Burrinjuck Discogenic Low Back Pain Pdf

BASI Pilates as Movement Therapy for Lumbosacral

(PDF) 15. Discogenic low back pain Jan Kallewaard

Discogenic low back pain pdf

(PDF) 15. Discogenic Low Back Pain ResearchGate. Various interventional treatment strategies for chronic discogenic low back pain unresponsive to conservative care include reduction of inflammation, ablation of intradiscal nociceptors, lowering intranuclear pressure, removal of herniated nucleus, and radiofrequency ablation of the nociceptors. Unfortunately, most of these strategies do not, Discogenic pain is usually located in the low back area, with frequent radiation bilaterally to the lower extremities. It has been demonstrated that patients with L3–4 disk lesions usually have pain radiating to the anterior leg, but without pain in the posterior thigh or leg. In patients with a L4–5 disk lesion, the pain could be located.

US Musculoskeletal Management of Discogenic Low-ba Review

Treatment of Discogenic Low Back Pain Current Treatment. Discogenic Low Back Pain . Who gets discogenic low back pain? It is likely most people will experience low back pain at some point in their lives. Research suggests that 4 out of 5 adults are likely to develop low back pain at some point [1]. Discogenic low back pain accounts for 26%-42% of persistent low back pain problems [4]., The tissue origin of low back pain and sciatica.Orthop Clin.North Am. 1991. see readings • Only a midline structure causes midline pain %% some pain significant pain pain location Vertebral end plate 61 9 back Nucleus pulposis 0 0 Central annulus 74 15 back Central lateral annulus 71 30 back Posterior dura mater 23 6 buttock leg Anterior dura 23 5 back buttock Normal nerve root 11 9 buttock.

Of those myriad of patients with low back pain, the prevalence of clinically significant discogenic pain approaches 40% (1). In the United States, between 3 and 6 million patients suffer from chronic discogenic low back pain. Treatment options for discogenic pain include conservative measures such as analgesics, antiinflammatory agents, steroid 04/01/2020В В· Discogenic pain is a common diagnosis for low back pain. However, research suggests that our ability to accurately diagnose discogenic low back pain is limited in clinical practice. Source: Fujii

Low Back Pain Dave Burton & Helen Ruane November 2012. Red Flags nRed flags are a list of prognostic variables for serious pathology n CSP Guidelines 2007: nAGE <20, >45 with no precipitating event nNight pain nPain that causes the patient to be constantly moving or curled up in the sitting position nBack pain with constitutional symptoms – fatigue, nausea, diarrhoea, fever etc. Red Flags Discogenic lower back pain is pain that originates from the discs of the lumbar spine and it is the most common cause of chronic lower back pain. Diagnosis of this type of pain uses a physical history, physical examination, imaging tests, and possibly discography

18/04/2013 · Discogenic low back pain is a serious medical and social problem, and accounts for 26%-42% of the patients with chronic low back pain. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of … 13/10/2009 · Discogenic lower back pain (DLBP) is the most common type of chronic lower back pain (LBP), accounting for 39% of cases, compared to 30% of cases due to disc herniation, and even lower prevalence rates for other causes, such as zygapophysial joint pain.

Discogenic Low-back Pain with a Non-surgical Decompression System (DRX9000™)—Case Report, US Musculoskeletal Review, 2008; 3 (1) 14–15 Management of Discogenic Low-back Pain with a Non-surgical Decompression System (DRX9000™) US MUSCULOSKELETAL REVIEW 3 1. Boswell MV,Trescot AM, Datta S, et al. Interventional techniques: Key words: Discogenic low back pain, chronic low back pain, lumbar discography, painful disc, black disc, disc degeneration, internal disc disruption, natural history, prognosis. Pain Physician 2012; 15:525-532 Prospective Study Prospective Clinical Study on Natural History of Discogenic Low Back Pain at …

discogenic low back pain. 3C. Background of the Study: Low back pain is an extremely common cause of pain and disability. Although several structures within the spine have been identified as pain generators, the intervertebral disc is felt to account for 40-50% of chronic low back pain [3]. The most common conservative treatment options include activity restriction, medications, physical BASI Pilates as Movement Therapy for Lumbosacral Discogenic Pain Syndrome Cedra Hill October, 2014 2014 CTTC; Mt Shasta, CA ! 2! Abstract: Pilates is a potentially beneficial movement therapy for managing symptoms of Lumbosacral Discogenic Pain Syndrome. Pelvic lumbar stabilization, trunk stabilization, and spinal elongation in Pilates enhances body alignment and produces therapeutic …

13/10/2009 · Discogenic lower back pain (DLBP) is the most common type of chronic lower back pain (LBP), accounting for 39% of cases, compared to 30% of cases due to disc herniation, and even lower prevalence rates for other causes, such as zygapophysial joint pain. 18/04/2013 · Discogenic low back pain is a serious medical and social problem, and accounts for 26%-42% of the patients with chronic low back pain. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of …

Background: Discogenic low back is a distinct clinic entity characterized by pain arising from a damaged disc. The diagnosis is clouded by the controversy surrounding discography. The treatment options are limited, with unsatisfactory results from both conservative treatment and surgery. discogenic low back pain. 3C. Background of the Study: Low back pain is an extremely common cause of pain and disability. Although several structures within the spine have been identified as pain generators, the intervertebral disc is felt to account for 40-50% of chronic low back pain [3]. The most common conservative treatment options include activity restriction, medications, physical

A 48-year-old insurance salesman presents with a 25-year history of back pain. He developed severe back pain while stacking shelves at the local supermarket at age 23. The pain resolved after 10 days of bed-rest, followed by 3 months of physiotherapy. He has had multiple episodes of back pain occurring at increasing regularity over the years The tissue origin of low back pain and sciatica.Orthop Clin.North Am. 1991. see readings • Only a midline structure causes midline pain %% some pain significant pain pain location Vertebral end plate 61 9 back Nucleus pulposis 0 0 Central annulus 74 15 back Central lateral annulus 71 30 back Posterior dura mater 23 6 buttock leg Anterior dura 23 5 back buttock Normal nerve root 11 9 buttock

A 48-year-old insurance salesman presents with a 25-year history of back pain. He developed severe back pain while stacking shelves at the local supermarket at age 23. The pain resolved after 10 days of bed-rest, followed by 3 months of physiotherapy. He has had multiple episodes of back pain occurring at increasing regularity over the years Discogenic lower back pain (DLBP) is the most common type of chronic lower back pain (LBP), accounting for 39% of cases, compared to 30% of cases due to disc herniation, and even lower prevalence rates for other causes, such as zygapophysial joint pain.

Pathophysiology, diagnosis, and treatment of discogenic low back pain Bao-Gan Peng Bao-Gan Peng, Department of Spinal Surgery, Institute of Spi-nal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing 100039, China Author contributions: Peng BG solely contributed to … Discogenic Pain Treatment Page 2 of 15 UnitedHealthcare Community Plan Medical Policy Effective 10/01/2019 Proprietary Information of UnitedHealthcare.

Discogenic pain is usually located in the low back area, with frequent radiation bilaterally to the lower extremities. It has been demonstrated that patients with L3–4 disk lesions usually have pain radiating to the anterior leg, but without pain in the posterior thigh or leg. In patients with a L4–5 disk lesion, the pain could be located THE PATHOGENESIS OF DISCOGENIC LOW BACK PAIN 63 VOL. 87-B, No. 1, JANUARY 2005 sures in a painful disc. Our aim was to investigate the pathological changes in and the innervation of painful discs

THE AFFERENT PATHWAYS OF DISCOGENIC LOW-BACK PAIN

Discogenic low back pain pdf

Effectiveness of Thermal Annular Pain Physician. Of those myriad of patients with low back pain, the prevalence of clinically significant discogenic pain approaches 40% (1). In the United States, between 3 and 6 million patients suffer from chronic discogenic low back pain. Treatment options for discogenic pain include conservative measures such as analgesics, antiinflammatory agents, steroid, implicated in the pathogenesis of discogenic pain [8,9]. Definition of Discogenic Low Back Pain According to the International Association for the Study of Pain (IASP), the definition of lumbar discogenic pain is lumbar spinal pain, with or without referred pain to the lower limb girdle or lower limb, stemming from a lumbar intervertebral disc.

(PDF) Discogenic Low Back Pain ResearchGate. Discogenic lower back pain (DLBP) is the most common type of chronic lower back pain (LBP), accounting for 39% of cases, compared to 30% of cases due to disc herniation, and even lower prevalence rates for other causes, such as zygapophysial joint pain., 18/04/2013 · Discogenic low back pain is a serious medical and social problem, and accounts for 26%-42% of the patients with chronic low back pain. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of ….

Discogenic low back pain Case history BMJ Best Practice

Discogenic low back pain pdf

Multipotent Mesenchymal Stem Cell Treatment for Discogenic. proportion of patients. Thus, discogenic pain may be a pri-mary source of low back pain. Even though this remains one of the greatest health care crises, it has remained poorly defined and its diagnosis and treatment continue to be controversial [6,19-26]. Malik et al. [19] concluded that despite its extensive affirmation in the literature and https://id.wikipedia.org/wiki/Low_Back_Pain_/_Lumbago Various interventional treatment strategies for chronic discogenic low back pain unresponsive to conservative care include reduction of inflammation, ablation of intradiscal nociceptors, lowering intranuclear pressure, removal of herniated nucleus, and radiofrequency ablation of the nociceptors. Unfortunately, most of these strategies do not.

Discogenic low back pain pdf


Discogenic lower back pain is pain that originates from the discs of the lumbar spine and it is the most common cause of chronic lower back pain. Diagnosis of this type of pain uses a physical history, physical examination, imaging tests, and possibly discography 04/01/2020В В· Discogenic pain is a common diagnosis for low back pain. However, research suggests that our ability to accurately diagnose discogenic low back pain is limited in clinical practice. Source: Fujii

Sitting, bending forward, coughing and sneezing can increase low back discogenic pain. Leg pain caused by pinching of the nerves in the low back (called radiculopathy) may also accompany low back discogenic pain; especially while sitting, standing or walking. Discogenic lower back pain is pain that originates from the discs of the lumbar spine and it is the most common cause of chronic lower back pain. Diagnosis of this type of pain uses a physical history, physical examination, imaging tests, and possibly discography

discogenic low back pain. 3C. Background of the Study: Low back pain is an extremely common cause of pain and disability. Although several structures within the spine have been identified as pain generators, the intervertebral disc is felt to account for 40-50% of chronic low back pain [3]. The most common conservative treatment options include activity restriction, medications, physical 04/01/2020В В· Discogenic pain is a common diagnosis for low back pain. However, research suggests that our ability to accurately diagnose discogenic low back pain is limited in clinical practice. Source: Fujii

Treating discogenic lower back pain is like treating many other musculoskeletal ailments; it's about reducing the inflammation from around the disc and also, importantly, about getting the muscles right to help take the pressure off the disc so that the same forces aren't going through it and we're not sitting back there having to think about how to reduce the inflammation again. Discogenic Low Back Pain . Who gets discogenic low back pain? It is likely most people will experience low back pain at some point in their lives. Research suggests that 4 out of 5 adults are likely to develop low back pain at some point [1]. Discogenic low back pain accounts for 26%-42% of persistent low back pain problems [4].

Keywords: discogenic pain, low back pain, computed tomography, discography, annular tear, degenerative disc disease Introduction Over two-thirds of individuals experience chronic low back pain (LBP) in their lifetime [1]. Some of the most common causes of low back pain include the biochemical degeneration of the A 48-year-old insurance salesman presents with a 25-year history of back pain. He developed severe back pain while stacking shelves at the local supermarket at age 23. The pain resolved after 10 days of bed-rest, followed by 3 months of physiotherapy. He has had multiple episodes of back pain occurring at increasing regularity over the years

Discogenic low back pain pdf

04/01/2020В В· Discogenic pain is a common diagnosis for low back pain. However, research suggests that our ability to accurately diagnose discogenic low back pain is limited in clinical practice. Source: Fujii 09/11/2019В В· Many studies have demonstrated that discogenic low back pain is the most common type of chronic low back pain (CLBP), one of the major causes of disability, and has a major socioeconomic impact. Our aim is to review present therapeutic interventions for discogenic low back pain. There are a multitude of treatments used in clinical practice to treat CLBP, but there is continued debate and lack

Road signs in Botswana are based on the SADC-RTSM, a document designed to harmonise traffic signs in member states of the Southern Africa Development Community.. A white background signifies the sign is permanent, while a yellow background signifies that the sign is temporary. Warning signs are an upwards-pointing red triangle and black pictogram describing the danger or obstruction. All road signs and meanings pdf Wami Kata Road symbols are the pictorial representations having the different necessary information required to be understood by every road user. As you all know, road safety is very much important to minimize accidents and to rescue your life. Whether a person on the vehicle or a pedestrian, a sound knowledge of traffic signs …

Diagnosis of Red Flags & Differential Low Back Pain

Discogenic low back pain pdf

The pathogenesis of discogenic low back pain. 18/04/2013 · Discogenic low back pain is a serious medical and social problem, and accounts for 26%-42% of the patients with chronic low back pain. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of …, Discogenic Low Back Pain and Disc Degeneration JeffreyZeckser, 1 MichaelWolff, 1 JasonTucker, 2 andJoshGoodwin 3 1 SouthwestSpine&Sports,9913N.95thStreet,Scottsdale,AZ85258,USA.

Discogenic low back pain ScienceDirect

Pathophysiology diagnosis and treatment of discogenic. An estimated 40% of chronic lumbosacral spinal pain is attributed to the discus intervertebralis. Degenerative changes following loss of hydration of the nucleus pulposus lead to circumferential or radial tears within the annulus fibrosus. Annular, with chronic discogenic LBP who have not responded to conservative treatment. Although IDET may provide intermediate-term relief of pain, further studies with long-term follow-up are necessary. Helm at al. (2009) conducted a systematic review of the effectiveness of thermal annular procedures in treating discogenic low back pain. A total of 67.

Discogenic lower back pain is pain that originates from the discs of the lumbar spine and it is the most common cause of chronic lower back pain. Diagnosis of this type of pain uses a physical history, physical examination, imaging tests, and possibly discography Key words: Discogenic low back pain, chronic low back pain, lumbar discography, painful disc, black disc, disc degeneration, internal disc disruption, natural history, prognosis. Pain Physician 2012; 15:525-532 Prospective Study Prospective Clinical Study on Natural History of Discogenic Low Back Pain at …

Lower Back Discogenic Pain or Lumbar Discogenic Pain (LDP) is the cause of low back pain in 39 percent of the patients. Know the causes, symptoms, investigations, treatment. Discogenic Low-back Pain with a Non-surgical Decompression System (DRX9000™)—Case Report, US Musculoskeletal Review, 2008; 3 (1) 14–15 Management of Discogenic Low-back Pain with a Non-surgical Decompression System (DRX9000™) US MUSCULOSKELETAL REVIEW 3 1. Boswell MV,Trescot AM, Datta S, et al. Interventional techniques:

Various interventional treatment strategies for chronic discogenic low back pain unresponsive to conservative care include reduction of inflammation, ablation of intradiscal nociceptors, lowering intranuclear pressure, removal of herniated nucleus, and radiofrequency ablation of the nociceptors. Unfortunately, most of these strategies do not Pain referred from a painful sacroiliac joint may be to the low back, buttocks, groin, or the thighs. This pattern may mislead the clinician to believe the cause to be a degenerate disc. Inflammatory conditions such as ankylosing spondylitis have characteristic inflammatory back pain. This is defined as back pain that is of insidious onset, is

Low Back Pain Dave Burton & Helen Ruane November 2012. Red Flags nRed flags are a list of prognostic variables for serious pathology n CSP Guidelines 2007: nAGE <20, >45 with no precipitating event nNight pain nPain that causes the patient to be constantly moving or curled up in the sitting position nBack pain with constitutional symptoms – fatigue, nausea, diarrhoea, fever etc. Red Flags Of those myriad of patients with low back pain, the prevalence of clinically significant discogenic pain approaches 40% (1). In the United States, between 3 and 6 million patients suffer from chronic discogenic low back pain. Treatment options for discogenic pain include conservative measures such as analgesics, antiinflammatory agents, steroid

11 REVIEW ARTICLE SPINE SURGERY AND RELATED RESEARCH Sensory nerve ingrowth, cytokines, and instability of discogenic low back pain: A review Seiji Ohtori1), Masayuki Miyagi2) and Gen Inoue2) 1) Department of Orthopaedic Surgery, Graduate School of Medicine Chiba University, Chiba, Japan Discogenic Low-back Pain with a Non-surgical Decompression System (DRX9000™)—Case Report, US Musculoskeletal Review, 2008; 3 (1) 14–15 Management of Discogenic Low-back Pain with a Non-surgical Decompression System (DRX9000™) US MUSCULOSKELETAL REVIEW 3 1. Boswell MV,Trescot AM, Datta S, et al. Interventional techniques:

04/01/2020 · Discogenic pain is a common diagnosis for low back pain. However, research suggests that our ability to accurately diagnose discogenic low back pain is limited in clinical practice. Source: Fujii Discogenic Low-back Pain with a Non-surgical Decompression System (DRX9000™)—Case Report, US Musculoskeletal Review, 2008; 3 (1) 14–15 Management of Discogenic Low-back Pain with a Non-surgical Decompression System (DRX9000™) US MUSCULOSKELETAL REVIEW 3 1. Boswell MV,Trescot AM, Datta S, et al. Interventional techniques:

18/04/2013 · Discogenic low back pain is a serious medical and social problem, and accounts for 26%-42% of the patients with chronic low back pain. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of … Discogenic Low Back Pain . Who gets discogenic low back pain? It is likely most people will experience low back pain at some point in their lives. Research suggests that 4 out of 5 adults are likely to develop low back pain at some point [1]. Discogenic low back pain accounts for 26%-42% of persistent low back pain problems [4].

09/11/2019В В· Many studies have demonstrated that discogenic low back pain is the most common type of chronic low back pain (CLBP), one of the major causes of disability, and has a major socioeconomic impact. Our aim is to review present therapeutic interventions for discogenic low back pain. There are a multitude of treatments used in clinical practice to treat CLBP, but there is continued debate and lack Discogenic Pain Treatment Page 3 of 15 UnitedHealthcare Oxford Clinical Policy Effective 09/01/2017 В©1996-2017, Oxford Health Plans, LLC and therapeutic injections, and other interventional and surgical treatments, have been proposed for the treatment back pain. Thermal Intradiscal Procedures (TIPs)

Key words: Discogenic low back pain, chronic low back pain, lumbar discography, painful disc, black disc, disc degeneration, internal disc disruption, natural history, prognosis. Pain Physician 2012; 15:525-532 Prospective Study Prospective Clinical Study on Natural History of Discogenic Low Back Pain at … Of those myriad of patients with low back pain, the prevalence of clinically significant discogenic pain approaches 40% (1). In the United States, between 3 and 6 million patients suffer from chronic discogenic low back pain. Treatment options for discogenic pain include conservative measures such as analgesics, antiinflammatory agents, steroid

Discogenic Low Back Pain Evidence‐Based Interventional

Discogenic low back pain pdf

US Musculoskeletal Management of Discogenic Low-ba Review. Low Back Pain Dave Burton & Helen Ruane November 2012. Red Flags nRed flags are a list of prognostic variables for serious pathology n CSP Guidelines 2007: nAGE <20, >45 with no precipitating event nNight pain nPain that causes the patient to be constantly moving or curled up in the sitting position nBack pain with constitutional symptoms – fatigue, nausea, diarrhoea, fever etc. Red Flags, Sitting, bending forward, coughing and sneezing can increase low back discogenic pain. Leg pain caused by pinching of the nerves in the low back (called radiculopathy) may also accompany low back discogenic pain; especially while sitting, standing or walking..

Title Bone Marrow Concentrate intradiscal Injection for

Discogenic low back pain pdf

Biochemical injection treatment for discogenic low back. Discogenic pain is usually located in the low back area, with frequent radiation bilaterally to the lower extremities. It has been demonstrated that patients with L3–4 disk lesions usually have pain radiating to the anterior leg, but without pain in the posterior thigh or leg. In patients with a L4–5 disk lesion, the pain could be located https://fr.wikipedia.org/wiki/Lombalgie The tissue origin of low back pain and sciatica.Orthop Clin.North Am. 1991. see readings • Only a midline structure causes midline pain %% some pain significant pain pain location Vertebral end plate 61 9 back Nucleus pulposis 0 0 Central annulus 74 15 back Central lateral annulus 71 30 back Posterior dura mater 23 6 buttock leg Anterior dura 23 5 back buttock Normal nerve root 11 9 buttock.

Discogenic low back pain pdf

  • Discogenic low back pain ScienceDirect
  • Discogenic Lower Back Pain Spine-health
  • Discogenic Low Back Pain Musculoskeletal Key

  • A complex, multifactorial, clinical condition characterized by low back pain with or without the concurrence of radicular lower limb symptoms in the presence of radiologically-confirmed degenerative disk disease. The pain is exacerbated by activity, but may be present in certain positions, such as sitting. BASI Pilates as Movement Therapy for Lumbosacral Discogenic Pain Syndrome Cedra Hill October, 2014 2014 CTTC; Mt Shasta, CA ! 2! Abstract: Pilates is a potentially beneficial movement therapy for managing symptoms of Lumbosacral Discogenic Pain Syndrome. Pelvic lumbar stabilization, trunk stabilization, and spinal elongation in Pilates enhances body alignment and produces therapeutic …

    Pain referred from a painful sacroiliac joint may be to the low back, buttocks, groin, or the thighs. This pattern may mislead the clinician to believe the cause to be a degenerate disc. Inflammatory conditions such as ankylosing spondylitis have characteristic inflammatory back pain. This is defined as back pain that is of insidious onset, is A complex, multifactorial, clinical condition characterized by low back pain with or without the concurrence of radicular lower limb symptoms in the presence of radiologically-confirmed degenerative disk disease. The pain is exacerbated by activity, but may be present in certain positions, such as sitting.

    etiology of chronic low back pain in adults. Crock [5] rst proposed the concept of internal disc disruption (IDD), which indicated the discogenic pain syndrome caused by disc degeneration and non-nerve root referred pain. IDD causing discogenic low back pain accounts for 26%-42% of chronic low back pain patients[4,6,7]. IDD had been as- Introduction . Chronic discogenic low back pain (CDP) is frequently diagnosed in patients referred to specialized pain clinics for their back pain. The aim of this study is to assess the impact of CDP both on the individual patient and on society. Materials and Methods . Using the baseline records of 80 patients in a randomized trial assessing the effectiveness of a new intervention for CDP

    discogenic low back pain. 3C. Background of the Study: Low back pain is an extremely common cause of pain and disability. Although several structures within the spine have been identified as pain generators, the intervertebral disc is felt to account for 40-50% of chronic low back pain [3]. The most common conservative treatment options include activity restriction, medications, physical A complex, multifactorial, clinical condition characterized by low back pain with or without the concurrence of radicular lower limb symptoms in the presence of radiologically-confirmed degenerative disk disease. The pain is exacerbated by activity, but may be present in certain positions, such as sitting.

    The intervertebral disk can be a common source of acute or chronic low back pain. • A thorough history and physical examination are needed to assess patients with discogenic low back pain. • Lifestyle modifications including smoking cessation, proper lifting mechanics, ergonomics, and lower body mass index are helpful. • Lower Back Discogenic Pain or Lumbar Discogenic Pain (LDP) is the cause of low back pain in 39 percent of the patients. Know the causes, symptoms, investigations, treatment.

    Keywords: discogenic pain, low back pain, computed tomography, discography, annular tear, degenerative disc disease Introduction Over two-thirds of individuals experience chronic low back pain (LBP) in their lifetime [1]. Some of the most common causes of low back pain include the biochemical degeneration of the proportion of patients. Thus, discogenic pain may be a pri-mary source of low back pain. Even though this remains one of the greatest health care crises, it has remained poorly defined and its diagnosis and treatment continue to be controversial [6,19-26]. Malik et al. [19] concluded that despite its extensive affirmation in the literature and

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