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According to Table 1. the best results were obtained using method 2, which involved indigo determination in the leuco form using absorption spectroscopy.

Repeatability and reproducibility values obtained in the three studied methods were under 6% and 1% respectively. The repeatability of method 1 was higher than the others. This is probably due to the low solubility of the dye in chloroform.

Regarding the accuracy test, the recovery obtained is shown in Table 3 .

Table 3. Accuracy obtained for each level of concentration studied.

Table 3. Accuracy obtained for each level of concentration studied.

Indigo Added (mg·L −1 )

Although method 3 gave lower dye recovery than methods 1 and 2, it did meet the established acceptance criteria. In method 2, about 100% of recovery was achieved, which demonstrates the high accuracy of this method. Method 3 showed similar recovery for each level of concentration. However, in method 1, when 300 mg·L −1 of indigo was added to the sample, the results exhibited lower recovery than when 200 mg·L −1 was used. The effect of high indigo dye concentration in results of method 1 is discussed in the Section 3.2 .

The lowest range of linearity was obtained in method 1 due to the limited solubility of the indigo dye in chloroform. However, method 3 can only be applied with an indigo concentration above 16.7 mg·L −1 .

Finally, methods 1 and 2 exhibited similar LoD and LoQ. It is important to highlight the LoQ obtained in method 3. Industrially, about 3–4 g·L −1 of indigo dye are used; therefore, this method has an advantage with respect to the other ones: the samples do not need a dilution step. In addition, redox titration does not require a previous preparation of dye baths, because the dye is already in its leuco form due to the addition of sodium dithionite in alkaline medium. Consequently, this method is much faster than the other ones.

3.2. Application of the Methods to the Analysis of Effluents and Dyeing Liquors

Five industrial effluents supplied by the denim yarn factory “Tejidos Royo” (Alcudia de Crespins, Valencia, Spain) were selected to evaluate the applicability of the three studied methods.

Sample 1 was the wastewater generated in first washing step after the dyeing process. Samples 2–5 were dye liquors collected during the dyeing process.

The indigo content in the samples was determined at least five times with each method. The average results are shown in Table 4 .

Table 4. Results from application of methods 1–3 to industrial samples.

The indigo concentration in industrial samples was unknown. As the validation tests (Section 3.1 ) showed high accuracy using method 2, values obtained with this method were selected as the reference levels.

From Table 3. it can be observed that method 2 provided the highest values for indigo dye concentration. With low indigo concentration, method 1 provided similar results to method 2. However, with high indigo concentration, method 3 exhibited similar results to method 2, whereas method 1 should be discarded. These differences are probably due to the high dilution rate, which produced errors in the determination and the low solubility of indigo in chloroform.

In summary, the three studied methods are suitable to be applied in the determination of indigo dye in textile effluents which have lower indigo concentration. In the case of dyeing liquors, methods 2 and 3 are more suitable (Figure 2 ).

Figure 2. Scheme of the studied methods and their applicability.

Figure 2. Scheme of the studied methods and their applicability.

4. Conclusions

The validation process carried out in this work showed that all three studied methods can be applied to the determination of indigo dye in both dyeing baths and wastewater effluents.

Method 1 is the most laborious from the experimental point of view because it requires a previous extraction of the indigo in chloroform and a posterior stabilization of the sample in an ultrasonic bath. In addition, its low linearity range, between 0 and 5.0 mg·L −1. implies generally a sample dilution before the spectrophotometric analysis. Despite that, the method meets the acceptance criteria.

Method 2, based on the determination of indigo in its leuco form, exhibited the best results in terms of validation parameters. About 100% of recovery is achieved, which indicates the high accuracy of the method. In addition, the concentration range (0–10.0 mg·L −1 ) is higher than in method 1, although the sample still required a dilution for the determination.

Method 3 showed the lower recovery value (84%), but its high range of linearity (from 16.7 mg·L −1 ) provides a significant advantage respect the other two studied methods. Moreover, it enables the simultaneous determination of sodium dithionite and indigo dye concentrations, which are both important to ensure the reproducibility and repeatability of the dyeing process. For these reasons, we consider that method 3 is the most suitable for application on an industrial scale. It is also easy for automation and the installation of an automatic titration provides a fast and simple way to control the dyeing of liquors and efficiency of indigo removal after wastewater treatments.

Acknowledgments

The authors thank for financial support from the Spanish Ministry of Economy and Competitiveness (CTM2012-31461) and Valentina Buscio is granted by UPC. The authors are also grateful to Tejidos Royo for its collaboration in this work.

Author Contributions

Valentina Buscio carried out the experimental work and analysis of results. The experimental was planned by Martí Crespi and Carmen Gutiérrez-Bouzán. All the authors participated in the writing of the manuscript.

Conflicts of Interest

The authors declare no conflict of interest.

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© 2014 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).

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Setamol Drug Information, Indications - Other Medicaments on

Setamol Drug Information Setamol forms, composition and dosages: Indications, usages and classification codes:
  • N02BE01 - Acetaminophen (Paracetamol)

There is an additional general information about this medication active ingredient paracetamol (acetaminophen):

Pharmacological action

Analgesic-antipyretic. It has analgesic, antipyretic and weak anti-inflammatory action. The mechanism of action is associated with inhibition of prostaglandin synthesis, the predominant influence on the thermoregulation center in the hypothalamus, enhances heat transfer.

Why is Setamol prescribed?

Pain weak and moderate intensity of different genesis (including headache, migraine, toothache, neuralgia, myalgia, algomenorrhea; pain in trauma, burns). Fever in infectious and inflammatory diseases.

Paracetamol dosage and administration

Oral or rectally adults and adolescents with a body weight over 60 kg is used in a single dose of 500 mg, the multiplicity of admission - up to 4 times / Maximum duration of treatment - 5-7 days.
Maximum dose: single - 1 g, daily - 4 g.
Single dose for oral administration for children aged 6-12 years - 250-500 mg, 1-5 years - 120-250 mg, from 3 months to 1 year - 60-120 mg, up to 3 months - 10 mg / kg. Single dose rectal in children aged 6-12 years - 250-500 mg, 1-5 years - 125-250 mg.
Multiplicity - 4 at intervals of not less than 4 h. The maximum duration of treatment - 3 days.
Maximum dose: 4 single dose per day.

Setamol Side Effects

Digestive system: rarely - dyspepsia; long-term use at high doses - hepatotoxic effects, methemoglobinemia, renal dysfunction and liver, hypochromic anemia. Hemopoietic system: rarely - thrombocytopenia, leukopenia, pancytopenia, neutropenia, agranulocytosis. Allergic reactions: rarely - skin rash, itching, hives.

Contraindications

Chronic active alcoholism, increased sensitivity to paracetamol, marked disturbances of liver function and / or kidney disease, anemia, pregnancy (I term).

Using during pregnancy and breastfeeding

Paracetamol crosses the placental barrier. So far, no observed adverse effects of paracetamol on the fetus in humans.
Paracetamol is excreted in breast milk: the content in milk was 0.04-0.23% of the dose adopted mother.
If necessary, use of paracetamol during pregnancy and lactation (breastfeeding) should carefully weigh the potential benefits of therapy for the mother and the potential risk to the fetus or child.
In experimental studies found no embryotoxic, teratogenic and mutagenic action of paracetamol.

Special Instructions

With caution used in patients with disorders of the liver and kidneys, with benign hyperbilirubinemia, as well as in elderly patients.
With prolonged use of paracetamol is necessary to monitor patterns of peripheral blood and functional state of the liver.
Used for treatment of premenstrual tension syndrome in combination with pamabrom (diuretic, a derivative of xanthine) and mepyramine (Histamine H1-receptors blocker).

Setamol Drug Interactions

With the simultaneous use with inducers of microsomal liver enzymes, means having hepatotoxic effect, increasing the risk of hepatotoxic action of paracetamol.
With the simultaneous use of anticoagulants may be slight to moderate increase in prothrombin time.
With the simultaneous use of anticholinergics may decrease absorption of paracetamol.
With the simultaneous use of oral contraceptives accelerated excretion of paracetamol from the body and may reduce its analgesic action.
With the simultaneous use with urological means reduced their effectiveness.
With the simultaneous use of activated charcoal reduced bioavailability of paracetamol.
When applied simultaneously with diazepam may decrease excretion of diazepam.
There have been reports about the possibility of enhancing mielodepression effect of zidovudine while applying with paracetamol. A case of severe toxic liver injury.
Described cases of toxic effects of paracetamol, while the use of isoniazid.
When applied simultaneously with carbamazepine, phenytoin, phenobarbital, primidonom decreases the effectiveness of paracetamol, which is caused by an increase in its metabolism and excretion from the body. Cases of hepatotoxicity, while the use of paracetamol and phenobarbital.
In applying cholestyramine a period of less than 1 h after administration of paracetamol may decrease of its absorption.
At simultaneous application with lamotrigine moderately increased excretion of lamotrigine from the body.
With the simultaneous use of metoclopramide may increase absorption of paracetamol and its increased concentration in blood plasma.
When applied simultaneously with probenecid may decrease clearance of paracetamol, with rifampicin, sulfinpyrazone - may increase clearance of paracetamol due to increasing its metabolism in the liver.
At simultaneous application with ethinylestradiol increases absorption of paracetamol from the gut.
Enhances the effect of indirect anticoagulants (coumarin derivatives and indandione). Antipyretic and analgesic activity of caffeine increases, reduce - rifampicin, phenobarbital and alcohol (accelerated biotransformation, inducing microsomal liver enzymes).

Setamol in case of emergency / overdose

At a reception in toxic doses (10-15 g in adults) may develop liver necrosis.
Symptoms of overdose may include: nausea, vomiting, loss of appetite, sweating, extreme tiredness, unusual bleeding or bruising, pain in the upper right part of the stomach, yellowing of the skin or eyes, flu-like symptoms

Storage Conditions

In a dry, protected from light place, temperature 15-25 °C. Expiration date for paracetamol: 3 years.

PLEASE, BE CAREFUL!

Be sure to consult your doctor before taking any medication!

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PPT - PAIN Principles and Nursing Management PowerPoint presentation

PAIN Principles and Nursing Management - PowerPoint PPT Presentation

Transcript and Presenter's Notes


Title: PAIN Principles and Nursing Management


1
PAINPrinciples and Nursing Management
2
Disclaimer
  • Views presented in this lecture are intended to
    expand your reasoning and not to offend, demean
    or insult anybody

3
Chances are that you know someone in pain!
  • 3.2 million people are living with pain and more
    women than men are affected
  • Productivity loss is 11.7 billion annually, or
    34 per cent of total pain-related costs
  • The burden of disease accounts for a further
    third at 11.5 billion
  • Health system costs account for 7 billion,
    around 20 per cent of total pain-related costs

4
The Australian Pain Society
  • Australian Pain Society Vision
  • All people should have timely access to pain
    management.
  • Australian Pain Society Mission Statement
  • The Australian Pain Society is a
    multidisciplinary body that aims to reduce pain
    and related suffering through leadership in
    clinical practice, education, research, and
    public advocacy.

5
International Association for the study of pain
  • Vision Statement Working together for pain
    relief throughout the world
  • Mission IASP brings together scientists,
    clinicians, health care providers, and policy
    makers to stimulate and support the study of pain
    and to translate that knowledge into improved
    pain relief worldwide.

6
Gold Rush
7
Pain as pleasure
  • Algolagnia is a sexual tendency which is defined
    by deriving sexual pleasure and stimulation from
    physical pain, particularly involving an
    erogenous zone.
  • Sadism refers to sexual or non-sexual
    gratification in the infliction of painor
    humiliation upon or by another person. Masochism
    refers to sexual or non-sexual gratification in
    the infliction of pain or humiliation upon
    oneself

8
Pain its causes
  • Unpleasant sensory emotional experience
    associated with actual or potential tissue damage
  • May be acute or chronic
  • Pain is a subjective experience there is no
    accurate assessment for the degree of pain
    experienced

9
Pain as pain
  • pain is defined by the International Association
    for the Study of Pain (IASP) as "an unpleasant
    sensory and emotional experience associated with
    actual or potential tissue damage, or described
    in terms of such damage".
  • Pain is highly subjective to the individual
    experiencing it. A definition that is widely used
    in nursing was first given as early as 1968 by
    Margo McCaffery "'Pain is whatever the
    experiencing person says it is, existing whenever
    he says it does".

10
Stress as pain
11
Questions Regarding Pain Control
  • What about the 20 who do not get relief from the
    WHO ladder or the 46 of those whose families
    stated we failed?
  • Have the opioids been titrated aggressively?
  • Is the pain neuropathic?
  • Has a true pain assessment been accomplished?
  • Have invasive techniques been employed?
  • Have you examined the patient?
  • Is the patient receiving their medication?
  • Is the medication schedule and route appropriate?

12
Physiological effects of Pain
  • Increased catabolic demands poor wound healing,
    weakness, muscle breakdown
  • Decreased limb movement increased risk of DVT/PE
  • Respiratory effects shallow breathing,
    tachypnea, cough suppression increasing risk of
    pneumonia and atelectasis
  • Increased sodium and water retention (renal)
  • Decreased gastrointestinal mobility
  • Tachycardia and elevated blood pressure

13
Psychological effects of Pain
  • Negative emotions anxiety, depression
  • Sleep deprivation
  • Existential suffering may lead to patients
    seeking active end of life.

14
Immunological effects of Pain
  • Decrease natural killer cell counts
  • Effects on other lymphocytes not yet defined.

15
Procedure Related Pain
  • Common in all patients
  • Frequent source of pain and distress

16
Therapeutic Procedures
  • Surgery
  • Only 50 of post-operative pain is adequately
    managed
  • Post-operative pain syndromes
  • Traumatic neuroma
  • Similar to other chronic pain syndromes
  • Psychological factors important
  • Treat symptoms
  • Maintain functional status

17
Principles of Assessment
  • Assess and reassess
  • Use methods appropriate to cognitive status and
    context
  • Assess intensity, relief, mood, and side effects
  • Use verbal report whenever possible
  • Document in a visible place
  • Expect accountability
  • Include the family

18
Pain Assessment
  • What methods can be used to assess pain?

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20
Patient Pain History
  • Site(s) of pain?
  • Severity of pain?
  • Date of onset?
  • Duration?
  • What aggravates or relieves pain?
  • Impact on sleep, mood, activity?
  • Effectiveness of previous medication?

21
Assessing pain in patients with dementia
  • Behavioral chances
  • Mood changes
  • Facial expression
  • Body language
  • Speech
  • Signs of physical examination

22
What Does Pain Mean to Patients?
  • Poor prognosis or impending death
  • Particularly when pain worsens
  • Decreased autonomy
  • Impaired physical and social function
  • Decreased enjoyment and quality of life
  • Challenges to dignity
  • Threat of increased physical suffering

23
Neuropathic Pain
24
Damned if do and damned if you dont
  • Over prescribing pain pain killers
  • reckless malpractice
  • charged with drug trafficking
  • manslaughter or murder
  • Under treating pain
  • sued for abuse

25
How do we get addicted
26
How do families influence addiction
27
Do families share the tablets.
28
Some medication have socially unacceptable side
effects
29
Useful but socially unacceptable side effects
30
There is no such thing as an old junkie
31
They said go to rehab and I SAID NO NO
32
Thinking out side the circle
  • A young woman went to her doctor complaining of
    pain."Where are you hurting?" asked the
    doctor."You have to help me, I hurt all over",
    said the woman."What do you mean, all over?"
    asked the doctor, "be a little more
    specific."The woman touched her right knee with
    her index finger and yelled, "Ow, that hurts."
    Then she touched her left cheek and again yelled,
    "Ouch! That hurts, too." Then she touched her
    right earlobe, "Ow, even THAT hurts", she
    cried.The doctor checked her thoughtfully for a
    moment and told her his diagnosis, "You have a
    broken finger."

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50
Physiology of Pain
  • Physical sensation of pain
  • Nerve endings are stimulated causing an impulse
    along the nerve pathway to the brain pain
    response
  • Psychological component
  • Emotional response based on pain threshold (level
    of nerve ending stimulus)

51
The perception of pain
  • Involves
  • Painful stimulus
  • (chemical, mechanical, thermal )
  • Tissue damage
  • Release of chemicals from damaged tissues
  • Enhanced by the release of prostaglandins
  • Stimulation of pain receptive fibres
  • (nocioreceptive)
  • Transmission of pain signals to the brain
  • recognition of pain by the brain

52
Classification of Pain
  • Acute
  • Chronic
  • 6 months or longer
  • Visceral
  • Dull aching due to stimulations of smooth muscle
    nerve endings
  • Somatic
  • Pain of skeletal muscles
  • Neuropathic
  • Burning, shooting, tingling caused by
    peripheral nerve injury
  • Psychogenic

53
Pain suppression can involve
  • Inhibition of prostaglandin production
  • Blocking transmission of pain messages
  • Blocking perception of pain at brain level
  • Non-narcotic analgesics have a direct effect on
    pain producing lesions, stopping pain at the
    source
  • Musculo-skeletal pain responds well to
    non-narcotic analgesics
  • Narcotic analgesics have an action only on the
    central nervous system
  • Non-narcotic analgesics are ineffective for
    visceral pain

54
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55
Non Pharmaceutical pain relief methods
56
WHO guidelines on analgesic use
  • By the ladder
  • By the clock
  • By the mouth
  • For the individual
  • With attention to detail

57
Analgesic Ladder
58
Analgesics
  • Paracetamol
  • NSAIDS
  • Narcotics/Opioids
  • Others?

59
Paracetamol
  • Action
  • Analgesic, anti-pyretic
  • Dose 0.5 1 gm, 4 hourly up to 4 gm daily.
  • Adverse Effects
  • nausea dyspepsia
  • allergic reaction
  • haematological reactions
  • hepatic necrosis
  • Nursing Points
  • Use with caution in hepatic or renal dysfunction

60
Paracetamol
  • Tylenol, Herron
  • Paralgin, Parahexal
  • Setamol, Panadol
  • Plus Codeine
  • Panadeine
  • Panadeine forte
  • Paracetamol overdose
  • Acetylcysteine (Parvolex)
  • Used for O/D 10 g or more (adult)

61
NSAIDs e.g. Diclofenac
  • Diclohexal, Fenac, Voltaren
  • inhibits biosynthesis of prostaglandins
  • anti-pyretic, anti-inflammatory, analgesic,
    anti-rheumatic
  • Uses
  • rheumatic arthritis oesteoarthritis
  • primary dysmenorrhea
  • post-operative inflammation
  • acute or chronic pain states due to inflammation
  • Dose 75 150 mg bd or tds

62
Diclofenac
  • Adverse Effects
  • gastrointestinal disturbances
  • Headache, dizziness, vertigo
  • Rash, puriris, urticaria
  • peripheral oedema
  • Nursing Points
  • should be swallowed whole with fluid and taken
    with food.
  • should not be used during pregnancy.

63
Other Anti-Inflammatories
  • Commonly used anti-inflammatories.
  • Diflunisal
  • Ketoprofen
  • Ibuprofen
  • Methyl Salicylate
  • Indomethacin
  • Aproxen

64
Narcotic (Opioid) Analgesics
  • Drugs that mimic endogenous opioid peptides
  • Cause prolonged activation of opioid receptors
    producing analgesia, euphoria and sedation
  • Routes may include oral, S/C, IM, IV, epidural,
    rectal, dermal patches
  • Oral absorption is irregular, up to 70 may be
    removed by 1st pass metabolism
  • Natural Opioids
  • The body has naturally occurring opioid receptors
    and produces its own opioid like compounds
  • Endorphins, dynorphins, enkephalins

65
Opioid Analgesics
  • Moderate pain
  • Codeine Phosphate
  • Dextromovamide (Palfium)
  • Detropropoxyphene (Dolobid)
  • Pentazorine (Fortral)
  • Pethidine
  • Tramadol (Tramal)
  • Moderate to Severe pain
  • Fentanyl
  • Methadone
  • Morphine
  • M.S Contin
  • Oxycodone (Endone, Proladone)

66
Opioids
  • Used for moderate to severe pain
  • Used as part of anaesthesia
  • Produses euphoria person is aware of pain, but
    is not bothered by it
  • CNS effects enhanced by alcohol. Sedatives,
    tranquillisers
  • More effective if given before onset of intense
    pain

67
Adverse effects
  • Nausea Vomiting
  • Anorexia
  • Constipation-decreased peristalsis due to opioid
    receptors in GIT
  • Difficulty voiding
  • Anti-diuretic
  • Decreased sexual function
  • Decreased cough

68
Adverse effects
  • Respiratory depression
  • Drowsiness, confusion
  • Bradycardia, postural hypotension
  • Miosis pupliary constriction
  • Euphoria or dysphoria
  • Sweating
  • Allergic reactions
  • Dependence
  • Tolerance

69
Opioid overdose Naloxone
  • Specific opioid antagonist
  • Reverses respiratory depression
  • Will precipitate a withdrawal syndrome when
    dependence has occurred
  • Overcaution in the use of opioid analgesics can
    result in unnecessarily poor pain control in
    patients

70
Morphine
  • Analgesia post operative pain, cancer
  • Relief of anxiety dyspnoea (APO)
  • Oral, S/C, IMI, IV, slow release, mixtures
  • Half life approximately 4 hours
  • High doses may be necessary in terminal cancer
  • Oxycodone Endone, Prolodone
  • Less marked side effects
  • Longer duration (8-10 hours

71
Pethidine
  • Analgesia
  • Obstetrics does not affect uterine contractions
  • Less biliary spasm than morphine
  • Less urinary retention constipation
  • No effect on cough
  • Half life approximately 3 hours
  • Less duration than morphine
  • Metabilites may accumulate causing seizures

72
Fentanyl
  • Avaliable for IV, epidural use
  • Transdermal for chronic stabilised pain
  • Patches last approx 3 days
  • Less risk of constipation

73
Tramadol
  • An atypical opioid which is a centrally acting
    analgesic, used for treating moderate to severe
    pain.
  • S4 Available oral, SR tablet (100,200,300).
  • IM. IV preparations
  • Usually does not produce respiratory depression,
    euphoria, tolerance or addiction

74
Codeine
  • If more than 8 mg prescription required
  • May be habit forming
  • Mild to moderate pain
  • Useful for cough suppression, diarrhoea

75
Equianalgesic table
Drug Dose 10mg morphine Duration (hrs) pharmakokinetics
hydromorphine IM/IV 1.5-2mg oral 6-7.5mg 2-4 2-4
Fentanyl 150-200 mcg SC/IV/transdermal 0.5-2 Useful in renal failure
Morphine IM/IV 10mg oral 30mg 2-4 2-3 (CR 12-24)
Methadone IM/O 10mg 24 Accumulates in body
Oxycodone oral 20-30mg 3-4 12-24 CR Alternative to morphine
Tramadol IM 40-50 mg oral 100mg 3-6 3-6 Low abuse potential
Pethidine IM 75-100 mg 2-3 C/I in renal failure
Codeine IM 130 mg Oral 200mg 3-4 3-4
76
Anaesthetics
  • General anaesthesia
  • Premedication
  • Induction of anaesthesia
  • Maintenace of anaesthesis
  • Reversal of anesthesia
  • Local anaesthetics
  • Local infiltration
  • Nerve blocks
  • Epidurals

77
General anaesthesia
  • Premedication (less common now)
  • Relieve anxiety (Anxiolytic)
  • Reduce saliva anticholinergic (atropine)
  • Increase stomach pH (ranididine)
  • Induction of anaesthesia
  • Thiopentone
  • Rapid acting but metabolised slowly may
    accumulate in the tissues. Used to induce
    anaesthesia
  • Propofol
  • Ketamine
  • Also has analgesic properties

78
General anaesthesia
  • Maintenance of anaesthesia
  • Inhalational anaesthetics
  • Nitrous oxide
  • Halophane etc
  • Muscle relaxants /-
  • Curare
  • Suxamethonium
  • Pancuronium etc
  • Reversal of anaesthesia
  • Anticholinesterase anticholinergic (?S/E)
  • Neostigmine atropine

79
Local Anaesthetics
80
GA for procedures in children
81
(No Transcript)

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