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[PMID]: 29490365
[Au] Autor:Canner JK; Harfouch O; Kodadek LM; Pelaez D; Coon D; Offodile AC; Haider AH; Lau BD
[Ad] Address:Johns Hopkins Surgery Center for Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
[Ti] Title:Temporal Trends in Gender-Affirming Surgery Among Transgender Patients in the United States.
[So] Source:JAMA Surg;, 2018 Feb 28.
[Is] ISSN:2168-6262
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Importance: Little is known about the incidence of gender-affirming surgical procedures for transgender patients in the United States. Objectives: To investigate the incidence and trends over time of gender-affirming surgical procedures and to analyze characteristics and payer status of transgender patients seeking these operations. Design, Setting, and Participants: In this descriptive observational study from 2000 to 2014, data were analyzed from the National Inpatient Sample, a representative pool of inpatient visits across the United States. The initial analyses were done from June to August 2015. Patients of interest were identified by International Classification of Diseases, Ninth Revision, diagnosis codes for transsexualism or gender identity disorder. Subanalysis focused on patients with procedure codes for surgery related to gender affirmation. Main Outcomes and Measures: Demographics, health insurance plan, and type of surgery for patients who sought gender-affirming surgery were compared between 2000-2005 and 2006-2011, as well as annually from 2012 to 2014. Results: This study included 37 827 encounters (median [interquartile range] patient age, 38 [26-49] years) identified by a diagnosis code of transsexualism or gender identity disorder. Of all encounters, 4118 (10.9%) involved gender-affirming surgery. The incidence of genital surgery increased over time: in 2000-2005, 72.0% of patients who underwent gender-affirming procedures had genital surgery; in 2006-2011, 83.9% of patients who underwent gender-affirming procedures had genital surgery. Most patients (2319 of 4118 [56.3%]) undergoing these procedures were not covered by any health insurance plan. The number of patients seeking these procedures who were covered by Medicare or Medicaid increased by 3-fold in 2014 (to 70) compared with 2012-2013 (from 25). No patients who underwent inpatient gender-affirming surgery died in the hospital. Conclusions and Relevance: Most transgender patients in this national sample undergoing inpatient gender-affirming surgery were classified as self-pay; however, an increasing number of transgender patients are being covered by private insurance, Medicare, or Medicaid. As coverage for these procedures increases, likely so will demand for qualified surgeons to perform them.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180228
[Lr] Last revision date:180228
[St] Status:Publisher
[do] DOI:10.1001/jamasurg.2017.6231

  2 / 3373 MEDLINE  
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[PMID]: 28481718
[Au] Autor:Qureshi RI; Zha P; Kim S; Hindin P; Naqvi Z; Holly C; Dubbs W; Ritch W
[Ad] Address:a School of Nursing, Rutgers , State University of New Jersey , Newark , New Jersey , USA.
[Ti] Title:Health Care Needs and Care Utilization Among Lesbian, Gay, Bisexual, and Transgender Populations in New Jersey.
[So] Source:J Homosex;65(2):167-180, 2018.
[Is] ISSN:1540-3602
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The purpose of this study was to explore prevalent health issues, perceived barriers to seeking health care, and utilization of health care among lesbian, gay, bisexual, and transgender (LGBT) populations in New Jersey. A cross-sectional online survey was administered to 438 self-identified LGBT people. Results identified health needs, which included management of chronic diseases, preventive care for risky behaviors, mental health issues, and issues related to interpersonal violence. Barriers to seeking health care included scarceness of health professionals competent in LGBT health, inadequate health insurance coverage and lack of personal finances, and widely dispersed LGBT inclusive practices making transportation difficult. There is a need for better preparation of health care professionals who care for LGBT patients, to strengthen social services to improve access and for better integration of medical and social services.
[Mh] MeSH terms primary: Health Services/utilization
Needs Assessment
Sexual and Gender Minorities
[Mh] MeSH terms secundary: Adult
Aged
Cross-Sectional Studies
Female
Homosexuality, Female/psychology
Homosexuality, Male/psychology
Humans
Male
Middle Aged
New Jersey
Sexual Behavior
Transgender Persons
Transsexualism
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180221
[Lr] Last revision date:180221
[Js] Journal subset:IM
[Da] Date of entry for processing:170509
[St] Status:MEDLINE
[do] DOI:10.1080/00918369.2017.1311555

  3 / 3373 MEDLINE  
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[PMID]: 28406387
[Au] Autor:Kattari SK; O'Connor AA; Kattari L
[Ad] Address:a Graduate School of Social Work , University of Denver , Denver , Colorado , USA.
[Ti] Title:Development and Validation of the Transgender Inclusive Behavior Scale (TIBS).
[So] Source:J Homosex;65(2):181-196, 2018.
[Is] ISSN:1540-3602
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Transgender-inclusive behaviors are actions and communication supporting transgender individuals. Examples include using language not reinforcing the gender binary, asking for and using correct pronouns, creation of spaces that welcome members of the transgender community, and acknowledging cisgender (non-transgender) privilege. A survey was developed measuring this behavior in individuals to examine the impact of transgender-inclusive behavior and the potential effect of interventions on promoting inclusive behavior. Data were collected utilizing an online survey (N = 1,051). The sample was split in half to run two sets of cases in a principal components analysis. Analysis of the full sample showed Cronbach's alpha to be .93 (n = 918). Findings suggest that the Transgender Inclusive Behavior Scale (TIBS) may be a useful instrument for identifying behaviors related to being inclusive of transgender individuals, groups, and communities. It may also be used to measure behavior change before and after transgender-specific educational and behavioral interventions.
[Mh] MeSH terms primary: Applied Behavior Analysis/methods
Transgender Persons/psychology
Transsexualism/psychology
[Mh] MeSH terms secundary: Adult
Female
Gender Identity
Humans
Male
Social Isolation
Surveys and Questionnaires
Young Adult
[Pt] Publication type:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Entry month:1802
[Cu] Class update date: 180221
[Lr] Last revision date:180221
[Js] Journal subset:IM
[Da] Date of entry for processing:170414
[St] Status:MEDLINE
[do] DOI:10.1080/00918369.2017.1314160

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[PMID]: 29346355
[Au] Autor:Delahunt JW; Denison HJ; Sim DA; Bullock JJ; Krebs JD
[Ad] Address:Clinical Lecturer, Department of Medicine, University of Otago, Wellington.
[Ti] Title:Increasing rates of people identifying as transgender presenting to Endocrine Services in the Wellington region.
[So] Source:N Z Med J;131(1468):33-42, 2018 01 19.
[Is] ISSN:1175-8716
[Cp] Country of publication:New Zealand
[La] Language:eng
[Ab] Abstract:AIMS: Overseas clinics specialising in management of transgender people have noted a marked increase in the numbers of people requesting therapy in the last few years. No data has been presented for New Zealand. We therefore reviewed the number of transgender people seen in the Wellington Endocrine Service to assess if the pattern was similar and assess any potential problems for service delivery. METHODS: Using hospital records, we reviewed the new appointments of people who were referred for advice on gender reassignment and seen in the Wellington Endocrine Service from 1990 to 2016. RESULTS: In total, 438 people who identified as transgender attended the clinic at least once in this period. There has been a progressive increase in number of people identifying as transgender presenting to the clinic, particularly since 2010. In addition to increasing overall numbers, there has been in particular increase in referrals for people under age 30, as well as an increasing proportion of people requesting female-to-male (FtM) therapy so that it is now approaching the number of people requesting male-to-female therapy (MtF). CONCLUSION: The pattern observed is comparable to changes reported overseas. These changes have practical consequences for the delivery of both secondary and primary level healthcare, requiring an increased focus on clinical coordination between the relevant medical services and their links to the primary services sector.
[Mh] MeSH terms primary: Referral and Consultation/trends
Transgender Persons/statistics & numerical data
Transsexualism/epidemiology
[Mh] MeSH terms secundary: Adolescent
Adult
Female
Humans
Male
New Zealand/epidemiology
Prevalence
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180215
[Lr] Last revision date:180215
[Js] Journal subset:IM
[Da] Date of entry for processing:180119
[St] Status:MEDLINE

  5 / 3373 MEDLINE  
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[PMID]: 29178533
[Au] Autor:Santucci RA
[Ad] Address:Brownstein Crane Surgical Services, Bee Caves Road, J201 Austin, Texas.
[Ti] Title:Urethral Complications After Transgender Phalloplasty: Strategies to Treat Them and Minimize Their Occurrence.
[So] Source:Clin Anat;31(2):187-190, 2018 Mar.
[Is] ISSN:1098-2353
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Radial forearm free flap phalloplasty (RFFP) is the current standard of care for most FTM gender confirmation surgeries. This procedure is associated with a rate of urethral stricture as high as 51%, which falls only to 23-35% even among the most experienced contemporary surgeons. While some modifications have been proposed to combat this high complication rate, it still remains a major source of lasting morbidity. The method involves literature review of RFFP literature. Lowest stricture rates are found when neourethra is made with a long, meticulously constructed tube of well-vascularized perivaginal/periurethral and labia minora tissue. In cases of urethral stricture, urethroplasty is required in 94-96% of patients. Surgery should be delayed until all acute inflammation has subsided. Urethroplasty is technically challenging and fails in up to 50% of cases. Repeated surgery or salvage urethral exteriorization procedures, which can leave the patient with lifelong perineal urethrostomy, are often required. Patient and physician knowledge regarding the high burden and poor treatment options for urethral stricture after phalloplasty is incomplete, and patient acceptance of this reality is crucial for honest understanding of the potential complications of this increasingly common but extremely complex surgery. Clin. Anat. 31:187-190, 2018. © 2018 Wiley Periodicals, Inc.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1711
[Cu] Class update date: 180213
[Lr] Last revision date:180213
[St] Status:In-Process
[do] DOI:10.1002/ca.23021

  6 / 3373 MEDLINE  
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[PMID]: 29422297
[Au] Autor:Verbruggen C; Weigert R; Corre P; Casoli V; Bondaz M
[Ad] Address:Service de chirurgie maxillo-faciale, stomatologie et chirurgie orale, centre François-Xavier-Michelet, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France. Electronic address: charlie.verbruggen@gmail.com.
[Ti] Title:Élaboration d'un questionnaire de satisfaction encadrant la chirurgie de féminisation faciale chez les patientes transsexuelles male to female (QESFF1) : Phase qualitative. [Development of the facial feminization surgery patient's satisfaction questionnaire (QESFF1): Qualitative phase].
[So] Source:Ann Chir Plast Esthet;, 2018 Feb 05.
[Is] ISSN:1768-319X
[Cp] Country of publication:France
[La] Language:fre
[Ab] Abstract:OBJECTIVE: Facial feminization surgery is becoming a more frequently requested procedure in transsexual male to female patients transformation. A global way of reporting outcomes data and showing the beneficial impact of this specific procedure is necessary. The objective of this study is to develop a reliable and valid tool to report patients' outcomes after facial feminization surgery. METHODS: A systematic literature review, input from experts working with transsexual patients and patient interviews were used to develop the conceptual framework of the questionnaire. It includes the outcomes deemed important to facial feminization surgery and it was used to construct items of the questionnaire. RESULTS: There is no specific tool for measuring patients outcomes after facial feminization surgery. Ten experts and 18 patients participated to this study. The conceptual framework includes the following themes: satisfaction with facial feminine appearance; adverse effects; quality of life. The questionnaire includes fourteen separate Likert scales, with preoperative and postoperative versions. The reliability of the questionnaire is excellent with a medium Alpha score of 0.85. Facial feminization surgery is associated with high patient satisfaction in this sample (83.7±7.41). CONCLUSION: QESFF1 is a reliable questionnaire and its development follows the steps recommended by the patient-reported outcomes process. A large sample pilot test is needed to demonstrate its validity. The QESFF1 can provide physicians with the necessary tools to measure the impact of facial feminization surgery on male to female transsexual patients and also has the potential to support clinical trials.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180209
[Lr] Last revision date:180209
[St] Status:Publisher

  7 / 3373 MEDLINE  
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[PMID]: 28459379
[Au] Autor:Rossman K; Salamanca P; Macapagal K
[Ad] Address:a Trans and Sexuality Teaching, Advocacy, and Research (TSTAR) , Louisville , Kentucky , USA.
[Ti] Title:A Qualitative Study Examining Young Adults' Experiences of Disclosure and Nondisclosure of LGBTQ Identity to Health Care Providers.
[So] Source:J Homosex;64(10):1390-1410, 2017.
[Is] ISSN:1540-3602
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Shifting cultural attitudes and legislation have increased focus on the health care needs of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients. However, patient nondisclosure of LGBTQ identity creates a barrier to accessing care. This qualitative study examined a diverse sample of LGBTQ young adults and their experiences of disclosure and nondisclosure to medical providers. Participants (n = 206, age range 18-27) completed questionnaires assessing health care access and use as part of a larger study. Participants' responses to open-ended items asking about experiences of LGBTQ identity disclosure to medical providers and reasons for nondisclosure were analyzed thematically. Results revealed intra- and interpersonal factors related to patient disclosure and nondisclosure of LGBTQ identity. Reasons for participant nondisclosure included providers not asking about identity, internalized stigma, and belief that health and LGBTQ identity are not related. When participants did disclose, they experienced reactions ranging from discrimination and disbelief to affirmation and respect. Findings confirm and extend previous research on young adults' identity disclosure and provide avenues for health professionals' continuing education when working with LGBTQ patients.
[Mh] MeSH terms primary: Health Personnel
Homosexuality
Physician-Patient Relations
Self Disclosure
Sexual and Gender Minorities
[Mh] MeSH terms secundary: Adolescent
Adult
Attitude
Female
Health Services Accessibility
Humans
Male
Qualitative Research
Sexual Behavior
Social Stigma
Surveys and Questionnaires
Transgender Persons
Transsexualism
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1707
[Cu] Class update date: 180120
[Lr] Last revision date:180120
[Js] Journal subset:IM
[Da] Date of entry for processing:170502
[St] Status:MEDLINE
[do] DOI:10.1080/00918369.2017.1321379

  8 / 3373 MEDLINE  
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Clinical Trials Registry

[PMID]: 27770819
[Au] Autor:Willging CE; Green AE; Ramos MM
[Ad] Address:Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 612 Encino Place NE, Albuquerque, NM, USA. cwillging@pire.org.
[Ti] Title:Implementing school nursing strategies to reduce LGBTQ adolescent suicide: a randomized cluster trial study protocol.
[So] Source:Implement Sci;11(1):145, 2016 10 22.
[Is] ISSN:1748-5908
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Reducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, "RLAS" (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain changes. METHODS/DESIGN: Mixed methods will be used to examine individual, school, and community factors influencing both implementation process and youth outcomes. A cluster randomized controlled trial will assess whether LGBTQ students and their peers in RLAS intervention schools (n = 20) report reductions in suicidality, depression, substance use, bullying, and truancy related to safety concerns compared to those in usual care schools (n = 20). Implementation progress and fidelity for each EB strategy in RLAS intervention schools will be examined using a modified version of the Stages of Implementation Completion checklist. During the implementation and sustainment phases, annual focus groups will be conducted with the 20 IRTs to document their experiences identifying and advancing adaptation supports to facilitate use of EB strategies and their perceptions of the DAP. DISCUSSION: The DAP represents a data-informed, collaborative, multiple stakeholder approach to progress from exploration to sustainment and obtain fidelity during the implementation of EB strategies in school settings. This study is designed to address the real-world implications of enabling the use of EB strategies by school nurses with the goal of decreasing suicide and youth risk behaviors among LGBTQ youth. Through its participatory processes to refine and sustain EB strategies in high schools, the RLAS represents a novel contribution to implementation science. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02875535.
[Mh] MeSH terms primary: Adolescent Behavior/psychology
Bullying/prevention & control
School Nursing/methods
Sexual and Gender Minorities/psychology
Sexuality/psychology
Suicide/prevention & control
[Mh] MeSH terms secundary: Adolescent
Bisexuality/psychology
Cluster Analysis
Female
Homosexuality/psychology
Humans
Male
New Mexico
Research Design
Suicide/psychology
Transsexualism/psychology
[Pt] Publication type:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Entry month:1712
[Cu] Class update date: 171210
[Lr] Last revision date:171210
[Js] Journal subset:IM
[Da] Date of entry for processing:161025
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE

  9 / 3373 MEDLINE  
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[PMID]: 29125908
[Au] Autor:Dragon CN; Guerino P; Ewald E; Laffan AM
[Ad] Address:1 Office of Minority Health, Centers for Medicare & Medicaid Services , Baltimore, Maryland.
[Ti] Title:Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data.
[So] Source:LGBT Health;, 2017 Nov 10.
[Is] ISSN:2325-8306
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: Data on the health and well-being of the transgender population are limited. However, using claims data we can identify transgender Medicare beneficiaries (TMBs) with high confidence. We seek to describe the TMB population and provide comparisons of chronic disease burden between TMBs and cisgender Medicare beneficiaries (CMBs), thus laying a foundation for national level TMB health disparity research. METHODS: Using a previously validated claims algorithm based on ICD-9-CM codes relating to transsexualism and gender identity disorder, we identified a cohort of TMBs using Medicare Fee-for-Service (FFS) claims data. We then describe the demographic characteristics and chronic disease burden of TMBs (N = 7454) and CMBs (N = 39,136,229). RESULTS: Compared to CMBs, a greater observed proportion of TMBs are young (under age 65) and Black, although these differences vary by entitlement. Regardless of entitlement, TMBs have more chronic conditions than CMBs, and more TMBs have been diagnosed with asthma, autism spectrum disorder, chronic obstructive pulmonary disease, depression, hepatitis, HIV, schizophrenia, and substance use disorders. TMBs also have higher observed rates of potentially disabling mental health and neurological/chronic pain conditions, as well as obesity and other liver conditions (nonhepatitis), compared to CMBs. CONCLUSION: This is the first systematic look at chronic disease burden in the transgender population using Medicare FFS claims data. We found that TMBs experience multiple chronic conditions at higher rates than CMBs, regardless of Medicare entitlement. TMBs under age 65 show an already heavy chronic disease burden which will only be exacerbated with age.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171110
[Lr] Last revision date:171110
[St] Status:Publisher
[do] DOI:10.1089/lgbt.2016.0208

  10 / 3373 MEDLINE  
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[PMID]: 29050875
[Au] Autor:Wolter A; Scholz T; Pluto N; Diedrichson J; Arens-Landwehr A; Liebau J
[Ad] Address:Department of Plastic and Aesthetic Surgery, Florence-Nightingale-Hospital - Kaiserswerther Diakonie, Kreuzbergstrasse 79, Duesseldorf, Germany. Electronic address: a_wolter@gmx.de.
[Ti] Title:Subcutaneous mastectomy in female-to-male transsexuals: Optimizing perioperative and operative management in 8 years clinical experience.
[So] Source:J Plast Reconstr Aesthet Surg;, 2017 Sep 29.
[Is] ISSN:1878-0539
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:INTRODUCTION: The incidence of complications, especially acute hematoma requiring surgical revision in female-to-male transsexuals (FTMTS), is consistently highly documented in literature with up to 33%. Since 2008 we perform subcutaneous mastectomies in FTMTS with an annually increasing number of cases. Due to an initially high hematoma revision rate in the previously published cohort (2008-2013), we implemented peri- and postoperative preventive measures and compared the results with the recent patient cohort (2014-2016). PATIENTS AND METHODS: The records of 356 patients (712 mastectomies) were retrospectively reviewed. We compared the first cohort (C1, 01/2008 - 12/2013, 346 mastectomies; peri- and postoperative standard procedure and implementation of an algorithmic care path in our institution) with the recent cohort (C2, 01/2014 - 01/2016, 366 mastectomies) and introduced in C2 the following preventive measures: perioperative administration of tranexamic acid, intraoperative elevation of blood pressure to at least 120 mmHg before wound closure, bedrest and consequent wearing of compression bandage without removal 12 hours postoperatively. Comparison of complication rate, patient satisfaction and secondary revision rate was obtained in both cohorts. RESULTS: The mean operation time could be reduced from 103.6 minutes to 72.5 minutes (p < 0.05). The overall complication rate could be diminished from 11.8% to 5.5% (p < 0.05), the acute hematoma revision rate from 9.2% to 4.1% (p < 0.05). Secondary revisions were similar in both patient cohorts. Patient satisfaction rate was ameliorated from 88% to 93.5% "very satisfied" to "satisfied" patients. CONCLUSION: Hematoma is the most common reason for reoperation in FTMTS patients. By implementation of peri- and postoperative preventive measures and additional application of an algorithmic care path we could achieve a significant reduction of complications, particularly of the hematoma evacuation rate. During 8 years clinical and operative treatment in FTMTS we could furthermore achieve a decrease in operative time and an ameliorated patient satisfaction with the aesthetic results.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171023
[Lr] Last revision date:171023
[St] Status:Publisher


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