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Häfner N, Kritsch D, Hoffmann F, Steinbach D, Diebolder H, Dürst M, Runnebaum IB. Analyse von Genen mit Cisplatin-Resistenz-assoziierter Hypermethylierung in Ovarialkarzinomzelllinien. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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102
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Hoffmann F, Meinl E. B cells in multiple sclerosis: good or bad guys?: An article for 28 May 2014 - World MS Day 2014. Eur J Immunol 2014; 44:1247-50. [PMID: 24771624 DOI: 10.1002/eji.201470045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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103
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Hoffmann F, Schmiemann G, Windt R. [Perceptions of GPs and community pharmacists on hypnotic prescribing on private prescriptions]. Dtsch Med Wochenschr 2014; 139:1153-8. [PMID: 24845524 DOI: 10.1055/s-0034-1369995] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIM Zolpidem and zopiclone ("Z-drugs") and benzodiazepine hypnotics are reimbursed by the statutory health insurance for short-term use and in exceptional cases for longer periods. A large proportion is prescribed on private prescriptions. The aim of this study was to assess the perceptions of general practitioners (GPs) and community pharmacists (CPs) on private prescriptions of hypnotics regarding frequency, reasons and measures for reduction. METHODS A questionnaire was mailed to a random sample of 1,350 GPs and 600 CPs in 2012. Questions were partly identical. Due to multiple testing, only p-values ≤ 0.01 were considered statistically significant. RESULTS 458 GPs and 202 CPs returned questionnaires (response 33.9 % and 33.7 %). According to the CPs, the proportions of private prescriptions was higher for Z-drugs than for benzodiazepines (57.5 vs. 47.4 %; p < 0.0001). The proportion of private prescriptions of Z-drugs was higher in the eastern than in the western part of Germany (78.2 vs. 52.3 %; p < 0.0001). For benzodiazepines no such differences were found. As most relevant reasons for private prescriptions, the specifications of the Arzneimittel-Richtlinie and patients' demands were named. Patients with long-term use receive more often private prescriptions. CONCLUSIONS A switch to private prescriptions for patients with long-term use seems conflicting, because such patients with (iatrogenic) dependence are indicated exceptional cases. Practicable changes of the regulatory framework are needed, their benefits and harms should be evaluated.
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Faiss JH, Dähne D, Baum K, Deppe R, Hoffmann F, Köhler W, Kunkel A, Lux A, Matzke M, Penner IK, Sailer M, Zettl UK. Reduced magnetisation transfer ratio in cognitively impaired patients at the very early stage of multiple sclerosis: a prospective, multicenter, cross-sectional study. BMJ Open 2014; 4:e004409. [PMID: 24722197 PMCID: PMC3987712 DOI: 10.1136/bmjopen-2013-004409] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/24/2014] [Accepted: 02/27/2014] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Cognitive impairment belongs to the core symptoms in multiple sclerosis (MS) and can already be present at the very early stages of the disease. The present study evaluated cognitive functioning after the first clinical presentation suggestive of MS and brain tissue damage in a non-lesion focused MRI approach by using magnetisation transfer imaging (MTI). SETTING AND PARTICIPANTS 47 patients (15 men and 32 women; mean age: 31.17 years) after the first clinical event suggestive of MS were recruited in six different MS centres in Germany and underwent a neuropsychological test battery including tests for attention, memory and executive function as well as depression and fatigue. MTI and conventional MRI measures (T1/T2 lesion load) were assessed. In addition, Magnetisation Transfer Ratio (MTR) maps were calculated. Primary outcome measure was the investigation of cognitive dysfunction in very early MS in correlation to MRI data. RESULTS 55.3% of patients with MS failed at least one test parameter. Specifically, 6% were reduced in working memory, 14.9% in focused attention, 25.5% in figural learning and up to 14.9% in executive function. When the sample was subdivided into cognitively impaired and preserved, MTR scores within the cognitively impaired subgroup were significantly lower compared with the preserved group (t(43)=2.346, p=0.02*). No significant differences between the two groups were found in T2-weighted and T1-weighted lesion volume. CONCLUSIONS After the first MS-related clinical event, 55.3% of patients showed distinct cognitive deficits. Cognitively impaired patients had significantly lower whole brain MTR, but no differences in focal brain lesion volumes supporting the idea that early cognitive deficits may be related to diffuse loss of brain tissue integrity.
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Köhler W, Ehrlich S, Dohmen C, Haubitz M, Hoffmann F, Schmidt S, Klingel R, Kraft A, Neumann-Haefelin T, Topka H, Stich O, Baumgartner A, Fassbender C. Tryptophan immunoadsorption for the treatment of autoimmune encephalitis. Eur J Neurol 2014; 22:203-6. [DOI: 10.1111/ene.12389] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/28/2014] [Indexed: 01/30/2023]
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Meyer D, Dong J, Garbrecht M, Hoffmann F, Brinksmeier E, Zoch HW. Mechanisch induziertes Härten*. ACTA ACUST UNITED AC 2013. [DOI: 10.3139/105.110048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Kurzfassung
Seit dem Jahr 2001 wird an der Stiftung Institut für Werkstofftechnik Bremen (IWT) ein neues endwärmebehandlungsfreies Verfahren zur Herstellung von randschichtgehärteten Stahlbauteilen erforscht. Bei diesem Verfahren wird die Randschichthärtung durch eine mechanisch induzierte martensitische Phasenumwandlung in die Fertigungslinie integriert. Neben einer deutlichen Verkürzung der Produktionsdauer wird die lokale Härtung von Funktionsflächen eines Bauteils ermöglicht. Zudem kommt es durch die Einsparung einer abschlieβenden Wärmebehandlung zu einer signifikanten Reduzierung des Energieverbrauchs und der damit verbundenen CO2-Emission.
Um eine spannungs- bzw. dehnungsinduzierte martensitische Phasenumwandlung aufgrund von rein mechanischen Effekten zu ermöglichen, wird zunächst ein bei Raumtemperatur metastabiles austenitisches Gefüge hergestellt. Dieser Werkstoffzustand soll so stabil sein, dass eine spanende Bearbeitung keine ausgedehnte martensitische Phasenumwand-lung auslöst und das Werkstück somit noch “weich” bearbeitet werden kann. In einem anschlieβenden mechanischen Verfahren, wie z. B. einem Festwalzprozess, soll die auf die Werkstückoberfläche ausgeübte Pressung so weit gesteigert werden, dass die zur martensitischen Umwandlung des Austenits benötigte Spannung in der Bauteilrandzone erreicht wird.
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Hohenauer T, Berking C, Schmidt A, Haferkamp S, Senft D, Kammerbauer C, Fraschka S, Graf SA, Irmler M, Beckers J, Flaig M, Aigner A, Höbel S, Hoffmann F, Hermeking H, Rothenfusser S, Endres S, Ruzicka T, Besch R. The neural crest transcription factor Brn3a is expressed in melanoma and required for cell cycle progression and survival. EMBO Mol Med 2013; 5:919-34. [PMID: 23666755 PMCID: PMC3779452 DOI: 10.1002/emmm.201201862] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 03/28/2013] [Accepted: 04/04/2013] [Indexed: 01/28/2023] Open
Abstract
Pigment cells and neuronal cells both are derived from the neural crest. Here, we describe the Pit-Oct-Unc (POU) domain transcription factor Brn3a, normally involved in neuronal development, to be frequently expressed in melanoma, but not in melanocytes and nevi. RNAi-mediated silencing of Brn3a strongly reduced the viability of melanoma cell lines and decreased tumour growth in vivo. In melanoma cell lines, inhibition of Brn3a caused DNA double-strand breaks as evidenced by Mre11/Rad50-containing nuclear foci. Activated DNA damage signalling caused stabilization of the tumour suppressor p53, which resulted in cell cycle arrest and apoptosis. When Brn3a was ectopically expressed in primary melanocytes and fibroblasts, anchorage-independent growth was increased. In tumourigenic melanocytes and fibroblasts, Brn3a accelerated tumour growth in vivo. Furthermore, Brn3a cooperated with proliferation pathways such as oncogenic BRAF, by reducing oncogene-induced senescence in non-malignant melanocytes. Together, these results identify Brn3a as a new factor in melanoma that is essential for melanoma cell survival and that promotes melanocytic transformation and tumourigenesis.
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Kosulin K, Hoffmann F, Clauditz TS, Wilczak W, Dobner T. Presence of adenovirus species C in infiltrating lymphocytes of human sarcoma. PLoS One 2013; 8:e63646. [PMID: 23671688 PMCID: PMC3646006 DOI: 10.1371/journal.pone.0063646] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/04/2013] [Indexed: 11/19/2022] Open
Abstract
Human adenoviruses are known to persist in T-lymphocytes of tonsils, adenoids and intestinal tract. The oncogenic potential of different adenovirus types has been widely studied in rodents, in which adenovirus inoculation can induce multiple tumors such as undifferentiated sarcomas, adenocarcinomas and neuroectodermal tumors. However, the oncogenic potential of this virus has never been proven in human subjects. Using a highly sensitive broad-spectrum qRT-PCR, we have screened a set of different human sarcomas including leiomyosarcoma, liposarcoma and gastro intestinal stroma tumors. Primers binding the viral oncogene E1A and the capsid-coding gene Hexon were used to detect the presence of adenovirus DNA in tumor samples. We found that 18% of the tested leiomyosarcomas and 35% of the liposarcomas were positive for the presence of adenovirus DNA, being species C types the most frequently detected adenoviruses. However, only in one sample of the gastro intestinal stroma tumors the virus DNA could be detected. The occurrence of adenovirus in the tumor sections was confirmed by subsequent fluorescence in-situ-hybridization analysis and co-staining with the transcription factor Bcl11b gives evidence for the presence of the virus in infiltrating T-lymphocytes within the tumors. Together these data underline, for the first time, the persistence of adenovirus in T-lymphocytes infiltrated in muscular and fatty tissue tumor samples. If an impaired immune system leads to the viral persistence and reactivation of the virus is involved in additional diseases needs further investigation.
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Rose A, Keßler O, Hoffmann F, Zoch HW, Krug P. Age hardening of forged aluminum components – distortion behavior after gas quenching∗. ACTA ACUST UNITED AC 2013. [DOI: 10.3139/105.100407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
In quenching of age hardenable aluminum alloys, today predominantly aqueous quenching media are used, which can lead to a non-uniform cooling of the components due to the Leidenfrost phenomenon, and thus to distortion. In relation to the conventional quenching procedures in aqueous media, gas quenching has a number of technological, ecological, and economical advantages. The quenching intensity can be adjusted by the variable parameters gas pressure, gas velocity as well as the kind of gas and thus can be adapted to the requirements of the component. By the higher uniformity and the better reproducibility, gas quenching offers a high potential for reducing distortion. It could be demonstrated that characteristic shape and dimension changes of forged components of the spray formed aluminum alloy DISPAL S232 (Al-17Si-4Fe-3Cu-0.5Mg-0.4Zr) are clearly lower after gas quenching than after water quenching. Thereby suitable processes proved to be high-pressure gas quenching with nitrogen at 10 bar as well as air quenching in a gas nozzle field. Cost saving would be possible, because of reduced distortion and therefore less reworking.
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Heinzel O, Daub J, Heimberg E, Gloning H, Hoffmann F. Erratum zu: Ausrüstung für Kindernotfälle – Praktische Empfehlungen für Klinik und Praxis. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-012-2856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hoffmann F. Perceptions of German GPs on benefits and risks of benzodiazepines and Z-drugs. Swiss Med Wkly 2013; 143:w13745. [PMID: 23348819 DOI: 10.4414/smw.2013.13745] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
QUESTIONS UNDER STUDY In many countries newer non-benzodiazepines, zolpidem and zopiclone ("Z-drugs"), are prescribed instead of benzodiazepine hypnotics. This is not supported by current evidence and guidelines. The aim of this study was to compare the perceptions of GPs on the benefits and harms of benzodiazepines and Z-drugs. METHODS A questionnaire was mailed to a random sample of 1,350 German GPs between May and June 2012. GPs were asked to rate their perceptions on a five-point Likert scale for 12 items asked for both benzodiazepines and Z-drugs. Wilcoxon signed rank test for paired observations was used for comparison between groups. Due to multiple testing, only p values ≤0.01 were considered statistically significant. RESULTS A total of 458 questionnaires were returned (response 33.9%). The mean age of participants was 53.3 years (59.4% males). GPs perceived that Z-drugs were significantly more effective in terms of reduced night-time waking, feelings of being rested on waking and improved daytime functioning than benzodiazepines (p <0.0001 for all comparisons), but not in terms of reduced time to get to sleep and increased total sleep time. All studied side effects were believed to be less often for patients receiving Z-drugs (p <0.0001 for all comparisons). A total of 73.4% and 80.4% answered that tolerance or withdrawal effects on stopping occur often or very often/always for benzodiazepines, whereas these values were only 30.6% and 28.7% for Z-drugs. CONCLUSIONS German GPs perceived that Z-drugs were more effective and safer compared to benzodiazepines, which is not supported by current evidence. The results are quite comparable to a British survey conducted seven years before.
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Hoffmann F. Wie schätzen Hausärzte den Nutzen und Schaden von Benzodiazepinen im Vergleich zu Z-Drugs bei Insomnien ein? Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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113
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Koller D, Hoffmann F, Maier W, Tholen K, Windt R, Glaeske G. Variation in antibiotic prescriptions: is area deprivation an explanation? Analysis of 1.2 million children in Germany. Infection 2012; 41:121-7. [PMID: 22826031 DOI: 10.1007/s15010-012-0302-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/04/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Inadequate use of antibiotics can lead to problems such as resistance. Overuse is especially a problem for children, since they are more affected by acute (often virus-caused) infections. While the problem has been addressed internationally over the past several years, regional variations in prescriptions are striking. Therefore, the present study aims to analyze regional variations in antibiotic prescription on a district level in Germany and tries to identify reasons for those variations through adding possible influencing factors to the analysis on individual and district levels. METHODS We analyzed 1.2 million children insured in a German health insurance fund. Antibiotic prescriptions were quantified in 2010 and reasons for prescriptions were analyzed in multilevel regressions based on the district of residence, regional deprivation, and age and sex of the child. RESULTS Thirty-six percent of all children aged 0-17 years received an antibiotic prescription in 2010. In the south, prevalences are generally lower, and also to the very north. The highest prevalences are found in the close-to-border districts in the west, as well as in a band throughout the middle of Germany, in rather low population density areas. Regional variation in the prevalence range from 19 to 53 % between districts. Regional deprivation can explain part of this variation. CONCLUSIONS Including area deprivation measures helped identify an influence of especially regional income and occupational deprivation on antibiotic prescriptions for children. Regional analysis such as this can help identify specific regions and groups of persons to address information programs on the risks of preventable antibiotic consumption and alternative treatment methods.
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Schimrigk S, Adibi I, Eberl A, Selka I, Galle J, Schmidt S, Fritz H, Fassbender C, Klingel R, Füchtemann D, Hoffmann F. Immunadsorption zur Eskalation der Schubtherapie bei Multipler Sklerose. AKTUELLE NEUROLOGIE 2012. [DOI: 10.1055/s-0032-1305029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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115
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Schimrigk S, Adibi I, Eberl A, Selka I, Galle J, Schmidt S, Fritz H, Fassbender C, Klingel R, Füchtemann D, Hoffmann F. Immunadsorption zur Eskalation der Schubtherapie bei Multipler Sklerose. AKTUELLE NEUROLOGIE 2012. [DOI: 10.1055/s-0032-1321387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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116
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Bublak P, Schwab M, Deppe R, Faiss J, Fischer M, Hoffmann F, Kunkel A, Redel P, Stadler E, Sailer M, Voigt K, Zettl U, Koehler W. Parametric Assessment of Information Processing Capacity at Different States of Multiple Sclerosis (MS) (P04.100). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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117
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Sailer M, Bublak P, Deppe R, Faiss J, Fischer M, Hoffmann F, Kunkel A, Stadler E, Schwab M, Voigt K, Zettl U, Kohler W. The Impact of Cerebral Atrophy on Information Processing Capacity in Patients with Multiple Sclerosis (P03.074). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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118
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Windt R, Glaeske G, Hoffmann F. [Prescription of TNF-alpha inhibitors and regional differences in 2010]. Z Rheumatol 2012; 70:874-81. [PMID: 21956828 DOI: 10.1007/s00393-011-0873-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tumor necrosis factor alpha (TNF-α) inhibitors are an important treatment option for rheumatoid arthritis and other chronic inflammatory diseases. However, attention should be paid to severe adverse drug reactions and very high costs of therapy. The objective of this study was to examine the prescription and costs of TNF-α inhibitors as well as regional differences at the district level in Germany. For this purpose, prescription claims data of a German health fund with 9.1 million insured persons from the year 2010 were analyzed. A total of 45,229 packs (0.1% of all prescribed drugs) and 3.15 million defined daily doses (DDD) of TNF-α inhibitors were prescribed. This leads to a total pharmacy revenue of 163.18 million Euro (share 4.1%) and 1 DDD costs on average 51.61 Euro. For 10,078 patients at least one TNF inhibitor was prescribed (prescription prevalence 111 per 100,000) with a higher proportion of women (125 vs. 92 per 100,000). The average revenue per insured person was often higher in districts of eastern Germany (>30 Euro) for reasons unknown. Provided that use is appropriate to indications there are only low saving potentials.
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Hoffmann F, Icks A. Diabetes Epidemic’ in Germany? A Critical Look at Health Insurance Data Sources. Exp Clin Endocrinol Diabetes 2012; 120:410-5. [DOI: 10.1055/s-0032-1306331] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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120
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Hoffmann F, Heimberg E. Notfall: Anaphylaxie. Monatsschr Kinderheilkd 2012. [DOI: 10.1007/s00112-011-2607-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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121
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Prado R, Hoffmann F, Garcı´a-Galán S, Muñoz Expósito J, Bertram T. On Providing Quality of Service in Grid Computing through Multi-objective Swarm-Based Knowledge Acquisition in Fuzzy Schedulers. Int J Approx Reason 2012. [DOI: 10.1016/j.ijar.2011.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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122
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Hoffmann F, Grobe T. Outpatient costs in patients with atrial fibrillation are underestimated. Europace 2011; 13:1801; author reply 1801. [DOI: 10.1093/europace/eur239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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124
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Wolf A, Leibbrand B, Hoffmann F, Zirke K. Die blinde Medizinische Tastuntersucherin (MTU) in der Rehabilitation nach Brustkrebs – Nachsorgediagnostik und/oder psychoonkologischer Support? Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1292715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Hoffmann F, Icks A. Do Persons that Changed Health Insurance Differ From those Who did not? The Case of Diabetes. Exp Clin Endocrinol Diabetes 2011; 119:569-72. [DOI: 10.1055/s-0031-1275277] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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