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1.
Orthop Clin North Am ; 51(2): 131-139, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138851

RESUMEN

In this review article, the authors present the many challenges that orthopedic surgeons in developing countries face when implementing arthroplasty programs. The issues of cost, sterility, and patient demographics are specifically addressed. Despite the many challenges, developing countries are beginning to offer hip and knee reconstructive surgery to respond to the increasing demand for such elective operations as the prevalence of osteoarthritis continues to increase. The authors shed light on these nascent arthroplasty programs.


Asunto(s)
Artroplastia de Reemplazo/normas , Países en Desarrollo , Osteoartritis/cirugía , Desarrollo de Programa/normas , Artroplastia de Reemplazo/economía , Artroplastia de Reemplazo/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Femenino , Salud Global/economía , Salud Global/normas , Humanos , Masculino , Misiones Médicas/economía , Misiones Médicas/normas , Misiones Médicas/estadística & datos numéricos , Osteoartritis/economía , Osteoartritis/epidemiología , Desarrollo de Programa/economía , Sistema de Registros/estadística & datos numéricos
6.
Gastroenterology ; 158(2): 404-417, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31759062

RESUMEN

Screening, followed by colonoscopic polypectomy (or surgery for malignant lesions), prevents incident colorectal cancer and mortality. However, there are variations in effective application of nearly every aspect of the screening process. Screening is a multistep process, and failure in any single step could result in unnecessary morbidity and mortality. Awareness of variations in operator- and system-dependent performance has led to detailed, comprehensive recommendations in the United States and Europe on how colonoscopy screening should be performed and measured. Likewise, guidance has been provided on quality assurance for nonprimary colonoscopy-based screening programs, including strategies to maximize adherence. Quality improvement is now a validated science, and there is clear evidence that higher quality prevents incident cancer and cancer death. Quality must be addressed at the levels of the system, provider, and individuals, to maximize the benefits of screening for any population. We review the important aspects of measuring and improving the quality of colorectal cancer screening.


Asunto(s)
Neoplasias Colorrectales/prevención & control , Detección Precóz del Cáncer/normas , Salud Global/normas , Tamizaje Masivo/normas , Calidad de la Atención de Salud/normas , Colonoscopía/normas , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Carga Global de Enfermedades , Humanos , Incidencia , Tamizaje Masivo/organización & administración , Guías de Práctica Clínica como Asunto
7.
Clin Ter ; 170(1): e66-e73, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31850487

RESUMEN

BACKGROUND: Cross-contamination and mix-ups are among the problems which could have a negative impact on the quality of the finished product during the production of highly active or sensitizing drugs with campaign manufacturing. Standardised, validated procedures ensure quality standards are maintained during production. In spite of this, the operating conditions and applicability of methods adopted by the various regulatory agencies manifest significant differences which could consequently compromise the safety of the finished product. This work has analysed and compared the GMP of various Regulatory Agencies to examine issues connected to campaign manufacturing highly active or sensitizing drugs. METHODS: The GMP of the following Regulatory Agencies have been studied: EMA, CFDA, COFEPRIS, FDA, Health Canada, ANVISA, CDSCO, PIC/S and WHO. The study was carried out for the purpose of understanding which agencies consent to the use of campaign manufacturing for the following categories of medicinal products: hormones, immunosuppressants, cytotoxic agents, highly active pharmaceutical ingredients (APIs), biological preparations, steroids, sensitizing pharmaceutical materials, antibiotics, cephalosporins, penicillins, carbapenems and beta-lactam derivatives. RESULTS: The GMP of Health Canada, EMA, PIC/S and FDA show a number of similarities, starting with the fact that they allow campaign manufacturing for similar categories of pharmaceutical products after an appropriate risk evaluation has been performed. CFDA, WHO, ANVISA authorise campaign manufacturing in "exceptional circumstances", though they do not always define what they mean by this. COFEPRIS authorises campaign manufacturing for certain classes of drugs, while there is no mention of campaign manufacturing in the CDSCO regulations. CONCLUSIONS: Quite a few significant differences have been found in the various regulations concerning the use of campaign manufacturing and the classes of drugs that can be produced with this method. In the light of this, it is obvious that efforts to harmonise legislation internationally have not yet been successful: currently, states can adopt different quality standards. The pharmaceutical industry could use this situation to its advantage by delocalising production on the basis of existing standards. The need to harmonise GMPs is a priority which must be achieved as soon as possible.


Asunto(s)
Industria Farmacéutica/legislación & jurisprudencia , Industria Farmacéutica/normas , Salud Global/legislación & jurisprudencia , Salud Global/normas , Guías como Asunto , Medicamentos bajo Prescripción/normas , Control de Calidad , Humanos
8.
Acta Trop ; 201: 105219, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31614120

RESUMEN

As the only specialized institution for research and control of parasitic diseases at the national level in China for almost 70 years, the National Institute of Parasitic Diseases (NIPD) at the Chinese Center for Disease Control and Prevention (China CDC) has been instrumental in supporting the remarkable progress from high prevalence to transmission interruption or low endemicity of several diseases, lymphatic filariasis, malaria and schistosomiasis in particular. This has taken place through technical guidance, emergency response and scientific research as well as providing technical service, education, training, health promotion and international cooperation. With China's increasing involvement in international cooperation and the increased risk for (re)emerging tropical diseases in mind, the Chinese Government designated in 2017 a new Chinese Center for Tropical Disease Research to NIPD. Responding to the expanded responsibilities, the institute is scaling up its activities in several ways: from parasitic diseases to the wider area of tropical diseases; from disease control to disease elimination; from biological research to policy evidences accumulation; and from public health to global health. Based on this new vision and China's previous accomplishments in the areas mentioned, the institute is in a position to move forward with respect to global health and equitable development according to the central principles of the United Nations' Sustainable Development Goals.


Asunto(s)
/organización & administración , Enfermedades Transmisibles/epidemiología , Salud Global/normas , Cooperación Internacional , Enfermedades Parasitarias/epidemiología , Salud Pública/normas , Medicina Tropical/normas , Academias e Institutos , Animales , China/epidemiología , Humanos , Objetivos Organizacionales , Estados Unidos
9.
Presse Med ; 48(12): 1536-1550, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31784255

RESUMEN

Africa along side with south-east Asia are the epicentres of emerging and epidemic prone-infectious diseases and megacity biosecurity threat scenarios. Massive mobility and reluctance in the populations exposed to epidemic and emerging prone-infectious diseases coupled by a weak health system made disease alert and control measures difficult to implement. The investigation of virus detection and persistence in semen across a range of emerging viruses is useful for clinical and public health reasons, in particular for viruses that lead to high mortality or morbidity rates or to epidemics. Innovating built facility to safely treat patients with highly pathogenic infectious diseases is urgently need, not only to prevent the spread of infection from patients to healthcare workers but also to offer provision of relatively invasive organ support, whenever considered appropriate, without posing additional risk to staff. Despite multiple challenges, the need to conduct research during epidemics is inevitable, and candidate products must continue undergoing rigorous trials. Preparedness including management of complex humanitarian crises with community distrust is a cornerstone in response to high consequence emerging infectious disease outbreaks and imposes strengthening of the public health response infrastructure and emergency outbreak systems in high-risk regions.


Asunto(s)
Enfermedades Transmisibles Emergentes/epidemiología , Epidemias , Control de Infecciones , Enfermedades Transmisibles Emergentes/prevención & control , Brotes de Enfermedades/prevención & control , Epidemias/prevención & control , Epidemias/estadística & datos numéricos , Salud Global/normas , Salud Global/tendencias , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Control de Infecciones/tendencias , Salud Pública/normas , Salud Pública/tendencias , Administración en Salud Pública/métodos , Administración en Salud Pública/tendencias
11.
J Rehabil Med ; 51(11): 847-853, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31663599

RESUMEN

OBJECTIVE: Rehabilitation services play an important role in optimizing functional ability and societal integration for people with disabilities. The Madagascar Rehabilitation Programme (2011-2013) resulted from a global training partnership and led to 8 doctors achieving a university diploma in rehabilitation medicine. This paper describes a 2014 evaluation of the programme methods, results and learning points. METHODS: A combination of qualitative methods was used for the evaluation, based on a Theory of Change model, with informants from Madagascar and the UK. RESULTS: Malagasy trainees and UK volunteers gained new theoretical knowledge and practical skills. For Madagascar, it led to changes in working practice and the formation of a national rehabilitation association. Key to its success was the strong collaboration between Malagasy and UK professionals, with support from the University and Ministry of Health in Madagascar, and the UK partners. Having a clear common vision ensured the programme met the needs of the Malagasy clinicians. CONCLUSION: Rehabilitation is increasingly recognized as an important focus for international development. Successful rehabilitation training programmes can be achieved at modest costs with global health partnerships. The combination of factors that enabled this programme to be a success is reproducible in other contexts.


Asunto(s)
Personas con Discapacidad/educación , Personas con Discapacidad/rehabilitación , Salud Global/normas , Rehabilitación/métodos , Humanos , Madagascar
12.
Rev Sci Tech ; 38(1): 155-171, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31564733

RESUMEN

In order to manage global and transnational health threats at the human- animal-environment interface, a multisectoral One Health approach is required. Threats of this nature that require a One Health approach include, but are not limited to, emerging, endemic and re-emerging zoonotic diseases, food safety, antimicrobial resistance (AMR), vector-borne and neglected infectious diseases, toxicosis and pesticides. Relevant Kenyan authorities formally institutionalised One Health in 2011 through the establishment of the Zoonotic Disease Unit (ZDU) and its advisory group, the Zoonoses Technical Group. At that time, the One Health agenda focused on zoonotic diseases. As the issue of AMR began to gain traction globally, a One Health approach to its management was advocated in Kenya in 2015. This paper summarises a series of interviews (with respondents and key informants) that describe how AMR institutionalisation evolved in Kenya. It also examines how responses to other health threats at the human-animal- environment interface were coordinated and used to identify gaps and make recommendations to improve One Health coordination at the national level in Kenya. Results showed that the road to the institutionalisation of AMR through the National Action Plan on Prevention and Containment of Antimicrobial Resistance, 2017-2022 and a formally launched One Health coordination mechanism, the National Antimicrobial Stewardship Interagency Committee (NASIC), took ten years. Moreover, supplementary actions are still needed to further strengthen AMR coordination. In addition to the ZDU and NASIC, Kenya has established two other formal multisectoral and multidisciplinary coordination structures, one for aflatoxicosis and the other for health threats associated with pesticide use. The country has four distinct and separate One Health coordination mechanisms: for zoonoses, for AMR, for aflatoxicosis and for the health threats associated with pesticide use. The main gap lies in the lack of overall coordination between these topic-specific structures. An overall coordination mechanism for all One Health issues is therefore needed to improve synergy and complementarity. None of the topic-specific mechanisms plays a critical role in the policy development process, institutionalisation or implementation of activities related to the other topic areas. The authors recommend renaming the ZDU as the One Health Office, and expanding it to include AMR and food safety teams, and their associated technical working groups. Through this restructuring, the One Health Office would become an umbrella organisation dealing with all four issues mentioned above. Based on Kenya's experience, the authors recommend that other countries also consider expanding the scope of multisectoral One Health coordination mechanisms to include other shared health threats.


Asunto(s)
Salud Global , Salud Única , Animales , Antibacterianos , Farmacorresistencia Bacteriana , Salud Global/normas , Política de Salud , Humanos , Kenia , Zoonosis/microbiología , Zoonosis/prevención & control
13.
Rev Sci Tech ; 38(1): 145-154, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31564744

RESUMEN

The One Health approach supports global health security by improving coordination, collaboration and communication at the human-animal-environment interface to address shared health threats such as zoonotic diseases, antimicrobial resistance, food safety and others. Over the past decade, country after country has implemented the One Health approach and demonstrated recognised benefits. However, in order to build sustainability of One Health in these efforts, One Health champions and implementers need to collect and provide government decision-makers with country-level data on One Health's impact to help justify policy decisions and resource allocations. Due to the broad, often seemingly all encompassing, nature of One Health in promoting synergies of multiple disciplines and sectors, the One Health community has faced difficulties in determining specific One Health impact indicators for formally evaluating One Health successes. In this paper, the author a) briefly reviews the ongoing commentary on the recognised benefits of the implementation of a One Health approach in the global health security context, b) discusses challenges in measuring the impact of One Health, and c) proposes possible solutions for evaluating the impact of One Health on global health security.


Asunto(s)
Salud Global , Salud Única , Desarrollo Sostenible , Animales , Salud Global/normas , Metas , Humanos , Salud Única/normas , Salud Única/tendencias , Zoonosis/prevención & control
14.
Lancet Haematol ; 6(12): e606-e615, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31631023

RESUMEN

BACKGROUND: Blood transfusions are an important resource of every health-care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions is often unknown. We therefore aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally. METHODS: We did a modelling study involving 195 countries and territories. We used blood component preparation data from 2011-13 to estimate blood availability for 180 (92%) of 195 countries from the WHO Global Status Report on Blood Safety and Availability. We calculated disease-specific transfusion needs per prevalent case for 20 causes in the USA using the National (Nationwide) Inpatient Sample dataset between the years 2000 and 2014, and the State Inpatient Databases between 2003 and 2007 from the Healthcare Cost and Utilization Project. Using prevalence estimates for the USA from the Global Burden of Disease (GBD) 2017 study, we estimated the ideal disease specific-transfusion rate as the lowest rate from the years 2000 to 2014. We applied this rate to GBD prevalence results for 195 countries to estimate transfusion needs. Unmet need was the difference between the estimated supply and need. FINDINGS: In 2017, the global blood need was 304 711 244 (95% uncertainty interval [UI] 293 064 637-314 049 479) and the global blood supply was 272 270 243 (268 002 639-276 698 494) blood product units, with a need-to-supply ratio of 1·12 (95% UI 1·07-1·16). Of the 195 countries, 119 (61%) did not have sufficient blood supply to meet their need. Across these 119 countries, the unmet need totalled 102 359 632 (95% UI 93 381 710-111 360 725) blood product units, equal to 1849 (1687-2011) units per 100 000 population globally. Every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs. INTERPRETATION: Our data suggest that the gap between need and supply is large in many low-income and middle-income countries, and reinforce that the WHO target of 10-20 donations per 1000 population is an underestimate for many countries. A continuous expansion and optimisation of national transfusion services and implementation of evidence-based strategies for blood availability is needed globally, as is more government support, financially, structurally, and through establishment of a regulatory oversight to ensure supply, quality, and safety in low-income and middle-income countries. FUNDING: National Institutes of Health.


Asunto(s)
Bancos de Sangre/provisión & distribución , Transfusión Sanguínea , Salud Global , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Evaluación de Necesidades/estadística & datos numéricos , Bancos de Sangre/economía , Bancos de Sangre/normas , Bancos de Sangre/estadística & datos numéricos , Seguridad de la Sangre/normas , Seguridad de la Sangre/estadística & datos numéricos , Transfusión Sanguínea/economía , Transfusión Sanguínea/normas , Transfusión Sanguínea/estadística & datos numéricos , Geografía , Carga Global de Enfermedades , Salud Global/economía , Salud Global/normas , Salud Global/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/normas , Humanos , Modelos Teóricos , Evaluación de Necesidades/economía , Evaluación de Necesidades/organización & administración , Evaluación de Necesidades/normas , Áreas de Pobreza , Prevalencia
17.
Malar J ; 18(1): 267, 2019 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-31477109

RESUMEN

Parasite resistance against anti-malarial drugs is a major threat to the ongoing malaria control and elimination strategies. This is especially true since resistance to the currently recommended artemisinins and partner drugs has been confirmed in South East Asia (SEA) and new anti-malarial compounds are not expected to be available in the near future. Spread from SEA or independent emergence of artemisinin resistance in sub-Saharan Africa (SSA) could reverse the achievements in malaria control that have been attained in the past two decades and derail the ongoing elimination strategies. The current surveillance of clinical efficacy and resistance to anti-malarial drugs is based on efficacy trials to assess the clinical performance of anti-malarials, in vivo/ex vivo assessment of parasite susceptibility to anti-malarials and prevalence of known molecular markers of drug resistance. Whereas clinical efficacy trials are restricted by cost and the complex logistics of patient follow-up, molecular detection of genetic mutations associated with resistance or reduced susceptibility to anti-malarials is by contrast a simple and powerful tool for early detection and monitoring of the prevalence of resistant parasites at population level. This provides needed information before clinical failure emerges, allowing policy makers to anticipate problems and respond. The various methods previously used in detection of molecular markers of drug resistance share some limitations: low-throughput, and high costs per sample and demanding infrastructure. However, recent technological advances including next-generation sequencing (NGS) methodologies promise greatly increased throughput and reduced costs, essentially providing unprecedented potential to address different research and operational questions of relevance for drug policy. This review assesses the potential role of NGS to provide comprehensive information that could guide drug policies in malaria endemic countries and looks at the foreseeable challenges facing the establishment of NGS approaches for routine surveillance of parasite resistance to anti-malarials in SSA.


Asunto(s)
Antimaláricos/uso terapéutico , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Resistencia a Medicamentos/genética , Secuenciación de Nucleótidos de Alto Rendimiento , Plasmodium falciparum/genética , Formulación de Políticas , África del Sur del Sahara , Control de Enfermedades Transmisibles/métodos , Quimioterapia Combinada , Salud Global/legislación & jurisprudencia , Salud Global/normas , Legislación de Medicamentos , Malaria Falciparum/tratamiento farmacológico , Plasmodium falciparum/efectos de los fármacos
18.
Artículo en Inglés | MEDLINE | ID: mdl-31370229

RESUMEN

Transnational restaurant chains sell food and beverage products in 75 to 139 countries worldwide linked to obesity and non-communicable diseases (NCDs). This study examined whether transnational restaurant chains reformulated products and standardized portions aligned with healthy dietary guidelines and criteria. Firstly, we describe the transnational restaurant industry structure and eating trends. Secondly, we summarize results from a scoping review of healthy dietary guidelines for restaurants. Thirdly, we describe a systematic review of five electronic databases (2000-2018) to identify studies on nutrient profile and portion size changes made by transnational restaurants over 18 years. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, identified 179 records, and included 50 studies conducted in 30 countries across six regions. The scoping review found a few expert-recommended targets for restaurants to improve offerings, but no internationally accepted standard for portions or serving sizes. The systematic review results showed no standardized assessment methods or metrics to evaluate transnational chain restaurants' practices to improve menu offerings. There was wide variation within and across countries, regions, firms, and chains to reduce energy, saturated and trans fats, sodium, and standardized portions. These results may inform future research and encourage transnational chain restaurants to offer healthy product profiles and standardized portions to reduce obesity and NCD risks worldwide.


Asunto(s)
/normas , Salud Global/normas , Enfermedades no Transmisibles/prevención & control , Política Nutricional , Obesidad/prevención & control , Tamaño de la Porción/normas , Restaurantes/normas , Calidad de los Alimentos , Guías como Asunto , Humanos
19.
Nat Rev Clin Oncol ; 16(12): 763-771, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31388125

RESUMEN

Disease burden is the most important determinant of survival in patients with cancer. This domain, reflected by the cancer stage and codified using the tumour-node-metastasis (TNM) classification, is a fundamental determinant of prognosis. Accurate and consistent tumour classification is required for the development and use of treatment guidelines and to enable clinical research (including clinical trials), cancer surveillance and control. Furthermore, knowledge of the extent and stage of disease is frequently important in the context of translational studies. Attempts to include additional prognostic factors in staging classifications, in order to facilitate a more accurate determination of prognosis, are often made with a lack of knowledge and understanding and are one of the main causes of the inconsistent use of terms and definitions. This effect has resulted in uncertainty and confusion, thus limiting the utility of the TNM classification. In this Position paper, we provide a consensus on the optimal use and terminology for cancer staging that emerged from a consultation process involving representatives of several major international organizations involved in cancer classification. The consultation involved several steps: a focused literature review; a stakeholder survey; and a consultation meeting. This aim of this Position paper is to provide a consensus that should guide the use of staging terminology and secure the classification of anatomical disease extent as a distinct aspect of cancer classification.


Asunto(s)
Salud Global/normas , Oncología Médica , Estadificación de Neoplasias/métodos , Estadificación de Neoplasias/normas , Neoplasias/patología , Terminología como Asunto , /normas , Comprensión , Consenso , Humanos , Internacionalidad , Oncología Médica/métodos , Oncología Médica/organización & administración , Oncología Médica/normas , National Cancer Institute (U.S.)/normas , Neoplasias/diagnóstico , Pautas de la Práctica en Medicina/normas , Pronóstico , Estados Unidos
20.
Respir Res ; 20(1): 183, 2019 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-31412856

RESUMEN

Asthma is a heterogeneous lung disease, usually characterised by chronic airway inflammation. Although evidence-based treatments are available in most countries, asthma control remains suboptimal, and asthma-related deaths continue to be an ongoing concern. Generally, it is believed that between 50 to 75% of patients with asthma can be considered as having mild asthma.Previous versions of Global Initiative for Asthma (GINA) suggested that mild asthma in adults can be well managed with either reliever medications, for example, short-acting beta2 agonists (SABA) alone or with the additional use of controllers such as regular low-dose inhaled corticosteroids (ICS). Given the low frequency or non-bothersome nature of symptoms in mild asthma, patients' adherence towards their controller medications, especially to ICS is usually not satisfactory. Such patients often rely on SABA alone to relieve symptoms, which may contribute to SABA over-reliance. Overuse of relievers such as SABAs has been associated with poor asthma outcomes, such as exacerbations and even deaths. The new GINA 2019 asthma treatment recommendations represent significant shifts in asthma management at Steps 1 and 2 of the 5 treatment steps. The report acknowledges an emerging body of evidence suggesting the non-safety of SABAs overuse in the absence of concomitant controller medications, therefore does not support SABA-only therapy in mild asthma and has included new off-label recommendations such as symptom-driven (as-needed) low dose ICS-formoterol and "low dose ICS taken whenever SABA is taken".The GINA 2019 report highlights significant updates in mild asthma management and these recommendations represent a clear deviation from decades of clinical practice mandating the use of symptom-driven SABA treatment alone in those with mild asthma. While the new inclusions of strategies such as symptom-driven (as-needed) ICS-formoterol and "ICS taken whenever SABA is taken" are based on several key trials, data in this context are still only emergent data, with clear superiority of as needed ICS-formoterol combinations over maintenance ICS regimens yet to be established for valid endpoints. Nevertheless, current and emerging data position the clinical asthma realm at a watershed moment with imminent changes for the way we manage mild asthma likely in going forward.


Asunto(s)
Asma/diagnóstico , Asma/tratamiento farmacológico , Salud Global/normas , Guías de Práctica Clínica como Asunto/normas , Administración por Inhalación , Antiasmáticos/administración & dosificación , Asma/epidemiología , Broncodilatadores/administración & dosificación , Ensayos Clínicos como Asunto/métodos , Manejo de la Enfermedad , Salud Global/tendencias , Humanos
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