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Octavius GS, Daleni VA, Sagala YDS. An insight into Indonesia's progress for newborn screening program: What is currently going on. Heliyon 2024; 10:e33479. [PMID: 39035496 PMCID: PMC11259875 DOI: 10.1016/j.heliyon.2024.e33479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/13/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives In this literature review, we describe the progress of Indonesia's NBS program (which is heavily centered on CH screening), its current pilot projects, and what lies ahead for this program. Setting Since its conception began with congenital hypothyroidism (CH) screening, Indonesia has experienced plodding progress in NBS. There is a shortage of literature discussing the history, or the lack of, and journey of NBS in Indonesia. Methods We searched for literature in Pubmed and Google Scholar with keywords such as "Newborn Screening, "Neonatal Screening," "Indonesia," "Asia Pacific," "Congenital Hypothyroidism," "Congenital Adrenal Hyperplasia,""Critical Congenital Heart Disease," "Hearing Loss," and "Inborn Error of Metabolism." Results The only mandatory and regulated NBS program in Indonesia is congenital hypothyroid (CH) screening, with some pilot projects being conducted on screening for congenital adrenal hyperplasia (CAH), critical congenital heart disease (CCHD), hearing loss, and to a lesser extent, inborn error of metabolisms (IEMs). Conclusion Despite the evidence and benefits, the government does not mandate or regulate newborn diseases such as CHD, CAH, hearing loss, and IEMs. The lack of regulation exists despite multiple pilot projects and studies showing a benefit in at least trying to screen newborns for those conditions.
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Affiliation(s)
- Gilbert Sterling Octavius
- Department of Pediatrics, Universitas Pelita Harapan, Banten, Indonesia
- St. Theresia Hospital, Jambi, Indonesia
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2
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Nguyen GT, Gauvreau C, Mansuri N, Wight L, Wong B, Neposlan J, Petricca K, Denburg A. Implementation factors of non-communicable disease policies and programmes for children and youth in low-income and middle-income countries: a systematic review. BMJ Paediatr Open 2024; 8:e002556. [PMID: 38830723 PMCID: PMC11149138 DOI: 10.1136/bmjpo-2024-002556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Despite declared life-course principles in non-communicable disease (NCD) prevention and management, worldwide focus has been on older rather than younger populations. However, the burden from childhood NCDs has mounted; particularly in low-income and middle-income countries (LMICs). There is limited knowledge regarding the implementation of paediatric NCD policies and programmes in LMICs, despite their disproportionate burden of morbidity and mortality. We aimed to understand the barriers to and facilitators of paediatric NCD policy and programme implementation in LMICs. METHODS We systematically searched medical databases, Web of Science and WHOLIS for studies on paediatric NCD policy and programme implementation in LMICs. Screening and quality assessment were performed independently by researchers, using consensus to resolve differences. Data extraction was conducted within the WHO health system building-blocks framework. Narrative thematic synthesis was conducted. RESULTS 93 studies (1992-2020) were included, spanning 86 LMICs. Most were of moderate or high quality. 78% reported on paediatric NCDs outside the four major NCD categories contributing to the adult burden. Across the framework, more barriers than facilitators were identified. The most prevalently reported factors were related to health service delivery, with system fragmentation impeding the continuity of age-specific NCD care. A significant facilitator was intersectoral collaborations between health and education actors to deliver care in trusted community settings. Non-health factors were also important to paediatric NCD policies and programmes, such as community stakeholders, sociocultural support to caregivers and school disruptions. CONCLUSIONS Multiple barriers prevent the optimal implementation of paediatric NCD policies and programmes in LMIC health systems. The low sociopolitical visibility of paediatric NCDs limits their prioritisation, resulting in fragmented service delivery and constraining the integration of programmes across key sectors impacting children, including health, education and social services. Implementation research is needed to understand specific contextual solutions to improve access to paediatric NCD services in diverse LMIC settings.
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Affiliation(s)
- Gina T Nguyen
- University College Dublin School of Medicine, Dublin, Ireland
| | - Cindy Gauvreau
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lisa Wight
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Bryan Wong
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Josh Neposlan
- University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Kadia Petricca
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Avram Denburg
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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3
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Therrell BL, Padilla CD, Borrajo GJC, Khneisser I, Schielen PCJI, Knight-Madden J, Malherbe HL, Kase M. Current Status of Newborn Bloodspot Screening Worldwide 2024: A Comprehensive Review of Recent Activities (2020-2023). Int J Neonatal Screen 2024; 10:38. [PMID: 38920845 PMCID: PMC11203842 DOI: 10.3390/ijns10020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 06/27/2024] Open
Abstract
Newborn bloodspot screening (NBS) began in the early 1960s based on the work of Dr. Robert "Bob" Guthrie in Buffalo, NY, USA. His development of a screening test for phenylketonuria on blood absorbed onto a special filter paper and transported to a remote testing laboratory began it all. Expansion of NBS to large numbers of asymptomatic congenital conditions flourishes in many settings while it has not yet been realized in others. The need for NBS as an efficient and effective public health prevention strategy that contributes to lowered morbidity and mortality wherever it is sustained is well known in the medical field but not necessarily by political policy makers. Acknowledging the value of national NBS reports published in 2007, the authors collaborated to create a worldwide NBS update in 2015. In a continuing attempt to review the progress of NBS globally, and to move towards a more harmonized and equitable screening system, we have updated our 2015 report with information available at the beginning of 2024. Reports on sub-Saharan Africa and the Caribbean, missing in 2015, have been included. Tables popular in the previous report have been updated with an eye towards harmonized comparisons. To emphasize areas needing attention globally, we have used regional tables containing similar listings of conditions screened, numbers of screening laboratories, and time at which specimen collection is recommended. Discussions are limited to bloodspot screening.
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Affiliation(s)
- Bradford L. Therrell
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA
- National Newborn Screening and Global Resource Center, Austin, TX 78759, USA
| | - Carmencita D. Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines;
| | - Gustavo J. C. Borrajo
- Detección de Errores Congénitos—Fundación Bioquímica Argentina, La Plata 1908, Argentina;
| | - Issam Khneisser
- Jacques LOISELET Genetic and Genomic Medical Center, Faculty of Medicine, Saint Joseph University, Beirut 1104 2020, Lebanon;
| | - Peter C. J. I. Schielen
- Office of the International Society for Neonatal Screening, Reigerskamp 273, 3607 HP Maarssen, The Netherlands;
| | - Jennifer Knight-Madden
- Caribbean Institute for Health Research—Sickle Cell Unit, The University of the West Indies, Mona, Kingston 7, Jamaica;
| | - Helen L. Malherbe
- Centre for Human Metabolomics, North-West University, Potchefstroom 2531, South Africa;
- Rare Diseases South Africa NPC, The Station Office, Bryanston, Sandton 2021, South Africa
| | - Marika Kase
- Strategic Initiatives Reproductive Health, Revvity, PL10, 10101 Turku, Finland;
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Vesaphong P, Lindemuth L, Istaz B, Kedsatha P, Saysanasongkham B, Hoehn T. Establishment of a sustainable newborn TSH-screening program in the People's Democratic Republic of Laos. Early Hum Dev 2021; 154:105306. [PMID: 33440296 DOI: 10.1016/j.earlhumdev.2021.105306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/12/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neonatal screening programs have been established and are in use in most countries worldwide. Laos belongs to the few countries which still have not established any kind of newborn screening. METHODS Basis for the current screening was an initial pilot project between 2008 and 2010. Then 11.362 samples of newborn infants were screened, samples were weekly air-shipped to a German screening laboratory. During the current project TSH-measurements take place at the laboratory of the largest delivery hospital in Laos, the Mother & Newborn Hospital in Vientiane. RESULTS Teaching regarding taking samples and doing measurements started in January 2019, until end of July 2020 altogether 3214 samples were measured. None of the samples was above the predefined cutoff of 20μU/l. CONCLUSIONS Newborn screening for congenital hypothyroidism with measurements of samples within Laos is feasible. Plausibility control is achieved by regular checks of screening results sent by email to Germany. The most challenging task is to cover all newborns born at participating hospitals and finally to expand the screening beyond the capital to other areas in the country.
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Affiliation(s)
| | - Lea Lindemuth
- Neonatology and Pediatric Intensive Care Medicine, Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich-Heine-University, Duesseldorf, Germany
| | | | | | | | - Thomas Hoehn
- Neonatology and Pediatric Intensive Care Medicine, Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich-Heine-University, Duesseldorf, Germany.
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Daich Varela M, Moya R, Schlottmann PG, Hufnagel RB, Arberas C, Fernández FM, Inga ME, Lores J, Pachajoa H, Prada CE, Sallum JMF. Ophthalmic genetics in South America. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:753-761. [PMID: 32856789 DOI: 10.1002/ajmg.c.31832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022]
Abstract
South America comprises of heterogeneous topographies, populations, and health care systems. Therefore, it is not surprising to see differences among the countries regarding expertise, education, and practices of ophthalmic genetics for patients with rare eye diseases. Nevertheless, common challenges such as limited genetics training in medical schools and among ophthalmologists, scarcity of diagnostic tools for phenotyping, and expensive genetic testing not covered by the public healthcare systems, are seen in all of them. Here, we provide a detailed report of the current status of ophthalmic genetics, described by the personal views of local ophthalmologists from Brazil, Colombia, Argentina, and Chile. By reporting our strengths and weaknesses as a region, we intend to highlight the need for guidelines on how to manage these patients aligned with public health policies. Our region contributes to research worldwide, with thousands of well diagnosed patients from a number of unique and genetically diverse populations. The constant expansion of ophthalmic genetics and molecular diagnostics requires us to join forces to collaborate across South America and with other countries to improve access to next-generation diagnostics and ultimately improve patient care.
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Affiliation(s)
- Malena Daich Varela
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.,University of Buenos Aires, Buenos Aires, Argentina
| | - Rene Moya
- Departamento de Retina y Departamento de Genética Ocular, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | | | - Robert B Hufnagel
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Claudia Arberas
- Sección Genética Médica, Hospital de Niños "R. Gutiérrez", Buenos Aires, Argentina
| | | | | | - Juliana Lores
- Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Harry Pachajoa
- Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Carlos E Prada
- Hospital Internacional de Colombia, Bucaramanga, Colombia.,Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Juliana M Ferraz Sallum
- Department of Ophthalmology, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Instituto de Genética Ocular, Sao Paulo, Brazil
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Olsen SJ, Vetsaphong P, Vonglokham P, Mirza S, Khanthamaly V, Chanthalangsy T, Chittanavanh S, Syhavong B, Moen A, Bresee J, Corwin A, Xeuatvongsa A. A retrospective review of birth outcomes at the Mother and Child Health Hospital in Lao People's Democratic Republic, 2004-2013. BMC Pregnancy Childbirth 2016; 16:379. [PMID: 27894346 PMCID: PMC5126820 DOI: 10.1186/s12884-016-1168-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background The Lao People’s Democratic Republic (Lao PDR) is a lower-middle income country making steady progress improving maternal and child health outcomes. We sought to ascertain if there have been improvements in three specific birth outcomes (low birth weight, preterm birth and small for gestational age) over the last decade. Methods We retrospectively reviewed birth records between 2004 and 2013 at the Mother and Child Health (MCH) hospital in Vientiane. We defined preterm birth as gestation <37 weeks and low birth weight as <2,500 g. We calculated small for gestational age (SGA). We describe birth outcomes over time and compare proportions using Chi square. Results Between 2004 and 2013, the annual average number of newborns delivered each year was 4,322 and the frequency of low birth weight ranged from 9.5 to 12%, preterm births from 6.3 to 10%, and infants born SGA from 25 to 35%. There were no improvements in these frequencies over time. Women <18 years at delivery had a statistically significantly higher frequency of babies born with a low birth weight (15.3 vs. 10.8%, p < 0.02) or preterm (16.4 vs. 7.8%, p < 0.01) than those aged >18. There was no difference in the frequency of babies born SGA by age (26.8% in women <18 years vs. 29.7% in women >18 years, p = 0.30). Conclusions At the largest maternal and child hospital in Lao PDR, we found a high frequency of poor birth outcomes with no improvements over the last decade.
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Affiliation(s)
- Sonja J Olsen
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.
| | | | | | - Sara Mirza
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | | | | | | | | | - Ann Moen
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Joseph Bresee
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Andrew Corwin
- Influenza Program, CDC, Vientiane, Lao PDR.,The QED Group, American Embassy, Vientiane, Lao PDR
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Schmidt S, Duangdala P, Saysanasongkham B, Sabir H, Brenner S, Schmid M, Kuehn T, Hoehn T. Neonatal Mortality and Morbidity in Regional Provincial Hospitals in the People's Democratic Republic of Laos. J Trop Pediatr 2016; 62:213-9. [PMID: 26851432 DOI: 10.1093/tropej/fmv101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to identify the causes and incidences of neonatal diseases and deaths in five provincial hospitals in People's Democratic Republic of Laos retrospectively for the years 2010-12. METHODS Data of neonatal patients were collected before a 3-year-training program for medical and nursing staff involved in the care of newborn infants in the provincial and associated district hospitals. RESULTS In the years 2010-12, a total of 1673 neonatal patients were treated in the provincial hospitals. The reasons of treatment were as follows: 48% infections, 17% complications of prematurity, 14% intrapartum-related complications and 9% other, not categorized diseases. The average mortality rate in all hospitals was 6.5%. The main causes of death were complications because of prematurity, infectious diseases and asphyxia. CONCLUSION These data could be the basis for any teaching program aimed at reducing neonatal mortality. Furthermore, they enable an evaluation of the ongoing teaching program.
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Affiliation(s)
- Simone Schmidt
- Department of Neonatology and Pediatric Intensive Care, Childreńs University Hospital, Heinrich-Heine University Duesseldorf, 40225, Düsseldorf, Germany
| | - Phouvieng Duangdala
- Department of Pediatrics, Luang Namtha Provincial Hospital, 03000, Luang Namtha, Lao PDR
| | | | - Hemmen Sabir
- Department of Neonatology and Pediatric Intensive Care, Childreńs University Hospital, Heinrich-Heine University Duesseldorf, 40225, Düsseldorf, Germany
| | - Sebastian Brenner
- Department of Pediatric and Adolescent Medicine, University Hospital Dresden, 01307, Dresden, Germany
| | - Manuel Schmid
- Department of Neonatology and Pediatric Intensive Care, University Hospital Ulm, 89075, Ulm, Germany
| | - Thomas Kuehn
- Department of Pediatric and Adolescent Medicine, Vivantes Klinikum Neukölln, 12351, Berlin, Germany
| | - Thomas Hoehn
- Department of Neonatology and Pediatric Intensive Care, Childreńs University Hospital, Heinrich-Heine University Duesseldorf, 40225, Düsseldorf, Germany
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Hoehn T, Lukacs Z, Huckenbeck W, Torresani T, Blankenstein O, Bounnack S. Congenital Adrenal Hyperplasia with Non-functional Mutations in Both Alleles in a Clinically Unaffected Infant. J Trop Pediatr 2016; 62:158-60. [PMID: 26721550 PMCID: PMC4886113 DOI: 10.1093/tropej/fmv078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Results in neonatal screening programs aiming at detection of congenital adrenal hyperplasia (CAH) can only report elevated levels of 17-hydroxy-progesterone (17-OHP), without being able to differentiate presence or absence of salt loss. AIM To predict presence or absence of salt loss in newborn infants with CAH. METHODS The first specimen of suspected CAH in samples sent from People's Democratic Republic of Laos (Lao PDR) was investigated for known mutations in CAH associated with salt loss. RESULTS Molecular genetic diagnosis revealed mutations associated with loss of function in both alleles; however, the infant was clinically unaffected even without any corticosteroid substitution therapy. CONCLUSIONS Although molecular genetic methods can theoretically predict loss of function in CAH, our infant was clinically unaffected even without therapy at 6 years of age. We speculate that in CAH, remaining enzyme activity can be sufficiently high, despite the presence of loss of function mutations, which do not affect infants clinically.
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Affiliation(s)
- Thomas Hoehn
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Neonatology and Pediatric Intensive Care Medicine, Heinrich-Heine-University, Duesseldorf 40225, Germany
| | - Zoltan Lukacs
- Newborn Screening and Metabolic Diagnostics, Hamburg University Medical Center, Hamburg 20246, Germany
| | | | | | - Oliver Blankenstein
- Institute for Experimental Pediatric Endocrinology, Charité-Universitätsmedizin Berlin, Berlin 13353, Germany
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Abstract
Detection by newborn screening (NBS) and treatment of babies with congenital hypothyroidism (CH) has largely eliminated the intellectual disability caused by this disorder. Lowering of the screening TSH cutoff and changes in birth demographics have been associated with an approximate doubling of the incidence of CH, from 1:3500 to 1:1714. The additional cases detected by lowering of the TSH cutoff tend to have milder hypothyroidism, with imaging often demonstrating a eutopic, "gland in-situ", and some cases turn out to have transient CH. Based on our search for current screening programs, approximately 71 percent of babies worldwide are not born in an area with an established NBS program, despite the existence of screening for over five decades in developed countries. Thus, the majority of babies with CH worldwide are not detected and treated early, such that the economic burden of retardation owing to CH remains a significant public health challenge.
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Affiliation(s)
- George Ford
- Department of Pediatrics [CDRCP], Doernbecher Children's Hospital, Oregon Health & Science University, 707 SW Gaines St., Portland, OR 97239-3098, USA.
| | - Stephen H LaFranchi
- Department of Pediatrics [CDRCP], Doernbecher Children's Hospital, Oregon Health & Science University, 707 SW Gaines St., Portland, OR 97239-3098, USA.
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