Dental Association Raises Awareness of Gray-Market Products

Posted on October 5, 2015

Tallahassee, Fla. – Gray-market dental products are sold to dentists and dental laboratories in the U.S. often without the buyer’s knowledge that the materials were imported into the U.S. and sold by an unauthorized vendor. According to a dental journal report, although gray-market products are sold at cheaper prices than regulated goods, they might not meet FDA registration requirements. The National Association of Dental Laboratories (NADL) created the “What’s In Your Mouth?” campaign to educate dentists on what it means to purchase a product from an authorized distributor who might be involved in the gray market and the risks they’re assuming by doing so.

“Gray market” is a generic term that primarily refers to products that are traded or sold outside of the manufacturer’s authorized distribution channels. It’s different than the black market, where products are illegally manufactured or illegally sold. Dentists and dental laboratories that purchase gray goods often have no knowledge of who has made contact with the materials nor how the vendor might have altered the product.   

Gray markets operate in and around most industries, including food, technology and cosmetics, and thrive in a down economy when many businesses are looking for the cheapest options. The dental industry is not immune to the effects of businesses trying to save – or in the vendor’s case – make a buck, which leaves dental patients and dentists vulnerable.

“Given that we know gray-market products are in the dental industry, it is important that dentists know how to spot a gray-market vendor and gray-market products,” said Gary Iocco, co-chair of the NADL Public Awareness Committee.

The “What’s In Your Mouth?” initiative encourages dentists to consider these questions to help identify gray-market vendors and products:

  1. Is the price “too good to be true?”

  2. Is the marketing from the distributor mainly through email?

  3. Is customer service for the vendor hard to reach?

  4. Is FDA registration information readily available for both the vendor and the material?

  5. Is the vendor able to provide you with reputable referrals?

  6. Is the vendor an authorized distributor of the manufacturer?


Deloitte Report: Americans Using Tech to Tackle Their Health and the Health System

Posted on October 5, 2015

NEW YORK, Oct. 5, 2015 /PRNewswire/ -- Today, during National Health IT Week, The Deloitte Center for Health Solutions is releasing a survey report showing that Americans are increasing their use of technology to improve their health, navigate the health system and flex their shopping muscles in acting like consumers instead of passive patients.    

The report, "Health Care Consumer Engagement: No One-Size-Fits-All Approach," found that 22 percent of respondents used technology to access, store and transmit health records in the last year, up from 13 percent in 2013. Use was higher for those with major chronic conditions: 32 percent compared to 19 percent in 2013.

The report also shows that 16 percent of respondents who needed care went online for cost information, up from 11 percent in 2013. Millennials in this group increased the most, 27 versus 17 percent. Further, 71 percent of all those surveyed said they have not gone online for cost information but are "very" or "somewhat" likely to use a pricing tool in the future. 

When it comes to judging quality, 25 percent of all respondents used a scorecard to compare the performance of doctors, hospitals and/or health plans, up from 19 percent in 2013. The rate was highest in the youngest cohort, with 49 percent of millennials who received care in the last year using a scorecard compared to 31 percent in 2013.

"Health care is becoming more digitized and consumer oriented," said Greg Scott, principal, Deloitte Consulting LLP, and vice chairman and national sector leader for the health plans practice. "It's not an overnight change, but more like how summer turns into fall – gradual yet very perceptible."

The specter of a more customer-driven industry is causing many health companies to transform into retail-focused organizations, said Scott, impacting everything from strategy and scale to operations and human capital. "For the enterprise, this is about more than a cool app – this is about making the end-to-end changes needed to better identify and engage a more empowered purchaser."

The report identifies six consumer types emerging in today's market and quantifies their size – a framework that can help companies pursue customer-segmentation strategies. The "casual and cautious" make up 34 percent of the surveyed market, followed by the "content and compliant" at 22 percent, the "online and onboard" at 19 percent, "sick and savvy" at 11 percent, "out and about" at 8 percent and "shop and save" at 6 percent. The report gives depth on each segment's approach to health care.

"Not all consumers are alike in how they engage the system, and a large segment still remains disengaged," said Harry Greenspun, M.D., Deloitte Services LP, director of the Deloitte Center for Health Solutions. "Companies likely won't take a one-size-fits-all approach in their marketing and operations, but a tailored strategy that considers the unique characteristics of the segments they are most interested in."

Respondents most trust physician groups/medical practices/doctor's offices as a reliable source of information on treatments, with 49 percent giving this category a high rating. However, the scores for health insurance and life sciences companies have doubled since 2010. Specifically, 21 percent gave health plans a high rating, compared to 10 percent in 2010, while 18 percent gave life sciences companies a high rating, compared to 9 percent in 2010.

"It's not just the hospitals and doctors who are striving to get closer to the patient – it's the entire industry," said Sarah Thomas, Deloitte Services LP, director of research at the Center. "The post-ACA rise of the individual market and the need for health organizations to demonstrate value are putting the patient at the center of the health ecosystem."

In other findings,

  • 28 percent of respondents have used technology to measure fitness and health goals, up from 17 percent in 2013.

  • 23 percent have used technology to monitor a health issue, versus 15 percent in 2013.

  • 40 percent of the surveyed technology users have shared their fitness or monitoring information with their doctor.

  • 63 percent of the surveyed technology users say their use of fitness or monitoring technologies has led to a significant behavior change.

  • 13 percent of respondents who take prescription drugs receive electronic alerts or reminders; more than half express interest in using technology to prompt them to take their medication.

  • Rates of conferring with doctors via email, texting or video have doubled in the last two years, suggesting digital communication between consumers and providers may continue trending upward.

  • 48 percent of respondents prefer to partner with doctors rather than have them make decisions for them, up from 40 percent in 2008, and 34 percent strongly believe doctors should encourage patients to raise questions. However, only 16 percent of respondents who received care report asking their doctor to consider treatment options other than the one initially recommended.

Get Into Character With New Pediatric Bibs

Posted on October 2, 2015

Earth City, Mo., Oct. 1, 2015 Zooby is excited to announce the launch of new Zooby Pediatric Bibs, which help transform patients into one of five wild Zooby characters.

Each bib features the body of an animal and acts as a costume that helps pediatric patients get into character! Add some fun and imagination to each dental appointment by allowing patients to choose from five friendly character designs:

·       Allie the Alligator

·       Francesca the Flamingo

·       Talon the Tiger

·       Toby the Turtle

·       Penelope the Penguin

Not only are Zooby Pediatric Bibs a great way to engage younger patients, these non-permeable bibs give patients a strong protective barrier against moisture. Measuring 13.5 x 9 inches, these pediatric-size bibs offer an excellent fit for children. Each 100-count box of bibs contains 20 of each character design.

New Zooby Pediatric Bibs are part of Zooby’s extensive line of fun, animal-themed pediatric dental products, which includes disposable prophy angles, flavored exam gloves, prophy pastes and fluorides. These kid-friendly products can help transform an ordinary dental visit into a more captivating encounter where pediatric patients don’t just open wide, they open wide with a roar! 

VOCO Extends Shade Selection for Award-Winning Composite

Posted on October 2, 2015

VOCO a global leader in the manufacturing of dental materials has extended the shade selection for its award winning universal nano-hybrid composite GrandioSO to include an Incisal shade and further extend its esthetic capabilities. GrandioSO is light cured and radiopaque with a wide array of indications including Class I-V restorations.

The size and type of nano-particulate within GrandioSO allows for a more natural esthetic that seamlessly blends into the surrounding tooth structure. As an optimized 89% (w/w) filled nano-hybrid composite GrandioSO possesses a list of physical characteristics such as elasticity, thermal cycling and flexural strength that measure similarly to those of natural dentition making GrandioSO one of the most tooth-like composite available on the market today.

For more information on GrandioSO please visit our website


Coye Receives Private Practice Award from American College of Prosthodontists

Posted on October 2, 2015

CHICAGO, Oct. 1, 2015 (GLOBE NEWSWIRE) -- Robert B. Coye, DDS, will be honored with the private practice award for Pacific Region 5 by the American College of Prosthodontists (ACP). Dr. Coye is to be honored at the Annual Awards & Presidents Dinner during the 45th Annual Session of the American College of Prosthodontists in Orlando from Oct. 21-24, 2015.

Based in Newport Beach, Calif., Dr. Coye is a well-respected member of the prosthodontic specialty. He is very active in his field, having achieved many spectacular accomplishments since beginning in private practice in 1975.

Dr. Coye now can be found practicing at R. Bruce Coye, D.D.S. in Newport Beach, where he specializes in prosthodontics, aesthetic, reconstructive, and implant dentistry. Dr. Coye has lectured nationally and internationally on numerous subjects related to his specialty, and he also served as past President of the California Section of the ACP.

"Patients have nothing but good things to say about Bruce and his compassion, demeanor, and professionalism in his office. Bruce is a part of a very impressive Prosthodontic office in Newport Beach that was started by prosthodontists Dr. Dan Gordon and Dr. Dave Eggleston. Bruce came in when Dan passed away and the office has not lost a step with its reputation and function," said prosthodontist Christopher P. Travis, DDS.

Created in 2013, the Private Practice Award may be given annually to up to five individual Prosthodontists (one per ACP Region). These individuals must have made outstanding contributions to the advancement of the prosthodontic specialty and the role that the Prosthodontist in private practice plays in advancing the patient's quality of life.

Prosthodontists are specialized dentists with advanced training in oral health issues, who are committed to improving patient outcomes. From implants, crowns, veneers and tooth whitening, to full-mouth reconstruction, Prosthodontists specialize in digital dentistrycosmetic dentistry, and sleep apnea solutions. 

Capitol Hill Event Advocates for Increased Access to Oral Healthcare for Older Adults

Posted on October 2, 2015

CHICAGOOct. 1, 2015 /PRNewswire-USNewswire/ -- Yesterday Oral Health America (OHA) and Oral Healthcare Can't Wait, an initiative of the Dental Trade Alliance, brought together dozens of oral health leaders on Capitol Hill to address the challenges facing older Americans when it comes to accessing needed oral healthcare. The event, Aging in America: "You Can't Be Healthy Without Good Oral Health," featured Ellie Hollander, President and CEO of Meals on Wheels America, as keynote speaker and recognized Dr.David Satcher as the 2015 recipient of the Marvin Goldstein Outstanding Public Service Award for his dedicated leadership in improving public health in the United States. Dr. Satcher served as Surgeon General of the United States from 1998 to 2002, releasing the first ever US Surgeon General's report on oral health, Oral Health in America.

"I'm pleased to accept the Marvin Goldstein Outstanding Public Service Award. It is a special occasion for me and I express my deepest appreciation for this award," said David Satcher, M.D., Ph.D. founder of the Satcher Health Leadership Institute of theMorehouse School of Medicine. "The theme 'Aging in America: You Can't Be Healthy Without Good Oral Health' is a very important theme and…it is also a very special year. It is the 50th anniversary of Medicare and Medicaid and the Older Americans' Act, very important anniversary in the history of our country as it relates to health and healthcare."

The Capitol Hill event is part of OHA's annual Fall for Smiles campaign, which educates Americans every September and October about the importance of maintaining a healthy mouth through daily brushing and flossing, regular dental visits, eating healthy foods and avoiding tobacco products. This year the campaign is focusing on older adults and the lack of resources and care available to them when it comes to oral health. According to a recent survey commissioned by OHA and conducted by Harris Poll, older adults already recognize the importance of oral health, with 58 percent saying they do not believe tooth loss is a natural part of aging and 92 percent agreeing that dental visits are still necessary even if you are missing some or all of your teeth. However, many are confused as to what Medicare covers when it comes to oral health, with 52 percent of older adults unsure about what Medicare covers or believing Medicare covers routine dental care. In addition, more than half of low-income older adults reported not having seen a dentist in over a year, with most citing money and lack of insurance as the reason for skipping a visit.

"The people having trouble chewing, experiencing pain, having trouble trying to afford their next meal. We're generally talking about those in the greatest social and economic need. Research tells us that poor dental health of course drives healthcare costs," said Ellie Hollander, President and CEO of Meals on Wheels America. "We both have the same challenge; if we do not address these inextricably linked issues, so we both have a vested interest in working together to resolve this issue as best we can. Not only are we going to serve seniors that are turning to us to be their champions, but we're also going to have stronger and healthier communities and we're going to have a much more vibrant national as a whole."

Today OHA staff and board members are meeting with members of Congress to advocate for making oral health for older adults a priority. Specifically, they are asking members of Congress to pass the Older Americans Act Reauthorization Act of 2015, restore funding for all programs within the Older Americans Act to pre-sequestration levels, support family caregivers through the Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act and support workforce innovations that will increase access to care.

Fall for Smiles is generously sponsored by: 3M ESPE, DentaQuest Foundation, Denticator, Hu-Friedy, Listerine, Midmark, National Dental Association, Oral Healthcare Can't Wait, Patterson Dental, Sunstar, Trident and Whip Mix.

Adult Dental Visits Decline As Dental Emergency Room Visits Rise

Posted on October 2, 2015

ATLANTAOct. 1, 2015 /PRNewswire-USNewswire/ -- Over the past decade more children are visiting the dentist, but dental care among adults is steadily declining. At the same time, dental emergency room visits are on the rise according to the Georgia Dental Association. During World Smile Day on Friday, Oct. 2, the association reminds Georgians to maintain a daily dental care regimen and to establish a dental home to prevent and treat oral health problems early.

Dental disease is almost entirely preventable. Left untreated, it can lead to serious health consequences such as tooth loss, bone or nerve damage or an infection that can spread to other parts of the body, which may even lead to death.

"Prevention is the key," says Georgia Dental Association President and Savannah dentist Dr. Tom Broderick. "Many easily remedied dental conditions are ignored until the point that they become a more serious and expensive dental issue. Simple steps like brushing and flossing your teeth, eating a balanced diet and seeing a dentist regularly can protect against tooth decay."

"Everyone has a stake in this issue," says Georgia Dental Association Executive Director Frank J. Capaldo. "Pain from untreated dental decay results in lost school and work hours. When people are in severe pain oftentimes they seek care in hospital emergency rooms, most of which are not well equipped to handle dental emergencies, and where the cost of treatment is far greater than a dental office visit."

In Georgia there were about 60,000 visits to Georgia emergency rooms for "non-traumatic" dental problems – oral health issues not caused by injuries. That cost more than $23 million (2007).[i] According to Capaldo, the problem is not a lack of capacity in the system. Most dentists in Georgia have the ability to see more patients. Rather, patients face barriers to getting needed care such as fear of the dentist, time off work and cost.

The Georgia Dental Association has several initiatives in place to address and help people overcome the barriers to seeing a dentist. In 2015, the association's leadership at the Capitol resulted in a $200,000 state appropriation to make it possible for more Medicaid dentists to practice in rural areas through a dental loan repayment program. In addition, association members regularly volunteer inGeorgia's free and reduced-cost dental clinics. Earlier this summer, the Georgia Dental Association and its Foundation hosted the Georgia Mission of Mercy dental clinic in Perry, Ga. Over the course of two days, more than 1,400 dentists and community volunteers saw 2,000 patients and provided $1.5 million of donated care to patients from 80 counties in Georgia.

On Oct. 2, World Smile Day (#WorldSmileDay), find your dental home. Visit the Georgia Dental Association website to locate a dentist in your community.

Kool Smiles to Host Online Career Fair for Dentists

Posted on October 2, 2015

ATLANTA, Oct. 2, 2015 /PRNewswire-USNewswire/ -- Kool Smiles, a leading provider of quality dental care in underserved communities nationwide, will host an Online Career Fair for dentist job seekers on October 5-11, 2015.  During the career fair, dentists and specialists will have the opportunity to explore professional opportunities throughout the country, reach out to recruiters, apply for positions online, and learn more about the Kool Smiles mission.

The online career fair will feature current job opportunities for both general dentists and specialists, including dentists, dental anesthesiologists, pediatric dentists, oral surgeons, and orthodontists. Dentists and specialists interested in attending the career fair will need to complete a one-time registration prior to the event.

"Kool Smiles is always looking for talented applicants – whether established dentists or recent graduates – who are passionate about making a difference in the lives of the patients we serve," said Dr. Dale Mayfield, Chief Dental Officer of Kool Smiles. "Our online career fair is designed to streamline the information-seeking process for dentists with busy schedules and makes it easy to explore current opportunities regardless of geographic location."

Kool Smiles dentists share the belief that all families have the right to receive quality dental care. The staff works together as a close-knit team, and as a vital part of the communities they serve, to provide first-rate dental services. Kool Smiles is hoping to expand its team with dedicated individuals who share this passion.

In addition to the Online Career Fair, Kool Smiles is offering a $2,500 referral bonus for those who recommend a job candidate hired on as a Kool Smiles dentist.

Online career fair participants will also have the opportunity tweet their questions to @Kool_Smiles. Recruitment specialists will be available to answer questions about current opportunities, career paths, company culture and benefits, along with any other questions job seekers may have.

Kool Smiles offers competitive compensation, comprehensive benefits and unique growth opportunities. Hiring qualified and passionate dentists is critical to the success of each Kool Smiles office. Kool Smiles clinical leaders want to ensure that every candidate gets a full understanding of the mission, company culture, and benefits of a career with Kool Smiles.  As a result, after speaking with a Manager of Talent Acquisition, qualified candidates will be invited to meet with a member of the clinical leadership team in a Kool Smiles office for a thorough interview and office tour.

For more information about the Kool Smiles Online Career Fair, please visit

Penn Dental Medicine Study Blocks Inflammatory Bone Loss in Gum Disease

Posted on October 2, 2015

Periodontitis, a severe form of gum disease, doesn't just cause soft-tissue inflammation and bleeding. It also destroys the bone that supports the teeth. If it progresses unchecked, it can lead to tooth loss and is even associated with systemic inflammatory conditions like atherosclerosis and rheumatoid arthritis.

A new study led by University of Pennsylvania School of Dental Medicine researchers demonstrates that a protein called Del-1, can inhibit bone loss associated with periodontitis. They also found the protein curbs the activity of osteoclasts, cells that absorb bone tissue, leading to a mechanistic explanation of how Del-1 can prevent periodontal bone loss.

The finding paves the way for therapeutic interventions to treat periodontitis and possibly other conditions.

"This is not just important for periodontitis," said George Hajishengallis, senior author on the work and the Thomas W. Evans Centennial Professor in the Department of Microbiology at Penn Dental Medicine. "It could also have implications for other inflammatory diseases where bone loss is involved, like osteoporosis and rheumatoid arthritis."

Additional Penn Dental Medicine collaborators included co-lead authors Jieun Shin and Tomoki Maekawa, as well as co-authors Toshiharu Abe, Evlambia Hajishengallis, Kavita Hosur and Kalyani Pyaram. The Penn team collaborated with Triantafyllos Chavakis and Ioannis Mitroulis from Germany's Technical University of Dresden.

"The findings underline the therapeutic potential of this endogenous anti-inflammatory factor, Del-1, in further human pathologies where the levels of Del-1 are reduced," Chavakis said.

The paper appears in the journal Science Translational Medicine.

Previous studies by Hajishengallis and colleagues have demonstrated the important role that Del-1 plays in inhibiting the movement and accumulation of neutrophils in gum tissue in mice, and they have found a similar mechanism occurs to reduce inflammation in the central nervous system. In both scenarios, Del-1 is able to restrain the recruitment of neutrophils, which prevents damaging inflammation. The Penn scientists demonstrated that applying Del-1 to the gums can inhibit inflammation and bone loss in a mouse model of periodontitis.

But evidence from those studies also suggested that Del-1's effect on bone loss was not solely due to its inhibition of neutrophil recruitment.

"When we compared Del-1 with a small-molecule inhibitor of neutrophil recruitment side by side, we found that Del-1 was much more effective at inhibiting bone loss," Hajishengallis said. "That suggested to us that Del-1 may have an additional mechanism to inhibit bone loss, perhaps by acting directly on the osteoclasts."

Del-1 is known to be expressed on various soft tissues, such as the gums, brain and lungs, but, to confirm their suspicions that it might also be involved in bone preservation, the research team stained bone tissue for the molecule. They found evidence of Del-1 in the same areas as osteoclast activity, then followed up by generating human and mouse osteoclasts in vitro and found Del-1 mRNA and protein expressed at high levels.

Osteoclasts from mice that lacked Del-1 or from cell lines lacking the protein could be differentiated faster and stronger.

"In fact, Del-1 doesn't block the formation of osteoclasts, but it does put the brakes on the process," Hajishengallis said.

Further experimentation in vitro with human osteoclasts and in vivo in mice identified a portion of the Del-1 protein that was particularly important for containing osteoclast activity, though additional parts of the molecule were needed to have the most potent inhibition of inflammation and bone loss. In further mechanistic experiments using different parts of the protein, the researchers were able to dissociate the anti-inflammatory action of Del-1 from its anti-osteoclastogenic action.

"Even when we administered Del-1 after the peak recruitment of neutrophils, we were still able to significantly inhibit bone loss," Hajishengallis said.

With this new understanding of how Del-1 can inhibit periodontal bone loss -- both by reducing inflammation and by restraining the activity of osteoclasts that resorb bone tissue -- the researchers tested it, in a preclinical model of periodontitis observing that Del-1 significantly reduced inflammation and tissue damage and that there was significantly less bone loss.

Hajishengallis and colleagues have implicated Del-1 in other inflammatory diseases, including multiple sclerosis, and are beginning to examine its possible involvement in rheumatoid arthritis and osteoporosis. Unlike some drugs used to treat these diseases, Del-1 is a protein that the human body already produces, so administration of a Del-1-based drug would likely be safer than some of the alternatives, especially for local inflammatory diseases.

"I'm convinced that this is a drug that could work in humans," Hajishengallis said.

Source: Penn Dental Medicine

UMC Utrecht Discovers Genetic Cause of Disturbed Dental Development

Posted on October 2, 2015

Utrecht, October 2, 2015 - Researchers at University Medical Center (UMC) Utrecht have identified a gene that may cause oligodontia, the agenesis of six or more teeth. The discovery of the so-called LPR6 gene makes it possible to diagnose patients more effectively, provide them with better information and develop customized treatment. The results were published today in The American Journal of Human Genetics.

Oligodontia is a rare but serious congenital anomaly defined by the absence of six or more permanent teeth. Children usually develop milk teeth at a young age, but when their permanent teeth start to erupt, it becomes clear that something is wrong. In several places, no adult teeth come in. In Europe, this condition affects 14 out of every 10,000 people. There are two types: oligodontia as part of a syndrome and oligodontie as an isolated condition.

Genetic research

We now know that 70 percent of oligodontia patients have mutations in several genes. Further research was recently carried out at UMC Utrecht, led by study leader Dr. Gijs van Haaften. The study involved additional genetic testing in 20 patients with nonsyndromic oligodontia using Whole Exome-Sequencing (WES). WES is a technique for identifying the protein coding regions (exome) of the human genome. The research results showed that, in these patients, the condition is often caused by a mutation in the LPR6 gene. The study also revealed that patients have a 50 percent chance of passing on the mutation to their offspring. Dr. Marie-José van den Boogaard, clinical geneticist at UMC Utrecht explains, “In these patients, the gene is primarily associated with the absence of teeth and, in principle, not with other serious conditions.”


Oligodontia greatly impacts quality of life and may lead to eating and speaking problems, among other things. Dr. Marijn Créton, dentist and maxillofacial prosthetist at the Department of Oral and Maxillofacial Surgery and Special Dental Care at UMC Utrecht, ensures - in consultation with patients – that ultimately they have a good set of teeth both at a young and adult age. This requires a treatment of many years, during which patients are treated by a dentist, oral surgeon and orthodontist. “Moreover, adolescents with oligodontia often have psychosocial issues,” says Créton. “Missing many teeth is conspicuous. Children, teenagers and young adults are sometimes bullied and regularly experience feelings of low self-esteem and shame.”

National Center of Excellence

At the Center of Excellence in Congenital Orofacial and Dental Anomalies, housed at UMC Utrecht, dentists, oral surgeons, plastic surgeons and orthodontists collaborate in a multidisciplinary setting with clinical geneticists of the Department of Medical Genetics. During a single visit, dental problems are assessed, the patient – and/or parents – are given an explanation of DNA research and are presented with the offer to use it. Based on the findings of the dentist and clinical geneticist, specific genetic research is possible. Van den Boogaard adds, “Most patients want to know the cause. Why does it develop? Will my children get it as well? And what is the risk of this happening? This new research provides better insight into the biology of tooth development. The LPR6 gene is now included in the DNA diagnostics of oligodontia, enabling us to give patients a better diagnosis, and to provide better information and to develop customized treatment.”


Source: UMC Utrecht Press Release



Massink MPG, Créton MA, Spanevello F, et al. Loss-of-Function Mutations in the WNT co-receptor LRP6 Cause Autosomal-Dominant Oligodontia, The American Journal of Human Genetics, in press 2015.

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