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Fiji

Cancer Statistics
Population in 2012: 0.88m
People newly diagnosed with cancer (excluding NMSC) / yr: 1,100
Age-standardised rate, incidence per 100,000 people/yr: 139.1
Risk of getting cancer before age 75:13.4%
People dying from cancer /yr: 700
Data from IARC GlobalCan (2012)

Fiji Web Resources
Latest Research Publications - Fiji

Fiji Web Resources (2 links)


Latest Research Publications - Fiji

Toh ZQ, Licciardi PV, Fong J, et al.
Reduced dose human papillomavirus vaccination: an update of the current state-of-the-art.
Vaccine. 2015; 33(39):5042-50 [PubMed] Related Publications
Human papillomavirus (HPV) infection is the primary cause of genital warts, some oropharyngeal cancers and anogenital cancers, including cervical, vagina, vulvar, anal and penile cancers. Primary prevention of cervical cancer requires the prevention of high-risk HPV infections, particularly HPV genotypes 16 and 18. Both Gardasil® and Cervarix® vaccines when administered by a three-dose schedule have been demonstrated to be effective against cervical, vulva, and vaginal cancer precursors from vaccine genotypes in phase III clinical trials, and post-marketing studies; Gardasil® vaccine also offers additional protection against anal cancer precursors. However, high costs of HPV vaccines and the logistics of delivering a three-dose schedule over 6 months are challenging in countries with limited resources. Several studies have demonstrated non-inferiority in antibody response between adolescents (9-15 years old) who received two doses (6 months apart) and women (>15 years old) who received the standard three-dose schedule. These studies provided evidence for the World Health Organization and European Medical Association to revise its recommendation to give two instead of three doses of HPV vaccine to adolescents below 15 years of age, provided the 2nd dose is given 6 months apart. Although reduced dose schedules can alleviate costs and logistics associated with HPV vaccination, especially in resource-poor countries, there are still gaps in this area of research, particularly regarding long-term protection. This review discusses the findings on antibody response and clinical outcomes in studies evaluating reduced dose HPV schedules, and highlights the important considerations of its implementation. In addition, other important immunological biomarkers that may be associated with long-term protection are highlighted and discussed.

Fong J, Gyaneshwar R, Lin S, et al.
Cervical screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy in Fiji.
Asian Pac J Cancer Prev. 2014; 15(24):10757-62 [PubMed] Related Publications
The purpose of this study was to demonstrate the feasibility of VIA screening with cryotherapy and to record normative values for indicators anticipated in similar low resource settings. Women aged 30-49 years were targeted, resulting in 1961 women screened and treated at two primary health care (PHC) centres near Suva, Fiji. Recruitment was through provision of information, education and communication (IEC). Referrals to a gynaecology outpatient department (OPD) at a referral hospital occurred throughout the screening pathway. Participation was 32% (95%CI 31-33%), higher in iTaukei (Melanesians) women (34%, 95%CI 33-36) compared to Fijians of Indian descent (26%, 95%CI 24-28). Regression analysis, adjusted for confounders, indicated significantly lower participation in those of Indian descent, and age groups 35-39 and 45-49 years. Of those examined by VIA, 190 were positive with aceto-white lesions (9.9%), within the expected range of 8-15%, with minor geographic and ethnic variation. Positive VIA results were more common in the peri-urban area, and in those aged 35-39 years. Of women aged 30-49 years, 59 received cryotherapy (none of whom had significant complications), 91 were referred to OPD, two cervical carcinomas were identified and eight cervical intra-epithelial neoplasms (CIN) II-III were diagnosed. These results provide normative findings from a community-based VIA screening program for other similar low resource settings.

Kameda T, Takahashi K, Kim R, et al.
Asbestos: use, bans and disease burden in Europe.
Bull World Health Organ. 2014; 92(11):790-7 [PubMed] Free Access to Full Article Related Publications
OBJECTIVE: To analyse national data on asbestos use and related diseases in the European Region of the World Health Organization (WHO).
METHODS: For each of the 53 countries, per capita asbestos use (kg/capita/year) and age-adjusted mortality rates (deaths/million persons/year) due to mesothelioma and asbestosis were calculated using the databases of the United States Geological Survey and WHO, respectively. Countries were further categorized by ban status: early-ban (ban adopted by 2000, n = 17), late-ban (ban adopted 2001-2013, n = 17), and no-ban (n = 19).
FINDINGS: Between 1920-2012, the highest per capita asbestos use was found in the no-ban group. After 2000, early-ban and late-ban groups reduced their asbestos use levels to less than or equal to 0.1 kg/capita/year, respectively, while the no-ban group maintained a very high use at 2.2 kg/capita/year. Between 1994 and 2010, the European Region registered 106,180 deaths from mesothelioma and asbestosis, accounting for 60% of such deaths worldwide. In the early-ban and late-ban groups, 16/17 and 15/17 countries, respectively, reported mesothelioma data to WHO, while only 6/19 countries in the no-ban group reported such data. The age-adjusted mortality rates for mesothelioma for the early-ban, late-ban and no-ban groups were 9.4, 3.7 and 3.2 deaths/million persons/year, respectively. Asbestosis rates for the groups were 0.8, 0.9 and 1.5 deaths/million persons/year, respectively.
CONCLUSION: Within the European Region, the early-ban countries reported most of the current asbestos-related deaths. However, this might shift to the no-ban countries, since the disease burden will likely increase in these countries due the heavy use of asbestos.

Aiyub S, Chan W, Szetu J, et al.
Congenital orbital teratoma.
Indian J Ophthalmol. 2013; 61(12):767-9 [PubMed] Free Access to Full Article Related Publications
We present a case of mature congenital orbital teratoma managed with lid-sparing exenteration and dermis fat graft. This is a case report on the management of congenital orbital teratoma. A full-term baby was born in Fiji with prolapsed right globe which was surrounded by a nonpulsatile, cystic mass. Clinical and imaging features were consistent with congenital orbital teratoma. Due to limited surgical expertise, the patient was transferred to Adelaide, Australia for further management. The patient underwent a lid-sparing exenteration with frozen section control of the apical margin. A dermis fat graft from the groin was placed beneath the lid skin to provide volume. Histopathology revealed mature tissues from each of the three germ cell layers which confirmed the diagnosis of mature teratoma. We describe the successful use of demis fat graft in socket reconstruction following lid-sparing exenteration for congenital orbital teratoma.

Law I, Fong JJ, Buadromo EM, et al.
The high burden of cervical cancer in Fiji, 2004-07.
Sex Health. 2013; 10(2):171-8 [PubMed] Related Publications
BACKGROUND: There are few population-based data on the disease burden of cervical cancer from developing countries, especially South Pacific islands. This study aimed to determine the incidence and mortality associated with cervical cancer and the coverage of Papanicolaou (Pap) cervical cytology in 20- to 69-year-old women in Fiji from 2004 to 2007.
METHODS: National data on the incident cases of histologically confirmed cervical cancer and the associated deaths, and on Pap smear results were collected from all pathology laboratories, and cancer and death registries in Fiji from 2004 to 2007.
RESULTS: There were 413 incident cases of cervical cancer and 215 related deaths during the study timeframe. The annualised incidence and mortality rates in 20- to 69-year-old Melanesian Fijian women, at 49.7 per 100?000 (95% confidence interval (CI): 43.7-56.4) and 32.3 per 100?000 (95% CI: 26.9-38.4) respectively, were significantly higher than among 20- to 69-year-old Indo-Fijian women at 35.2 per 100?000 (P<0.001, 95% CI: 29.5-41.7) and 19.8 per 100?000 (P=0.002, 95% CI: 15.1-25.5) respectively. Of 330 cases diagnosed between 2004 and 2006, 186 (56%) had died by 31 December 2006. Pap smear coverage for this period was 8.0% (95% CI: 7.9-8.1) of the target population.
CONCLUSIONS: The incidence and mortality related to cervical cancer in Fiji is high, whereas Pap smear coverage is very low. Greater investment in alternative screening strategies and preventive measures should be integrated into a comprehensive, strategic cervical cancer control program in Fiji.

Kuehn R, Fong J, Taylor R, et al.
Cervical cancer incidence and mortality in Fiji 2003-2009.
Aust N Z J Obstet Gynaecol. 2012; 52(4):380-6 [PubMed] Related Publications
BACKGROUND: Previous studies indicate that cervical cancer is the second most frequent cancer and most common cause of cancer mortality among women in Fiji. There is little published data on the epidemiology of cervical cancer in Pacific countries.
AIMS: To determine the incidence 2003-2009 of, and mortality 2003-2008 from, cervical cancer by ethnicity and period in Fiji, identify evidence of secular change and relate these data to other Pacific countries, Australia and New Zealand.
METHODS: Counts of incident cervical cancer cases (2003-2009) and unit record mortality data (2003-2008) from the Fiji Ministry of Health were used to calculate age-standardised (to the WHO World Population) cervical cancer incidence and mortality rates, and cervical or uterine cancer mortality rates, by ethnicity, with 95% confidence intervals. On the basis of comparison of cervical cancer mortality with cervical or uterine cancer mortality in Fiji with similar populations, misclassification of cervical cancer deaths is unlikely.
RESULTS: There is no evidence of secular change in cervical cancer incidence and mortality rates for the study period. For women of all ages and ethnicities, the age-standardised incidence rate of cervical cancer (2003-2009) was 27.6 per 100,000 (95% CI 25.4-29.8) and the age-standardised mortality rate (2003-2008) was 23.9 per 100,000 (95% CI 21.5-26.4). The mortality/incidence ratio was 87%. Fijians had statistically significant higher age-standardised incidence and mortality rates than Indians. Fiji has one of the highest estimated rates of cervical cancer incidence and mortality in the Pacific region.
CONCLUSION: Cervical cancer screening in Fiji needs to be expanded and strengthened.

Tabrizi SN, Law I, Buadromo E, et al.
Human papillomavirus genotype prevalence in cervical biopsies from women diagnosed with cervical intraepithelial neoplasia or cervical cancer in Fiji.
Sex Health. 2011; 8(3):338-42 [PubMed] Related Publications
BACKGROUND: There is currently limited information about human papillomavirus (HPV) genotype distribution in women in the South Pacific region. This study's objective was to determine HPV genotypes present in cervical cancer (CC) and precancers (cervical intraepithelial lesion (CIN) 3) in Fiji.
METHODS: Cross-sectional analysis evaluated archival CC and CIN3 biopsy samples from 296 women of Melanesian Fijian ethnicity (n=182, 61.5%) and Indo-Fijian ethnicity (n=114, 38.5%). HPV genotypes were evaluated using the INNO-LiPA assay in archival samples from CC (n=174) and CIN3 (n=122) among women in Fiji over a 5-year period from 2003 to 2007.
RESULTS: Overall, 99% of the specimens tested were HPV DNA-positive for high-risk genotypes, with detection rates of 100%, 97.4% and 100% in CIN3, squamous cell carcinoma (SCC) and adenosquamous carcinoma biopsies, respectively. Genotypes 16 and 18 were the most common (77%), followed by HPV 31 (4.3%). Genotype HPV 16 was the most common identified (59%) in CIN3 specimens, followed by HPV 31 (9%) and HPV 52 (6.6%). Multiple genotypes were detected in 12.5-33.3% of specimens, depending on the pathology.
CONCLUSION: These results indicated that the two most prevalent CC-associated HPV genotypes in Fiji parallel those described in other regions worldwide, with genotype variations thereafter. These data suggest that the currently available bivalent and quadrivalent HPV vaccines could potentially reduce cervical cancers in Fiji by over 80% and reduce precancers by at least 60%.

Cama JK
Recurrent abdominal pain post appendectomy--a rare case.
Pac Health Dialog. 2010; 16(2):78-81 [PubMed] Related Publications
Right iliac fossa pain in young adults who have previously had an appendicectomy represents a diagnostic challenge. In such cases it is important to review the histology of the appendix and the previous operation notes. The appendix stump, if left long following an appendectomy, can result in chronic appendicitis of the stump, or it can rarely develop into a mucocele. This case report describes a patient with an appendix stump mucocele who presented with chronic pain under the right iliac fossa incision and was successfully treated by laparoscopic resection.

Foliaki S, Best D, Akau'ola S, et al.
Cancer incidence in four pacific countries: Tonga, Fiji Islands, Cook Islands and Niue.
Pac Health Dialog. 2011; 17(1):21-32 [PubMed] Related Publications
BACKGROUND: We have established and/or upgraded cancer registries in four Pacific countries, a region where few cancer registries exist. We report age-standardised cancer incidence in Tonga (2000-2005), Fiji (2002-2005), Cook Islands (2000-2005) and Niue (2000-2005), and in Pacific people in New Zealand (2000-2005).
METHODS: In each country we identified incident cancer cases by reviewing hospital discharge, death registration, cancer registration records, and pathology reports. The primary site and morphology data were coded using ICD-0, and age-standardised incidence rates were calculated.
RESULTS: Age-standardised cancer incidence rates for Pacific people in New Zealand (315 per 100,000 person-years in females, 379 in males) were similar to those for New Zealand overall (322 in females, 404 in males); incidence rates were lower in the Pacific, with rates of 195 and 151 per 100,000 person-years for females and males respectively in Tonga, 231 and 126 in Fiji, 165 and 142 in the Cook Islands, and 228 and 131 in Niue. However, some specific cancers were elevated in the Pacific including cervical cancer (16 per 100,000 in Tonga, 51 in Fiji, 17 in Cook Islands, and 26 in Niue compared with 10 in Pacific people in New Zealand, and 8 in New Zealand overall), liver cancer (rates of 8, 5, 19, 0, 7, and 2 respectively) and uterine cancer (rates of 24, 18, 47, 19 and 12 respectively).
CONCLUSIONS: Cancer incidence in the Pacific is lower than for Pacific people living in New Zealand. Environmental rather than genetic factors are most likely to explain these patterns, and cancer incidence in the Pacific is likely to increase to rates similar to those in New Zealand as the region becomes more 'westernised' The high rates of cervical cancer and liver cancer in the Pacific indicate an important role of

Singh-Carlson S, Neufeld A, Olson J
South Asian immigrant women's experiences of being respected within cancer treatment settings.
Can Oncol Nurs J. 2010; 20(4):188-98 [PubMed] Related Publications
The purpose of this focused ethnographic inquiry was to examine South Asian immigrant women's experiences and perceptions of respect within health professional-client relationships in the context of a Canadian outpatient treatment clinic. Characteristics of respect described by 11 women interviewed were the meaning of respect, health professional's way of being, their way of attending to the person, and their way of talking. Language, cultural values and beliefs, along with underlying societal, individual and institutional factors that coexist with health professionals' ability to create respect were some of the dimensions that influenced how immigrant women experienced respect. Health professionals' capacity to acknowledge South Asian immigrant women as individuals helped to formulate/construct respect for their individual identities. The need to be respected for 'my social identity' as an immigrant woman with cancer was woven throughout women's stories, illustrated by their personal experiences and perspectives.

Garland SM, Brotherton JM, Skinner SR, et al.
Human papillomavirus and cervical cancer in Australasia and Oceania: risk-factors, epidemiology and prevention.
Vaccine. 2008; 26 Suppl 12:M80-8 [PubMed] Related Publications
The region encompassing Australasia and Oceania, including Australia, New Zealand, Fiji and Papua New Guinea, is a diverse one with respect to ethnicities, cultures and behaviours. It includes countries with comprehensive cervical cytology screening programmes which can be credited with significant reductions in cervical cancer incidence and mortality, and countries with no prevention programmes and significantly higher incidence and mortality. As elsewhere in the world, human papillomavirus (HPV)-16 and 18 are the commonest high-risk types, with the highest rates in women under 25 years of age. These two high-risk HPV types are found most frequently in cervical cancers and high-grade dysplasias, although there are minimal data for many countries in Oceania. In April 2007, Australia became the first country worldwide to commence a government funded universal HPV vaccine programme. The school-based programme targets 12-year old females in an ongoing schedule, with a catch-up programme up to 26 years of age, to be completed in mid-2009. Vaccine introduction has been comprehensively rolled out, with around 75% uptake of the complete vaccine schedule among school-girls in the first year of this initiative. This represents a successful model for other countries. We present data on cervical cancer, risk factors and prevention strategies, including epidemiology of HPV and HPV vaccine strategies.

Afolabi IR, Shashidhar VM
Carcinoma of the oesophagus masquerading as actinomycosis: a case report and a review of literature.
Pac Health Dialog. 2004; 11(1):94-5 [PubMed] Related Publications
Actinomycosis is a granulomatous lesion caused by actinomyces species, which is an anaerobic non-spore forming gram-positive bacillus. It is a relatively uncommon disease which occurs as opportunistic infection. Most of the reported cases have underlying diseases predisposing them to actinomycosis3. This case report is presented to illustrate the necessity to exclude an underlying disease that may predispose individuals to secondary infection caused by actinomycosis. Two weeks after discharge the patient returned to hospital with symptom of dysphagia. Actinomycosis is not an uncommon disease which occurs throughout the world. Carcinoma of the oesophagus needs to be excluded in a patient with dysphagia and weight loss. Actinomycosis and carcinoma of the oesophagus may coexist in patient with dysphagia. The need for repeated upper gastrointestinal endoscopy and biopsy to confirm or exclude a primary diagnosis of oesophageal actinomycosis has been endorsed by many authors.

Comfort AO
Burkitt's lymphoma of the jaws: role of dental practitioner in management.
Pac Health Dialog. 2004; 11(1):89-93 [PubMed] Related Publications
Burkitts lymphoma, a malignant solid tumour of B lymphocytes grouped under the umbrella of non-Hodgkin's B-cell lymphoma. Burkitt's lymphoma is known to be endemic in Africa but can occur sporadically in other part of the world. It is one of the most aggressive malignancies in human body. In the past, the prognosis was very poor, however; complex chemotherapeutic regimens can now cure approximately 50-80 percent of adult patients with Burkitt's lymphoma, and in paediatric populations, the cure rate is even higher This report describes a typical case of Burkitt's lymphoma of the jaws with associated rapid spread. This type of rapid progression calls for the need for prompt recognition and life saving referral by the general dental practitioner The clinical features of Burkitt's lymphoma involving the jaws include severely mobile teeth, displaced teeth and generalized lymphadenopathy (submandibular, cervical, axillary and inguinal). The objective of this case report and review of the literature is to highlight the clinical and histopathological features of Burkitt's lymphoma to help general dental practitioner and clinicians recognize such cases readily and facilitate prompt and potentially life-saving referral.

Waqainabete I
Management of malignant pleural effusions by talc pleurodesis.
Pac Health Dialog. 2006; 13(2):103-5 [PubMed] Related Publications
Since July 2002, the Cardiothoracic Surgical team started talc pleurodesis with or without surgical assisted video thorascopy. This paper reports a retrospective review of medical records of 6 patients who received talc pleurodesis from July 2002 to March 2003, three males and three females. The primary malignancy was proven histological in five patients. All the six patients presented with dyspnoea. Two patients received thoracocentesis 2 or 3 times while 4 had formal chest drains till pleurodesis. The total amount of fluid drained before pleurodesis ranged from 2 to 7 litres. One patient died from metastasis 1 month after pleurodesis with a Blake drain in situ. The pleurodesis success rate was 100% for the 5 patients that lived. All the patients had MPE as a consequence of metastatic malignancy. The patients were discharged home after pleurodesis with a Blake drain and grenade. The complete pleurodesis rate was 5/5. Pain was the most common complication of tetracycline and doxycycline pleurodesis. Talc pleurodesis is a relatively cheap and safe procedure undertaken at Cardiothoracic Surgical Unit, Christchurch Public Hospital. Chemical pleurodesis using talc is an important consideration.

Afolabi IR
Towards prevention of breast cancer in the Pacific: influence of diet and lifestyle.
Pac Health Dialog. 2007; 14(2):67-70 [PubMed] Related Publications
Breast cancer is a multifactorial disease which has created a significant health problem worldwide. The literature suggests that there is an increase the prevalence of breast cancer among the Pacific Islanders in the last two decades. Factors which influence breast cancer risk include gender, genetic mutation, diet, parity and endocrine. Nutritional studies and epidemiological surveys show that dietary and lifestyle factors play significant role in breast cancer risk. Breast cancer risk is reduced by regular intake of fruits, vegetables and omega-3 fatty acids-rich diet. Whereas obesity, smoking, alcohol consumption and sedentary lifestyle increase breast cancer risk. Breast feeding practice is protective against breast cancer. Intensive awareness campaigns and public education are necessary to discourage risk behaviour among the Pacific Islanders.

Afolabi IR
Sacrococcygeal teratoma: a case report and a review of literature.
Pac Health Dialog. 2003; 10(1):57-61 [PubMed] Related Publications
Sacrococcygeal teratoma is a congenital tumour, which may present in the prenatal period or at birth. The case presented illustrated one of the complications of sacrococcygeal teratoma, which is tumour rupture at birth. Other complications include fetal hydrops, fetal hydronephrosis, cervical dystocia, bleeding and death. Currently, diagnosis of sacrococcygeal teratoma is made during the prenatal period using modern imaging technique. The diagnostic technique of choice is ultrasonography. Early diagnosis influences clinical decision and management, which produces, better outcome.

Afolabi OO
Oral melanosis: a case report of Peutz-Jegher's Syndrome in Suva, Fiji.
Pac Health Dialog. 2003; 10(1):55-6 [PubMed] Related Publications
This paper reports on a case of oral melanosis resultng from Peutz-Jeghers Syndrome, a hereditary disease characterized by harmatomatous polyposis and by mucocutaneous melanic pigmentation, in a 14-year-old Fijian girl with a family history of the disease. The patient underwent surgery for treatment of an intestinal obstruction due to a small intestine intussusception. Recognition of the characteristic pigmentation by dentists may lead to early diagnosis of associated harmatomatous polyps or neoplastic disease that may be life threatening.

Shaw JE, Hodge AM, de Courten M, et al.
Isolated post-challenge hyperglycaemia confirmed as a risk factor for mortality.
Diabetologia. 1999; 42(9):1050-4 [PubMed] Related Publications
AIMS/HYPOTHESIS: The aim of this study was to examine the possible link between isolated post-challenge hyperglycaemia (2-h post-challenge plasma glucose >/= 11.1 mmol/l, and fasting plasma glucose < 7.0 mmol/l) and mortality.
METHODS: The data from three population based longitudinal studies (in Mauritius, Fiji and Nauru) were pooled and mortality rates were determined in 9179 people who were followed for between 5 and 12 years.
RESULTS: There were 595 people with previously diagnosed diabetes, and 799 with newly diagnosed diabetes, of whom 243 (31) had isolated post-challenge hyperglycaemia. In comparison with people without diabetes, people with isolated post-challenge hyperglycaemia had an increased risk of all-cause mortality [Cox proportional hazards ratio (95 % CI): 2.7 (1.8-3.9) - men; 2.0 (1.3-3.3) - women], and of cardiovascular mortality [2.3 (1.2-4.2) - men; 2.6 (1.3-5.1) - women]. In addition, men with isolated post-challenge hyperglycaemia had a high risk of cancer death [8.0 (3.6-17.9)].
CONCLUSION/INTERPRETATION: These data show that isolated post-challenge hyperglycaemia, which can only be identified by the 2-h glucose, is common, and at least doubles the mortality risk. This should be considered in the design of screening programmes that use only fasting glucose.

Okoji GO, Dotollo RA
Massive hepatomegaly in a 6-week-old infant: is it neuroblastoma?
Ann Trop Paediatr. 1994; 14(4):337-41 [PubMed] Related Publications
Neuroblastoma is described in a 6-week-old baby presenting with a rapidly enlarging liver. Initial ultrasound examination of the abdomen could not characterize the tumour but a second examination showed a cyst in the superior pole of the kidney which at autopsy was found to be due to adrenal haemorrhage. The role of prenatal and postnatal ultrasonography in the diagnosis of neuroblastoma is emphasized. This tumour is more common in white children in the more industrialized countries, but even in developing countries clinicians should remain alert to its myriad manifestations.

Henderson BE, Kolonel LN, Dworsky R, et al.
Cancer incidence in the islands of the Pacific.
Natl Cancer Inst Monogr. 1985; 69:73-81 [PubMed] Related Publications
The South Pacific Commission Cancer Registry has been operational since 1977, and reasonably complete cancer incidence rates are available for New Caledonia, Fiji, Micronesia, the Cook Islands, and Niue. In addition, less complete reporting is available from American Samoa, Papua New Guinea, and French Polynesia. Cancers of the lung, oral cavity, esophagus, liver, and cervix are potentially preventable but prevalent in many Pacific island countries. Unusually low rates of many cancers were observed in Fiji, the most notable being lung and colon-rectum. Thyroid cancer rates are elevated in some but not all female populations. These and other variations in cancer by site are important areas for further research.

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