How to Choose the Right Nebulizer

Nebulizers, Compressors, Desktop, Portable

A modern nebulizer system turns liquid medications for respiratory diseases into a fine mist that can be inhaled. Your doctor may determine that a powered nebulizer, instead of a metered-dose inhaler alone, may help you maximize the use of the inhaled medication to treat and manage asthma, COPD, cystic fibrosis and other respiratory conditions.

Your doctor and respiratory therapist are the best resource for helping you choose the right nebulizer type or system that works with your prescribed medications. Still their recommendation might be broad and generic. They also might not take your lifestyle into consideration. Most consumer nebulizers on the market today fall into two categories:

Desktop nebulizer systems are designed for home use and tend to be larger but cheaper.

Mabis MiniComp

Desktop Nebulizer Systems

  • Often require a firm, flat surface and AC power for indoor use
  • May have built-in compartments, therefore can be bulkier, to store oxygen tubing, medication cups and electrical cords
  • Likely based on proven piston-pump technology (see below) to generate mist
  • May be weighted at the bottom to increase stability for pediatric use

 

Portable nebulizers are handheld and have multiple power sources.

Portable nebulizers are handheld and have multiple power sources.

Portable and/or Handheld Systems

  • Are designed for handheld operation at home or on the go
  • May use piston-pump or ultrasonic technology to generate mist (see below)
  • Offer multiple ways to power your nebulizer: with AC power, a car charger, or rechargeable battery

Advances in technologies have helped similar nebulizer systems consistently produce finer mists without the bulky housing of the past. If you use a nebulizer only at home, a bulky housing may not matter much. And they tend to be more cost effective. Nebulizer technologies fall largely into three categories:

Piston-Pump Compressor Nebulizers (Jet Nebulizers)

  • High-velocity air created by a piston-powered compressor helps aerosolize liquid medication in the nebulizer cup so you can inhale the medication as a mist
  • Tends to be heavier and noisier, but cheaper, than ultrasonic nebulizers

Ultrasonic Wave Nebulizer

  • Vibrating a metal plate at ultrasonic frequencies creates a mist in the medication cup, which is then mixed with air for easy inhalation
  • Creates slightly smaller and more uniform aerosols than compressor nebulizers
  • Operates almost silently, comes in compact, portable forms, and costs more than jet nebulizers

Ultrasonic Vibrating Mesh Technology Nebulizer (“Mesh” Nebulizer)

  • A membrane, or mesh, with thousands of tiny holes vibrates at ultrasonic frequency to pump out a mist which is then mixed with air for inhalation
  • Operates nearly silently, comes in compact, portable forms, creates uniform particles with little waste
  • The most expensive of all types of nebulizers

Disposable parts are also important to keep in mind when choosing a nebulizer system.

Air filters: Nebulizer compressors usually require an air filter that should be replaced every 30 days or whenever it becomes dirty.

Nebulizers: Manufacturers recommend that disposable nebulizers be replaced every two weeks, while reusable nebulizers be replaced every six months. They should still be cleaned regularly according to manufacturer instructions.

Cleaning and Maintenance: Cleaning instructions vary according to manufacturer and the technology used in a nebulizer system. Regular cleaning and maintenance go a long way in helping you get the most use of your nebulizer system.

 

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Neuroscience 2014: Sneak Peak at a New Stimulator, Live Demos of Behavioral Analysis, Plus Optopatcher in Action

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Since 1976, A-M Systems has manufactured high-quality, affordable instrumentation and supplies for the neuroscientist. This year at Neuroscience, we have demos and sneak peaks of new electrophysiology instruments as well as tools for optogenetics and video analysis of behavioral tasks. Visit our booth to see what’s new for 2015, and qualify for free U.S. shipping on any purchase until the end of the year.

neuroscience-2014-box-actual-analyticsSee a live demo of how you can automatically track, recognize and analyze common fly, fish and rodent behavioral tasks from your own videos. ActualTrack lets you track and analyze videos in batches all without any special hardware or a dongle key.


neuroscience-2014-box-3800With 8 completely independent channels, a front panel touch screen, and computer control capabilities, our Model 3800 MultiStim 8-Channel Programmable Stimulator is the fastest multichannel, high-power stimulator on the market and has enough flexibility to meet your most demanding requirements.


neuroscience-2014-box-optopatcherUnmatched accuracy in applying optical stimulation to an in-vivo patch-clamp protocol. The holder houses both an optical fiber and an electrode enabling simultaneous patch-clamp recording and optogenetic activation.  Come see the Optopatcher in action!


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For over 30 years, A-M Systems’ Model 2100 Isolated Pulse Stimulator has been the leading pulse generator used in labs worldwide. With a built-in constant current/voltage isolator and easy-to-use front panel controls, the 2100 is a cost-effective stimulator that can serve as your lab’s workhorse.

But even the 2100 can be improved upon, and 2015 will see the release of our new updated single-channel isolated pulse generator. More power, more functionality, and now with complete computer control, our new stimulator continues the tradition of the Model 2100, but extends its capabilities while not breaking your budget. Come see a sneak preview of our new stimulator!

Dr. Jonathan Bakin, Neuroscience & Physiology Product Manager, and Dr. David Mittmann, chief engineer, will be at booth 2517 answer your questions and walk you through the demos.

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Electrophysiology and Neuroscience Technical Sales and Support Representative

__official-ams-logo_RGB_vector_v2_200px A-M Systems is seeking a motivated sales and support scientist/engineer to represent and service our products. The candidate will have experience in electrophysiology or neuroscience with an oversized interest in electronic instrumentation. Ideal qualifications include expertise in patch clamp electrophysiology. Qualified candidates will have excellent English communication skills (spoken and written), are self-motivated, self-directed, detail oriented, and personable. Job includes full benefits package: (Medical/Dental, Retirement Plan, Vacation/Sick days). Competitive salary (base + commission & expenses) that is commensurate with experience. The ideal candidate should have a BS/MS degree in biology, physiology, neuroscience, or electrical or biomedical engineering, with extensive experience utilizing scientific instrumentation in a laboratory setting.

  • Technical Sales: Develop strong business relationships with existing customers as well as generating new customers through the use of provided leads, reviewing the scientific literature and governmental database sources, and your own knowledge of the industry. Visit customers at different institutions as needed to promote/provide servicing of their current A-M System’s equipment, and generate new sales of our products. Speak to and email customers about their equipment needs, prospect for new customers, make quotes, and follow up to procure orders.
  • Technical Support: become completely proficient in the use of our equipment, which includes both hardware and software. Help customers use our products by giving them superior technical support via telephone, email, and site visits. Be able to perform simple equipment calibrations using instruments such as a function/signal generator, an oscilloscope, and a voltmeter. Be able to follow written procedures documenting calibration procedures, including being able to read schematics as needed.
  • Product Development: Use own knowledge of neuroscience and patch clamp physiology to assist in development of new target customers, new applications for our existing products, and new products.
  • Trade Show Support: attend trade shows as needed. Assist during installation and breakdown of trade show exhibit. Staff booth and meet customers during trade show. Follow up with trade show customers and make appointments for on site visits to secure orders.
  • The position requires travel locally, around the US, and sometimes abroad (Valid Drivers License, own transportation, Passport a must).

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Three Share Nobel Prize for Discovery of ‘Inner GPS’ in Brain

The 2014 Nobel Prize in Physics or Medicine was shared by three neuroscientists: John O'Keefe and husband-and-wife team May-Britt Moser and Edvard Moser. (Images courtesy: Per Henning/NTNU, The Kavli Institute at the NTNU, Wikimedia.)

The 2014 Nobel Prize in Physics or Medicine was shared by three neuroscientists: John O’Keefe and husband-and-wife team May-Britt Moser and Edvard Moser. (Images courtesy: Per Henning/NTNU, The Kavli Institute at the NTNU, Wikimedia.)

Three scientists were awarded this year’s Nobel Prize in Physiology or Medicine for their discovery of “an inner GPS” system in the hippocampus and the entorhinal cortex that allows complex spatial navgiation.

The three recipients of the prestigious award are John O’Keefe, a U.K. and U.S. citizen and director of the Sainsbury Wellcome Centre in Neural Circuits and Behaviour at University College London; May-Britt Moser, a Norwegian neuroscientist and director of the Centre for Neural Computation in Trondheim; and her husband Edvard Moser, a neuroscience professor and director of the Kavli Institute for Systems Neuroscience, also in Trondheim.

Their research spanning more than three decades has answered an age-old question about how “we navigate our way through a complex environment,” the Nobel Assembly at Karolinska Institutet said in a press release.

In 1971 Dr. O’Keefe discovered a network of hippocampal “place cells” that activated depending on where a rat was in an open room. In 2005 and 2006, May-Britt and Edvard Moser described how certain cells of the entorhinal cortex actviated as the rat passed through multiple locations arranged in a hexagonal grid. These “grid cells” allowed spatial navigation, they concluded.

The circuitry formed by grid and place cells “constitutes a comprehensive positioning system, an inner GPS, in the brain. The positioning system in the human brain appears to have similar components as those of the rat brain,” the Nobel Assembly said.

Understanding the mechanism of complex spatial navigation is likely to have a profound impact on Alzheimer’s disease research and on other areas where loss of spatial memory is a component of the devastating neurodegenerative disease.

Read more about May-Britt and Edvard Moser, whom Nature News dubbed “minor celebrities” in Norway for their teamwork and research at the Kavli Institute.

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NIH Awards $46 Million to 58 Projects Under Brain Initiative

The National Institutes of Health has awarded US$46 million to 58 projects in the initial round of funding for the Brain Initiative. (Image courtesy NIH)

The National Institutes of Health has awarded US$46 million to 58 projects in the initial round of funding for the Brain Initiative. (Image courtesy NIH)

The first round of funding for the Obama administration’s Brain Initiative has been announced for research projects ranging from futuristic wearable PET scanner to remote targeting of cell activity using radio waves, nanoparticles and genetically modified viruses.

The National Institutes of Health has awarded US$46 million to 58 projects in six categories:

  • classification of cell types in the brain
  • tools and techniques for analyzing brain cells and circuits
  • next-generation brain imaging technology
  • new methods and tools for large-scale recording-modulation
  • optimization of large-scale recording-modulation
  • understanding functions of neural circuits

“How do the billions of cells in our brain control our thoughts, feelings, and movements? That’s ultimately what the Brain Initiative is about,” Dr. Thomas R. Insel, M.D., director of the National Institute of Mental Health, was quoted as saying in a press release. “Understanding this will greatly help us meet the rising challenges that brain disorders pose for the future health of the nation.”

A focus of the initial years of the BRAIN Initiative is the development of next-generation tools for exploring how dynamic patterns of neural activity in the brain control thoughts, feelings and movements. (Image courtesy NIH)

A focus of the initial years of the BRAIN Initiative is the development of next-generation tools for exploring how dynamic patterns of neural activity in the brain control thoughts, feelings and movements. (Image courtesy NIH)

Among the recipients were research labs at various University of California campuses, the Allen Institute, Rockefeller University, Cold Spring Harbor, CalTech, Pierre and Marie Curie University in Paris, and University of Zurich. But MIT alone received six grants for 15 researchers.

Optogenetics remained a popular tool in the initial round of funding with eight projects ranging from the development of noninvasive light-and-sound system to the creation of optrodes for large-scale electrophysiological recording.

University of California Berkeley received a total of $7.2 million in NIH funding over three years for three research projects under the Brain Initiative. In May, the Center for Neural Engineering and Prostheses, a joint project between UC Berkeley and UCSF, received a five-year, US$26 million grant from the Defense Advanced Research Projects Agency.

Federal funding for the Brain Initiative is set to double next year to US$200 million. It was unclear whether the Food and Drug Administration and the Intelligence Advanced Research Projects Activity will share the proposed budget with the NIH, Darpa and the National Science Foundation.

According to White House figures, the National Photonics Initiative, GE, Google, GlaxoSmithKline and Inscopix have realigned their resources and US$30 million to support the Brain Initiative. And more than US$240 million have also been set aside for the research initiative by private foundations and universities.

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Study: Inhaled Glucocorticoids Don’t Reduce COPD Exacerbations

An example of a valved holding chamber that helps patients inhale COPD and asthma medications. (Image courtesy Philips Respironics)

An example of a valved holding chamber that helps patients inhale COPD and asthma medications. (Image courtesy Philips Respironics)

European researchers are questioning the benefits of inhaled glucocorticoids in reducing the risk of exacerbations among patients with severe or very severe COPD. A double-blind study of nearly 2,500 patients found that glucocorticoids do not have a significant impact on reducing COPD exacerbations.

An inhaled glucocorticoid is commonly prescribed as an adjunct to LAMA (tiotropium) and LABA (salmeterol) combination therapy for patients with severe or very severe COPD with a history of exacerbations.

The study, published in the New England Journal of Medicine, found the patients that underwent a phased withdrawal of inhaled glucocorticoids over 18 weeks did not have a significantly greater risk of exacerbations.

All patients started out with 18 μg of tiotropium delivered once daily, 50 μg of salmeterol xinafoate twice daily and 500 μg of fluticasone propionate  twice daily by a metered-dose inhaler. Over 18 weeks, a group of patients, went from 1,000 μg of inhaled glucocorticoids to 500 μg, to 200 μg and then to 0 μg.

When the phased withdrawal was complete at week 18, those patients had a slight drop in FEV1 (38 mL) when compared to those who continued the inhaled glucocorticoid regimen. At the conclusion of the study, at 52 weeks, a similar difference (52 mL) was seen between the groups. However, the larger reduction of FEV1 from baseline “does not seem to be associated exacerbations,” the authors wrote.

Overall “the stepwise withdrawal of glucocorticoids was noninferior to the continuation of such therapy, with respect to the risk of moderate or severe exacerbations,” the authors concluded.

NAC-Australia-asthma_medication_chart

A chart of common types of asthma and COPD medications available in Australia as published by the National Asthma Council of Australia.

The study challenges current treatment guidelines which call for a triple therapy, including inhaled corticosteroids, for patients with severe COPD. It is unclear what immediate impact the European study might have on established therapies. (Learn more about the current recommended guidelines at the Global Initiative for Chronic Obstructive Lung Disease, or GOLD.

In a separate study of patients who were 66 years or older, Canadian researchers found that a combination therapy of long-acting β-agonists and inhaled corticosteroids (ICS) was associated with a modestly reduced risk of death (36.4% vs 37.3%) or COPD-related hospitalizations (27.8% vs. 30.1%).

The benefits of the LABA-ICS combination therapy was greater in patients with a comorbidity of asthma with a difference in composite outcome at 5 years reaching -6.5% (at 95% confidence internal, and a hazard ratio of 0.84 at 95% CI) and those who were not receiving inhaled long-acting anticholinergic (LAA) drugs (-8.4%, 95% CI with HR of 0.79 at 95% CI).

Dr. Andrea Gershon, at the Sunnybrook Health Sciences Centre and Institute for Clinical Evaluative Sciences in Toronto, and her colleagues followed nearly 12,000 patients over eight years for the real-world, population-based study.

“Our finding of an association between LABAs and ICSs and outcomes helps clarify the management of patients with COPD and asthma, as many studies of COPD medications have excluded people with asthma and vice versa,” Dr. Gershon was quoted as saying by the Journal of the American Medical Association.

“In addition, practice guidelines for COPD recommend that LABAs be considered first-line treatment while asthma guidelines warn against use of LABAs without ICSs. Our findings also offer insight into the optimal treatment of COPD patients without asthma—those who would not be considered especially corticosteroid responsive.”

 

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Karl Deisseroth Earns Keio Medical Science Prize for Optogenetics

Keio Prize Awarded to Karl DeisserothKarl Deisseroth was chosen as one of two recipients of this year’s prestigious Keio Medical Science Prize for his “enormous contributions towards the fundamental understanding of brain function in health and disease,” Keio University announced yesterday.

Keio University lauded his efforts in inventing optogenetics, which has been adopted rapidly as a tool to precisely target and demonstrate “causal relationship between neuronal circuits and behavior.”

Thus, Dr. Deisseroth first provided “a method by which all neurons of just one type could be activated or inactivated, leaving the others more or less unaltered” (Francis Crick, 1979), which had been a long-required task in the field of neuroscience.

Optogenetics has further permitted us to control intracellular signals such as calcium and cAMP signals, and thus it can be widely applied to biomedical and life science research. By making optogenetics a reality and leading this new field, Dr. Deisseroth has made enormous contributions towards the fundamental understanding of brain function in health and disease.

“It is a tremendous honor to receive the 2014 Keio Medical Science Prize, in recognition of our efforts to develop optogenetics,” Deisseroth told Keio University. “Prize is particularly meaningful because optogenetics originated as a tool to study the basic science of biology, not medical illness.”

But optogenetic investigations into forms of Parkinson’s in rodent models have already helped neurosurgeons better target implanted stimulating electrodes. Some Parkinson’s patients receive implanted electrodes as part of their treatment to reduce symptoms. However, the precise neuronal connections to target had been up for debate–until optogenetics helped pinpoint the wiring.

“Now neurosurgeons are finding that placing their electrical contacts to target connections gives better results in treating symptoms in people with Parkinson’s and many other conditions,” Deisseroth told Standord News Service in an interview.

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Spirometry Data Coming to Your iPhone

Apple's decision to add spirometry data types could herald a new era of portable spirometers.

Apple’s decision to add spirometry data types could herald a new era of portable spirometers.

The addition of three spirometry data types to Apple’s iOS 8 HealthKit, announced ahead of Apple’s iPhone 6 launch event next Tuesday, may herald a new era of personal medical devices designed for monitoring asthma, emphysema, chronic bronchitis and other respiratory conditions.

By offering recognition of data types that can be gathered from sleep monitors and portable spirometers, Apple’s HealthKit goes beyond common apps that track, calculate and store fitness- and nutrition-related data.

Spirometry, which measures your lung capacity as well as various functions, remains the gold standard in diagnosing and monitoring asthma, chronic bronchitis, emphysema and pulmonary fibrosis.

In the release notes of iOS 8 Beta 5, Apple announced that “Spirometry data types are now available in HealthKit.” An iPhone alone cannot measure your lung functions or diagnose COPD, for example. But the availability of spirometry data types allows software and medical device developers to design apps and portable spirometers that pass the data to an iPhone for recognition.

So far three basic spirometry data types have been added to HealthKit:

  • HKQuantityTypeIdentifierForcedExpiratoryVolume1
  • HKQuantityTypeIdentifierForcedVitalCapacity
  • HKQuantityTypeIdentifierPeakExpiratoryFlowRate
MySpiroo, a portable spirometer developed in Poland by Piotr Bajtala and Dr. Lukasz Koltowski, plugs into an iPhone. (Image courtesy MySpiroo)

MySpiroo, a portable spirometer developed in Poland by Piotr Bajtala and Dr. Lukasz Koltowski, plugs into an iPhone. (Image courtesy MySpiroo)

In a move seen as a push to develop a platform for health-related software and hardware, Apple has recently hired a team of medical device experts, including Roy Raymann, a sleep researcher and founder of the Philips Sleep Experience Lab, and Divya Nag, dubbed “a rising star in the medical device community” and an expert in regulatory affairs.

Even before Apple’s recognition of spirometry as an important diagnostic and monitoring tool, developers around the world have been looking for ways to turn an iPhone into a pocket-sized spirometer.

The Respi Project, a graduate of the DreamIt Health accelerator at Johns Hopkins University, wants to help patients monitor lung conditions constantly from anywhere.

The Respi Project, a graduate of the DreamIt Health accelerator at Johns Hopkins University, wants to help patients monitor lung conditions constantly from anywhere.

As mentioned here previously, researchers at University of Washington’s Ubiquitous Computing Lab created SpiroSmart, a software that measures FEV1, FVC and PEF using only a user’s lip reverberation.

In Poland, Piotr Bajtala and Dr. Lukasz Koltowski are wrapping up their development of MySpiroo, a portable spirometer designed to relay its spirometry data to an iPhone through the earphone jack. MySpiroo so far can measure FEV, FVC, PEF, MVV, SVC, TLC, FRC, RV, ERV and more.

The Respi Project, a graduate of the DreamIt Health accelerator at Johns Hopkins University, has also designed a portable spirometer for iPhones with the goal of allowing patients to monitor their lungs from anywhere at any time.

These personal, portable spirometers do not replace consultations with and diagnoses by a physician. However, Apple’s recognition of spirometry as an important tool in managing and monitoring chronic lung conditions is likely to help empower patients living with asthma and COPD.

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ACP Releases New Sleep Apnea Diagnosis Guidelines

Illustration of Obstructive Sleep Apnea (Courtesy Habib M’henni / Wikimedia Commons)

Sleep studies for the assessment of obstructive sleep apnea should be limited to patients with unexplained daytime sleepiness after other potential causes have been ruled out, according to new guidelines from the American College of Physicians.

The Clinical Guidelines Committee of the College also recommended that patients suspected of having obstructive sleep apnea (OSA) should undergo polysomnography (PSG). But those without serious comorbidities may use portable sleep monitors when a sleep study lab is not available to them.

The recommendations, however, were rated as weak and based on low- to medium-quality evidence, the Committee wrote in the paper published in the latest edition of the Annals of Internal Medicine.

Polysomnography performed at a sleep lab has been the gold standard in diagnosing obstructive sleep apnea, but it’s expensive, resource-intensive and requires patients to spend a night away from home.

Some portable sleep monitors, those designed for use at home, may help identify suspected OSA cases through the apnea-hypopnea indiex (AHI), the number of apnea or hypopnea events per sleeping hour. But their results vary widely across different types of portable monitors. And no study to date has directly compared different portable monitors.

There was insufficient evidence to determine if sleep questionnaires, like the Epworth Sleepiness Scale, phased testing and preoperative screening for OSA were useful, the authors noted.

OSA is caused by an obstruction of the upper respiratory tract which can partially (hypopnea) or completely (apnea) block the airflow. The most common risk factor for obstructive sleep apnea is obesity. And OSA may lead to daytime sleepiness, hypertension, heart attack, stroke, cognitive impairment and other serious conditions.

Learn more about OSA at the National Heart, Lung, and Blood Institute.

 

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Back-to-School Pollution Could Trigger Respiratory Problems

No Idle Zones are popping up across the United States. (Courtesy Mike Licht / flickr)

No Idle Zones are popping up across the United States. (Courtesy Mike Licht / flickr)

Returning to classes after a relaxing summer vacation could pose multiple challenges to school children with asthma and other respiratory conditions. A myriad triggers and factors may contribute to the challenges. But one factor has gained the attention of parents and health professional: health consequences of exhaust from excessive idling.

Many previous studies, including those done in Taiwan, the U.K. and the U.S., have linked traffic-related air pollution to the risk of developing or triggering asthma in children, but ‘No Idling Campaigns’ urge concrete steps to minimize the health impact of excessive idling on school grounds.

It is easier said than done especially when extreme temperatures can either melt or freeze you without an A.C. or a heater. Still some California air pollution control districts, including the one in San Joaquin Valley, are urging parents to turn off their engine while waiting for their children. In Seattle, CoolMom has partnered with the Puget Sound Clean Air Agency to promote “Idle-Free Elementary” schools and protect children’s health.

For its part, the U.S. Environmental Protection Agency has a “Turn Off Your Engine, Kids Breathe Here” campaign designed to educate school bus drivers. While air pollution, fuel, money and wear on the engine factor into their campaign, the impacts on human health is cited as a key reason for their push.

EPA has determined that diesel exhaust is a likely human carcinogen and can contribute to other acute and chronic health concerns (see EPA’s Health Assessment Document for Diesel Exhaust). People with existing heart or lung disease, asthma, bronchitis or other respiratory problems are most sensitive to the health effects of fine particles. The elderly and children are also at risk. Children are more susceptible to air pollution than healthy adults because their respiratory systems are still developing and they have a faster breathing rate.

What has been your experience with no-idling campaigns and state laws?

 

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