Houston, Texas
The University of Texas School of Dentistry
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The HOUSTON Fill
07/ ISSUE
09/ MONTH
14/ YEAR
! Recipient, Meskin Journalism Award for Excellence in Dental Student Publications. Presented by the American Association of Dental Editors, October 2013.
UT HOUSTON President | Graham Reed ‘16 President elect | Andrew Naeger ‘17 Immediate Past President | Katie Sowa ‘15 Class Delegate | Andrew Naeger ‘17 Treasurer | Hunter Owen ’15. Francisco Nieves ‘16
Historian | Hieu Pham ‘17 Outreach Coordinator | Kelsey Edmonson ’15, Shivani Patel ’16, & Clara Yoo ‘17 Legislative Liason | Kyle Hale ’16 & Glennis Katzmark ‘17 Events/Meetings Coordinator | Andrew Smith ’15, Marisa McKee ’16, & Mary Becker ‘17 Pre-Dental Coordinator | Iliana Saavered ’15, Paola Salazar ’16, Chris Thorburn ’16, & Alex Edgerly ‘17 Publications Editor | Laura Nelson ’16, Macey Cartrite ’16, & Michelle Boecker ‘17 Website Manager | Andre Nguyen ’15 & Matthew Franzen ‘17 Leadership Development Chair| Ryan Hyde ‘17 Social Chair| Steven Balandran ‘17
ASDA EXECUTIVE COMMITTEE President | Kristopher Mendoza, Los Angeles ‘15 Vice-presidents | Daryn Lu, Oklahoma ’15; Jason Watts, Nova Southeastern ‘15 District 9 Trustee | Christopher Thorburn ‘16 All views in this newsletter are those of the authors and not necessarily of the American Student Dental Association or The University of Texas School of Dentistry.
CONTENTS 03/asda week 2014
09/ picture recap
04/ ASDA in the media
10/ I Love ASDA because
05 - 06/ update on advocacy
11-12/ Anti-caries therapy gains
07 – 08 / lending a helping hand
13/ TMOM
Welcome/ Welcome!back!to!another!edition!of!the!Houston!Fill!!!The!new!semester!brings!new!and!exciting!ASDA! events,!news!and!membership!opportunities!that!I!am!happy!to!share!with!you.!! In!ASDA!chapter!news,!we!are!excited!to!announce!the!formation!of!six!new!committees!D!PreDDental,! Advocacy,!Community!Service,!Gold!Crown!Award,!Leadership!Development,!and!Golf!Tournament.!!Over!the! summer,!chapter!members!were!given!the!opportunity!to!apply!for!these!committees!and!we!are!happy!to! welcome!the!thirteen!new!committee!members!who!will!work!closely!with!the!executive!committee!to!better!our! ASDA!chapter.!!We!look!forward!to!working!together!and!continuing!to!strive!for!excellence.! ! Our!ASDA!chapter!wasted!no!time!getting!back!into!the!swing!of!things!after!the!summer!break.!!We! kicked!off!the!semester!by!hosting!an!Advocacy!mock!debate.!!Kyle!Hale!and!Glennis!Katzmark!took!the! opportunity!to!debate!and!discuss!two!important!topics!pertaining!to!all!dental!students,!student!debt!and! midlevel!providers.!!The!debate!was!a!huge!success!and!we!are!looking!forward!to!Advocacy!Academy!next! semester!in!preparation!for!State!Lobby!Day!in!Austin.! ! Last!week,!our!chapter!stepped!up!to!the!plate!when!Colorado!ASDA!challenged!our!entire!chapter!to!the! ALS!Ice!Bucket!Challenge.!!With!the!help!of!Dean!Valenza,!Dr.!Cooley,!and!our!ASDA!chapter!members,!we!all! participated!in!the!challenge!and!submitted!ourselves!to!enduring!an!iceDcold!bucket!of!water!being!poured!on!our! heads.!!The!chilly!experience!was!no!match!to!this!horrific!disease!and!we!were!happy!to!do!our!part!to!promote! ALS!awareness.!!A!monetary!donation!has!been!made!to!the!ALS!Foundation!and!we!continued!the!challenge!by! calling!out!the!San!Antonio!and!Baylor!ASDA!chapters.!You!can!check!out!our!chapter!ALS!Ice!Bucket!Challenge! video!on!ASDA’s!national!website,!ASDAnet.org,!where!we!are!featured!as!the!video!of!the!month.!! ASDA!Week!is!September!8th!through!12th!and!our!ASDA!chapter!will!host!an!event!each!day!of!this!week! to!celebrate!and!promote!our!local!ASDA!chapter!as!well!as!the!national!ASDA!organization.!!A!complete!list!of! events!and!details!can!be!found!inside!this!newsletter.!!I!invite!you!all!to!attend!each!and!every!event!and!I!look! forward!to!seeing!you!all!there!! This!week!is!also!very!important!for!our!newest!chapter!members.!!The!class!of!2018!will!be!electing!their!! ASDA!class!officers!to!serve!on!our!chapter!officer!team!for!the!next!four!years.!!Don’t!forget!to!cast!your!ballot!!! Voting!ends!Wednesday,!September!10th.!!Good!luck!to!all!running!for!ASDA!class!officers!! I!am!looking!forward!to!a!successful!semester!and!hope!that!you!all!enjoy!ASDA!week!as!well!as!the!many! upcoming!events!that!we!have!planned!this!year!! ! Graham!Reed,!‘16!
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Laura Nelson | ‘16
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ASDA WEEK: WHY SHOULD YOU BE INVOLVED If lecture and clinic are the heart of dental school then I believe the clubs and organizations are the soul. It is never too late to get involved and ASDA will help you to meet fellow classmates and socialize with professors and dentists in the community. ASDA events have provided me with some of my most memorable experiences in dental school! Here is what is scheduled for ASDA Week: • September 8th – ASDA Informational, Room 4310, 12 PM • September 9th – Houston Food Bank, 6pm • September 11th – Thirsty Thursday and Arm Wrestling Tournament, Cooley Center, 5 PM • September 12th – ADPAC Drive, Room 4310, 12 PM We encourage everyone to get involved and visit all of the events. Talk to an ASDA officer if you have any questions and enjoy the week!
During the month of March, I started my spring break attending the first Explore UTSD at the University of Texas School of Dentistry in Houston, Texas. It was such an intriguing way to start my spring break as a predental student. I first heard about the event through my predental club at the University of Houston and quickly reserved a spot.
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The day first started out with donuts and coffee where we were able to meet other predental students from across Texas and current dental students. It was fascinating to be around others who had the same dream as I did: to become a dentist. Dean John A. Valenza welcomed us and informed us of the vision of the school. I was very delighted to know how welcomed we were. We then heard from Dr. Pierpont about dentistry and the admissions process, and it was great to hear how the process plays out from his point of view.
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We went on guided tours around the campus, and I was excited to start applying to follow my dream. Throughout the day we heard from dental students about their obstacles in their undergrad days as well as their experiences getting into dental school. Out of all the exciting events planned that day, my personal favorite was being able to drill and wax for the first time. The only time I had ever held a drill was to clean it. It
MY PREDENTAL EXPERIENCE AT EXPLORE UTSD
was exciting to see how powerful the dental drill actually was. For two hours I was able to sit in the same chairs as dental students and try my hardest to drill and wax like the professionals. We were able to take home our preprepped horse tooth and #30 occlusal prep. I will forever keep them as a reminder of how captivated I felt that day to be a part of Explore UTSD. Words cannot explain how excited I felt as I attended Explore UTSD. As a predental student it means a lot to me that ASDA officers, members and dental students, and staff take time out of their busy schedules to reach out to students like me to make us that more excited about pursing our future. As a predental student, I sincerely encourage other predentals to take
advantage of opportunities like the one I had. It will give you a feel for what dental school is like, and you will fall more in love with your passion for dentistry. A great way to learn about upcoming events is to ‘Like’ dental schools and their ASDA chapters on Facebook. Here you can like the UTSD at Houston page and here is the UTSD ASDA page. Another way to get connected is to become an ASDA member and take advantage of networking opportunities, exclusive member benefits and publications written just for dental students and predental students. ! ! Reprinted!with!permission!from!ASDA’s!“Mouthing!Off”!Blog,!August!1st,!2014!Written!by:!Kaylee!Jordan,!PreIDental!Student! !
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Update on Advocacy
Glennis Katzmark ‘17
ADPAC: The Most Effective Way to Influence Dental Policy It is that very special time of year. The birds are singing, the leaves are changing, and in Texas the temperature is in a fairly reasonable 80-90 degree range. We all know what that means. Oh yes! The ADPAC drive is almost here! What’s that? You don’t know what ADPAC is? Well allow me to educate you! What is ADPAC? ADPAC is an acronym for the American Dental Political Action Committee. It is essentially the legislative arm of the ADA. In other words, this committee makes sure that dentists all across the beautiful U.S. of A have some friends in Washington D.C. looking out for the interests of dentists and ultimately the interest of the patients. For the sports fans out there, consider a pitcher that is walking batters left and right. The coach has to make a call, and get a guy in there who can perform. In this incredibly well thought out metaphor, ADPAC is the coach and the pitchers are legislators. Dentists want legislators that can perform on their behalf. How does this work? How does ADPAC make friends you may ask? Well, quite simply they elect congressional candidates who understand the dentistry is important to overall health. They may then supply funds to their campaign, or opportunities that will increase the likelihood of getting them into office. ADPAC obtains these funds from donations. These donations come from dentists, and (clearing of the throat sound) dental students. From the previous baseball metaphor this would make you, the donor, the owner of the team.
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Are you interested in dental advocacy? Visit ASDA’s Engage page to take action! www.cqrcengage.com/asda/home
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Why should you donate? Typically, when one graduates from a dental institution they may find themselves practicing dentistry. The legislative process is slow; meaning that decisions made on The Hill today may affect you in 20 years. In fact, one could argue that they are affecting you today (Oh, hello student debt!). Therefore, it is critical that you begin the good fight today. If you are anything like me, dentistry has seeped into every aspect of your life. Not a single day goes by that I don’t do something related to school. I work too hard to let the political environment change the profession that I sweat, stress, and bleed for (I cut myself with the Hollenback once). I am not waiting to be a part of dentistry; I am a part of dentistry. With a mere $5 you are considered a member of ADPAC. If you are feeling like you want!to make more of an impact $50 will get Capital Club membership. You will receive a lapel pin indicating your level of donation, which I would highly recommend wearing to dental conferences (Oh, Hello Star of the South). You might be surprised at who ends up shaking your hand. This method of advocacy is the most effective way to protect dentist interest. Why? Because getting a person in office who cares about our issues will increase the probability of bettering dental care not just today, not just tomorrow, but for the ENTIRETY OF THEIR TERM IN OFFICE!!! Talk about return on investment. If you are interested in learning more please attend the ADPAC Drive on September 12, 2014 or contribute directly at http://www.ada.org/en/advocacy/adpac.
LENDING A HELPING HAND
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Alejandro Barrera| Brittany Gillard ‘17
The Albert Schweitzer Fellowship (ASF) was created to allow graduate-level students to carry on the legacy of Dr. Albert Schweitzer by addressing the unmet health needs of vulnerable and marginal populations. ASF is a community-based service program aimed at improving community health and developing leaders in service who are educated, experienced, and committed to addressing unmet health needs. Students that are chosen as fellows are given the opportunity to create a self-driven service project over the course of a year. To date, nearly 2,500 Schweitzer Fellows have delivered nearly 500,000 hours of service to those in need. The Albert Schweitzer Fellowship has allowed us to combine our passions of dentistry and public health by focusing on a population that is underserved and stigmatized in the world of dental care. For our project, we have chosen to focus on the xerostomia faced by the HIV/AIDS community of Houston at the Bering Omega Community Services Dental Clinic. Xerostomia, or dry mouth, is a condition often associated with HIV/AIDS as a result of the many medications taken to battle the disease, radiation therapy, or the disease itself.
Patients who have xerostomia experience dental decay at a much higher rate than those with normal salivary flow. Xerostomia also causes discomfort and reduces a person’s quality of life by compromising their speech, chewing, tasting, and by causing bad breath. Because of these complications, xerostomia has shown to also have social and psychological side effects. The goal of our project is to improve the lives of our clients by reducing the discomfort of xerostomia and by empowering them to take charge of their oral health. Our project plan includes personalized sessions with each client, providing them with free products, and conducting focus group sessions and health fairs. Each client is seen twice for a thirty minute session with us at the clinic. During the first session, we discuss the causes and symptoms of xerostomia and assess the participants’ initial symptoms through a series of survey questions. During this initial evaluation, we also get a glimpse of how much the patient knows about their oral health and learn about past dental experiences that Continued on page 8
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these patients have had. At the end of the session, we give them free dry mouth treatment products and explain how they will help combat their symptoms. To date, we have received generous donations of dry mouth products from companies including Colgate, Biotene, Spry, MighTeaFlow, and OraCoat. At the second session, we re-evaluate the symptoms after using the products and get an idea of the types of products that each client prefers. Beyond our direct service with the patients of Bering Omega, we meet monthly with the 11 other 2014-2015 Houston-Galveston fellows and attend networking events with current and previous fellows from around the country. In the fall, we have been invited to attend the Albert Schweitzer Leadership Conference in Boston. The fellowship allows us to network and collaborate with other people who share the similar motivation of helping others and make a difference in the world. From the start of our project, the Bering Omega dental staff has been tremendously helpful in recruiting their patients for our sessions. The work of Bering Community Service was established in 1986 to address the staggering challenges posed by a completely new and frightening epidemic. Soon after, several agencies were created to provide
08/ compassionate care to people living with HIV/AIDS virus and to their loved ones. Today, the core programs consist of an oral health program, housing assistance program, day treatment program and Omega House, our residential hospice. The goal of this foundation is to bridge the gaps in care for low income individuals by providing care to as many HIV/AIDS affected people as possible. Guided by our mentors, Dr. Catherine Flaitz and Dr. Mark Nichols, we have been introduced to the discipline of oral medicine. This approach to dentistry is concerned with the oral health care of medically complex patients, including the diagnosis and management of medical conditions that affect the oral and maxillofacial region. Our mentors have also taught us to be compassionate health care providers by showing us that different populations will require different approaches to maintain their oral health. Our project so far has been a wonderful experience for both the patients and ourselves. Several of our participants have even asked to return after their second session. We are thrilled with the involvement and are pleased to see that there is an improvement of symptoms that these patients are experiencing.
For more information on the Albert Schweitzer Fellowship- Houston Galveston Chapter contact jennifer.cook@bcm.edu or visit http://www.schweitzerfellowship.org/.
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Welcome Class of 2018
floss
09/ Ignite DDS Event
ASDA Annual 1 st Year Welcome
UTSD at the Texas Board of Dental Examiners
I Love ASDA Because…
I like networking and having a good time at the events - Anonymous
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10/ ! It has taught me the importance of organized dentistry and has allowed me to begin networking and exposed me to different aspects of dentistry -Mary Becker ‘17
It has helped prepare me to be a dentist! ASDA has made me think outside the box and understand more about the profession -Anonymous
It has taught me what organized dentistry is and the importance to our profession. It encourages its members to get actively involved in leadership, development, networking and advocating the rights and ethics of our career. -Adrien Lewis ‘16
I love my career, love the people in my career, and love working with people in my career -Nicole Fishbeck ‘16 !
ANTI-CARIES THERAPY GAINS Synopsis: There is a long history with the use of silver compounds in dentistry. Silver compounds such as silver diammine fluoride and silver nitrate have powerful antibacterial effects and have been effective at caries arrest and caries prevention. These properties, combined with low cost, offers an opportunity for research which could have a lasting impact. As early as the 1840s, silver compounds were widely used in both medicine and dentistry for their antimicrobial properties. Important historical figures of dentistry like G.V. Black, P. Howe and others routinely used silver compounds in their practices. The use of silver compounds in dentistry began to fall out of favor in the 1930s with the discovery of penicillin and the development of antibiotics. (4) Since then, the use of silver has been revisited for its antimicrobial properties because of its low human toxicity and antibiotic effect against a wide range of microorganisms. In the 1960s, the development of Silver Diammine Fluoride (SDF) combined both fluoride and silver ions as an anticaries agent which has gained international acceptance. Japan has accepted SDF as a therapeutic agent since the 1970s. In Brazil, the use of SDF has been encouraged for children with moderate to high tooth decay activity. (4) Recent studies have shed some light on to the effectiveness of silver and fluoride as a viable treatment and prophylaxis for caries. In 2012, a task group of the World Dental Federation (Federation Dentaire Internationale or FDI) analyzed multiple research studies involving SDF. The FDI task! group!concluded!that!as!little!as!“twiceD yearly!application!of!38%!SDF!may be able to arrest the carious process” and suggested that SDF can be used for both caries prevention and operative intervention.(5) In a recent study entitled, Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school!children,
11/ the finding was that just one annual application of SDF was more effective at arresting carious lesions than quarterly applications of sodium fluoride.(4) In another study, the conclusion was that one treatment of 38% SDF was effective at arresting lesions for up to two years. (3)
“Little black scar” as a result of silver nitrate application to cavitated lesion (14)
Appearance of tooth after addition of tooth colored filling Pending FDA approval, SDF is not readily available in the United States. However, many researchers and practitioners in the US are using a combination of silver nitrate and fluoride varnish to produce a similar effect. The use of silver nitrate by doctors as an antimicrobial is nothing new. Beginning in the 1880s, babies were treated with eye drops of a 12% solution of silver nitrate upon delivery!to prevent blindness from gonorrhea exposure in the birth canal. Until recently, this was the standard
treatment in most hospitals. Most hospitals today use antibiotic eye drops like erythromycin as a substitute because they are less irritating.(8) The logic in cariology is that fluoride has a strong remineralizing effect as well as weak antimicrobial effects. Silver nitrate is a good source of silver ions which have a strong antimicrobial effect. The combination of silver nitrate with the fluoride varnish helps keep the silver ions in place at the site of active caries. It is important to keep silver nitrate isolated to the site of active caries because it is a caustic solution. In high concentrations or repeated use, it can be used for removal of warts and granulated tissue. Additionally, silver fluoride can cause staining. In one study published in December 2013, researchers intentionally caused the black surfaces caused by silver fluoride to appear on carious lesions to determine whether it could be used in place of the dental explorer. Because of the potential of dental explorers to cause iatrogenic damage on noncavitated lesions, the researchers wanted to find an “alternative, non-invasive, visual assessment” of lesion status. The study concluded that the black surface “can provide a useful visual indicator of lesion progression”.(10) A major proponent for silver nitrate and fluoride varnish combination therapy is Dr. Steve Duffin. In a Youtube video, Duffin explains that he began working in an underserved community with many of his patients at high caries risk. Being unable to control rampant caries with conventional methods, Duffin began to treat his patients with applications of silver nitrate and fluoride varnish and reports a near 100% success rate in arresting and preventing any new carious lesions.(10) Dr. Moffett Burgess supports Duffin’s claims. Burgess asserts that the silver nitrate and fluoride varnish not only stops the caries process but also stimulates underlying secondary dentin formation. Burgess explains that restorations were easier because, as the tooth recovered from the carious assault, more solid tooth structure due to reparative dentin was available to place the restoration.(9) Although silver nitrate is used by many practitioners and is available from dental suppliers, relying on expert opinion is not enough. More research is needed before a high quality systematic review is
available and for this combination therapy to become the standard of care. Current (but limited) research supports that silver compounds have low human toxicity and low bacterial resistance with long lasting therapeutic action. Additionally, silver nitrate and fluoride varnish are inexpensive and have a low barrier to entry thus making it an ideal treatment for rural settings and empowering dental auxiliaries. As the body of research continues to grow and this anticaries therapy gains widespread acceptance, we can expect this treatment to have a lasting impact on the populations we serve. For more information, please visit http://www.mmclibrary.com
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References: 1.
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Chu CH, Lo ECM, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res. 2002;81(11):767–70. [PubMed] (http://www.ncbi.nlm.nih.gov/pubmed/12407092 ) Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res. 2005 Aug;84(8):721-4. PMID: 16040729 [PubMed - indexed for MEDLINE] (http://www.ncbi.nlm.nih.gov/pubmed/16040729) Yee R, Holmgren C, Mulder J, Lama D, Walker D, van Palenstein Helderman W. Efficacy of silver diamine fluoride for Arresting Caries Treatment. J Dent Res. 2009 Jul;88(7):644-7. doi: 10.1177/0022034509338671. PMID: 19641152 [PubMed indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/19641152 Peng, J. J., M. G. Botelho, and J. P. Matinlinna. "Silver Compounds Used in Dentistry for Caries Management: A Review." National Center for Biotechnology Information. U.S. National Library of Medicine, 3 Apr. 2012. Web. 01 July 2014. <http://www.ncbi.nlm.nih.gov/pubmed/22484380>. Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group. Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Int Dent J. 2012 Oct;62(5):223-43. doi: 10.1111/idj.12007. Review. PMID: 23106836 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/23106836 The Editors of Encyclopædia Britannica. "Silver Nitrate (chemical Compound)." Encyclopedia Britannica Online. Encyclopedia Britannica, n.d. Web. 08 June 2014. <http://www.britannica.com/EBchecked/topic/544876/silver-nitrate>. "Tollens' Reagent." Wikipedia. Wikimedia Foundation, 21 May 2014. Web. 08 June 2014. <http://en.wikipedia.org/wiki/Tollens%27_reagent>. Dekker, Rebecca, PhD, RN, APRN. "Is Erythromycin Eye Ointment Always Necessary for Newborns? - Evidence Based Birth." Evidence Based Birth. N.p., 11 Nov. 2012. Web. 08 June 2014. <http://evidencebasedbirth.com/is-erythromycin-eye-ointmentalways-necessary-for-newborns/>. "NNOHA 2013 - Silver Nitrate Presentation – Dr. Steve Duffin and Dr. Moffett Burgess." YouTube. YouTube, n.d. Web. 24 June 2014. <https://www.youtube.com/watch?v=6B-gInGvMRA>. Bawden, J. W. "Fluoride Varnish: A Useful New Tool for Public Health Dentistry." National Center for Biotechnology Information. U.S. National Library of Medicine, Fall 1998. Web. 27 June 2014. <http://www.ncbi.nlm.nih.gov/pubmed/10390707>. "Off-label Use." Wikipedia. Wikimedia Foundation, 26 June 2014. Web. 27 June 2014. <http://en.wikipedia.org/wiki/Off-label_use>. Craig, G. G., K. R. Powell, and C. A. Price. "Clinical Evaluation of a Modified Silver Fluoride Application Technique Designed to Facilitate Lesion Assessment in Outreach Programs." National Center for Biotechnology Information. U.S. National Library of Medicine, 28 Dec. 2013. Web. 28 June 2014. <http://www.ncbi.nlm.nih.gov/pubmed/24373700>. Rehm, Diane, and Louis Sullivan. "The Diane Rehm Show." Why Millions Of Americans Don't Get The Dental Care They Need. NPR, 16 June 2014. Web. 17 Aug. 2014.
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A group of students from UTSD attended The Texas Mission of Mercy (TMOM) clinic this past summer in Georgetown. TMOM is a mobile dental clinic that travels around the state providing free dental care to uninsured Texans and its focus is relieving those in pain. TMOM wouldn’t exist if it weren’t for volunteers and dentists that donate their time to give back to the community. We were volunteers there to assist other dentists while performing treatments such as fillings and extractions. Also, third and fourth year students that are already seeing patients in the UTSD clinic were able perform procedures on patients to maximize the amount of people that were seen that day. Most patients had been waiting for over ten hours to be seen, which meant that they lined up in the middle of the night and slept outside. As a third year student, it was very rewarding to me that I was able to take my knowledge and clinical skills that I had learned in school and use them to help those in need. We had an overseeing dentist and an oral surgeon at all times that were there to help us at any step along the way. Not to mention we learned a lot from each dentist over the two days, everything from clinical advice all the way to owning your own practice. These dentists were great educators and they were willing to give us tips and tricks from the 20 plus years of experience they had in dentistry. The weekend was a great success and any dental student would benefit from volunteering at a TMOM event.
TMOM: Students providing free dental care
Marisa Zitterich | ‘16
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