The subject matter described herein relates to intravenous (IV) filter devices.
Some known membrane-type IV filter devices can remove impurities from liquids or fluids that are to be intravenously introduced into the human body. Some filter devices may use carrier fluids that act as carriers for medications, such as saline solutions and nutrient solutions as carrier fluids.
One problem that can be encountered with some known membrane-type IV filter devices is the presence of gas. The carrier fluid may need to be filtered before entering the patient to remove the gas and contaminants in the fluid. Gas in IV filter device or that is mixed with the carrier liquid may prevent effective filtration of the carrier liquid. When the IV filter device is attached to the patient and fluid flow is initiated, gas can enter the conduits connected to the IV filter device or may already be present in the IV filter device. This can be dangerous in that it can pose a significant health risk to the patient.
Some IV filter devices can make use of hydrophobic membrane air vents which are capable of passing gas out of the housings of the IV filter devices through vents while preventing carrier liquids and medications from passing through the membranes (and out of the IV filter devices). However, these hydrophobic membranes can be compromised by sterilization methods used in manufacturing of the IV filter devices. For example, some sterilization methods use radiation or e-beams that can degrade the membrane material properties. This, in turn, can allow the membrane air vent to be degraded and wetted, causing a fluid leak from the IV filter device. This also can pose a safety and health risk to the patient.
It may be desirable to protect the membrane material during sterilization and/or have manufacturing processes that differs from those that are currently available.
An IV medication filter device described herein can include a housing defining an interior chamber. The housing has an inlet through which a liquid medication is received, an outlet through which the liquid medication exits the housing, and a vent hole through which gases exit from the interior chamber. The filter device also can have a hydrophilic filtration media disposed inside the interior chamber of the housing. The hydrophilic filtration media can filter the liquid medication between the inlet and the outlet. The filter device also can include a hydrophobic gas filter disposed inside or outside the housing at the vent hole. The hydrophobic gas filter can prevent entry of contaminants into the interior chamber via the vent hole. The vent hole can be shaped to block e-beam radiation from reaching the hydrophobic gas filter or attenuate the e-beam radiation directed toward the hydrophobic gas filter.
Another IV medication filter device may include a housing defining an interior chamber. The housing can have an inlet through which a liquid medication is received, an outlet through which the liquid medication exits the housing, and a vent hole through which gases exit from the interior chamber. The filter device may have a hydrophilic filtration media disposed inside the interior chamber of the housing. The hydrophilic filtration media can filter the liquid medication between the inlet and the outlet. The filter device can include a hydrophobic gas filter disposed inside or outside the housing at the vent hole. The hydrophobic gas filter can prevent entry of contaminants into the interior chamber via the vent hole. The filter device can include a shroud positioned over the vent hole outside of the housing, the shroud blocking e-beam radiation from reaching the hydrophobic gas filter or attenuating the e-beam radiation directed toward the hydrophobic gas filter.
Another IV medication filter device can include a housing having a medication inlet, a medication outlet, and a gas vent. The filter device also can include a hydrophobic gas filter inside the housing between the inlet and the gas vent and between the gas vent and the outlet. The hydrophobic gas filter can prevent medication received into the housing via the inlet from existing the housing via the gas vent. The hydrophobic gas filter can permit gas in the housing to exit the housing through the hydrophobic gas filter and out of the gas vent. The vent hole can have a shape that prevents sterilizing radiation directed at the gas vent from reaching the hydrophobic gas filter.
The inventive subject matter may be understood from reading the following description of non-limiting embodiments, with reference to the attached drawings, wherein below:
The subject matter relates broadly to membrane-type filter devices, and especially to IV medication filter devices used to remove impurities from liquids or fluids that are to be introduced intravenously to the human body for infusion therapies.
The filter device 1 can be a multi-part construction having a first housing portion 10A and a second housing portion 10B separated by a liquid filter 16 (
The housing 10 can have an interior chamber once assembled. The liquid filter 16 and a gas filter 18 (
In one embodiment, the liquid filter 16 can be generally planar, and secured within the housing 10. Optionally, the liquid filter 16 can have other shapes or textures such as an accordion or folded mesh pattern. The liquid filter 16 can separate the fluid inlet connector 12 and the fluid outlet connector 14 within the housing 10. For example, the liquid filter 16 may be between the fluid inlet connector 12 and the fluid outlet connector 14. Fluid traveling into the fluid inlet connector 12 can pass through the liquid filter 16 before passing out of the filter device 1 through the fluid outlet connector 14.
The filter device 1 can have a vent hole or passage 20 for releasing entrapped gas from the inner chamber of the housing 10. The vent hole 20 can be configured as a passage traversing between the interior chamber of the housing 10 and the exterior of the housing 10. In one example, the vent hole 20 may be arranged orthogonally between the interior surface and the exterior surface of the housing. Gases inside the housing 10 can exit or vent from the housing 10 via the vent hole 20.
In one example, the vent hole 20 can extend one or more directions that are non-orthogonal to the inner surface and the exterior surface of the housing 10. The vent hole 20 can extend along one or more non-orthogonal directions. For example, the vent hole 20 can have a single center axis that oriented at an acute angle or obtuse angle to the inner surface and/or the exterior surface of the housing 10. As another example, the vent hole 20 can have different segments with different center axes. At least one of these axes can be oriented at an acute or obtuse angle to the inner surface and/or the exterior surface of the housing 10. As another example, these center axes of the different segments can be oriented at an acute or obtuse angle to each other (e.g., to the center axis of the next segment). As another example, the different segments of the vent hole can be curved at different radii. As another example, the different segments of the vent hole can be curved at the same or different radii, but with at least two of the segments curved in opposite or different directions. As another example, the segments may have a cross-section that is circular, oval, square, rectangular, triangular, or other shape.
In one embodiment, the hydrophobic membrane 18 can be arranged in proximity to the vent hole 20. In one example, the hydrophobic membrane 18 can be a generally circular or oval shape having a diameter substantially larger than the diameter of the vent hole 20. The hydrophobic membrane 18 can be sized to cover the vent hole 20. The hydrophobic membrane 18 may be positioned abutted to one end of the vent hole 20. For example, the hydrophobic membrane 18 can be positioned on the interior chamber of the housing 10 and couple to an interior opening of the vent hole 20. In one example, the hydrophobic membrane 18 can be positioned on an exterior surface of the housing 10 and couple to an exterior opening of the vent hole 20.
In one example, one of the first or second housing 10A, 10B can have an array of fluid channels 17 formed on and/or in the body of the housing to facilitate a fluid path from the fluid inlet connector 12 to the fluid outlet connector 14 through the liquid filter 16. The fluid outlet connector 14 can typically be coupled to a conduit or other component supplying a liquid (e.g., a medication or other liquid substance) to a patient. In one example, the housing 10 can be generally rectangular.
In one embodiment, fluid can enter the fluid inlet connector 12. This fluid can be directed toward the vent hole 20 by a directed fluid path. Entrapped gas bubbles in the fluid entering the filter device 1 can contact the hydrophobic membrane 18. This gas filter 18 can prevent the gas from remaining in the liquid, venting air or gas to the outside of the filter device 1, while allowing the liquid to pass through the filter device 1. The removed gas can exit the housing via the vent hole 20 while the liquid fluid remains in the housing 10. The fluid can travel within the filter device 1 to the liquid filter 16 and pass there through. The liquid filter 16 can remove particulate, bacteria, and other contaminants from the liquid as the liquid passes through the liquid filter 16. The filter device 1 is shown having a single vent 20, however the filter device 1 may be provided with additional vent holes and respective hydrophobic membranes.
In operation, a liquid medication is received into the inlet 12, such as via a conduit, line, tube, or connector that mates with or connects with the inlet 12. This medication flows inside the housing 10, is internally filtered by the filter 16 to remove contaminants from the medication, and flows to and exits from the housing 10 via the outlet 14. The filter 18 is between the inlet 12 and the vent hole 20 and between the vent hole 20 and the outlet 14. The outlet 14 may be connected to a line, conduit, tube, or other connector that is also connected with a patient to administer the medication to the patient. Air or other gases may enter into the housing via the inlet 12. The air or other gases may be entrained within the medication and flow by the filter 18. The filter 18 can prevent the liquid medication from passing through the filter 18 (and out of the housing 10 via the vent hole). The filter 18 allows the air or other gases in the liquid medication to pass through the filter 18 such that the air or other gases can pass through the filter 18 and exit from the housing 10 via the vent hole 20.
Referring now to
The exemplary filters illustrated in
One sterilization process with which the present subject matter may be used can include sterilization processes wherein the sterilization medium or sterilant may include steam, dry heat, radiation, plasma, as well as one or more gaseous sterilants, ethylene oxide, one or more liquid sterilants, and the like. The radiation-based processes used may include an electron beam or any electromagnetic spectra including ionizing radiation, pulsed white or ultraviolet light, microwave, and the like. The radiation may comprise gamma or beta radiation. The irradiation may be by, for example, electron beam (e-beam), gamma, X-ray, or other energy forms such as UV radiation. For e-beam radiation, the irradiation dosage may be, for example, from approximately 10 kGy to approximately 50 kGy. Devices and methods of the present subject matter may be described with respect to an e-beam sterilization process wherein a beam of highly charged stream of accelerated electrons may be directed towards a product/material being sterilized. The energy from the e-beam can be absorbed in the material of the product, which can alter various chemical bonds to damage DNA or destroy the reproductive capability of microorganisms present on the product. The e-beam energy can be focused to scan a defined size sometimes in a sweeping motion to create an aligned array of electrons, sometimes referred to herein as an e-beam array. The product being sterilized can be conveyed through the e-beam array at a tightly controlled and measured speed. The sterilization process can take place behind a radiation shield that can be a large, insulated structure, which prevents radiation from leaving the confines of the radiation shield.
In one embodiment, the hydrophobic membrane can be made of or include a thermoplastic material, for example, polyvinylidene fluoride (PVDF) or polytetrafluoroethylene (PTFE). The use of these material for the hydrophobic membrane, sometimes referred to herein as an air vent membrane, can enable use of the filter device 1 for administration of many chemotherapeutic solutions that are known to degrade or cause unwanted wetting or leaking of air vent membranes. For example, membranes made of PVDF or PTFE can be used to administer a variety of IV solutions and medications, including more aggressive solutions that are low in surface tension, or caustic and wet out or degrade the hydrophobic membrane, causing it to leak.
When PVDF materials are exposed to e-beam sterilization, for example, the material properties associated with hydrophobic performance can be impacted. Therefore, embodiments of the present inventive subject matter relate to protecting hydrophobic properties of the air vent membrane upon end-of-line sterilization of the filter device 1 and/or the filter 40.
In one example depicted in
Turning now to
For discussion purposes, several filters 1 will be used as an illustrative example. In one example, the filters 1 can be arranged end-to-end in two rows on the table 131. The rows can be separated by a distance generally between 5-6 inches and can be dependent on the size and shape of the filter device 1. When the filter device 1 is arranged closer to the center of the of the e-beam array 134 as opposed to the peripheral e-beam array 134, the e-beam exposure can be more consistent in its dose range, and potentially lower in dose, as compared to the level of exposure experienced when the filter device 1 is located further away or at a more peripheral location from the e-beam emitter 132. Thus, sterilization can be delivered in a way that minimizes the e-beam dose range and subsequent intensity, thereby limiting the potential for hydrophobic membrane degradation from an inadvertently higher dose.
The illustrative embodiments of attenuating methods and structures presented herein with reference to
During sterilization, the intensity of the e-beam array 134 can be controlled in multiple ways. By arranging the filters 1 in rows as depicted and described with reference to
An IV medication filter device described herein can include a housing defining an interior chamber. The housing has an inlet through which a liquid medication is received, an outlet through which the liquid medication exits the housing, and a vent hole through which gases exit from the interior chamber. The filter device also can have a hydrophilic filtration media disposed inside the interior chamber of the housing. The hydrophilic filtration media can filter the liquid medication between the inlet and the outlet. The filter device also can include a hydrophobic gas filter disposed inside or outside the housing at the vent hole. The hydrophobic gas filter can prevent entry of contaminants into the interior chamber via the vent hole. The vent hole can be shaped to block e-beam radiation from reaching the hydrophobic gas filter or attenuate the e-beam radiation directed toward the hydrophobic gas filter.
The vent hole may not encompass any linear path that intersects the hydrophobic gas filter but does not extend through the housing. The vent hole can be an elongated conduit oriented at an acute angle to the hydrophobic gas filter. The vent hole can be segmented into several linear conduits oriented at an acute angle to each other.
The filter device optionally may include a shroud positioned over the vent hole outside of the housing. The shroud can block the e-beam radiation from reaching the hydrophobic gas filter or attenuating the e-beam radiation directed toward the hydrophobic gas filter. The shroud may have side openings through which the gas vented out of the housing via the vent hole passes.
The IV filter also may include a gas permeable plug disposed in the vent hole. The gas permeable plug can be porous for the gas to pass through as the gas exits the housing via the vent hole while also attenuating the e-beam radiation directed toward the hydrophobic gas filter. The housing can have an increased thickness around a perimeter of the vent hole relative to a remainder of the housing.
Another IV medication filter device may include a housing defining an interior chamber. The housing can have an inlet through which a liquid medication is received, an outlet through which the liquid medication exits the housing, and a vent hole through which gases exit from the interior chamber. The filter device may have a hydrophilic filtration media disposed inside the interior chamber of the housing. The hydrophilic filtration media can filter the liquid medication between the inlet and the outlet. The filter device can include a hydrophobic gas filter disposed inside or outside the housing at the vent hole. The hydrophobic gas filter can prevent entry of contaminants into the interior chamber via the vent hole. The filter device can include a shroud positioned over the vent hole outside of the housing, the shroud blocking e-beam radiation from reaching the hydrophobic gas filter or attenuating the e-beam radiation directed toward the hydrophobic gas filter.
The shroud can have side openings through which the gas vented out of the housing via the vent hole passes. The vent hole can be shaped to block the e-beam radiation from reaching the hydrophobic gas filter or attenuate the e-beam radiation directed toward the hydrophobic gas filter. The vent hole may not encompass any linear path that intersects the hydrophobic gas filter but does not extend through the housing. The vent hole can be an elongated conduit oriented at an acute angle to the hydrophobic gas filter. The vent hole can be segmented into several linear conduits oriented at an acute angle to each other.
The filter device also may include a gas permeable plug disposed in the vent hole. The gas permeable plug can be porous for the gas to pass through as the gas exits the housing via the vent hole while also attenuating the e-beam radiation directed toward the hydrophobic gas filter. The housing can have an increased thickness around a perimeter of the vent hole relative to a remainder of the housing.
Another IV medication filter device can include a housing having a medication inlet, a medication outlet, and a gas vent. The filter device also can include a hydrophobic gas filter inside the housing between the inlet and the gas vent and between the gas vent and the outlet. The hydrophobic gas filter can prevent medication received into the housing via the inlet from existing the housing via the gas vent. The hydrophobic gas filter can permit gas in the housing to exit the housing through the hydrophobic gas filter and out of the gas vent. The vent hole can have a shape that prevents sterilizing radiation directed at the gas vent from reaching the hydrophobic gas filter.
The filter device also can include a radiation shroud coupled to the housing outside of the housing over the gas vent. The radiation shroud can attenuate or block the sterilizing radiation from reaching the hydrophobic gas filter via the gas vent.
Provided herein is an example of an intravenous medication filter for infusion therapy that can include a housing defining an interior chamber, the housing may have an inlet through which a liquid medication can be received, an outlet through which the liquid medication can exit the housing after being filtered, and a vent hole through which gases can exit from the interior chamber. The intravenous medication filter can include a hydrophilic filtration media disposed inside the interior chamber of the housing, the hydrophilic filtration media can be configured to remove one or more constituents from the liquid medication to filter the liquid medication. The intravenous medication filter can include a hydrophobic gas filter disposed inside or outside the housing between the interior chamber of the housing and the vent hole, the hydrophobic gas filter can be configured to prevent entry of contaminants into the interior chamber via the vent hole, wherein the vent hole one or more of: (a) extends along one or more directions that can be non-orthogonal to an inner surface and an exterior surface of the housing or (b) can have an aspect ratio equal to or less than 2.
In one example, the vent hole can include different segments that are oriented at different angles relative to each other. The vent hole can be acutely oriented relative to the inner surface and the exterior surface of the housing. The vent hole extends along a non-linear path. The vent hole one or more of can (a) extend along the one or more directions or (b) have the aspect ratio equal to or less than 1.
Provided herein is an example of an intravenous medication filter for infusion therapy that can have a housing defining an interior chamber. The housing can have an inlet through which a liquid medication can be received, an outlet through which the liquid medication can exit the housing after being filtered, and a vent hole through which one or more gases can exit from the interior chamber. The intravenous medication filter can include a liquid filter disposed inside the interior chamber of the housing. The liquid filter can be configured to remove one or more constituents from the liquid medication to filter the liquid medication. The intravenous medication filter can include a gas filter disposed inside the housing between the interior chamber of the housing and the vent hole. The gas filter can be configured to allow gas to vent out of the filter and to prevent entry of one or more contaminants into the interior chamber via the vent hole. The intravenous medication filter can include an attenuating component disposed over the vent hole such that the attenuating component reduces a dose of sterilizing e-beam stream or ionizing irradiation directed toward the gas filter.
In one example, the attenuating component can include a shroud disposed over and enclosing the gas filter and the vent hole between the shroud and the housing. The shroud can include one or more vent openings through which the one or more gases exit from the interior chamber via the vent hole and the one or more vent openings in the shroud. In one example, the attenuating component can include a porous plug disposed in the vent hole and including one or more pores through which the one or more gases can exit from the interior chamber via the vent hole. In one example, the attenuating component can include one or more of an adhesive sticker disposed over the vent hole.
Provided herein is an example of an intravenous medication filter for infusion therapy that may include a housing defining an interior chamber, the housing having an inlet through which a liquid medication can be received, an outlet through which the liquid medication can exit the housing after being filtered, and a vent hole through which one or more gases can exit from the interior chamber. The intravenous medication filter can include a liquid filter disposed inside the interior chamber of the housing, the liquid filter can be configured to remove one or more constituents from the liquid medication to filter the liquid medication. The intravenous medication filter can include a gas filter disposed inside the housing between the interior chamber of the housing and the vent hole, the gas filter can be configured to allow gases to exist and prevent entry of one or more contaminants into the interior chamber via the vent hole. The intravenous medication filter can include a dosimeter coupled with the housing proximate to the vent hole and can be configured to change appearance based on a dose of sterilizing e-bean stream or irradiation that is received by the gas filter.
Provided herein is an intravenous medication filter for infusion therapy that can include a housing defining an interior chamber, the housing can have an inlet through which a liquid medication can be received, an outlet through which the liquid medication can exit the housing after being filtered, and a vent hole through which one or more gases can exit from the interior chamber. The intravenous medication filter can include a liquid filter disposed inside the interior chamber of the housing, the liquid filter can be configured to remove one or more constituents from the liquid medication to filter the liquid medication. The intravenous medication filter can include a gas filter disposed inside the housing between the interior chamber of the housing and the vent hole, the gas filter can be configured to allow gases to exit and to prevent entry of one or more contaminants into the interior chamber via the vent hole. The housing can have an attenuating segment proximate to the gas filter that reduces a dose of sterilizing radiation directed toward the gas filter while sterilizing the gas filter.
In one example, the attenuating segment of the housing can have a greater thickness relative to a remainder of the housing. In one example, the attenuating segment of the housing can be formed from a resin containing an attenuating additive that can reduce the dose of the sterilizing e-beam stream and irradiation. In one example, the attenuating segment of the housing can have a greater density relative to a remainder of the housing. In one example, the attenuating segment of the housing can be concave or convex relative to the remainder of the housing. In one example, the attenuating segment that may be concave or convex deflects at least some of the sterilizing e-beam stream or irradiation away from the gas filter or dissipates the at least some of the sterilizing e-beam stream or irradiation before reaching the gas filter.
Provided herein is an example of an intravenous medication filter for infusion therapy that can include a housing defining an interior chamber, the housing can have an inlet through which a liquid medication can be received, an outlet through which the liquid medication can exit the housing after being filtered, and a vent hole through which one or more gases can exit from the interior chamber. In one example, a liquid filter can be disposed inside the interior chamber of the housing, the liquid filter can configured to remove one or more constituents from the liquid medication to filter the liquid medication. The intravenous medication filter can include a gas filter disposed inside the housing between the interior chamber of the housing and the vent hole, the gas filter can be configured to allow gases to vent and prevent entry of one or more contaminants into the interior chamber via the vent hole. The gas filter one or more of can: (a) include or can be formed from one or more layers or laminates of an irradiation or e-beam stream diffusing or blocking material or (b) can be formed from multiple, separate layers of polytetrafluoroethylene (PTFE) or polyvinylidene fluoride (PVDF).
In one example, the gas filter can include or is formed from the one or more gas filter materials, or multiple thickness of a single layer.
Provided herein is a method that can include arranging a plurality of intravenous medication filters for infusion therapy in a pattern within a chamber of an e-beam sterilization device, each filter can have a housing defining interior chambers and having an inlet through which liquid medication can be received, an outlet through which the liquid medication can exit the housing after being filtered, and a vent hole through which one or more gases can exit from the interior chamber. Each filter can include a gas filter disposed inside the housing between the interior chambers and the vent hole, the filters arranged in the pattern such that as they are presented to an e-beam stream in proximity to a center of the e-beam sterilization equipment. The method can include exposing the gas filters to an e-beam to sterilize the filters. The filters can be arranged in the pattern such that the gas filters are no farther than generally 5.8 inches apart.
In one example, the method can include the step of arranging the several intravenous medication filters may include stacking the several intravenous medication filters in two rows separated by a gap having a width of approximately 5.8 inches.
The inventive subject matter described herein can reduce or prevent premature deterioration of the filter media in the housing of an IV medication filter device that otherwise is caused by exposure of the filter media to sterilizing (or other) radiation energy, such as UV or e-beam radiation. In one example, the vent hole through the housing of the filter device may define an internal shape or path that is angled so that the vent hole does not encompass a linear path that extends through or intersects the filter. The path of the vent hole may be linear, but oriented at an acute angle to the housing and the filter such that e-beams or other energy cannot reach the filter without first reaching (and being attenuated or blocked) by the material of the housing. Optionally, the vent hole may define several linear paths that are angled relative to each other while not including or encompassing any linear path from extending through the vent hole and intersecting the filter. The vent hole may be or extend along a linear path that is orthogonal (e.g., perpendicular) to the filter. But the vent hole may have a sufficiently large aspect ratio (defined by the depth or length of the vent hole through the housing divided by the diameter of the vent hole) that few e-beams or other radiation reach the filter, thereby protecting the filter from deterioration from this radiation. For example, the aspect ratio may be at least two, a value found by the inventors to sufficiently protect the filter from e-beam radiation deterioration.
As another example, a shroud may be placed over the vent hole. This shroud may have a closed top surface that blocks or attenuates any e-beam or other radiation directed perpendicularly toward the filter. The shroud may be open along its sides to provide transverse holes that are transversely oriented (e.g., perpendicular) to the vent hole. As another example, a gas permeable plug may be placed into the vent hole. This plug may be porous to allow gas to pass out of the vent hole through the pores in the plug. The plug may be dense enough, however, to attenuate or block e-beam or other radiation directed toward the filter.
The housing may be thicker in an immediate area around the perimeter of the vent hole. This thicker housing may impede, attenuate, or block more e-beam or other radiation directed toward the filter (relative to the housing not being thicker at and around the perimeter of the vent hole).
The singular forms “a”, “an”, and “the” include plural references unless the context clearly dictates otherwise. “Optional” or “optionally” means that the subsequently described event or circumstance may or may not occur, and that the description may include instances where the event occurs and instances where it does not. Approximating language, as used herein throughout the specification and claims, may be applied to modify any quantitative representation that could permissibly vary without resulting in a change in the basic function to which it may be related. Accordingly, a value modified by a term or terms, such as “about,” “substantially,” and “approximately,” may be not to be limited to the precise value specified. In at least some instances, the approximating language may correspond to the precision of an instrument for measuring the value. Here and throughout the specification and claims, range limitations may be combined and/or interchanged, such ranges may be identified and include all the sub-ranges contained therein unless context or language indicates otherwise.
This written description uses examples to disclose the embodiments, including the best mode, and to enable a person of ordinary skill in the art to practice the embodiments, including making and using any devices or systems and performing any incorporated methods. The claims define the patentable scope of the disclosure, and include other examples that occur to those of ordinary skill in the art. Such other examples are intended to be within the scope of the claims if they have structural elements that do not differ from the literal language of the claims, or if they include equivalent structural elements with insubstantial differences from the literal language of the claims.
This application claims priority to U.S. Provisional Application No. 63/505,782 (filed 2 Jun. 2023), the entire disclosure of which is incorporated herein by reference.
Number | Date | Country | |
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63505782 | Jun 2023 | US |