s Breakthrough treatment reduces post-surgical scarring for glaucoma patients | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Breakthrough treatment reduces post-surgical scarring for glaucoma patients

Staff Researcher

articles by this author...

Editing and Researching news and stories about Australian and International Pharmacy Issues

Scientists at the Singapore Eye Research Institute (SERI) and Nanyang Technological University (NTU) have developed an innovative way to combat post-surgical scarring for glaucoma patients.
A clinical trial has shown that the use of a new drug delivery method has resulted in 40 per cent fewer injections needed by glaucoma patients to prevent scarring after surgery.
This also means fewer hospital visits for these patients in future.

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Glaucoma, a disease characterised by a build-up of pressure in the eye, is a major cause of blindness worldwide. It affects about 3 per cent of the population in Singapore and an estimated 30 per cent of sufferers require surgery to adequately control the disease. However, success rates for glaucoma surgery in Asian patients are considerably lower than those reported in Caucasian patients because Asians have a higher risk of scarring after such surgery. Up to one out of three operated patients requires a minor surgical procedure in the first six months in order to maintain the ideal low post-operative eye pressure.

“The post-operative scarring response is the major obstacle for successful glaucoma surgery. We’ve seen in our clinics that Asian patients scar earlier and more aggressively than their Caucasian counterparts, and a significant number require at least one post-operative intervention to treat this scarring response,” said Associate Professor Tina Wong, Senior Consultant with SNEC’s Glaucoma Service, and Head of the Ocular Therapeutics and Drug Delivery Research Group at SERI. She is also the senior author of this study.

The breakthrough treatment method is made possible by Professor Subbu Venkatraman, Acting Chair of NTU’s School of Materials Science and Engineering, who invented a way to make the drug, which prevents post-surgical scarring, last longer at the site of the injection. This considerably increases the interval before the drug has to be administered again.

Using a gel know as hyaluronic acid, Professor Venkatraman discovered a way to contain the drug, 5-Fluorouracil (5-FU) inside the gel. “Leveraging NTU’s expertise in controlled-release technology, we have found a way to deliver the drug 5-Fluorouracil gradually into the patient. This allows the drug to be time-released over several days, compared to the current effect of the drug which remains at the injected site for only a few hours. The benefit for patients who have undergone glaucoma surgery is clear – fewer injections of the drug are needed. This results in less post-surgical scarring and fewer visits to the hospital.”

The aim of glaucoma surgery is to create a new pathway for the aqueous fluid to flow out, thereby lowering eye pressure. During glaucoma surgery, a flap is created using the patient’s own tissue to regulate the outflow of aqueous fluid. A small blister, known as a conjunctival bleb, marks the new surgically created filtration site.

The flap that allows fluid to flow out can be blocked if scar tissue forms, preventing the fluid from draining effectively and causing the eye pressure to rise again. This is a particularly common problem in Asian patients. To restore outflow through the surgical flap, the obstructing scar tissue needs to be removed by injecting 5-FU which prevents further scarring. This procedure is called bleb needling.*

The clinical trial involved 49 patients, who were randomised to receive an injection of either the current 5-FU solution or the new combined formulation following bleb needling. All subjects were followed up for three months. The trial was conducted at the Singapore National Eye Centre.

The team found that the subjects who were randomised to receive the new treatment had an improved post-operative outcome. “With this novel treatment, we observed a dramatically lower rate for repeat needling, with only 12 per cent requiring further intervention, whereas 50 per cent of subjects receiving the standard 5-FU solution treatment required further needlings,” said Dr Arun Kumar Narayanaswamy, Senior Clinical Research Fellow, SERI, and first author of this study.

“In addition, because these patients require fewer interventions, their risk of ocular infection and side effects are significantly reduced,” he added.

Assoc Prof Wong, also an adjunct professor at NTU’s School of Materials Science and Engineering, and Professor Subbu Venkatraman together with his team of scientists, are improving the new treatment method further using nano-encapsulation. The team aim to achieve a precise release of the correct amount of drug at a steady daily dose over a course of several weeks instead of just a few days as shown by the study.

“Because the acute and most active stage of wound healing occurs in the first twelve weeks after surgery, we ideally need a sustained time release of the anti-scarring drug that can be administered as a single injection and provide the right amount of drug to continually suppress the scarring response for that crucial time frame. That way, we won’t have to keep injecting patients with top-ups, often on a fortnightly or even weekly basis which is not only inconvenient for the patient but greatly increases the risk of complications with each additional injection,” said Assoc Prof Wong.

In the future, this novel treatment could also be applied at the time of the glaucoma surgery to further improve surgical outcomes, as well as reduce the possible need for or frequency of bleb needling interventions after surgery.

The study, published in the journal Ophthalmology early this year, has been shortlisted for a Best Clinical Research Oral Presentation at the second SingHealth Duke-NUS Scientific Congress, which will take place on 3 and 4 August at Raffles City Convention Centre.

This research was supported in part by an Individual Research Grant awarded to Assoc Prof Wong by the Singapore Ministry of Health’s National Medical Research Council.

Notes:

*About bleb needling
:
During a bleb needling procedure, the surgeon uses a fine needle to cut and break down the scar tissue to restore drainage. A chemotherapy drug, 5-Fluorouracil (5-FU) is injected into the surrounding tissues to halt further scarring. However, the drug only acts on cells and surrounding tissues at the time of injection, which means patients often have to go back for repeat injections to provide adequate anti-scarring action against the tissues around the drainage site and improve on the long-term success of the surgery.

In addition to the possible need for repeat injections, there is also the risk that the 5-FU solution may be transferred to other parts of the eye following its injection. Repeat injections can lead to an increased risk of sight-threatening complications. The invasive procedure can also increase the patients’ risk of eye infections.

About SingHealth Duke-NUS Scientific Congress 2012
The SingHealth Duke-NUS Scientific Congress 2012 is a highly anticipated event that brings together various institutions from SingHealth, Duke-NUS, and from around the region, sharing the latest medical developments and scientific advances across the medical disciplines. Pushing the frontiers of healthcare and biomedical sciences, the collaboration between SingHealth and Duke-NUS Graduate Medical School Singapore aims to boost the exchange of ideas and research findings among healthcare professionals in our pursuit of defining tomorrow's Medicine.

The 2012 Congress will be held on 3 and 4 August at the Raffles City Convention Centre and its theme is “Defining Tomorrow’s Medicine”. These three words are an inspiration and challenge for all healthcare practitioners and biomedical researchers, young and old. In Defining, we seek to set the standards and benchmarks for local and international clinical practice, sharpened through the rigours of academic medicine. Tomorrow's reminds us that medicine is never static but constantly evolving, with shifting global conditions and complex social trends bringing about new disease conditions and healthcare concerns. Finally, Medicine reminds us that patients, and patient-oriented services, must remain at the centre of all our activities, and that we are ultimately judged by the impact we effect on patients, at the individual or national level.

About Singapore Eye Research Institute (SERI)
SERI is the national research institute for ophthalmic and vision research in Singapore. Serving as the research institute of the Singapore National Eye Centre, and affiliated to the Yong Loo Lin School of Medicine, National University of Singapore, as well the Duke-NUS Graduate Medical School SIngapore, SERI undertakes vision research in collaboration with local clinical ophthalmic centres and biomedical research institutions, as well as major eye centers and research institutes throughout the world. For further information, kindly visit: www.seri.com.sg.

About Nanyang Technological University (NTU)
A research-intensive public university, Nanyang Technological University (NTU) has 33,500 undergraduate and postgraduate students in the colleges of Engineering, Business, Science, and Humanities, Arts, & Social Sciences. In 2013, NTU will enrol the first batch of students at its new medical school, the Lee Kong Chian School of Medicine, which is set up jointly with Imperial College London.

NTU is also home to four world-class autonomous institutes – the National Institute of Education, S Rajaratnam School of International Studies, Earth Observatory of Singapore, and Singapore Centre on Environmental Life Sciences Engineering – and various leading research centres such as the Nanyang Environment & Water Research Institute (NEWRI), Energy Research Institute @ NTU (ERI@N) and Institute on Asian Consumer Insight (ACI).

A fast-growing university with an international outlook, NTU is putting its global stamp on Five Peaks of Excellence: Sustainable Earth, Future Healthcare, New Media, New Silk Road, and Innovation Asia.

Besides the main Yunnan Garden campus, NTU also has a satellite campus in Singapore’s science and tech hub, one-north and is setting up a third campus in Novena, Singapore’s medical district. For more information, visit www.ntu.edu.sg

About the School of Materials Science and Engineering, NTU
The School of Materials Science and Engineering (MSE) stands as one of the world’s largest materials engineering institutions, comprising more than 1000 undergraduates and 230 research students. While continuing to equip students with the latest scientific and technological skills sets much needed by the industry, the School has evolved into a hub of excellence in its niche areas of research.

As part of NTU’s College of Engineering, MSE is now recognised worldwide as a premier research institution with top universities, multinational corporations and R&D institutions as its research collaborators and funding partners. Inter-disciplinary research is emphasized, involving academics and researchers from world-class research institutions and universities. With an excellent history of successfully commercializing research concepts, MSE has received international recognition and attracted multi-million dollar funding, both locally and overseas.

Apart from nurturing students with a passion for research and innovation, the School aims to provide an integrated science-driven and application-oriented engineering education in advanced materials for cutting-edge technologies. Further information can be found on the website, www.mse.ntu.sg

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