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Crealey GE, Hackett C, Harkin K, Heckmann P, Kelleher F, Lyng Á, McCarthy T, McEnery M, Meaney C, Roche D, Tobin AM. Melanoma-related costs by disease stage and phase of management in Ireland. J Public Health (Oxf) 2023; 45:714-722. [PMID: 37169550 PMCID: PMC10470331 DOI: 10.1093/pubmed/fdac154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/08/2022] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Management options for the treatment of melanoma have expanded in recent years. In an era of promising, but expensive novel pharmacological treatments, robust stage-specific melanoma-related cost estimates are necessary to support budgetary planning, evaluation of cost-effectiveness and to contribute to the investment case for prevention. METHODS A detailed decision model, describing the melanoma care pathway (by disease stage) from diagnosis, through treatment and follow-up was developed over a 5-year time frame from the perspective of the Irish healthcare system. The model was populated with real-world data from the National Cancer Registry Ireland. Uncertainty was explored using one-way and probabilistic sensitivity analysis. RESULTS The cost of managing a case of melanoma diagnosed at Stage IV (€122 985) was more than 25 times more expensive than managing a case diagnosed at Stage IA (€4269). Total costs were sensitive to the choice of immunotherapeutic and targeted drug, duration of treatment and proportion of patients receiving immunotherapy agents. CONCLUSIONS The rising incidence of melanoma and high cost of new novel therapies presents an immediate challenge to cancer control and public health globally. This study highlights the cost differential between early and late detection and the potential return on investment for prevention versus high-cost treatment.
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Affiliation(s)
| | | | - Katharine Harkin
- HSE National Cancer Control Programme (NCCP), King’s Inns House, 200 Parnell Street, Dublin 1 DO1 A3Y8, Ireland
| | - Patricia Heckmann
- HSE National Cancer Control Programme (NCCP), King’s Inns House, 200 Parnell Street, Dublin 1 DO1 A3Y8, Ireland
| | - Fergal Kelleher
- St. James and Tallaght University Hospitals, Department of Medicine, Trinity College Dublin, Dublin 2 D02 R590, Ireland
| | - Áine Lyng
- HSE National Cancer Control Programme (NCCP), King’s Inns House, 200 Parnell Street, Dublin 1 DO1 A3Y8, Ireland
| | - Triona McCarthy
- HSE National Cancer Control Programme (NCCP), King’s Inns House, 200 Parnell Street, Dublin 1 DO1 A3Y8, Ireland
| | - Maria McEnery
- HSE National Cancer Control Programme (NCCP), King’s Inns House, 200 Parnell Street, Dublin 1 DO1 A3Y8, Ireland
| | - Clare Meaney
- National Cancer Control Programme (NCCP), King’s Inn House, 200 Parnell Street, Dublin, D01 A3Y8, Ireland
| | | | - Anne-Marie Tobin
- Tallaght University Hospital, Tallaght, Dublin 24 D24 NR0A, Ireland
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Bruns N, Trocchi P, Felderhoff-Müser U, Dohna-Schwake C, Stang A. Hospitalization and Morbidity Rates After Pediatric Traumatic Brain Injury: A Nation-Wide Population-Based Analysis. Front Pediatr 2021; 9:747743. [PMID: 34660495 PMCID: PMC8515415 DOI: 10.3389/fped.2021.747743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Even though traumatic brain injury (TBI) is a major cause of morbidity and mortality in children around the globe, population-based and nation-wide data to assess the burden of TBI is scarce. Methods:Based on diagnosis related groups from nation-wide hospital data, we extracted data on all TBI-related hospitalizations in children <18 years in Germany between 2014 and 2018. We calculated crude, age-specific and standardized incidence rates for hospitalizations, imaging, intracranial injury, neurosurgery, and mortality. Results:Out of 10.2 million hospitalizations, we identified 458,844 cases with TBI as primary or secondary diagnosis, resulting in a crude incidence rate of 687/100,000 child years (CY). Age-specific rates of computed tomography were below 30/100,000 CY until the age of 10 years and increased to 162/100,000 CY until 17 years of age. Intracranial injury was diagnosed in 2.7%, neurosurgery was performed in 0.7% of patients, and 0.7% were mechanically ventilated. Mortality was 0.67/100,000 CY (0.1%). Conclusions:Despite substantial hospitalization rates for pediatric TBI in Germany, the rates of imaging, the need for mechanical ventilation, neurosurgery and mortality were overall very low. Reasons for hospitalization and measures to reduce unnecessary admissions warrant further investigation.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Pediatric Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational and Behavioural Neurosciences (TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Pietro Trocchi
- Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Pediatric Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational and Behavioural Neurosciences (TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Pediatric Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, United States
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Egeler SA, Huang A, Johnson AR, Ibrahim A, Bucknor A, Peymani A, Mureau MAM, Lin SJ. Regional incidence of and reconstructive management patterns in melanoma and nonmelanoma skin cancer of the head and neck: A 3-year analysis in the inpatient setting. J Plast Reconstr Aesthet Surg 2019; 73:507-515. [PMID: 31787545 DOI: 10.1016/j.bjps.2019.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 09/07/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Currently, there is limited literature on reconstructive trends for inpatient head and neck skin cancer. Rather, studies have focused primarily on patients treated on an outpatient basis. To gain a better understanding of the effect that reconstructive correction of complex skin cancer defects has on the healthcare system, we examined the existing incidence and reconstructive trends of head and neck melanoma and nonmelanoma skin cancer (NMSC) in the inpatient setting. METHOD We performed the analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database (NIS) for the years 2012-2014 of the United States (US). Adults diagnosed with melanoma skin cancer or NMSC of the head and neck region were included. Patient characteristics, reconstructive modality, surgical specifics, and outcomes were retrieved. Trends with time for reconstruction techniques were analyzed. RESULTS In total, 41,185 patients with a diagnosis of skin malignancy were identified, of whom 5,480 (13.3%) underwent reconstruction. Most patients were white (90.0%), male (71.6%), and had a diagnosis of NMSC (79.2%). An increase in flap reconstruction (p < 0.001) was observed. After population adjustment, the highest incidence of skin malignancy was found in the Northeast. CONCLUSION There has been a trending increase in inpatient NMSC and melanoma skin cancer of the head and neck region, correlating to an increase in the reconstructive procedures performed, and greater cost burden. Resources may be allocated toward early identification and treatment for skin cancer to help control the current rise in complex skin cancer cases necessitating inpatient admission.
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Affiliation(s)
- Sabine A Egeler
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Anne Huang
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Anna R Johnson
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Ahmed Ibrahim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alexandra Bucknor
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Abbas Peymani
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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Skin cancer rates in North Rhine-Westphalia, Germany before and after the introduction of the nationwide skin cancer screening program (2000–2015). Eur J Epidemiol 2018; 33:303-312. [DOI: 10.1007/s10654-017-0348-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
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Walendy V, Stang A. Clinical management of unruptured intracranial aneurysm in Germany: a nationwide observational study over a 5-year period (2005-2009). BMJ Open 2017; 7:e012294. [PMID: 28096250 PMCID: PMC5253577 DOI: 10.1136/bmjopen-2016-012294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our aim was to provide nationwide age-standardised rates (ASR) on the usage of endovascular coiling and neurosurgical clipping for unruptured intracranial aneurysm (UIA) treatment in Germany. SETTING Nationwide observational study using the Diagnosis-Related-Groups (DRG) statistics for the years 2005-2009 (overall 83 million hospitalisations). PARTICIPANTS From 2005 to 2009, overall 39 155 hospitalisations with a diagnosis of UIA occurred in Germany. PRIMARY OUTCOME MEASURES Age-specific and age-standardised hospitalisation rates for UIA with the midyear population of Germany in 2007 as the standard. RESULTS Of the 10 221 hospitalisations with UIA during the observation period, 6098 (59.7%) and 4123 (40.3%) included coiling and clipping, respectively. Overall hospitalisation rates for UIA increased by 39.5% (95% CI 24.7% to 56.0%) and 50.4% (95% CI 39.6% to 62.1%) among men and women, respectively. In 2005, the ASR per 100 000 person years for coiling was 0.7 (95% CI 0.62 to 0.78) for men and 1.7 (95% CI 1.58 to 1.82) for women. In 2009, the ASR was 1.0 (95% CI 0.90 to 1.10) and 2.4 (95% CI 2.24 to 2.56), respectively. Similarly, the ASR for clipping in 2005 amounted to 0.6 (95% CI 0.52 to 0.68) for men and 1.1 (95% CI 1.00 to 1.20) for women. These rates increased in 2009 to 0.8 (95% CI 0.72 to 0.88) and 1.7 (95% CI 1.58 to 1.82), respectively. We observed a marked geographical variation of ASR for coiling and less pronounced for clipping. For the federal state of Saarland, the ASR for coiling was 5.64 (95% CI 4.76 to 6.52) compared with 0.68 (95% CI 0.48 to 0.88; per 100 000 person years) in Saxony-Anhalt, whereas, ASR for clipping were highest in Rhineland-Palatinate (2.48, 95% CI 2.17 to 4.75) and lowest in Saxony-Anhalt (0.52, 95% CI 0.34 to 0.70). CONCLUSIONS To the best of our knowledge, we presented the first representative, nationwide analysis of the clinical management of UIA in Germany. The ASR increased markedly and showed substantial geographical variation among federal states for all treatment modalities during the observation period.
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Affiliation(s)
- Victor Walendy
- Zentrum für Klinische Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Zentrum für Klinische Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
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Pilgrim W, Hayes R, Hanson DW, Zhang B, Boudreau B, Leonfellner S. Skin Cancer (Basal Cell Carcinoma, Squamous Cell Carcinoma, and Malignant Melanoma): New Cases, Treatment Practice, and Health Care Costs in New Brunswick, Canada, 2002–2010. J Cutan Med Surg 2014; 18:320-31. [DOI: 10.2310/7750.2014.13162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: In Canada, there is no formal process for registering nonmelanoma skin cancer (NMSC); thus, the epidemiology, treatment practices, and associated health costs are not well known. Objectives: To investigate trends in new cases of skin cancer, treatment practices, and health care costs in New Brunswick, Canada. Methods: Data were extracted from the Provincial Cancer Registry and New Brunswick administrative health databases for 2002–2010. Results: New cases: Basal Cell Carcinoma (BCC) was the most common skin cancer diagnosed, and incidence rates significantly increased between 1992 and 2010. Treatment practice: Dermatologists managed the majority (45%) of the overall skin cancer treatments. Health care costs: NMSC accounted for ˜80% of the health care costs for skin cancer and was dominated by BCC. Conclusions: Development of best practice treatment guidelines for NMSC in New Brunswick would improve future health care efficiencies, and standard protocols for registering new cases of NMSC in Canada would strengthen surveillance and reporting capacity.
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Affiliation(s)
- Wilfred Pilgrim
- From the New Brunswick Department of Health and private practice, Fredericton, NB
| | - Robert Hayes
- From the New Brunswick Department of Health and private practice, Fredericton, NB
| | - Dana W. Hanson
- From the New Brunswick Department of Health and private practice, Fredericton, NB
| | - Bin Zhang
- From the New Brunswick Department of Health and private practice, Fredericton, NB
| | - Bonnie Boudreau
- From the New Brunswick Department of Health and private practice, Fredericton, NB
| | - Suzanne Leonfellner
- From the New Brunswick Department of Health and private practice, Fredericton, NB
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Thyroid cancer surgery in Germany: an analysis of the nationwide DRG statistics 2005-2006. Langenbecks Arch Surg 2012; 397:421-8. [PMID: 22230962 DOI: 10.1007/s00423-011-0897-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 12/14/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE In 2004, a Diagnosis Related Groups (DRG)-based hospital reimbursement system became mandatory in Germany. The aim of this study was to provide nationwide data on the surgery of thyroid cancer by analyzing DRG statistics of the years 2005 and 2006. METHODS The unit of analysis was hospital admission with a diagnosis of thyroid cancer. We assessed the influence of age, sex and region on the relative frequency of thyroid cancer-related hospitalisations with surgery of the thyroid and we measured the association between hospitalisation rates and incidence rates of thyroid cancer among the Federal States of Germany. RESULTS Over the period 2005 to 2006, 11,107 thyroid cancer-associated hospitalisations included surgical treatment of the thyroid. The age-standardised DRG-based hospitalisation rates and the corresponding cancer registry-based incidences of thyroid cancer were positively associated. Overall, 68% of the hospitalisations with thyroid surgery included a total thyroidectomy. The percentage of surgery of the thyroid with a total thyroidectomy was nearly identical among men and women, decreased among men aged over 60 and varied considerably by region (minimum, 48% in Saarland; maximum, 78% in Saxony-Anhalt). CONCLUSIONS Our analyses of DRG statistics provide for the first time representative population-based data of the surgical management of thyroid cancer patients in Germany. Despite an identical health care system all over Germany and existing guidelines for surgical treatment of thyroid cancer, we observed a considerable regional variation in the proportion of total thyroidectomies performed in Germany.
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Stang A, Merrill RM, Kuss O. Hysterectomy in Germany: a DRG-based nationwide analysis, 2005-2006. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:508-14. [PMID: 21904583 DOI: 10.3238/arztebl.2011.0508] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 05/05/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hysterectomy is among the more common surgical procedures in gynecology. The aim of this study was to calculate population-wide rates of hysterectomy across Germany and to obtain information on the different modalities of hysterectomy currently performed in German hospitals. This was done on the basis of nationwide DRG statistics (DRG = diagnosis-related groups) covering the years 2005-2006. METHODS We analyzed the nationwide DRG statistics for 2005 and 2006, in which we found 305 015 hysterectomies. Based on these data we calculated hysterectomy rates for the female population. We determined the indications for each hysterectomy with an algorithm based on the ICD-10 codes, and we categorized the operations on the basis of their OPS codes (OPS = Operationen- und Prozedurenschlüssel [Classification of Operations and Procedures]). RESULTS The overall rate of hysterectomy in Germany was 362 per 100 000 person-years. 55% of hysterectomies for benign diseases of the female genital tract were performed transvaginally. Bilateral ovariectomy was performed concomitantly in 23% of all hysterectomies, while 4% of all hysterectomies were subtotal. Hysterectomy rates varied considerably across federal states: the rate for benign disease was lowest in Hamburg (213.8 per 100 000 women per year) and highest in Mecklenburg-West Pomerania (361.9 per 100 000 women per year). CONCLUSION Hysterectomy rates vary markedly from one region to another. Moreover, even though recent studies have shown that bilateral ovariectomy is harmful to women under 50 who undergo hysterectomy for benign disease, it is still performed in 4% of all hysterectomies for benign indications in Germany.
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Affiliation(s)
- Andreas Stang
- Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität, Halle-Wittenberg, Deutschland.
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Stang A, Weichenthal M. Micrographic surgery of skin cancer in German hospitals 2005-2006. J Eur Acad Dermatol Venereol 2011; 25:422-8. [PMID: 20636492 DOI: 10.1111/j.1468-3083.2010.03805.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVE Surgical therapy of skin cancer includes conventional wide excision and micrographic surgery (MS). Little is known about the population-wide spread of MS for the treatment of skin cancer. The aim was to estimate the in-hospital use of MS for the treatment of skin cancer in Germany. METHODS We used nationwide DRG data from 2005 through 2006. We identified hospitalizations with a main diagnosis of cutaneous malignant melanoma (CMM) (ICD-10: C43) or non-melanoma skin cancer (NMSC) (ICD-10: C44). MS was identified by OPS procedure codes including 5-895.1, 5-895.3, 5-212.1, 5-181.1, 5-181.4, 5-181.6, 5-182.1, 5-091.1, or 5-091.3. RESULTS We identified 52 660 and 98 484 hospitalizations with a primary diagnosis of CMM and NMSC respectively; 54.6% and 36.5% of NMSC and CMM-related admissions with local skin cancer treatment included MS. The relative frequency of MS varied by anatomic subsite of the skin cancer and by region of the hospital. Local infections were the most frequent complications after MS with 3.2-4.0% for NMSC and 2.3-2.9% for CMM followed by haemorrhages. Dehiscence of the operation wound is a rare event with risks ranging between 0.1% and 0.3%. CONCLUSIONS Micrographic surgery is frequently used for the local treatment of NMSC and varies considerably across Federal States of Germany. It is difficult to speculate how many MS might be performed in private or ambulatory settings in Germany. As MS requires surgical expertise, technical support and dermatopathology, we speculate that MS is much less frequently undertaken in private practices in Germany.
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Affiliation(s)
- A Stang
- Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.
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Stang A, Merrill RM, Kuss O. Nationwide rates of conversion from laparoscopic or vaginal hysterectomy to open abdominal hysterectomy in Germany. Eur J Epidemiol 2011; 26:125-33. [DOI: 10.1007/s10654-010-9543-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 12/24/2010] [Indexed: 11/29/2022]
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Stang A. Re: "Identification of patients with nonmelanoma skin cancer using health maintenance organization claims data". Am J Epidemiol 2010; 172:123-4; author reply 124. [PMID: 20543030 DOI: 10.1093/aje/kwq132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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