, Europe and Asia. Some of these companies have been doing great work for 30 years or so, so to bring them together would be positive for this whole sector. 

“But it’s not just the technology we need – it is the teams, the really experienced managers. It is very challenging to find such people who are trained and accomplished in product management, development, R&D, sales, all aspects of running a company.

“Through acquisition, this will help us run faster, strengthen the team, and is a brilliant opportunity for us, which has been made possible by the investment. 

“We are big believers in collaborating, not competing, and there are a few small companies who are competing with each other, but they are too small on their own. We are excited to see where this goes – everyone is looking for a leader in this field to help take us all forward.”

 

Ready to lead by example

And with the rapid expansion and unrelenting ambition of Fourier, there can be few better placed than the business – which has recently relocated to the Silicon Valley of the East in Shanghai – to take on that mantle. 

“I think there is definitely an opportunity for us to take a lead on a global scale,” says Zen, the incoming president of the International Industry Society in Advanced Rehabilitation Technology (IISART). 

“In 20 years working in health, I have seen many companies come and go, but we have managed to sustain our success.

Fourier Intelligence’s RehabHub

“In spite of what has happened with COVID, the business is exactly where we want it to be. Instead of slowing down, we have speeded up, and investors believe in our dream. These are major mainstream investors, we are playing in the top league now.

“I was speaking with a friend, who is a very experienced individual in this area, and he said he is sure Fourier are now in a position to take control of the market. I see that as a huge vote of confidence in what we are doing. 

“Fourier will do the right thing and raise the flag high in this industry. We will lead us all in working together to a future where we are helping to make a difference to people’s lives. 

“But when you reach that milestone, to quote Spiderman, ‘With more power comes responsibility’. We appreciate that when you are big enough, you should ‘do well and do good’. All eyes are on us now but we are on the right track, the track we want to be on.”

 

Improving lives through technology

But while its presence in rehab tech continues to make waves internationally – with partnerships in place with fellow world-renowned names in neuro-rehab, including the Shirley Ryan AbilityLab – Fourier’s capability is now seeing it look at how to improve people’s lives in general, beyond the field of rehab. 

Alex Gu and Zen Koh

“Our slogan from the start has been ‘Empowering You’, which means through technology and health solutions, but also through research and education and other applications outside rehab,” says Zen, who co-founded Fourier with Alex Gu. 

“Alex and I are engineers who have worked in robotics since graduation, and this is very exciting for us. Healthcare has been our initial application but we are looking at other areas. The launch of the bionic robot is going to move things to another level. 

“In terms of what we have already, we are looking to extend our EXOPS™ system (the Fourier Exoskeleton & Robotics Open Platform System, which delivers education to help accelerate the development of rehab tech opportunities) and will encourage more people to adopt it, to make that application available outside of rehab. 

“VR is a strong area for us and the launch of Galileo is going to be very exciting, it’s going to be huge, not just as a product but in showing what we can do.

“We are making major advances in technology and now have the freedom to go beyond healthcare in applying that.” 

 

Today’s investment creates tomorrow’s talent

As a business on a path of strong global growth, while being acutely aware of its responsibility as a leader, one area in which Fourier is keen to make a difference is in creating tomorrow’s talent. Opportunities are being created around the world for aspiring young engineers and developers, and partnerships have been formed with a growing number of leading academic institutions. 

“Existing knowledge can never be enough in this industry. We are always advancing and with that, we need the talent to enable this development,” says Zen. 

“We are working with some of the leading researchers to create joint labs, we offer scholarships for PhD students with the Shirley Ryan AbilityLab and University of Melbourne. We want to continue to partner with universities to offer the highest standards in continuing education. 

“The MotusAcademy (founded to enable ongoing professional development in advanced robotics rehab tech) will offer a research platform and will help to lead this further, with the highest standards and results. 

“We can never think what we are doing is good enough, as we can always do more. The world is advancing, and through knowledge, we can continue to advance.”

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