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Viewpoint: The Doctor is Out. Are Immigration Laws to Blame?
The United States health-care system is struggling with an acute shortage of doctors. What does that have to do with immigration? The short answer is: Quite a lot. The longer answer leads us to an inescapable conclusion: Our policies at the U.S. border are failing us. They are putting obstacles in the way of bring highly […]
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The United States health-care system is struggling with an acute shortage of doctors. What does that have to do with immigration? The short answer is: Quite a lot.
The longer answer leads us to an inescapable conclusion: Our policies at the U.S. border are failing us. They are putting obstacles in the way of bring highly skilled and trained physicians from other countries to address the shortage we face here. A large part of my practice is representing hospitals, medical centers, and physician-practice groups on physician immigration issues. I’ve put together a list of frequently asked questions to explain the issues.
How severe is the shortage?
The Association of American Medical Colleges (AAMC) — in its report: “The Complexities of Physician Supply and Demand: projections from 2016-2030” — estimates that we’ll face an unprecedented shortage of up to 120,000 physicians by 2030. The largest gap, of between 33,800 and 72,700 physicians, will be for non-primary care specialties. The AAMC also estimates a shortage of between 14,800 and 49,300 primary care physicians.
Much of the demand for health-care services comes from a growing, aging population. “We must start training more doctors now to meet the needs of our patients in the future,” said Dr. Darrell G. Kirch, president of the AAMC (https://news.aamc.org/press-releases/article/workforce_report_shortage_04112018).
This shortage will be felt most deeply in rural and medically underserved communities that already struggle to get access to adequate health care. According to a recent report by the American Immigration Council (https://www.americanimmigrationcouncil.org/research/foreign-trained-doctors-are-critical-serving-many-us-communities) , more than 247,000 doctors with medical degrees from foreign countries practice in the United States. This report highlights “the critical role foreign-trained doctors play regionally, in underserved communities, in rural areas, and in providing primary health care.”
Why do foreign-trained doctors focus on disadvantaged areas?
Due to certain visa requirements and restrictions, international medical graduates (IMGs) often must practice in underserved communities for a certain period of time before they are allowed to stay and work in a purely “work visa” status or to be able to get a green card. An IMG who entered in a J-1 visa status is subject to the two-year home residency requirement, which must be met or forgiven through a waiver. One very popular and successful program is the Conrad State 30 program which allows J-1 medical doctors to apply for a waiver of the two-year home residency requirement by agreeing to be employed in a medically underserved area (MUA) or health professional shortage area (HPSA) for at least three years.
That sounds like a good solution. What’s the problem?
It’s all in the numbers. The Conrad 30 program is administered by each state’s health department and allows a limit of 30 waiver slots per state each year to qualified IMGs. This is just not enough in high-demand states such as New York, where the demand for a Conrad waiver is more than double the allotted 30 waiver spots. Those who are here are filling a critical need, but there’s more to be done.
The larger problem is that we have outdated and insufficient immigration laws to address the increasing shortage. An IMG has come to the United States, (often with spouse and children), completed residency training in a specific state or area, and started to build a life for himself/herself. The IMG receives no promise to be able to stay or work or provide a life for his/her family. If an IMG cannot get a waiver he/she cannot get work authorization in the U.S. and must return to his/her home country.
Think about this: IMGs have moved far from home, often with dependent family members, invested significant time and money to get additional training beyond what was required at home, and yet live under the uncertainty that they may not be able to continue to practice. Against that uncertainty, we are now seeing a decline in the number of foreign-trained physicians interested in practicing here. So our policies are not serving the country’s need for more doctors, nor capitalizing on the commitment and expertise of these professionals.
Consider the type of situation described in this recent profile done by Public Radio International about the highly skilled medical doctor, Dr. Consuelo Lopez de Padilla, with 15 years of practice under her belt in her home country of Venezuela, who must now complete another medical residency training in the United States but can’t match into a program. You can read full article here: https://www.pri.org/stories/2018-03-26/highly-trained-and-educated-some-foreign-born-doctors-still-can-t-practice
How else are immigration laws and policies failing us?
The demand for foreign-trained doctors will only increase as the U.S. population ages and faces an increasing need for affordable health care in this country. This will happen sooner rather than later. The Association of American Medical Colleges (AAMC) found that the demand for doctors will continue to outpace supply, leading to a projected shortfall of between 46,100 and 90,400 doctors by 2025, many in primary care, accelerating through 2030 These shortages are compounded by the fact that large numbers of doctors will be retiring in the next few years.
Yet U.S. immigration policies significantly limit the ability of these doctors to immigrate to and practice in the U.S. As policymakers debate what immigration reforms would best serve the national interest, they should keep in mind that foreign-trained doctors are already taking the lead on providing care to many communities across the U.S.
How can immigration laws be changed to help with the doctor shortage?
As a part of the multi-pronged approach recommended in its report, the AAMC supports federal incentives and programs such as the Conrad 30 Waiver.
Congress is considering proposed legislation (S. 948) to renew and improve the Conrad 30 Program, but frankly even that falls short. We need a more flexible Conrad 30 Program that is responsive to the demand and community needs for health care nationwide, so if one state doesn’t use its 30 waiver slots, they can be transferred to high-demand states such as New York, and California. Neither current law nor existing proposals include that provision.
Other U.S. immigration laws are also creating barriers to many IMGs from countries such as India, where the green card backlog means that they can face a 10- 15 year wait before they can even apply for their green card. This puts them in a holding pattern and a work visa/ temporary status limbo in the U.S., even as they continue to serve our neediest communities and help solve our physician-shortage problems.
The need for high-quality health care in the U.S. have been well-documented. Congress must act, and in this case, it should be lowering the wall to enable physicians to enter and deliver their services.
Andrea Godfread-Brown is senior immigration counsel in the Syracuse offices of Harris Beach PLLC . Contact her at agbrown@harribeach.com

Golisano donates $3M for center for special needs at Upstate Golisano Children’s Hospital
SYRACUSE — Business executive Tom Golisano has made another significant donation to Upstate Medical University. The medical school will use Golisano’s $3 million donation to help establish a center for special needs at Upstate Golisano Children’s Hospital. Golisano — the founder and chairman of Rochester–based Paychex Inc. — had previously provided a $6 million naming
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SYRACUSE — Business executive Tom Golisano has made another significant donation to Upstate Medical University.
The medical school will use Golisano’s $3 million donation to help establish a center for special needs at Upstate Golisano Children’s Hospital.
Golisano — the founder and chairman of Rochester–based Paychex Inc. — had previously provided a $6 million naming gift for the Children’s Hospital.
The donation announcement was part of a Sept. 27 event marking the facility’s 10th birthday.
“It’s not a secret but Tom does have an adult child in his mid-50s with intellectual disabilities and Tom’s first act of philanthropy 35 years ago was the Golisano Foundation with a contribution of only $90,000. So, this is a cause, a condition … it’s very near and dear to Tom’s heart,” Ann Costello, executive director of the Golisano Foundation in Rochester, said in making the funding announcement.
“It gives me great pleasure to contribute $3 million to Upstate Golisano Children’s Hospital to help create the Center for Special Needs, and improve and expand services for children with intellectual and developmental disabilities and their families. The number of children needing services and the number currently on the wait list is staggering. The expansion and co-location will help meet the growing demand for services and expedite patients’ progress toward healthy, productive lives,” Golisano said in the Upstate news release.
Golisano had planned to attend the birthday event but had to deal with another matter and couldn’t make it, Eileen Pezzi, VP for development at Upstate Medical University, noted in her remarks at the event.
About the center
The center, which will be named the Golisano Center for Special Needs in Golisano’s honor, will provide “comprehensive, coordinated and scientifically based” medical and behavioral care for children and adolescents with “many types” of intellectual and developmental disabilities, Upstate Medical said. It will centralize programs and services at Upstate that are currently “available to this population.”
The facility does a “phenomenal job caring for children,” but children with intellectual and developmental disabilities is the one group that “we really need to do more for,” Dr. Gregory Conners, executive director of the children’s hospital, said in his remarks at Friday’s event.
“Children are waiting too long to receive an evaluation. The average wait time to receive a developmental evaluation is about 22 months. Access to services needs to be improved,” said Conners.
Conners notes that the new center will “significantly” increase how many children with intellectual and developmental disabilities that Upstate Golisano Children’s Hospital is able to serve.
“The center will enable us to increase capacity to 7,600 children per year, which is a 167 percent increase in unique numbers served compared to 2018,” Conners said.

Upstate Medical University opens new simulation center
SYRACUSE — Doctors and those studying to become doctors absorb a lot of information from books and journals, but it doesn’t always translate into good patient care because “we have to put what we learned into action,” says Dr. Erik Rufa, director of education at the new simulation center at Upstate Medical University. “That’s not
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SYRACUSE — Doctors and those studying to become doctors absorb a lot of information from books and journals, but it doesn’t always translate into good patient care because “we have to put what we learned into action,” says Dr. Erik Rufa, director of education at the new simulation center at Upstate Medical University.
“That’s not always easy. We don’t want to practice on real humans because that could be a safety issue,” says Rufa, who is also an internal-medicine physician.
That’s the purpose behind the medical school’s new simulation center and the programmed manikins that act as patients for the medical students. The manikins help the students to “bridge” the book knowledge with the bedside care, according to Rufa.
“Whether it be a procedure like a spinal tap or an intubation, putting a tube down someone’s trachea, or whether it be responding to a patient emergency like an anaphylactic-shock patient who was exposed to like peanuts or a medication they were allergic to,” says Rufa. He spoke with CNYBJ on Sept. 19 before Upstate Medical University formally opened a new $11 million teaching center that will simulate real-time responses to medical emergencies.
They could include incidents in a hospital’s intensive-care unit, labor and delivery areas, the operating room, or any setting where health care is delivered.
The medical school wants the Upstate Simulation Center to “improve patients safety and patient care, as well as build highly trained multidisciplinary health-care teams,” per a news release.
The 8,600-square-foot facility will become a “hub of teaching and training” for students from all areas of the health professions, Upstate contends.
“The Upstate Simulation Center exemplifies our mission and vision to improve the health of our communities through education, biomedical research and health care and to create a healthier world for all,” Dr. Mantosh Dewan, interim president of Upstate Medical University, said in Upstate’s news release. “This special space provides Upstate with the ability to enhance the training of our students and our region’s health care professionals by addressing real-life patient care scenarios through advanced technology, while providing us with the ability to offer immediate feedback on how to best manage patient care scenarios that are faced every day.”
A SUNY 2020 Challenge Grant provided the funding for the Upstate Simulation Center. Murnane Building Contractors of DeWitt handled the construction on the project, while Glastonbury, Connecticut–based SLAM, which has an office in Syracuse, was the project architect, Upstate said.
Simulation center details
The center, which is located on the lower level of Weiskotten Hall, features a simulated operating room; six simulated acute-care rooms with headwalls which can be “flexed” for additional configurations like intensive care units or outpatient rooms; two 16-person skills and task training rooms which can be de-partitioned to accommodate up to 32 students; a haptics training room; dedicated administrative offices and workspaces to support the center; and the required storage area for all equipment and supplies. It also has four control rooms so that multiple rooms can be used at once or in sequence as well as observational windows.
The patients in the simulation center are eight high-tech manikins that can be programmed to reflect a seemingly endless range of medical complications. They can have convulsions, breathing difficulties, pharyngeal swelling, cardiac issues or another warning sign or symptom that future doctors might face in a real patients
“These manikins are about as life-like as one can get,” Erin Graham, manager of simulation services, said in Upstate’s news release. “They allow us to set specific scenarios, while providing for the safest training of learners.”
Sadly, New York Continues the Outward Migration
I love New York State. Our diverse natural resources offer opportunities with which not many other states can compete. We have the beautiful mountains of the Adirondacks and Catskills. We have access to the Atlantic Ocean, Niagara Falls, two Great Lakes, the St. Lawrence River, and the beautiful Finger Lakes. We have the rolling hills
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I love New York State. Our diverse natural resources offer opportunities with which not many other states can compete. We have the beautiful mountains of the Adirondacks and Catskills. We have access to the Atlantic Ocean, Niagara Falls, two Great Lakes, the St. Lawrence River, and the beautiful Finger Lakes. We have the rolling hills of the Southern Tier, the scenic views of the Hudson River, and the beaches of Long Island.
Mixed with our natural resources, we have New York City, which one could argue is the premier metropolitan area of the world along with the smaller cities of Buffalo, Rochester, Syracuse, and Albany that offer the same cultural and entertainment opportunities as bigger cities but in a more manageable setting. We have high-performing schools, an infrastructure that, for the most part, allows ease of travel throughout the state and a multitude of recreational and cultural activities regardless of the season. So against this backdrop, why is New York state losing population. With all that the state has to offer, one might think we would be attracting people. Sadly, that is not the case.
In 2018, New York state was the number one state in the country in outward migration and unfortunately, 2018 was not an outlier. From 2010 to 2017, New York also led the nation in outward migration, followed by Illinois, California, New Jersey, and Michigan. Some have argued, including Gov. Cuomo, that our state’s outward migration is due to the weather. Certainly, some people have left our state for warmer climates but can weather alone explain why nearly 1 million people have left New York state since 2010? Probably not. If climate alone was the cause, California would not be one of the nation’s top outward migration states and New Hampshire, with a similar climate as New York, would not be an inward migration state.
Likely there are other factors at stake. The American Enterprise Institute (AEI) conducted a study comparing economic policies of the 10 states with the highest outward migration versus the economic policies of the 10 states with the highest inward migration. Not surprisingly, states with high outward migration were states that lead the nation in high taxes, an unfriendly business climate, and weak economic health. States with high inward migration (Florida, Texas, and Arizona, for example), are states with lower taxes, that are more friendly to business, and are economically strong.
The AEI study used a state’s business-tax climate ranking as one comparison measure. A state’s business-tax climate index is based on each state’s corporate-income taxes, individual-income taxes, sales taxes, property taxes, and unemployment-insurance taxes. In this comparison, five of the top 10 outbound states (New York, New Jersey, Connecticut, Louisiana, and California) were among the seven states with the worst business-tax climate. Specifically, New York, California, and New Jersey ranked as the three worst states in terms of business-tax climate. In contrast, for the top 10 inbound states, five of those states (Nevada, Oregon, New Hampshire, Montana, and Florida) ranked among the top nine U.S. states for business-tax climate.
Clearly, regardless of the many wonderful attributes a state can offer its citizens, economic opportunity looms large as a deciding factor as to where people live. Unlike climate, which states cannot control, state policies do have a huge impact on economic opportunity. Unfortunately for New York, over the last decade, Albany has done little to implement policies that foster growth. In fact, with continued tax and fee increases, additional mandates on businesses, and an overall hostility to economic engines, we have gone in the opposite direction. Unless it is recognized in Albany that people and businesses “vote with their feet” and will seek out state’s with better opportunities, our state will continue to lead the nation in outward migration despite all of our state’s wonderful attributes.
William (Will) A. Barclay is the Republican representative of the 120th New York Assembly District, which encompasses most of Oswego County, including the cities of Oswego and Fulton, as well as the town of Lysander in Onondaga County and town of Ellisburg in Jefferson County. Contact him at barclaw@assembly.state.ny.us or (315) 598-5185.
You’re probably chuckling already. Seriously? “The joy of politics”? That was pretty much the reaction I got the other day when, in the middle of a conversation about how confrontational, adversarial, and downright unpleasant politics has become of late, I suggested that it could be both fun and a source of satisfaction. Yes, of course
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You’re probably chuckling already. Seriously? “The joy of politics”?
That was pretty much the reaction I got the other day when, in the middle of a conversation about how confrontational, adversarial, and downright unpleasant politics has become of late, I suggested that it could be both fun and a source of satisfaction.
Yes, of course there are always irritations and inconveniences. And the often mean-spirited tone of today’s contentious politics is well beyond anything I encountered when I was in office.
But none of this erases the satisfactions that also come with the territory. They start with the people you can meet in the political arena — people who are able, ambitious, articulate, and often at the top of their game. They may be friends or foes, but the foes aren’t usually permanent — sometimes they become friends, as the debate moves along to other issues and you find yourself sharing common ground. In fact, you’re never lonely in politics, because nothing can be accomplished alone. You can gain huge satisfaction in the teamwork, in rolling up your sleeves with a likeminded group of people focused on a common goal.
Politics is also what allows you to hold government to account, call out its misdeeds and failures, and highlight its successes. You find that you have a voice in the public debate. It’s hard, maybe impossible, to measure your own impact. But there is a true thrill in the battle: win, lose, or draw. You’re participating in the success and the direction of your community and your country.
More to the point, you’re trying to change things. As Teddy Roosevelt said in a famous 1910 speech, “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena… [Whose] place shall never be with those cold and timid souls who neither know victory nor defeat.”
The satisfactions of engaging in politics do not just come when things are easy or running smoothly. They’re most acute, in fact, when circumstances are difficult, when being involved can make a difference, and when working through fraught times yields progress on the other side.
It’s true that progress is often incremental; it rarely comes all at once. The pleasures come from knowing that you’re doing your best to solve or mitigate problems and fighting for what you think is right. You’re participating in the great experiment of democracy in America, and are part of a long line of Americans trying to answer Lincoln’s question at Gettysburg of whether this nation “so conceived and so dedicated can long endure.”
Oliver Wendell Holmes once said that one “may live greatly in the law.” It’s true for politics, too, despite its difficulties. It challenges you to develop your talents, to hone skills — listening, articulating your thoughts, negotiating with able adversaries and partners, building consensus, compromising in the name of moving forward — that are vital in all walks of life. At its best, politics stretches you and makes you live better.
I have to confess that when I suggested to some of my colleagues that I planned to write about the joy of politics, they thought I was joking. Many people don’t like the political process, and they don’t want to engage in it. There is something about it that turns them off.
I recognize that it’s not an endeavor that fits everyone’s makeup or desires. But I’d also ask you this: if you’re serious about being a citizen in a democracy, how can you avoid engaging in it in the manner and to the extent of your choosing? In the end, politics is just how we Americans do our best to help our neighborhoods, our towns and cities, our states, and our country become even better places to live. And if you do get involved, here’s my bet: that you’ll have times that make you wonder why you bothered, but you’ll also find plenty of moments that bring you satisfaction, and even joy.
Lee Hamilton is a senior advisor for the Indiana University (IU) Center on Representative Government, distinguished scholar at IU Hamilton Lugar School of Global and International Studies, and professor of practice at the IU O’Neill School of Public and Environmental Affairs. Hamilton, a Democrat, was a member of the U.S. House of Representatives for 34 years, representing a district in south central Indiana.

LAUREN ZACHER has joined in-Architects as its new senior interior designer. She brings more than eight years of experience in the Central New York region. Zacher is a state-certified interior designer, member of the International Interior Design Association, and founding director of the Syracuse City Center chapter. She received her bachelor’s degree in interior design
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LAUREN ZACHER has joined in-Architects as its new senior interior designer. She brings more than eight years of experience in the Central New York region. Zacher is a state-certified interior designer, member of the International Interior Design Association, and founding director of the Syracuse City Center chapter. She received her bachelor’s degree in interior design from Jefferson University in Philadelphia (previously called Philadelphia University). in-Architects is downtown Syracuse’s newest architecture and design firm, located on Water Street above Water Street Bagel.

Red Shed Brewery has hired a new brewer, JOSHUA HUGHES. He has 10 years of experience in the craft beer industry, a love of science, passion for local ingredients, and a desire to help others. Hughes started in the craft beer industry as a home brewer, experimenting with different materials and ingredients in Rochester and
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Red Shed Brewery has hired a new brewer, JOSHUA HUGHES. He has 10 years of experience in the craft beer industry, a love of science, passion for local ingredients, and a desire to help others. Hughes started in the craft beer industry as a home brewer, experimenting with different materials and ingredients in Rochester and Weedsport. He has also gained experience brewing in different breweries, most recently serving as brewmaster and operations manager at Roscoe Beer Co. in the Catskills region.

Fortus Healthcare Resources recently added two new employees. PAIGE KIRKLEY joined as an account executive in its Ambulatory Surgery Department. Previously, she worked as the senior national recruiter for Surgical Care Affiliates, a large ambulatory surgery management company with more than 200 centers across the U.S. During Kirkley’s time there, she executed full-cycle talent acquisition
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Fortus Healthcare Resources recently added two new employees.
PAIGE KIRKLEY joined as an account executive in its Ambulatory Surgery Department. Previously, she worked as the senior national recruiter for Surgical Care Affiliates, a large ambulatory surgery management company with more than 200 centers across the U.S. During Kirkley’s time there, she executed full-cycle talent acquisition efforts.
SIMONE PALUMBO recently joined Fortus Healthcare Resources as a recruiting specialist in its travel division. She joined the firm as an intern in the summer of 2019. Palumbo is a recent graduate of Johnson and Wales University with a bachelor’s degree in health-care administration.
Five new employees have joined CHA Consulting, Inc.’s Syracuse staff. PATRICK BROWN has joined the firm’s electrical group as an assistant engineer. He received his bachelor’s degree in mechanical engineering with a minor in business administration from the Inamori School of Engineering at Alfred University. JOSHUA DUMAS has joined as an assistant engineer to assist
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Five new employees have joined CHA Consulting, Inc.’s Syracuse staff. PATRICK BROWN has joined the firm’s electrical group as an assistant engineer. He received his bachelor’s degree in mechanical engineering with a minor in business administration from the Inamori School of Engineering at Alfred University. JOSHUA DUMAS has joined as an assistant engineer to assist with utility-related projects in the industry & energy group. He received his bachelor’s degree in mechanical engineering from Syracuse University and his associate degree in engineering science from Onondaga Community College. SEAN ROBINSON has joined the firm as a senior systems analyst, assisting with geographic information systems (GIS) and asset systems. He is a GE Smallworld GIS Application subject-matter expert with seven years of experience providing GIS and asset systems support and electric distribution design. He received his bachelor’s degree in alternative and renewable energy systems from SUNY Canton. TONI SECRETI has joined the firm’s industry & energy group as a project coordinator. She has experience in the coordination, planning, implementation, and monitoring of construction projects. Secreti has a bachelor’s degree in marketing from Le Moyne College and is working toward a master’s degree in operations and project management from Southern New Hampshire University. CALEB LANGE will oversee industry & energy projects and cultivate client relationships as a project manager. He has 11 years of experience in geotechnical engineering, operational management, and business development. Lange received his bachelor’s degree in civil engineering from Clarkson University and an associate degree in mathematics from Cayuga Community College.
Ryan Biggs/Clark Davis Engineering & Surveying, D.P.C.
Ryan Biggs/Clark Davis Engineering & Surveying, D.P.C. has promoted AARON LEENTJES to design engineer II. With the firm since 2016, he provides structural engineering design of projects in the educational, medical, and residential markets. Leentjes earned his bachelor’s degree from Le Moyne College and master’s degree from Syracuse University. He served as project engineer for
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Ryan Biggs/Clark Davis Engineering & Surveying, D.P.C. has promoted AARON LEENTJES to design engineer II. With the firm since 2016, he provides structural engineering design of projects in the educational, medical, and residential markets. Leentjes earned his bachelor’s degree from Le Moyne College and master’s degree from Syracuse University. He served as project engineer for The Living Building Challenge Project at Binghamton University, one of only 11 buildings so far achieving full certification. Leentjes is also the project engineer for the Park Center Façade renovation project at SUNY Cortland. NICK MERRIFIELD and SPENSER MAUNU have also joined the firm. Merrifield has been hired as a design engineer I. He holds a bachelor’s degree from the Rochester Institute of Technology. Merrifield will be providing engineering support for projects in the education, commercial, and medical markets. Maunu has been hired as a design engineer I. He holds bachelor’s and master’s degrees from Oregon State University. He will be providing engineering support for projects in the education and commercial markets.
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