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Diabetic- acarbose Precose ; , clorpropamide Diabinese ; , glimepiride Amaryl ; , glipizide Glucotrol ; , glyburide Diabeta, Micronase ; , insulin all types ; , metformin Glucophage ; , pioglitazone Actos ; , rosiglitazone Avandia ; , tolazamide Tolinase ; , tolbutamide Orinase ; . Hyperlipidemia- atorvastatin Lipitor ; , cholestyramine Questran ; , colesevelam Welchol ; , ezetimibe Zetia ; , fenofibrate Tricor ; , gemfibrozil Lopid ; , niacin Niaspan, Nicotinic Acid, Slo-Niacin ; , pravastatin Pravachol ; , rosuvastatin Crestor ; . Wasting- carafate Sucralfate ; , cyproheptadine Periactin ; , diphen-atopine Lomotil ; , dronabinol Marinol ; , esomeprazole Nexium ; , famotidine Pepcid ; , lansoprazole Prevacid ; , megestrol acetate Megace ; , omerprazole Prilosec ; , pancrease Enzymes all formulations, generics ; , pantoprazole Protonix ; , rabeprazole Aciphex ; , ranitidine Zantac ; , testosterone replacement products All types ; . 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Removed in 2005 - celecoxib Celebrex ; , rofecoxib Vioxx ; , valdecoxib Bextra. Win with Generics was implemented in July 2003 Since all of the prescription drug data were and ran through October 2003. By using smart edits in automated, vouchers were not needed, Lassen its claims adjudication system, Prime identified BCBpoints out. Instead, targeted members who SKS members who had recently been prescribed one requested generic substitution at the time of refill of 45 multi-source branded drugs -- all for chronic automatically had their copayment waived. By conditions -- for which generic equivalents are considusing claim system edits, the PBM also could idenered therapeutically equivalent. See Figure 1. ; In July tify members who were already using generic med2003, BCBSKS mailed a letter to these members ications and ineligible for the incentive program so informing them to ask their pharmacists or doctors to that pharmacies knew when copays should not be switch their brand-name drugs to therapeutically waived. equivalent generic drugs at their next refill during the "We didn't have to staff a help desk or mail out 90-day period. See Figure 2 on page 82. ; vouchers, so this was a more efficient way to handle The letter explained that, like brand-name a generic drug incentive program, " Lassen says. counterparts, generic drugs are: When structuring the program, BCBSKS sought FDA-approved and regulated, input from an advisory committee of its members equal to the brand-name drug in terms of that meets twice a year. Last year, the health plan safety and effectiveness, and also conducted a comprehensive member education manufactured with the same active ingredients. campaign about the cost drivers of healthcare that "They could try the generic at no cost, which suggested generic substitution as one strategy for actually saved them more than $10 because we have reducing costs. "Maybe we laid the foundation for a tiered prescription drug plan, " Bailey points out. members to be more receptive to the Win with Based on results with other BCBS plans that Generics program, " Bailey muses. have similar programs, Prime had predicted a During periodic face-to-face meetings and in its generic conversion rate of 10% to 30%, says David Lassen, senior director of clinFigure 1: Win with Generics Member Incentive Program ical utilization programs at Prime, which The following listed drugs qualify for the program. is collectively owned by several BCBS plans, subsidiaries, or affiliates. Of the Brand Name Generic Name Most commonly used for: members who received a letter from BCB- Accutane isotretinoin Acne Adalat CC, Procardia XL nifedipine extended-release High blood pressure SKS, 256, or 15.3%, switched to a generic Anexsia, Lorcet, Lorcet Plus, product, and all but 28 of these stayed Pain Lortab, Norco, Vicodin, Vicodin hydrocodone acetaminophen with the generic for six months. ES, Vicodin HP Though the conversion rate may Calan SR, Isoptin SR verapamil extended-release High blood pressure Cardizem CD diltiazem extended-release High blood pressure appear small, it's higher than those Cardura doxazosin High blood pressure, BPH achieved by BCBS plans that have tried Darvocet-N 50, Darvocet-N 100 propoxyphene acetaminophen Pain other generic substitution approaches, Demadex torsemide Diuretic water pill ; Bailey maintains. Win with Generics Dyazide triamterene hydrochlorothiazide Diuretic water pill ; yielded an overall savings of $6.99 per Glucophage metformin Diabetes blood sugar ; terazosin capsules High blood pressure, BPH targeted member -- those who received a Hytrin Klonopin clonazepam Seizures letter as part of the program -- and Lasix furosemide Diuretic water pill ; $45.65 per utilizing member -- those who Lopressor metoprolol High blood pressure, BPH actually switched to the generic equivaMaxzide, Maxzide-25 triamterene hydrochlorothiazide Diuretic water pill ; Mevacor lovastatin High cholesterol lent. Depending on the number of preestropipate Hormone replacement scriptions and the cost of branded drugs, Ogen Percocet, Tylox oxycodone acetaminophen Pain savings were as high as $263, net of the Prinivil, Zestril lisinopril High blood pressure free copay, for some members, according Prinzide, Zestoretic lisinopril hydrochlorothiazide High blood pressure Proventil or Ventolin Inhaler albuterol inhaler Asthma, COPD to Lassen. Provera medroxyprogesterone Hormone replacement "The savings from the initial switch Prozac fluoxetine Depression to the generic equivalent are significant, Relagen nabumetone Pain, inflamation even with the waived copayment facTenormin atenolol High blood pressure tored in, " Lassen says. "But the longUltram tramadol Pain Vasotec enalapril High blood pressure term savings come from the consumers' Xanax alprazolam Nervousness, anxiety continued use of the generic product. Zantac ranitidine Stomach acid That's our goal, and preliminary results Ziac bisoprolol hydrochlorothiazide High blood pressure show this program is effective in achievSource: Blue Cross Blue Shield of Kansas. Reprinted with permission. ing that.

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Cos-1 cell populations were transfected with the plasmid expression constructs for PGHS-1 pSVT7-PGHS-1 ; or for PGHS-2 pSVL-PGHS-2 ; crosomal membranes were then prepared from these transfected cells and used for oxygenase assays to determine kinetic constants for the two murine PGH synthase isozymes. Initial measurements of cyclooxy0 genase activity with varying arachidonate concentrations es10-8 10-9 10-7 O O O O 0001 tablished that the K , values of PGHS-1 and PGHS-2 for [lndornelhactn]. M arachidonic acid were essentially the same: 3.0 and 2.5 p ~ , FIG. 1. Dose-response curve for inhibition by indomethacin respectively. We used 10 p~ arachidonate for all subsequent of murine PGHS-1 and PGHS-2 acoxygenase assays to determine the IDbovalues for cyclooxy- tivities. Cyclooxygenase activities ofcyclooxygenase COX ; cells microsomes from cos-1 genase inhibition by various nonsteroidal anti-inflammatory expressing murine PGHS-1 or PGHS-2 were measured in the presdrugs NSAIDs this substrate concentration was high ence of 10 p~ arachidonate as describedpreviously 24 ; . The maximal enough to give near-maximal oxygenase activity, but low activities in the absence of inhibitor 100% ; for PGHS-1 andPGHSenough to permit detection of inhibition by some of the less 2 were23 and 10.9 nmol of arachidonate consumed min mg of microsomal protein, respectively. water-soluble inhibitors. The NSAIDs tested in this study could be loosely grouped into three categories based on their relative abilities to in- Acetaminophen, a commonly used analgesic and antipyretic stantaneously inhibit the oxygenase activity of the PGHS-1 drug that lacks the anti-inflammatory properties common to and PGHS-2 enzymes Table I ; . In the first group were true NSAIDs 29 ; , was also tested; however, at concentrations meclofenamate and the propionic acid derivatives ibuprofen as high as 100 pM, acetaminophen had no detectable effects and flurbiprofen, three drugs that inhibited PGHS-1and on the oxygenase activities of either PGHS-1 or PGHS-2 PGHS-2 with comparable potencies Table I ; . Differences data not shown ; . between the ID values toward PGHS-1 and PGHS-2 for this IDaovalues for each NSAID were determined from microgroup of NSAIDs ranged from about a 2-fold preference for somes prepared from at least two different transfections of PGHS-2 for ibuprofen to about a7-fold preference for PGHS- cos-1cells. Each ID60 value was calculated from approximately 1 for meclofenamate. The substrate analog docosahexanoic 10 measurements made, at minimum, in duplicate see Fig. acid also inhibited both isozymes equally. A second group of 1 most of the IDm values agreed closely between separate compounds included NSAIDs that were about 10-30-fold experiments. The largest variations in IDso values, about 3better inhibitors of PGHS-1 than PGHS-2. Included in this fold, were observed for piroxicam and 6-MNA, but the varigroup were piroxicam and two structurally related members ances in these values are less than the5-fold variances in K , of the acetic acid family of NSAIDs, indomethacin and sulin- values previously reported for the sheep vesicular gland dac sulfide. The magnitudes of the differences in IDb0values PGHS-1 30 ; , values that were also determined byoxygen for this group are illustrated by the dose-response curves for electrode measurements. Transient expression of the murine indomethacin shown in Fig. 1. At 20 indomethacin, PGH synthase enzymes is, at present, the only method availPGHS-1 was completely inhibited, whereas PGHS-2 retained able for obtaining sufficient quantities of both PGH isozymes about 80% of its activity. Of the NSAIDs tested, only a single from any single species to allow direct kinetic measurements compound, 6-methoxy-2-naphthylacetic acid, the active me- comparing relative PGHS-1and PGHS-2 inhibition. Altabolite of nabumetone Relafen" ; 28 ; , was found to have a though PGHS-1 is expressed at high levels in vesicular gland, significant selectivity for inhibition of PGHS-2. 6"NA was no cell lines or tissues are known that express high levels of abouta 7-fold betterinhibitor of PGHS-2 than PGHS-1. only PGHS-2. That theseven NSAIDs tested show a unique.

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The majority of treatment in the United States is provided in primary care settings, and primary care providers can be effective at providing treatment. Although either pharmacotherapy or psychotherapy can be recommended in mild or moderate major depression, and they have about equal efficacy, in patients with severe depression, psychotherapy as a monotherapy is not recommended, because it often requires 6 to 8 weeks to provide improvement in symptoms. In such patients, psychotherapy may be combined with pharmacotherapy and remeron.
P119 MASS SPECTROMETRIC S TUDIES OF THE NONCOVALENT INTERACTION BETWEEN AMYLOID-? PEPTIDE AND BIOACTIVE COMPOUNDS F.N. Bazoti1, 2 , J. Bergquist 3 , K. Markides3, A. Tsarbopoulos1, 2 1 University of Patras, Greece. 2 GAIA Research Center, Kifissia, Greece. 3 Uppsala University, Sweden 187 P120 DETERMINATION OF HYDROFLUMETHIAZIDE BY TIME RESOLVED CHEMILUMINESCENCE J.A. Murillo Pulgarn , A. Alan Molina, G. Prez-Olivares Nieto University of Castilla-La Mancha, Ciudad Real, Spain 188 P121 TIME-RESOLVED CHEMILUMINESCENCE AS A DETERMINE HYDRALAZINE IN PHARMACEUTICALS J.A. Murillo Pulgarn , P. Fernndez Lpez, P. Hoyas Nuo University of Castilla-La Mancha, Ciudad Real, Spain TOOL TO.
National Registry Fraunfelder FT. National Registry of Drug-Induced Ocular Side Effects. Monitoring for Drug Safety. W. H. Inman, ed. London, MTP Press; 1985: 363-369 and risperdal, for example, relafen abuse.

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Tient. To prevent further selfinjury, patients should wear protective polycarbonate goggles, and they should be monitored closely in conjunction with the psychiatry service. Treatment of the underlying disorder with behavior modification and pharmacotherapy is essential, and pharmacological agents that antagonize dopamine are most effective in reducing the severity of motor and vocal tics. Sue Lim, MD Kourous A. Rezai, MD Gary W. Abrams, MD Dean Eliott, MD Detroit, Mich and ritalin.
R. Nring, J ork. B. Born, B. Labrot, H. Mann, P. Saake, M. Spallek, Transepidermaler Wasserverlust bei Atopie, Dermatosen 41, Heft 3, 1993 Bei 279 Meitarbeitern wurde der Atopie-Score bestimmt, an vier verschiedenen Krperstellen Unterarmstreckseite, Unterarmbeugeseite, Handrcken und Handflche ; wurde der Transepidermale Wasserverlust TEWL ; gemessen. Es zeigt sich, da der Atopie-Score und der TEWL unabhngige Gren sind. V. Bousquet, D. Redoules, I. Raynal, G. Dahlem, Y. Gall, Les principales techniques d'objectivation des effets des dermo-cosmtiques, Cosmtologie, 1993 La mise au point de produits dermo-cosmtiques de plus en plus performants grce aux progrs de la galnique a entran le dveloppement d'un ensemble de mthodes d'valuation visant mesurer leurs effets directement sur la peau et de la manire la plus objective. R. Marks, C. Edwards, Methods to aid the coice of shade from a range of colour disguise cosmetics, University of Wales College of Medicine, 26 May 1993 The range of cosmetic camouflage products for major disfiguring skin conditions are well known, and are available in a wide range of shades. They require considerable skill and training for their blending and application which also needs a finishing layer of powder for best effect. These products are admirably suited to their use on major blemishes, but would be difficult to apply by a consumer at home for minor blemishes. A.O. Barel, P. Clarys, Study of the Stratum Corneum barrier function by Transepidermal water loss TEWL ; measurements. Comparison between two commercial instruments: Evaporimeter and Tewameter, Studio sulla funzione barriera dello strato corneo per mezzo della perdita di umiditaper traspirazione cutanea TEWL ; . Confronto tra due strumenti: Evaporimeter e Tewameter ; , Cosmetics & Toiletries Ed.It.n. 1 94 The measurement of Trans Epidermal Water Loss TEWL ; is an important non invasive method for assessing the efficiency of the skin as a protective barrier. As a consequence, the measurement of TEWL provides information concerning the integrity of the epidermis in normal, irritated and diseased skin situations, concerning the effects of chemicals on the surface of the skin and concerning the objective evaluation of occlusive pharmaceutical and cosmetic preparations. In the past different non invasive methods and instruments have been developed to measure TEWL. Until recently, the only commercial available TEWL instrument was the Evaporimeter made by Servomed, Sweden, based on the open chamber evaporation gradient method. This widely used instrument, measures the water evaporation gradient developed from the skin surface in an open chamber system. Hygrosensors coupled with thermistors measure at two different distances from the skin surface, the water evaporation at the skin surface. Recently a new instrument based on the same principle of measurement of the water evaporation gradient in an open chamber, was developed and became commercially available: Tewameter TM 210 made by Courage + Khazaka, Germany. It is the purpose of this chapter to compare the two commercial instruments under identical experimental conditions. The following parameters will be comparatively analyzed and described: general technical description of the probes and the instruments, evaluation of the accuracy, reproducibility and range of TEWL measurements and a comparative study of some typical applications of TEWL measurements in dermato-cosmetic research. TEWL-measurements were carried out with both instruments after stripping, occlusion and the treatment with irritant detergents. Jeanne Duus Johansen, Dorte Ramsing, Gunhild Vejlsgaard and T. Agner, Skin barrier properties in patients with recessive x-linked ichthyosis, Second International Symposium on Irritant Contact Dermatitis ISICD ; , Zurich, April 14-16, 1994 Recessive X-linked ichthyosis RXLI ; is scaling disorder of the skin with the biochemical abnormality known to be steroid sulphate deficiency. In epidermis levels of cholesterol are decreased and levels of cholesterol sulphate increased. The influence of this disturbed lipid composition of the epidermis with respect to skin barrier function was.

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2-, and 3-GABAA receptors. In addition, zaleplon binds with greater sensitivity to 3- and 5-GABAA receptors than zolpidem [28]. The impact of these differences in activity at different receptor subtypes on the magnitude and duration of residual ; drug activity needs to be addressed by future research.

We will be responsible for keeping track of your out-of-pocket cost amount and will let you know when you have qualified for catastrophic coverage. If you are in a coverage gap and have purchased a covered Part D drug at a network pharmacy under a special price or discount card that is outside the Plan's benefit, you may submit documentation and have it count towards qualifying you for catastrophic coverage. In addition, every month you purchase covered prescription drugs through us, you will get an Explanation of Benefits that shows your out-ofpocket cost amount to date and serevent.

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6MNA undergoes biotransformation in the liver, producing inactive metabolites that are eliminated as both free metabolites and conjugates. None of the known metabolites of 6MNA has been detected in plasma. Preliminary in vivo and in vitro studies suggest that unlike other NSAIDs, there is no evidence of enterohepatic recirculation of the active metabolite. Approximately 75% of a radiolabeled dose was recovered in urine in 48 hours. Approximately 80% was recovered in 168 hours. A further 9% appeared in the feces. In the first 48 hours, metabolites consisted of: nabumetone, unchanged not detectable 6-methoxy-2-naphthylacetic acid 1% 6MNA ; , unchanged 6MNA, conjugated 11% 6-hydroxy-2-naphthylacetic acid 5% 6HNA ; , unchanged 6HNA, conjugated 7% 4- 6-hydroxy-2-naphthyl ; -butan-2-ol, 9% Conjugated O-desmethyl-nabumetone, conjugated 7% unidentified minor metabolites 34% Total % Dose: 73% Following oral administration of dosages of 1, 000 mg to 2, 000 mg to steady state, the mean plasma clearance of 6MNA is 20 to min and the elimination half-life is approximately 24 hours. Elderly Patients: Steady-state plasma concentrations in elderly patients were generally higher than in young healthy subjects see Table 1 for summary of pharmacokinetic parameters ; . Renal Insufficiency: In moderate renal insufficiency patients creatinine clearance 30 to 49 min ; , the terminal half-life of 6MNA was increased by approximately 50% 39.2 7.8 hrs, N 12 ; compared to the normal subjects 26.9 3.3 hrs, N 13 ; , and there was a 50% increase in the plasma levels of unbound 6MNA. Additionally, the renal excretion of 6MNA in the moderate renal impaired patients decreased on average by 33% compared to that in the normal patients. A similar increase in the mean terminal half-life of 6MNA was seen in a small study of patients with severe renal dysfunction creatinine clearance 30 mL min ; . In patients undergoing hemodialysis, steady-state plasma concentrations of the active metabolite 6MNA were similar to those observed in healthy subjects. Due to extensive protein binding, 6MNA is not dialyzable Dosage adjustment of RELAFEN generally is not necessary in patients with mild renal insufficiency 50 mL min ; . Caution should be used in prescribing RELAFEN to patients with moderate or severe renal insufficiency. The maximum starting doses of RELAFEN in patients with moderate or severe renal insufficiency should not exceed 750 mg or 500 mg, respectively once daily. Following careful monitoring of renal function in patients with moderate or severe renal and serzone.
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Discharge at the agreed time if all the above satisfactory. Minimum is 6h if suitable for day-case biopsy, see below. In all cases patient must have passed urine 6h or final BP and pulse should have been recorded patient must be given a number to call if problems renal ward ; results usually given at an outpatient appointment in near future returning to work and other activities: a day or two off work is usually enough. Heavy manual activities should be avoided for a few days. No other special precautions are required. Day case biopsies These are suitable if the following conditions can be met: Inclusion criteria: Low risk Suitable responsible person at home Can arrange own transport for discharge in evening Exclusions: Anticoagulation Creatinine 250 micromol l Serious comorbid disease Diabetes mellitus does not automatically exclude day case biopsy as there is no requirement to fast. Patients must have an appropriately early biopsy. Urgent biopsies warn renal pathologist Out of hours procedures contact the consultant pathologist first Further info on the web: Information for patients about renal biopsy and synthroid. A new 'click-on' system for insulin pens has recently been devised. Disetronic Medical Systems, Inc, launched PenFine Universal Click Insulin Pen Needles on the market at the beginning of August. This new system allowing for needles to be clicked on, instead of threaded on, any insulin pen, appears to represent a significant advance for people with diabetes who inject insulin with a pen. The new needles range in length from 6 to 12 mm, to accommodate various injection sites and techniques. Future developments letter to flexeril an excessive flexeril are awarding relafen lung and tamoxifen and relafen.
Was matched with 233 untreated patients at three Taiwanese medical centers. At the end of the 11-year follow-up period median, 6.8 years ; , patients in the interferon group achieved a higher rate of HBeAg seroconversion and a reduced rate of cirrhosis and HCC compared with untreated patients Fig 1 ; .3 Overall, patients who seroconverted, whether in the treated or untreated group, showed a significantly lower incidence of cirrhosis and HCC compared with untreated nonconverters. Nonconverters in the interferon-treated group, however, had a modestly lower incidence of cirrhosis and HCC compared with untreated nonconverters. The rate of HBeAg seroconversion was higher and the rate of cirrhosis and HCC was lower in patients infected with genotype B compared with patients infected with genotype C, regardless of treatment status. Patients who have rheumatoid arthritis can take other drugs that act on their immune systems to help cut pain and temazepam. Vast majority of living organisms that have mitochondria, than will accumulate in the cells of humans who are only eating 60 mg of Vitamin C per day. The reason humans are able to survive with much lower levels of vitamin C than the vast majority of other higher organisms, both plants and animals, normally enjoy, is because our distant primate ancestors lived in trees and ate a lot of leaves and or fruit. Those foods provided high and steady dietary levels of Vitamin C. Thus, over millions of years their mitochondria were able to "devolve" the ability to produce the Vitamin C that they would otherwise have needed to make for themselves. Since our later ancestors left the trees, they have evolved some mechanisms to conserve Vitamin C, so that they could still survive, even when they were producing and or eating much less that the optimum amount of it. Thus, it is true that we can survive with as little as 60mg of it per day. That still does not make so little the optimum amount. Cats, dogs, goats, rabbits and most other mammals still produce all of the Vitamin C they need for their own use, and they typically enjoy concentrations of Vitamin C in their bodies that a human would have to consume 515 grams of Vitamin C per day to achieve. There is much evidence that we would do best if we also still had such high concentrations of Vitamin C in our blood, and in our mitochondria. Even with as little as gram 500 mg ; of Vitamin C per day, the vast majority of people will have faster metabolism, and feel better, than they would if they were only getting 60 mg of it per day. So why has our government set the standards we are supposed to live by so low? Probably because vitamins cost money, and if food processors had to add more optimal levels of them into their products, then it could cost them a fraction of a penny more per serving. Besides, if foods were more nutritious, then doctors, and pharmaceutical companies, would not have as much business. In case you were not aware, the medical establishment, and its interests, are much more involved in shaping our public health policies and laws, than are you and your friends. Since larger dietary amounts of Vitamin C help to speed metabolism, particularly in more active kinds of cells, such as immune cells, and older people tend to suffer disproportionately from slowing metabolism, I believe that those over 40 would do better with about 1-5 grams of Vitamin C per day. While I talking about vitamin supplements, let me mention that we also need adequate amounts of all of the other essential vitamins and minerals. The international "codex agreements", if we ever allow them to be imposed upon this county, would make it so that it requires a doctor's prescription to get more than the Minimum Daily Value of any vitamin or mineral in any one pill. Remember that depression, psychosis and many other mental and physical illnesses are often caused by vitamin and or or mineral deficiencies, and that everyone has a unique metabolism, and unique needs of particular. Chronic Obstructive Pulmonary Disease Chest Infection Breathing Difficulties Abdominal Pain Back Pain Headaches Sickness Diabetes Fits Convulsions Burns Falls Neuro Head Injury Animal Bites Palliative care needs This may include intravenous therapy and medication, oxygen therapy etc. They may step patients down to 24 7 team for ongoing care once the assessment is complete and a treatment plan is in place. Their response time is 30 mins of referral whenever possible. If unable to respond within this time this will be discussed at time of referral. The Urgent Care Team maintains close links with CDU at City Hospitals and will arrange for patients who are not stabilising to be seen promptly and further assessed in CDU without the need to refer back to the GP.
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A. C. F. Hui, K. M. Chow, V. C. T. Mok, C. C. Szeto, K. S. Wong Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong.
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