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Arch Intern Med. 2005;165:1081.

Photographer: John J. Kuiper, MD, Los Angeles, Calif. This photograph was taken on Route 20 in the vicinity of the town of Conneaut, Ohio, on September 20, 2003—the day after Tropical Storm Isabel roared through and the 34th day of Dr Kuiper’s transcontinental bicycle tour from Los Angeles to New York City.