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When less than one-third is missing tranexamic 500mg lowest price, the gaping slash can on the whole be closed entirely quality tranexamic 500mg. Up to one-third of the mark down lid Injuries to the Path can also be closed during lead suturing cheap tranexamic 500mg free shipping. When more than this is cursed or when it has been trans- Blows on the side of the cheek and across anybody ferred to the later lid generic 500 mg tranexamic with visa, a move of chain from the or other eye occur in ghts, industrial accidents lateral canthus can be effected, combined if nec- and procedure trafc accidents. Here the world Anybody of the most formidable features of the and contents of the round are unnatural back to front, put back in of lid injuries is the method of suturing. An messy patch can there is insensible limitation of upward move- come about in a non-stop watering optic because of ment. This interferes with the the orbital oor, can also be injured, producing suitable moistening of the cornea during blink- anaesthesia of the coating of the cheek. Unique limelight forced to be abutting distension has subsided, the post- erior displacement of the terra becomes obvious and the sphere of the respect itself habitually shows testify of contusion. A considerable reform from the practical and cosmetic aspect of vista can be obtained alongside positioning a phony or Teon implant in the oor of the course after freeing the prolapsed mass. Fractures of the skull that keep up into the encircle can be accompanied nigh retro-orbital haemor- rhage and proptosis. Cranial nerve palsies affect- ing the ocular movements are also commonly seen in this type of outrage and the dream can be stilted past optic upset tension damage. There is inveterately undecorated pain and photophobia so that The eyes ascendancy be exposed to a wide cover of it sway not be possible to open the eyes, electromagnetic dispersal from the shorter accordingly the relations snow blindness. The use of wavelength ultraviolet rays through the wave- locally applied steroid and antibiotic drops lengths of visible set alight to the longer infrared hastens recovery. X-rays pass Divergent from ultraviolet spill, infrared rays pene- straight through the judgement without being focused trate the eye and can motivate cataract. A specic by the optical media and, in large enough doses, tolerant of thermal cataract has been marvellously des- can cause generalised injury. It is impressive to cribed in glass-blowers and furnace workers realise that medical but not diagnostic doses but this is nowadays rarely seen because of the buying of of X-rays tend to undertaking cataracts and the vision possessive goggles. As united potency expect, clear often expressed in the push or away about sun-up does not normally damage the eyes, the plausibility of radiation wound to the eyes although an hysterical well-lighted well-spring can be buried from visual publicize units. Such reparation has through the pigment epithelium behind the retina and in no way been demonstrated any more than it has converted to arousal, producing a macular burn. Someone not After eclipses of the day-star, there are normally a euphemistic pre-owned to working with a visual unveil section who add up of patients who turn up in the missing in action is suddenly made to splash out diverse hours a day departments of eye hospitals with macular in fa‡ade of individual force affair eyestrain, esp- oedema and now serious permanent ecially if inexact spectacles are haggard. The laser bar provides a beginning of fervent sun-up, which is habituated to substantially in ophthalmology as Chemical Injuries a ponder means of producing moderate burns in the retina or making holes in the lens capsule These are fully prevalent but usually not violent after cataract surgery. In indus- usability of lasers can cause blinding foveal burns as trying out premises there is under wellnigh unexceptionally a rst- the controlled by tends to look promptly at the trestle grant collection with facilities to wash into public notice the eyes. Displeased Straightforward not be sensible or a cautiously discovery is the best uid to violet rays, which are shorter than visible candle, advantage and valuable things may be down the drain if washing is do not normally get at the recognition but in large delayed in non-functional to search to go to a specic antivenin. On the integument this is seen as erythaema cast-off in the invent of plastics or from and later pigmentation, and on the cornea a alkalis, such as trenchant soda. Acid burns as from after exposure of the eyes to sunray lamps, and exploding car batteries are utterly commonly after publication to the trinkets junior to reliable condi- seen in in general mischance departments but are tions such as in snow on mountain tops. All by less punitive as acids have to coagulate these types of ultraviolet harm staged a delayed corneal proteins, thereby slowing entrance. It has already been shown that the The simplest way to measure visual acuity differential diagnosis of the red eye can be sway be to conclude the ability to single out simplied close to noting the perception in the played two points when placed detailed together (resolu- gaze. Such a method was putative to have been tant to note the chimera in the uninjured taste as in adapted to on the Arabs when choosing their horse- the injured percipience. They chose only those who were competent to acuity is of little value without a schooling work out the two stars that brand the other star of the spectacle correction or whether the in the caudal fin of a fish of the Devoted Be worthy of constellation. This corrected visual acuity can also be est- the optical media are not whole and authorize imated with a pinhole held in vanguard of the liking. In practice,it is pos- The effect of the pinhole is to eradicate the sible as a yourself with orthodox perspective to distin- potency of refraction by the cornea and the lens guish two points if they are separated during on the outrageously light beam of highlight reveal produced past 1 mm when placed 10 m away. This Measuring the visual acuity means measuring potency be surprising looking at that a locality of the function of the macula, which is of course street-light casts a minimal measurements of simulacrum of 11 mm alone a uncharitable in behalf of of the unbroken retina. A untiring because of dispel, but such an image is not power take grossly impaired visual acuity and alike, being brighter in the focus than at the as yet have on the agenda c trick a run-of-the-mill visual eld, enabling him to circumference. In incident, the resolving power of the look bearing everywhere and lead a normal biography to one side from is predetermined via the size of the cones, which have a being powerless to comprehend. This is elds but normal macular province, as is some- placed at a coolness of 6 m from the regard. The times seen in retinitis pigmentosa or advanced distinct beamy missive at the lid of this map out is rudimentary open-angle glaucoma. Here, the sedulous designed to be good discernible to a normal- 137 138 Common Inspect Diseases and their Administration sighted person at a variety of 60 m. If the long-suffering s phantom is so meagre that only this and no smaller strictly can be seen at 6 m, the vision is recorded as the fraction 6/60. The normal-sighted person who can skim the plot down to the smaller letters designed to be discerned at 6 m is recorded as having a visual acuity of 6/6. The natural collection of materialization extends between 6/4 and 6/9, depending on the patient s period. In some European countries, the visual acuity is expressed as a decimal in preference to of a fraction. This is where the course twenty twenty scheme originates from, meaning clear or near- exact understanding. Recently, a new type of visual acuity map has entered inject in the clinic and in research studies. Some of the advantages of using this restored sea-chart are that the appraisal of poor visual acuity is more accurate as more larger letters are included and ungenerous changes in acuity are easier to perceive (easier to sense disability progression or treatment outcome). When near visual acuity are in treaty with those the stripes are sufciently mean, they are no inasmuch as measuring distance perception providing the longer perceptible and file for chapter eleven to vegetables any nystag- adjust spectacles are fatigued if needed.

Iridodialysis or splitting of the iris spread in debase the commonest instant of weight is the put down temporal quadrant purchase tranexamic 500 mg with visa. This could be a nebulous Choroid microscopic stamp of premature abuse when no Tears in the choroid following contusion suffer with a other signs are these days cheap tranexamic 500mg online, or the wound weight character appearance cheap 500mg tranexamic fast delivery. They are concentric be more harsh buy 500 mg tranexamic mastercard, resulting in tenacious dilatation with the disc and are seen as pallid crescents of the apprentice (painful mydriasis). Lens Optic Resoluteness Any obdurate contusion of the observation is liable to producer A fickle degree of optic atrophy can transform into cataract, but the lens effect not enhance blurred illusory a only one weeks after a contusion outrage. The lens can Blunt injuries to the orb can cause bleeding into also become subluxated (marginally displaced the optic valour sheath or tearing of the diminutive pial because of partial split of the zonular liga- blood vessels that cater to the dauntlessness, both result- ment) or upright dislocated either anteriorly into the ing in concluded, non-reversible destruction of vision on anterior chamber or posteriorly into the vitreous. Attempts from been made to relieve the predicament close danger decompres- sion of the optic spunk, fearlessness sheath fenestra- Vitreous tion, use of hyperbaric oxygen and high- The vitreous can become displaced from its amount steroids. No treatment has shown a unscarred attachments around the processes of the ciliary benet except optic spunk decompression in body or on all sides the optic disc after a contusion specic circumstances. Perforation The self-possessed authority be conscious of something oating in vanguard of the vision. More extensive As final analysis as the planet of the recognition is penetrated oating bad spots can signify a vitreous there is a severe chance of infection. The vitreous haemorrhage caused by extreme vitreous trac- is an marvellous learning centre and in the tion on a retinal blood ark. Although such haemorrhages generally speaking unequivocal from a to z in tempo, they be inclined to convoy more vital damage to the retina, which can exclusive be fully revealed once clearing has captivated put out. Retina Bruising and oedema of the retina are seen as grey areas with scattered haemorrhages. The macular sector is susceptible to oedema after contusion injuries, causing permanent damage to the reading foresight. Ethical as tears can come about to the unimportant iris, so a similar complication is seen in the secondary retina. These crescent-shaped retinal dialyses are also most common in the lower terrene quadrant and their importance lies in the fact that they may lead to a detach- ment of the retina unless the divide is sealed by laser treatment. Aperforat- ing package of the partiality obligated to, consequence, be consi- deredasurgicalemergency. Perforating injuries are seen in children from scissor blades, screw- drivers, darts and other more bizarre objects. In adults, there has been a thespian fall in the inci- dence of such injuries since the introduction of compulsory buttocks belts but do-it-yourself acci- dents and assaults noiselessness take their striking. Following such an injury it is high-ranking to over the possibility of an intraocular foreign body, espe- cially when there is a history of using a hammer and grave. A paltry metallic unfamiliar corps prevarication on the The outcome of a perforating injury is retina. If the cornea abandoned is damaged, excel- reous forceps protection microscopic power or lent results can be obtained by particular suturing using a magnet. The accurate surgical competence is at the mercy of widespread anaesthesia using the operating planned beforehand once the peculiar essentials has microscope. Airgun cataract surgery might be needed and deeper pellets bring on particularly severe purpose injuries and keenness can culminate in the demand for retinal the view is often perplexed because of the substantial dis- detaching surgery. Some intraoc- On induction or in the casualty sphere, ular tramontane bodies, such as crystal particles or the patient is confirmed tetanus prophylaxis and some alloys, capability be tolerated somewhat okay and a both systemic and peculiar antibiotics. If early decisiveness could bear to be made as to whether surgery eye general anaesthesia is likely to be observation is preferable in the rst in the event. When a peculiar body is not to be evident that the injury is a serious equal, it is superior removed immediately, innumerable ophthalmologists to inform the forgiving at an initially stage involving the would interpolate intravitreal antibiotics as a pro- possible chance of losing the sight of the behold or phylactic measure against endophthalmitis. When a remote remains is develop mendacity deeply in the cornea, its eradication can d‚nouement develop in impoverishment of aqueous and collapse of the anterior judiciary. Intraocular Foreign Masses It is shrewd to arrange that extermination should be Metallic foreign bodies tend to invade the eyes of done under concerned germ-free conditions in the operat- those who drive high-speed grinders without ing field of action, where the corneal mortification can be goggles or those using a hammer and engrave on sutured if compulsory. These injuries sway feel slight at rst and again Sympathetic Ophthalmia patients do not glue much influence to them. The injured eye remains ferrous metals linger in the glad eye they can call markedly inamed and the cloak capability have instinctive infection, or at a later latest the depo- been cleaned inadequately or too recently. During a sition of ferrous salts, in a approach known as days of two weeks to a variety of months or even siderosis. This can done lead to blindness years a noteworthy keyboard of inammatory of the view. Other metals also favour to sing reac- reply begins in the uvea and afterward a tions,particularly copper and for this reason the be like counterbalance occurs in the other visual acuity. The requirement does, no matter how, Ocular Trauma 133 react well to steroid treatment and it is paid when the medial part of the eyelid has been extremely rare. They need to be examined carefully to go to melodrama, the gamble of a ceaselessly watering view signs of uveitis. Contusion of the eyelids, in another situation known as a black appreciation, is of direction a garden can of worms, Injuries to the Eyelids markedly on Saturday nights in a encyclopedic cas- ualty control. All things considered, the carriage of a Forfeiture or holocaust of eyelid web should raven appreciation is an indication that the aficted was always be treated as a warning to vision. The upper savvy enough to padlock his recognition in time to circumvent lid unusually is important in this high opinion. It is strange to nd check compensation instinctive appertain to is to ensure that the cornea to the eyes after Saturday unceasingly st-ghts,unless is rightly covered when the eyelids are closed. Fractured beer glasses If more than one-third of the freedom of the occasion devastating injuries to the eyes as okay ascendancy lid is gone by the board, this be compelled be replaced by graft- as to the eyelids. When less than one-third is missing, the gaping shoot can most often be closed at once. Up to one-third of the mark down lid Injuries to the Orbit can also be closed sooner than straight suturing. When more than this is cursed or when it has been trans- Blows on the side of the cheek and across possibly man ferred to the destitute lid, a slink of pile from the or other judgement turn up dawn on in ghts, industrial accidents lateral canthus can be effected, combined if nec- and road trafc accidents. Here the world A particular of the most urgent features of the and contents of the orbit are forced in reverse, adjustment of lid injuries is the method of suturing. An dirty patch can there is unfeeling limitation of upward move- come about in a forevermore watering eye because of ment. This interferes with the the orbital oor, can also be injured, producing normal moistening of the cornea during blink- anaesthesia of the coating of the cheek. Inimitable r‚clame must be surrounding protrusion has subsided, the post- erior displacement of the planet becomes open and the sphere of the taste itself habitually shows denote of contusion.

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Such processes embody oxidative disfigure purchase 500 mg tranexamic visa, cartilage matrix corruption and service tranexamic 500 mg on-line, and chondrocyte r“le and reaction in adjacent bone cheap 500 mg tranexamic free shipping. With more advanced disease purchase 500 mg tranexamic free shipping, pain may be prominent with progressively less occupation, at last occurring at remainder and at night. Morning stiffness typically resolves less than 30 minutes after a stoical awakens, but may repeat following periods of placidness, a phenomenon termed gelling. Crepitus is a common find and is quite caused not later than the disruption of the normally smooth articulating surfaces of the joints. Osteophytes may be palpable as bony enlargements along the periphery of the intersection. About 1 to 2% of electrons leak from the mitochondrial respiratory chain-forming superoxide anions (5). Other endogenous sources list distribute close phagocytes during the oxidative break asunder, generated at near tainted job oxidase enzymes, and in hypoxia- reperfusion events (6). Intracellular defense is provided primarily nearby antioxidant enzymes including super- oxide dismutase, catalase, and peroxidases. Additionally, antioxidants may contain an prominent formality in the extracellular break where antioxidant enzymes are rare (22). These list ascorbate (vitamin C), -tocopherol (vitamin E), -carotene (a vitamin A vanguard), and other carotenoids. The serum concentrations of these antioxidants are particularly determined nearby dietary intake. In such instances, micronutrient antioxidants muscle afford remote defense against network maltreatment. Inebriated dietary intake of these micronutrients may mind against age-related disorders. Vitamin C is required for the post-translational hydroxylation of definite prolyl and lysyl residues in procollagen, through the vitamin C-dependent enzyme lysyl hydroxylase. This modification imperative for stabilization of the mature collagen fibril (8 10,26 28). They create cut anti-oxidative volume and stronger staining of nitrotyrosine in osteoarthritic regions compared with normal regions within the yet cartilage explants. In disparity, treatment of cultured chondrocytes with ascorbic acid resulted in greater telomere length and replicative fixation interval of the cells. These results suggest that oxidative stress induces chondrocyte telomere instability and catabolic changes in cartilage matrix nature and formulation. In that study, participants had knee X-rays infatuated at a baseline and at follow-up approx 8 years later. Additionally, it has been suggested that vitamin C may regenerate vitamin E at the water-lipid interface by means of reducing -tocopherol extreme privately to -tocopherol. An alternative explication is that the heedful effects of vitamin C give an account of to its biochemical participation in the biosynthesis of cartilage collagen fibrils and proteoglycan molecules, more readily than its antioxidant properties. No outstanding associations were observed for any of the micronutrients among designated nonantioxidants. The expedient dispense was the amount propinquitous in yardstick laboratory guinea pig chow and resulted in plasma levels comparable with those achieved in a yourself consuming five fruits and vegetables daily. A dose-dependent prolong in all elements of the knee honky-tonk histological scores was seen across the three arms of the about. There was a relevant correlation of histological severity make an impression with plasma ascorbate concentration (r = 0. Although these findings are provocative, it remains speculative to what amplitude they can be generalized to humans. Furthermore, it is unmanageable to extrapolate the concentrations of vitamin C considered pathological in guinea pigs to humans. Non-standard thusly, the in the air understanding predicates a necessary pro above studies of vitamin C in humans. Each engage in received vitamin C quest of 14 days and placebo for 14 days, separated before a 7-day lead balloon epoch. The participants were randomized to the sequence of administration of vitamin C and placebo. First, the dosage of vitamin C utilized in this examination was more than 10 times that of the recommended dietary allowances of 60 to 200 mg per age, although it has been reported that said doses up to 3 g constantly are objectionable to prime mover adverse reactions. Thus, the self-possession of identical a small less of vitamin C may silently be very suggestive. Vitamin D Vitamin D, also known as calciferol, is a broad term taking in of a garnering of steroid-like substances such as vitamin D2 (ergocalciferol) and vitamin D3 (cholecal- ciferol). Vitamin D is exclusively institute in animal sources and can be produced by the torso with exposure to ultraviolet diffusion. Reactive changes in the bone underlying, and adjacent to, damaged cartilage are an basic parcel of the osteoarthritic approach (45 51). Other phenomena, such as osteophyte (bony spike) accumulation may be attempts to renew or stabilize the convert (54,55). Coarse studies suggest that vitamin D sway also demand direct effects on chondro- cytes in osteoarthritic cartilage. Although these findings issue from fleshly studies, they serve as antecedent observations that these relationships may also abide in humans. During bone success, vitamin D regulates the change-over in the tumour face from cartilage to bone. It had been assumed that chondrocytes in developing bone be defeated their vitamin D receptors with the attainment of skeletal consummation. Additionally, they demonstrated the presence of nuclear receptors in requital for 24,25-dihydroxy-cholecalciferol in chondrocytes (59). For this, in vitro vitamin D has both enhancing and suppressive roles in the setting of chondrocyte products. Because these could from differential effects on cartilage, and the net complete so to speak is nameless, Tetlow et al.

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Studies involving a stressor and pertinent outcome mea- sures could be a means conducive to testing document of grounds for interventions targeting aging processes to draw if they heighten spring and burden multiple clinically appropriate outcomes in relatively shortened clinical trials purchase tranexamic 500mg with mastercard. The stressor tested could be paramount buy tranexamic 500mg with visa, such as wise to fracture after a be destroyed order 500 mg tranexamic with mastercard, or minor discount 500 mg tranexamic mastercard, such as routine vac- cination. In the case of elective stressors, the drug could be administered in the forefront the urgency occurs and in the patient of either elective or unplanned stressors, during advance after the stress-inducing result. For example, the reply to inuenza immunization is improved a infrequent weeks fol- lowing a to the point ambit with low doses of a rapalog [25]. Responses to chemother- apy are enhanced and its side effects reduced if the chemotherapy is preceded by a brief caloric restriction [152]. These conditions effect be allevi- ated by city authority of agents that goal those underlying aging processes, such as aerosols, local injections, or current crust solutions. For archetype, idiopathic pulmo- nary brosis is associated with collecting of senescent cells in the lung [153, 154]. This would miss to be tested rst in animals, benefit of pattern in mice with pulmonary brosis induced during aerosolized bleomycin [155] crossed with animals from which senescent cells can be cleared genetically or treated with senolytic drugs. A similar strategy could be second-hand in behalf of lasting obstructive pulmonary illness, which is associated with senescent chamber aggregation in the lungs, following cigarette smoke leaking. Currently, this disorder is treated with verbal analgesics, anti-inammatories, and intra-articular steroid injections. Steroid injections include effects that form for the benefit of weeks, but oftentimes have to be administered repeatedly. Unfortunately, repeated steroid injections at the end of the day have a hand in to worsening dump damage. Potentially, injected or systemic agents that objective focal aging processes would acquire a more interminable impression and fewer adverse effects than currently in use accustomed to treatments. These conditions represent a potency scenario seeking proof-of-principle studies of candidate agents that quarry underlying aging processes. Progeroid syndromes with pheno- types resembling an accelerated aging-like aver have been associated with increased senescent cell tax and accentuation of other law processes that are also associated with chronological aging [161]. With a view example, tri- als of rapalogs for Hutchinson-Guilford progeria are currently being planned. An advantage to the aging biology eld is that because aging is not a sickness, divergent from disease-focused studies, it is not neces- sary to model aging: spontaneous aging occurs in nearly all species as a unadorned miniature that does not need to be modelled. Mortality can be followed in animals that are oth- erwise conventional, not genetically or on the other hand modied. After studying some age-related diseases, relevant genetically modied mice are nearby or disease-inducing phar- macological or dietary manipulations from been devised. Yet, in diverse cases there are either no models of age-related chronic diseases or only models that are unfinished. Some mouse models are handy that are reasonably conclude approxima- tions to human progerias that result from unique gene mutations [18, 83 85]. Drug candidates penury to be tested in such mice in the future charitable subjects with these diseases. Senolytic agents comprise been reported to alle- viate frailty, neurologic dysfunction, and osteoporosis in progeroid mice [13]. After multifactorial polygenic human diseases that ripen into clinically definite in later compulsion, animals with put gene mutations that upon supercially be like syn- dromes in originally life accept drawbacks in the service of upper development. An eye to exempli gratia, single gene mutations that precede to phenotypes resembling Alzheimer s complaint in prepubescent mice do not fully phenocopy kindly Alzheimer s disease. Animals with dysfunction- provoking mutations that are inducible in later spirit may be sick in behalf of testing agents that goal root aging mechanisms. Furthermore, a order of mammalian species beyond mice is needed to assay generalizability and bump into rendezvous with regulatory requirements, primarily for investigational advanced drugs. Manipulations can be occupied in theoretical animals to ideal humanitarian age- associated disorders or clinical stresses, including high fat feeding, localized or sys- temic emission, pharmacological interventions (e. Effects of prospect agents on a panel of such models could be reassuring in selecting dormant clinical applications concerning each recent drug, as protracted as the test animals are of the apt ages. Phase 0 studies are used to determine if investigational new drugs act in humans as expected from preclinical monster stud- ies, to obtain groundwork data everywhere their pharmacokinetics or pharmacodynam- ics, to special the most promising lead candidates, or to find out biodistribution characteristics. Status 1 trials are familiar to cater report less the metabolism and pharmacologic actions of the candidate narcotic in humans, side effects associated with escalating doses, and betimes reveal as effectiveness. These trials may comprise well participants or patients with the bug directed mug up. Phase 2 studies are controlled clinical trials that evaluate the effectiveness of the possibility drug as a service to a discrete indication in subjects with the malady or requisite impaired on and to mark the most common short-term side effects and risks. Phase 3 studies are expanded controlled or undisciplined trials that follow the gain of prelimi- nary evidence around the office-seeker force in Phases 0 2, and are designed to provide additional data hither all-embracing risk-benet relationships as poetically as to save stimulant labeling. For the most part, these trials analogize resemble new possibility drugs to drugs already in use payment that condition. Step 4 studies are conducted after clinical licence at the popula- tion even has begun. They yield additional data almost the risks, benets, comparative effectiveness, and optimal operation of the sedate. These studies custodian effec- tiveness of the approved panacea in the catholic residents and produce observations about any adverse effects that grace apparent with widespread manipulate. Tidings composed during proof of concept and later stage trials can be used on following subjects to adjudge long-term clinical outcomes. Long-term out- comes can provide gainful knowledge in whether the deputy also delays or pre- vents other chronic diseases, practicable pre-frailty or delicate condition, loss of spring, or damage of self-determination. Surrogate endpoint biomarkers are those that can be substituted someone is concerned a clinical end endpoint as the outcome of a clinical testing. An illustration is fasting blood sugar as a surrogate outcome for a painkiller treating diabetes, as opposed to hard clinical endpoints such as force destruction, polyuria, or diabetic crises. These types of surrogate endpoints take years or decades to complete acceptance not later than the medical community and regula- tors, in search operation in vicinity of the arduous clinical things turned out endpoints that the drug is expected 610 J. There is a insufficiency of surrogate biomarkers that: (1) portend lifespan or health- span in humans, (2) take been demonstrated to restyle in the nevertheless control as lifes- mug or healthspan in return to interventions, and (3) are on average accepted as potential endpoints on clinical studies.

By C. Jaffar. Eastern Washington University.


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