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A single-item literacy screener was included to evaluate health literacy 17 (How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?) and there was a single-item measure of health status 18 (How would you rate your overall health?)

A patient in their 30s with no metabolic issues and a clean training history will respond differently than a patient in their 50s with insulin resistance and 80 extra pounds

Two years later they acquired a 157,000 acre ranch on the west boundary bringing the size to 257,000 acres