Biggest news of the week may this morning in the announcement of of health and human services through definitive rules under the new health care law dictate how health insurance companies must spend rewards collecting Department.
The anticipated suspense and much-discussed provisions on medical claims so-called is presented.According to the law, insurers must spend at least 80 cents of every premium dollar that improving the welfare of their Kunden.Der rest goes to administrative costs, including profits.
"Expect much analysis (and spin), mean what the final regulations on the industry and buyers of health insurance.""Thanks to the affordable care Act, millions of Americans better value for your health insurance premium dollar received," said Kathleen Sebelius, Secretary of health and human services, in a press release.
"These new rules are an important step to account insurance companies and value for consumers increase drag."
Read more about the new rules can in the accompanying fact sheet and regulations itself.
Analysts expect the dread, on which the regulations might look will now disappear and investors with company stocks to make convenient.
But don't expect the drama full of many States will be - expected under the new law, relying on the possible disruption to your market forces each insurer is bitten.Infolgedessen to meet the new provisions for exemptions will be closely each to see which States step forward and how receptive federal regulators are exactly to your needs.
Mean the Thanksgiving holiday, it is relatively quiet on other fronts, with no food and Drug Administration Advisory Committee scheduled hearings for this week.
It is only a quarterly earnings report from Medtronic, the large medical devices manufacturers before the market Tuesday opens. during Rick wise, analyst at White rink Swann, the quarter thinks "low utilization and increasing pressure on prices will reflect" says he better than expected results could come out with the company.
If you missed it, could a provocative story in the Wall Street Journal on the States, contemplation dropping out of the Medicaid program (although the article really think you are) and my colleague Robert PEAR's want to check interesting piece on Sunday about the concerns that the warmth and blur to create alliances between hospitals and doctors to help you better serve out under the new health care law in a much less competitive health care system translate could.
Let us know if we missed something.
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As more families are enrolled in health plans with high deductibles find, are always more likely to delay or avoid medical care because of the health-care financing shows cost, a new study.
The study published Monday in the archives of internal medicine, asked the people who are plans with deductible of at least $2,000 in family hesitated or decided against always care because of costs.
While the researchers say you were expecting people think twice less money for your care made, "We were surprised families even high income high delayed or lost care, had", said Dr. Jeffrey t. Kullgren, a primary care doctor medical and lead author of the study.
Explorer survey one of 400 families, a high deductible plan offered in New England belonged. While 57 percent of low-income participants had delayed said or left without care due to cost said in the past six months, 42 percent with high income families you similar decisions made.
The real question is of course whether people are medical costs more aware which will use, if you spend your own money and avoids the cost of care little or if you decide not to go ahead with basic types of treatments and tests.
"It's still an open question," said Dr. Kullgren, who pointed out numerous studies he said proposed people are not very demanding when it comes to decide what kind of care benefit, and what is not.
"Dr. Kullgren said many people want questions about your health care provider the costs of treatment and possible alternatives, but that these discussions are rarely found today statt.Selbst when asked, can doctors have no idea, how much one treatment or where you the best price for a test, and he and other family doctors have little time to discuss these issues.""It very difficult if not impossible to go patients through these decisions at the point of service", he said.
Do you think people better and are more savvy consumers if you share in the costs for your medical care?
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Merck has a potential blockbuster in Anacetrapib experimental cholesterol-drug, HDL or "good" cholesterol drastically increases even as you reduce LDL "bad" cholesterol.
But don't keep your Atem.Kardiologen, patients and investors will have to wait until at least until 2015 to determine whether the drug protects heart, by reduced heart attacks and other heart circulation problems, said Merck.
Anacetrapib works by inhibiting an enzyme called CETP that is involved in the conversion of particles of the good cholesterol in bad cholesterol.
In a study published in the New England Journal of medicine researchers reported that patients in the group where a Anacetrapib seen 39.8 percent reduction in bad cholesterol, also in the placebo group hatte.Mehr striking is the Anacetrapib Group had an increase good cholesterol, 138.1 percent said the study.
This is promising in theory, doctors said good cholesterol because epidemiological studies - the kind that consider the illness in a population - have an association between high and reported a lower risk of heart problems.
But the true impact of Anacetrapib on heart health from will be unknown until researchers a much larger study lead investigating whether the drug, can reduce the risk of heart attacks, coronary deaths and other heart problems, said Dr. Luciano Rossetti, head of global scientific strategy at Merck research laboratories.
The study on Tuesday "are promising and reassuring, but inconclusive," Dr. Rossetti said in a telephone interview. "This is why we are forward with 30,000 patients in a very large results study."
Researcher in Oxford at the Dienstag.Die Merck is about 150 million US dollars - the larger study, sponsor coordinated at Oxford University £ 96 million expenditure - results of this study will be known before 2015, said Rossetti said Dr..
Merck needs such results data before it approval of food and Drug Administration on the market said the drug cardiologists searches because a similar experimental cholesterol drug Pfizer proved to be problematic.
In 2004 a phase i study of persons, the Pfizer drug, a CETP inhibitor Torcetrapib called, reported that it could improve good cholesterol and bad cholesterol reduction.
But later a large results study showed that the drug increases the risk of death by 59 percent and heart attacks by 25 percent. After spending more than develop $800 million, the drug, Pfizer ended the project in the year 2006.
Dr. Rossetti said Merck researchers intensively the disadvantages the Pfizer drug to ensure that there was no similar problems with its own drug.Torcetrapib, such as levels of aldosterone, can increase a hormone, can increase blood pressure, he said.
But the new study involving 1623 reported patients who were your cholesterol control with Statins that there no significant differences in change of blood pressure or aldosterone levels between Anacetrapib groups and placebo.
The study also reported that there were 16 cardiac events - including four deaths from heart cycle causes-Anacetrapib group compared with 21 major heart problems, including a Cardiavascular relating to death in the Placebogruppe.Aber the difference was not statistically significant Studie.Die Anacetrapib group said to 28 in the placebo group experienced eight compared less Revascularization - operations.
Dr. Howard Weintraub, a cardiologist, he who is the Clinical Director of the Center for the prevention of cardiovascular disease at NYU Langone Medical Center said anacetrapib's ability to raise good cholesterol was beeindruckend.Aber, said cardiologists not yet know whether artificially increase the good cholesterol levels automatically a protective effect on the heart hat.Dr.Weintraub is a speaker for Pfizer, AstraZeneca and Abbott.
Good cholesterol, said Dr. Weintraub, works like a garbage truck with to the Recycle Bin, the bad cholesterol password.but quality, not only the amount that may be very important for reducing the risk of heart disease, said good cholesterol er.Aber artificially increase that good cholesterol with drug can do not have the same effect on the heart as naturally increase only study on Anacetrapib can answer this question the larger results, he said.
In the meantime should Dr. Weintraub said people remember that some changes of the quality of life of their heart health can improve.
"" The American public should remember that the best way to improve HDL and triglycerides and exercise to lose weight and watch your diet, ", said Dr. Weintraub."These two markers are very sensitive to lifestyle changes."
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Personalized medicine - often described as the right medicine for the right patient at the right time - was considered as an ideal. But it is also a threat to some pharmaceutical companies wedded to the idea of blockbuster drugs that could be taken by potentially all patients with a certain disease.
But pharmaceutical companies are now pursuing personalised medicine, according to a new report from Tufts Center for the study of drug development at Tufts University.
"You really go to this whole pig," said Christopher Paul Milne, Associate Director at the Tufts Center for the pharmaceutical industry receives some funding. "You are basically transition the way of development in a personalized medicine approach. "
Mr. Milne said from 12 to 50 percent of the companies subject to the company involved in developing drugs a personalized medicine approach.
The Tufts report based survey of 25 companies, large and small on a replied on 16 enterprises as well as interviews with representatives of 13 companies.
Often includes personalized medicine Genetical or other tests that can be used to determine which patients are most likely of a drug or who suffer the most serious side effects are to benefit.
Relatively few drugs are now accompanied by such so-called companion Diagnostics.Are most common in the Onkologie.Das breast cancer-Medikament Herceptin, receives only to women, whose tumors have a wealth of a protein called HER2.
That's not likely, only 10 percent of drugs immediately to level.the says Tufts study now in late stage clinical studies have tested a diagnostic Companion.
But this should change with drugs which are not so far in the development.The survey found that 50 percent of trials now collect DNA by the participants to help to find a drug "Biomarkers" safety or efficacy issues to korrelieren.Rund 30 percent of companies said, now all connections in development, you require a biomarker. "
The report notes, the personalized medicine will complicate may drug development, weniger.Und while some companies are interested of biomarkers to understand how a drug in the body, you're less enthusiastic about the establishment of the necessary tests before a drug can be used.
Still could inevitable make it growing cost pressure in the health sector that drugs only benefit most likely patients are used.
"I think you are in a situation where you have not much choice," Mr. Milne said the drug companies. "I think that's why we see make the transition. "
Correction: Mr. Milne results Thursday on a personalized medicine Conference at Harvard Medical School presented.The report is also posted on the University website.
An earlier version of this post incorrectly say post's availability, you had been made public.
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A Federal Advisory Committee said on Wednesday that Medicare pay treatment for the $93.000 gave evidence that the drug Provenge it probably extended the lives of people with advanced prostate cancer, an endorsement that makes.
Medicare coverage of Advisory Committee voted that it had "intermediate confidence" in the strength of the data, that the drug developed by Dendreon, improves survival. "
The session on Wednesday is part of a process where the Centers for Medicare and Medicaid Services is decide whether the figures for Provenge, by the food and Drug Administration was approved in April.
Medicare's action has been partially controversial as unusually ist.Einige prostate cancer patients and lawyers, doctors and investors in Dendreon say such a review, which had already decided since the f.d.a the drug helps patients that Medicare's review was based more on cost and in a manner was the beginning of health care rationing.
"For a second Government agency to open second guess that is not constructive," said Brad Loncar, an investor in Dendreon, whose grandfather died of prostate cancer in the Committee which met in Baltimore. " One must wonder if other is meeting today about something than science, namely the cost. "
Medicare officials denied that the session costs and instead more about attempted to come up with a single national policy for, whether the drug should be covered rather than leaving it up to Medicare's regional contractor.
"I think people tried, read more in our motives than honestly would justify," said Dr. Louis Jacques, Director of the reporting and analysis group for Medicare and Medicaid, in an interview Wednesday. "
The Advisory Committee, consisting of doctors and health policy experts, the cost of Provenge to discuss or even make a cover recommendation.It examines the data from clinical trials.
Provenge is a treatment in a patient taking blood and processing of patient immune system against the tumour to trainieren.In clinical studies advanced that median survival of about four months compared to a Kontrollgruppe.Dendreon is charging $93.000 for each patient treatment.Some private insurance companies and some Medicare carriers are already cover.
Panel members agreed then on how convinced were that the data on a scale of 1 to 5 supported different possible conclusions.
10 Voting members had an average vote from 3.6 to the question whether the evidence was, which is strong enough to complete that Provenge life verlängert.Das something about 3, intermediate confidence, but less than 5, high level of trust.
Analysts say that level that reporting by providing sollte.Die panelists were about equally confident the drug helped patients to avoid side effects of treatment.
However, the panelists had very little confidence in the evidence for use of the drug in patients who are sicker than those in the clinical trial or not so sick.
A way to cover so-called off-label use of Provenge could refuse, the Medicare bieten.Solche off label are used quite usual in cancer, try desperate patients from various therapies in the hope it will work.
Provenge is approved for men whose Krebs has spread beyond the prostate gland and who no longer respond to androgen deprivation therapy but have still minimal or no symptoms.
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On Monday morning to his financial support of this nation's struggle against the leading cigarette companies commit Mayor Michael R. Bloomberg of New York telephoned the Uruguayan President José Mujica.
Mr. Bloomberg, billionaire with a long record of smokers activism made the announcement after a Front page article on Sunday in the New York Times erschien.Der article detailing some lobbying and marketing court activities of multinational tobacco companies.
Mr. Bloomberg announced on Monday afternoon a press conference that he million direct would some of the $375 to Uruguay legal defense he has set aside in a philanthropy fighting smoking. In a press release he call no precise figure.
Uruguay, regarded as the world's leader in anti smoking laws, cigarette is an affiliate-Washington based World Bank of Philip Morris International verklagt.Die giant objects, two new Uruguayan law. 80 Percent of the front and back of cigarette includes packages with graphic warning health. The more than a kind of every brand of cigarette, such as Marlboro red, gold and silver other prohibitions.
The suit has anti smoking forces global gathering. Interpreted it as an attempt to intimidate Uruguay and send a message to other developing countries on the eve of Conference of tobacco control officials from 171 Nations.The Conference in Punta del Este, Uruguay, plans sponsored by the WHO to recommend policies to enforce a wide smoking contract.
In the press release Mr. Bloomberg money "Uruguayan Government officials will support by legal research and expertise." world launches public awareness campaigns, mass media and hot dip galvanizing support and public opinion
Peter Nixon, a spokesman for Philip Morris International, said in recent interviews that the action was necessary, to which he said message in February regardless of the Conference which was tobacco control officials, company's trademarks and intellectual property to Schützen.Seine.The suit seeks not unspecified damages.
The size of the health warning, Mr. Nixon, said "the previous ones were 50 percent and we thought this was angemessen.sobald take it up to 80 percent, there is no place for trademarks shown werden.so we that went too far thought."The limit for brands, added he forced to remove a number of brands Philip Morris from the market.
A group of non-profit health organizations bought a full-page ad in Uruguay's leading newspaper Monday the President of the country until thanks to stand Tabakunternehmen.Philip Morris International's $66 billion annual turnover is twice the size of the gross domestic product of Uruguay.
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Cardiologist, not to mention Wall Street analysts, are the results of several important studies that meet at the American Heart Association this week presented closely monitor.
In particular, are on Monday morning bring researchers developed the results of the rocket AF a study that compared warfarin, Rivaroxaban, blutgerinnung retardant a new drug from Bayer and Johnson and Johnson to prevent strokes in patients with atrial fibrillation.
The question is not only whether the new pill worked as also warfarin, an older drug to take effective but often uncomfortable for patients, but the new drug was how secure when compared to the older drug caused bleeding.
Johnson and Johnson has a Ð food and Drug Administration to approve that for any other purpose - to reduce the risk of large blood clots Rivaroxaban in people the knee or hip replacement surgery are subject to.
But the f.d.a has already approved the first new generation alternative to warfarin. Pradaxa, also known under its chemical name, made by Boehringer Ingelheim, Dabigatran Agency received approval last month as stroke prevention treatment for people with atrial fibrillation.
Meanwhile researchers will present on Wednesday morning, expected that define a study called includes Anacetrapib, cholesterol-Medikament in the development of Merck.It is designed to increase HDL, also known as "good" cholesterol while reducing LDL, also known as "bad" cholesterol.
The meeting continue through Wednesday in Chicago.Can developments in one of my favorite blogs, Larry of cough's CardioBrief or by his Twitter feed @ Cardiobrief follow.
Heart lovers cardiologist, Dr. Harlan Krumholz, the Yale should follow their Twitter feed @ Hmkyale is.
On Monday's Kathleen Sebelius Secretary of health and human services planned the keynote speech at the annual meeting of the National Business Coalition of health liefern.Die non profit group around the country representing more than 7,000 employers, including the implication of the law, discuss employers health overhaul.
About are the f.d.a it a busy week for external experts on Advisory Committee panels, to check the industrial applications for new drugs.
On Tuesday, this is arthritis advisory panel, Benlysta, a human monoclonal antibody of Human Genome Sciences, for the treatment of patients with Lupus prüfen.Am discuss a regulatory path for potential anthrax-Impfstoffe Tuesday the vaccine Advisory Committee and Wednesday, which consider same group approval for Gardasil that Merck to include prevention of anal cancer vaccine of HPV is erweitern.Inzwischen Thursday the Agency plastic surgery Panel, a new handheld device called MelaFind as a system to detect, predict whether moles and skin lesions cancerous device shall be checked.
Towards the end of the week, kidney specialists become aware of developments of the meeting of the American Society of Nephrology in Denver, where late-breaking clinical trials are due will be presented on Saturday.
In particular, presents researcher at Oxford University the results Of the sharp study, one Merck-sponsored study the effectiveness of the use of cholesterol treatments simvastatin and Ezetimibe, also known as the combination tested pill Vytorin on cardiovascular events in patients with chronic kidney disease.
If you want to nominate your favorite blog or Twitter on developments feed in the treatment of kidney disease, please send us a note.
Correction: An earlier version of this post wrong type of specialists who most closely monitor the American Society of Nephrology Conference in Denver running.make are not liver, kidney, specialists.
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November 15
He says New York's Mayor some of his philanthropic resources use is to fight tobacco companies.November 15
A discussion on new trends in health insurance.November 15
Coagulation retardant and cholesterol drugs are developments expected this week.November 12
The campaign for tobacco-free kids takes exception cigarette packaging, the function of the cities with a hip image.November 10
The analysis has been issued, such as Medicare, if it chooses an expensive drug payable Provenge.
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R.j. Reynolds's Special Edition packs camel cigarettes playing from the images of cities having a hip image introduction - drawing fire from antismoking groups who say are marketing to youth.
The names and pictures of places, including Seattle, Austin, San Francisco, Las Vegas and Williamsburg Brooklyn neighborhood using the packs.
"Some of the most famous hipster neighborhood call it," says the Williamsburg Pack."But it's not about Hüfte.Es is ausbrechen.Es goes to last call, a sloppy kiss goodbye and a solo stroll to a rock show in an abandoned building."
R.j j. Reynolds Tobacco Company
Matthew L. Myers, President of the Washington-based campaign for tobacco free kids, demanded the company withdraw the packages.
"It is deeply disturbing that RJR used calls the good name and hard-earned reputation this large American cities to deadly and addictive cigarettes, in particular to market openly to children," he said in a statement on Friday.
"Certainly the citizens and the leaders of these cities want to not be linked to a product, the more than 400,000 Americans each year kills. RJR death and suffering its products showed really shameless contempt cause by calling this campaign a fixed ' the sites involved."
A Reynolds spokesman responded to requests for comment.
Vince Willmore, a spokesman for the campaign for tobacco-free kids, said State attorneys general action against the cigarette 1998 could take tobacco settlement agreement companies under one.It says: "no participating manufacturers can take action directly or indirectly, to thy youth within each successful countries in the advertising, promotion or marketing of tobacco products."
The States have forced r.j. Reynolds, other youth-oriented marketing campaigns, put an end to areas, said Mr Willmore, including the sale of sweets, fruit - and alcohol flavored cigarettes stop in 2006.
Marty Markowitz, Brooklyn Borough President, told the Brooklyn
Paper: "as an ex-smoker, I know there is no way, responsibly use cigarettes."So, if we say that Williamsburg and Brooklyn smokin ', we believe smokin 'hot - not smokin' cigarettes!"
Mr. Myers said youth marketing not to laugh.More than 3,000 young people begin to smoke every day in America.
"" It really the Joe Camel campaign over and over again is ", said Mr Myers."There are many youth appealing topics Joe Camel campaign, where the now banned cartoon camel was often portrayed, with fast cars and motorbikes or fun at parties."
The camel Seattle pack says: "home grunge, a coffee revolution and alternatives that will probably tell you, you are only happy when it rains."
Camel Austin: "name shaken a live show, the story - we put money, camel camel gab.So zweistufiger his way to Texas for a lone star taste that independent spirit and all access pass to the live music capital of the world."
Camel San Francisco: "the summer of love, to civil protests and a rainbow of Gegenkultur.Ob you started here or to put flowers in your hair, grabbed a drum and hitched a ride with a painted minibus is camel, this little piece of San Francisco, to develop with the spirit, to rotate or revolt pulses and follows the power to exempt."
The promotion is part of online and direct mail campaign of camel called "break free adventure."Readers, providing information confirmed he adults, can win prizes by guessing, where camel that week has site besucht.Jede a special Pack design.
The legal age for smoking in most countries is 18 Jahre.Auf of his website code Reynolds says it following the rules in the settlement agreement States and promoting voluntary cigarette is promising to "indicate that smoking is essential social prominence, distinction, success or sexual attraction."
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There is only "moderate" evidence that the newly approved Provenge prostate cancer drug helps patients, according to an analysis for Medicare, released on Wednesday. "
The analysis is part of the controversial review by the Centers for Medicare and Medicaid Services, whether for Provenge, the cost of $93.000 per patient and extended life of about four months in clinical trials to zahlen.Medicare meet consultants on Wednesday to discuss by Dendreon the drug, a Seattle-based biotechnology company was developed.
Provenge is the first so-called therapeutic cancer vaccine - i.e., it works by training patient's immune system against the tumour - f.d.a permission to gewinnen.Die handled for each patient in his own blood. sales have been small, because Dendreon production capacity was limited.
While Medicare generally for drugs that the food and drug administration pays, has the debate about the payment for Provenge expressed concern some cancer patients, physicians and investors who say shot send the Government of an alert is that it does not automatically for high-priced medicines pay.
"Not only is CMS's action contrary to the intention of Congress beneficiary access to drugs and Biologicals used in an anti-cancer chemotherapy treatment, but it threatens to future innovation and cancer research for the coming years," Dr. Al B. Benson III, President of the Association of Community Cancer Center, said in a comment, CMS presented. "
But others say that cannot afford health care system, continued high prices to pay for all treatments, in particular cancer drugs to prolong the life of only a few months.
With expensive medicines a dual licensing system, especially with private insurers type already exists.First f.d.a must get a drug approval and then a manufacturer must often go through a lengthy process to convince to pay insurer for the drug.
Medicare should not consider price in the determine whether a drug to cover.
Some analysts have assumed that Medicare will pay for Provenge, for patients who's using those label - advanced prostate cancer, specified in the drug therapy is resistant to hormone deprivation, but if you experience no or minimal symptoms.
The Medicare review may be more off-label use of the drug expensive, as for example to limit already be scanned.the designed symptoms for patients review for Medicare said, there was insufficient evidence to assess whether Provenge would work if off-label uses.
The f.d.a declined, Provenge in 2007, approve setting from the protests of patients and investors in Dendreon.Nachdem Dendreon a further study confirms a survival benefit in the treatment is performed Provenge April of this year was approved.
But the analysis for Medicare said that there were issues such as the studies was, it was difficult, how effectively Provenge really judge designed wurde.Ein problem was, that used the placebo in the control group not really inert.
"Robyn Karnauskas said biotechnology analyst at Deutsche Bank in a note to clients Wednesday that the assessment of the moderate evidence to support the Provenge well for reimbursement boded."Historically, moderate means that CMS will reimburse the product for its on label indication, "she wrote.
Dendreon's shares rose in trading after the end of the market.
The evaluation was a technology test group with the Blue Cross and Blue Shield Association on behalf of the Government Agency for healthcare research and quality done.
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ULI since for the New York Times
Every philanthropist dreams a model program funding, the successful enough that others proves want to replicate it.
But Laurie M. table had no idea that you would pave the way for other cities if you offered to donate $250,000 to help nutrition program off the ground.
Mrs table, daughter of Preston Preston Robert Tisch, along with his brother Laurence, the Loews Corporation built had only just begun a new Foundation, the Fund to the room, if you have a call from the Mayor's Office asking to visit a press conference on the regulation of food carts in the city.
The NYC attracts almost two years and $1.5 million later, green carts program attention from other philanthropists and food Organisationen.Auch Federal Deposit Insurance Corporation it is considered a potential economic stimulus program in Philadelphia.
"" It is because of the success it has multi-level attractive ", said Jim Slama, President of FamilyFarmed.org who works to expand the production and distribution of locally grown foods in the Chicago area."Not only is access to the problem of food successfully, its success in stimulating economic development and job creation has been significant."
ULI since for the New York Times
"Green carts fitting set in a Chicago street food however difficult. no part of Chicago's is culture, as it is in New York or Los Angeles in large part because the city has strict rules to regulate the sale of foodstuffs on its streets."The bottom line is that it enough regulatory issues that are the city to be a key stakeholder, before everything could even begin to happen, said Mr. Slama."
For this reason his organization in permutations of street seeks shopping cart model as the installation of kiosks in corner stores that could be replenished every day.
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