17 results on '"Goldstein, Marc A."'
Search Results
2. DELAYED STENOSIS RATE POST VASECTOMY REVERSAL: A MULTICENTER COHORT.
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Deebel, Nicholas, Goldstein, Marc, Lipshultz, Larry I., Brannigan, Robert E., Kavoussi, Parviz K., Terlecki, Ryan, Ramasamy, Ranjith, Halpern, Joshua A., and Trost, Landon
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VASECTOMY , *STENOSIS - Published
- 2024
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3. MP13-19 UNILATERAL ABSENCE OF THE VAS IN MEN PRESENTING FOR VASECTOMY: INCIDENCE AND IMPLICATIONS.
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Kuchakulla, Manish and Goldstein, Marc
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VASECTOMY ,CYSTIC fibrosis transmembrane conductance regulator ,MALE infertility - Published
- 2024
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4. National Outcomes of Vasectomy in Men without Children.
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Najari, Bobby B. and Goldstein, Marc
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VASECTOMY , *TRAINING of medical residents , *DEMOGRAPHIC characteristics , *AGE discrimination , *OLDER men - Published
- 2021
5. Relating Economic Conditions to Vasectomy and Vasectomy Reversal Frequencies: a Multi-Institutional Study.
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Sharma, Vidit, Zargaroff, Sherwin, Sheth, Kunj R., Le, Brian V., Dupree, James M., Sandlow, Jay I., Polackwich, A. Scott, Hedges, Jason C., Fuchs, Eugene F., Goldstein, Marc, and Brannigan, Robert E.
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CONTRACEPTIVES ,VASECTOMY ,VASOVASOSTOMY ,RETROSPECTIVE studies ,MEDICAL literature reviews ,UNEMPLOYMENT statistics - Abstract
Purpose: It was theorized that the use of permanent contraceptive methods may vary with economic conditions. We evaluated the relationship between vasectomy/vasectomy reversal frequencies at several large referral centers and national economic indicators during 2 recessions spanning 2001 to 2011. Materials and Methods: We performed an institutional review board approved, retrospective chart review to identify the number of vasectomies/vasectomy reversals per month at several large referral centers from January 2001 to July 2011. The rates of these procedures were pooled, correlated with national economic data and analyzed in a multivariate linear regression model. Results: A total of 4,599 vasectomies and 1,549 vasectomy reversals were performed at our institutions during the study period. The number of vasectomies per month positively correlated with the unemployment rate (r = 0.556, p <0.001) and personal income per capita (r = 0.276, p = 0.002). The number of reversals per month negatively correlated with the unemployment rate (r = −0.399, p <0.001) and personal income per capita (r = −0.305, p <0.001). Neither vasectomy nor vasectomy reversal frequency significantly correlated with the inflation rate or the S&P 500®. Regression models confirmed that the unemployment rate explained more of the variance in vasectomy/vasectomy reversal frequencies than other indicators. Conclusions: We noted a correlation between the number of vasectomies/vasectomy reversals performed at our institutions and national economic indicators. The strongest association was with the unemployment rate. This points to the importance of financial pressure on family planning decisions. [Copyright &y& Elsevier]
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- 2014
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6. Vasectomy reversal in humans.
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Bernie, Aaron M., Charles Osterberg, E., Stahl, Peter J., Ramasamy, Ranjith, and Goldstein, Marc
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VASOVASOSTOMY ,VASECTOMY ,LITERATURE reviews ,SURGERY ,MANAGEMENT - Abstract
Vasectomy is the most common urological procedure in the United States with 18% of men having a vasectomy before age 45. A significant proportion of vasectomized men ultimately request vasectomy reversal, usually due to divorce and/or remarriage. Vasectomy reversal is a commonly practiced but technically demanding microsurgical procedure that restores patency of the male excurrent ductal system in 80-99.5% of cases and enables unassisted pregnancy in 40-80% of couples. The discrepancy between the anastomotic patency rates and clinical pregnancy rates following vasectomy reversal suggests that some of the biological consequences of vasectomy may not be entirely reversible in all men. Herein we review what is known about the biological sequelae of vasectomy and vasectomy reversal in humans, and provide a succinct overview of the evaluation and surgical management of men desiring vasectomy reversal. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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7. Nomograms to Predict Patency After Microsurgical Vasectomy Reversal.
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Hsiao, Wayland, Goldstein, Marc, Rosoff, James S., Piccorelli, Annalisa, Kattan, Michael W., Greenwood, Eleni A., and Mulhall, John P.
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MICROSURGERY ,VASOVASOSTOMY ,PATERNITY ,HUMAN reproductive technology ,FERTILIZATION in vitro ,SPERM motility - Abstract
Purpose: After undergoing vasectomy up to 6% of men will elect to undergo vasectomy reversal. For these men paternity can be achieved with vasectomy reversal or surgical sperm retrieval coupled with assisted reproduction. Nevertheless, it remains difficult for surgeons to accurately counsel men on the chance of patency after vasectomy reversal. Materials and Methods: A retrospective review was conducted of 548 patients who underwent microsurgical vasectomy reversal. Surgery was considered successful if sperm concentration was 100,000 or more sperm per ml, total count was 100,000 or more sperm per ejaculate, motile sperm were present and there was no evidence of subsequent failure. A multivariate logistic regression model was constructed to calculate the probability of having a successful vasectomy reversal and nomograms for patency were generated from this model. Results: A total of 548 patients met the inclusion criteria for this study. Mean followup was 1.8 ± 0.10 years. Mean patient age was 43.4 ± 0.3 years and mean duration of obstruction was 10.4 ± 0.2 years. Two nomograms to predict patency were generated, one for preoperative counseling and a second for postoperative counseling. The factors with the largest effect on patency were average testicular volume and obstruction duration. The factor with the least effect was the presence of sperm granuloma. The concordance index for the preoperative and the postoperative nomograms was 0.64 and 0.66, respectively. Conclusions: To our knowledge this represents the first use of nomograms to predict the likelihood of patency after microsurgical vasectomy reversal. These nomograms may prove useful to guide further treatment decisions. [ABSTRACT FROM AUTHOR]
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- 2012
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8. Value of Serum Antisperm Antibodies in Diagnosing Obstructive Azoospermia.
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Lee, Richard, Goldstein, Marc, Ullery, Brant W., Ehrlich, Joshua, Soares, Marc, Razzano, Renee A., Herman, Michael P., Callahan, Mark A., Li, Philip S., Schlegel, Peter N., and Witkin, Steven S.
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ANTISPERMATOGENIC agents ,IMMUNOGLOBULINS ,VASECTOMY ,SPERMATOGENESIS ,DIAGNOSTIC imaging ,SERUM ,BLOOD testing ,MALE infertility - Abstract
Purpose: The requisite presence of active spermatogenesis for antisperm antibody production may be useful in identifying obstructive azoospermia. The diagnostic performance of serum antisperm antibody was evaluated as a test for obstructive azoospermia. Materials and Methods: A total of 484 men with male infertility who had undergone antisperm antibody testing were evaluated. Demographic data, patient history, and followup were recorded. Obstruction was confirmed by surgical exploration. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated to quantify diagnostic performance. ROC curves were calculated and compared. Results: Of 484 men 272 possessed documented obstruction of the vas or epididymis and 212 had documented infertility without azoospermia. The obstructed group had significantly increased antisperm antibody levels compared to the nonobstructed group. IgG, IgA, and IgM were analyzed as diagnostic tests for obstruction. The AUC for IgG, IgA and IgM ROC curves was 0.92, 0.85 and 0.67, respectively. The AUC for serum IgG against sperm tails was 0.92, 0.87 against sperm heads and 0.79 against sperm midpieces. IgG demonstrated the highest sensitivity (85%) with a specificity of 97% (chi-square test p <0.01). IgA possessed the highest specificity (99%), positive predictive value (99%) and positive likelihood ratio (70.0). Conclusions: The presence of serum antisperm antibody was highly accurate in predicting obstructive azoospermia, particularly after vasectomy. It can obviate the need for testis biopsy, the current but more invasive and costly gold standard of detection. This allows the surgeon to proceed directly to surgical reconstruction or sperm retrieval after a simple blood test. [Copyright &y& Elsevier]
- Published
- 2009
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9. Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy.
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Chan, Peter T. K., Brandell, Roy A., and Goldstein, Marc
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VASECTOMY ,MALE contraception ,MICROSURGERY ,INFERTILITY ,GENITAL diseases ,INTESTINAL intussusception ,UROLOGY - Abstract
To prospectively analyse the outcomes of microsurgical vasoepididymostomy using the intussusception technique, as vasoepididymostomy is considered the most challenging reconstructive microsurgery in urology. From 1998 to 2003, of 324 men with obstructive azoospermia who had undergone microsurgical reconstruction of the reproductive tracts, 68 (21%) had intussusception vasoepididymostomy bilaterally or unilaterally in a functionally solitary testis. The outcomes of these patients were analysed prospectively. The mean age was 39.8 years for the men and 31.8 years for their partners. The causes of obstruction were after vasectomy in 31%, infection in 22%, iatrogenic in 19%, trauma in 1.5%, and idiopathic in 27%. The median duration of obstruction was 18.8 years; 37% of patients had had previous failed attempts at reconstruction. The mean (range) follow-up was 15.2 (1–36) months. The overall patency (>10 000 sperm/mL) rate was 84% (53/63). Patency was achieved in 60% (38/63) of men at 1 month after surgery. The mean best sperm count was 12.8 (0.01–80) × 10
6 /mL, with a 21 (0–30)% motility. Among patients with a follow-up of > 1 year, the natural paternity rate was 40%. The median time to achieve a natural pregnancy was 14.3 (3–30) months. Pregnancy was achieved with in vitro fertilization or intracytoplasmic sperm injection in 31% of cases, all using fresh ejaculated sperm. A favourable patency and pregnancy rate can be achieved using microsurgical intussusception vasoepididymostomy. Even when assisted-reproductive technology is needed, fresh ejaculated sperm can be used without requiring a subsequent sperm retrieval procedure. Thus, microsurgical reconstruction of the reproductive tract should be primary therapeutic method in cases of azoospermia from epididymal obstruction. [ABSTRACT FROM AUTHOR]- Published
- 2005
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10. Superior outcomes of microsurgical vasectomy reversal in men with the same female partners
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Chan, Peter T. K. and Goldstein, Marc
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VASECTOMY , *MALE contraception , *MALES , *RESEARCH - Abstract
Objective: To evaluate the outcomes of vasectomy reversals in men with the same female partners.Design: Retrospective analysis with comparison with a historical cohort.Setting: University hospital.Patient(s): Among 1,048 patients who underwent microsurgical vasectomy reversal from 1986 to 2002, 27 men (2.6%) were identified who had the same partners as before their vasectomy.Intervention(s): Microsurgical vasovasostomy or vasoepididymostomy.Main outcome measure(s): Semen parameters, clinical pregnancy, and live birth rates.Result(s): The mean age of the men was 38.5 years, and 37.2 years for their female partners. The reasons for vasectomy reversal were death of a child in 33% of cases and desire for more children in 66% of cases. The overall patency rate was 100% at 1 month postoperatively, with an average sperm concentration of 30 million/mL and 24% motility. Among patients with follow-up beyond 1 year, the natural pregnancy rate was 86%, which was achieved at 8.3 months postoperatively, with a live birth rate of 82%. The live birth rate in couples with the death of a child was 100%.Conclusion(s): The outcomes of vasectomy reversal in men with the same female partners are better than for men with new partners. Possible reasons for these superior results are previous proven fecundity as a couple, shorter time interval since vasectomy, and emotional dedication. [Copyright &y& Elsevier]
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- 2004
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11. Infertility.
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Goldstein, Marc
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INFERTILITY , *ANNUAL meetings , *CRYOPRESERVATION of organs, tissues, etc. , *ANTINEOPLASTIC agents , *VASECTOMY - Abstract
The article presents an overview of issues on infertility, discussed during the 2012 American Urological Association (AUA) Annual Meeting. Fertility preservation in males having cancer treatment is said to be important to be discussed regardless of age. A study of sperm cryopreservation prior to antineoplastic treatment found that men with a non-seminomatous germ cell tumor had better post-thaw recovery. A study noted an increase in requests for vasectomy and a decline in requests for reversal.
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- 2012
12. Microsurgical vasectomy reversal: contemporary techniques, intraoperative decision making, and surgical training for the next generation.
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Hayden, Russell P., Li, Philip S., and Goldstein, Marc
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GENITALIA , *VASECTOMY , *DECISION making , *HUMAN fertility , *MICROSURGERY , *PREOPERATIVE education - Abstract
Men seeking fertility after elective sterilization can be treated with a wide array of interventions. Reconstruction of the reproductive tract remains the gold standard and most cost-effective option for the appropriately selected candidate. In the following review, the treatment algorithm for men desiring vasectomy reversal is outlined. Specifically, the current evidence basis for preoperative evaluation, intraoperative decision making, postsurgical management, and emerging advances to optimize outcomes will be discussed. Finally, the important role of microsurgical training and how the field can improve quality of care will be reviewed. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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13. PD07-03 COMPARING VASOEPIDIDYMOSTOMY TECHNIQUE OUTCOMES: LONGITUDINAL INTUSSUSCEPTION VASOEPIDIDYMOSTOMY (LIVE) VERSUS OTHER TECHNIQUES.
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Neto, Filipe, Ayangbesan, Abimbola, Najari, Bobby, Bach, Phil, Gottesdiener, Andrew, Li, Philip, and Goldstein, Marc
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INTESTINAL intussusception ,MEDICAL care research ,INTRACYTOPLASMIC sperm injection ,VASECTOMY ,FOLLOW-up studies (Medicine) - Published
- 2016
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14. PD07-04 MEN UNDERGOING VASOEPIDIDYMOSTOMY FOR VASECTOMY REVERSAL HAVE WORSE OUTCOMES THAN MEN WITH PRIMARY EPIDIDYMAL OBSTRUCTION.
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Najari, Bobby, Ayangbesan, Abimbola, Gottesdiener, Andrew, Bach, Phil, Tenorio Lira Neto, Filipe, Li, Philip, and Goldstein, Marc
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VASECTOMY ,PRIMARY care ,MEDICAL care research ,MEDICAL quality control ,EPIDIDYMITIS - Published
- 2016
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15. Pros and cons of robotic microsurgery as an appropriate approach to male reproductive surgery for vasectomy reversal and varicocele repair.
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Chan, Peter, Parekattil, Sijo J., Goldstein, Marc, Lipshultz, Larry I., Kavoussi, Parviz, Mccullough, Andrew, and Sigman, Mark
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MALE reproductive organ surgery , *MICROSURGERY , *SURGICAL robots , *VASOVASOSTOMY , *VARICOCELE , *THERAPEUTICS , *COMPARATIVE studies , *COST effectiveness , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *STERILIZATION reversal , *VASECTOMY , *EVALUATION research , *TREATMENT effectiveness , *DIAGNOSIS , *SURGERY - Published
- 2018
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16. Simultaneous Vasectomy and Varicocelectomy: Indications and Technique
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Lee, Richard K., Li, Philip S., and Goldstein, Marc
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VASECTOMY , *VARICOCELE , *POSTOPERATIVE care , *VAS deferens - Abstract
Introduction: When men present for vasectomy, incidental varicoceles may be discovered. After varicocelectomy, the deferential veins become the only avenue for testicular venous return and could be compromised during nonmicroscopic vasectomy. We discuss the indications and technique required to safely perform simultaneous vasectomy and varicocelectomy. Technical Considerations: From 1992 to 2005, 18 (4.8%) of 379 men presenting for vasectomy had incidental palpable varicoceles and low or low normal serum testosterone levels. All underwent microsurgical subinguinal varicocelectomy. All spermatic, cremasteric, and gubernacular veins were ligated. The vas was then isolated under magnification, the deferential vessels were preserved, and the vas was transected, cauterized, and clipped. Results: All 18 men (mean age 39.6 years) had grade II to III varicoceles on physical examination. We performed 27 microsurgical varicocelectomies with simultaneous microsurgical vasectomy. On average, the first follow-up visit occurred 14 weeks postoperatively. The mean testosterone level increased from 348 ng/dL preoperatively to 416 ng/dL postoperatively. No complications, episodes of testicular atrophy, vasectomy failures, or varicocelectomy recurrences developed. The incidence of varicoceles in fertile men presenting for vasectomy (4.8%) was lower than in the general population (15%); fertile men appear to be less likely to possess varicoceles. Conclusions: Men presenting for vasectomy with incidental palpable varicoceles could benefit from simultaneous vasectomy-varicocelectomy. This should be performed microsurgically to identify and ligate both spermatic veins and vasa deferentia and to preserve not only the testicular artery, but also the deferential vessels to minimize the risk of testicular atrophy and the risk of insufficient venous drainage. [Copyright &y& Elsevier]
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- 2007
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17. One size does not fit all: variations by ethnicity in demographic characteristics of men seeking fertility treatment across North America.
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Chen, Andrew B., Jarvi, Keith A., Lajkosz, Katherine, Smith, James F., Lo, Kirk C., Grober, Ethan D., Lau, Susan, Bieniek, Jared M., Brannigan, Robert E., Chow, Victor D.W., Domes, Trustin, Dupree, James M., Goldstein, Marc, Hedges, Jason C., Hotaling, James M., Ko, Edmund Y., Kolettis, Peter N., Nangia, Ajay K., Sandlow, Jay I., and Shin, David
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DEMOGRAPHIC characteristics , *HUMAN fertility , *ETHNICITY , *FERTILITY , *INFERTILITY treatment , *LIFESTYLES , *RESEARCH , *HEALTH services accessibility , *CROSS-sectional method , *RESEARCH methodology , *HEALTH status indicators , *RETROSPECTIVE studies , *MEDICAL cooperation , *EVALUATION research , *INFERTILITY , *PATIENTS' attitudes , *RISK assessment , *SURVEYS , *COMPARATIVE studies , *HEALTH attitudes , *HUMAN reproductive technology , *MATERNAL age , *VASECTOMY , *PATERNAL age effect , *HEALTH equity , *BODY mass index - Abstract
Objective: To compare racial differences in male fertility history and treatment.Design: Retrospective review of prospectively collected data.Setting: North American reproductive urology centers.Patient(s): Males undergoing urologist fertility evaluation.Intervention(s): None.Main Outcome Measure(s): Demographic and reproductive Andrology Research Consortium data.Result(s): The racial breakdown of 6,462 men was: 51% White, 20% Asian/Indo-Canadian/Indo-American, 6% Black, 1% Indian/Native, <1% Native Hawaiian/Other Pacific Islander, and 21% "Other". White males sought evaluation sooner (3.5 ± 4.7 vs. 3.8 ± 4.2 years), had older partners (33.3 ± 4.9 vs. 32.9 ± 5.2 years), and more had undergone vasectomy (8.4% vs. 2.9%) vs. all other races. Black males were older (38.0 ± 8.1 vs. 36.5 ± 7.4 years), sought fertility evaluation later (4.8 ± 5.1 vs. 3.6 ± 4.4 years), fewer had undergone vasectomy (3.3% vs. 5.9%), and fewer had partners who underwent intrauterine insemination (8.2% vs. 12.6%) compared with all other races. Asian/Indo-Canadian/Indo-American patients were younger (36.1 ± 7.2 vs. 36.7 ± 7.6 years), fewer had undergone vasectomy (1.2% vs. 6.9%), and more had partners who underwent intrauterine insemination (14.2% vs. 11.9%). Indian/Native males sought evaluation later (5.1 ± 6.8 vs. 3.6 ± 4.4 years) and more had undergone vasectomy (13.4% vs. 5.7%).Conclusion(s): Racial differences exist for males undergoing fertility evaluation by a reproductive urologist. Better understanding of these differences in history in conjunction with societal and biologic factors can guide personalized care, as well as help to better understand and address disparities in access to fertility evaluation and treatment. [ABSTRACT FROM AUTHOR]- Published
- 2021
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