transfemoral prosthesis components

Compare and contrast the design, fit, and function of the four most popular… Alignment of the prosthesis. Amputees often lose the sense of normalcy they once had. A study conducted by the National Institute for the Orthopedically Handicapped suggests that the energy expenditure an amputee expends is far greater when walking with fitting crutches versus walking with a prosthetic. According to the International Committee of the Red Cross, the following nine components make . A imponente casa de espetáculos erguida no coração da Amazônia passaria, então, a exercer sua prestigiosa vocação, recebendo companhias líricas que seguiam uma rota internacional no calendário operístico, com temporadas em cidades como Milão, Lisboa e Nova York. The force applied by state-of-the-art components could be up to 1322 N or 161%BW. force generates prosthetic hand motion.) TT prosthetic components. Print. Entre elas, a formação de plateia – foram cerca de 144 mil espectadores em mais de duzentas récitas, concertos e recitais – e a constituição de uma potente cadeia produtiva da ópera no Pará, com a profissionalização de centenas de músicos, técnicos e cantores líricos. This book provides an up-to-date scientific account of all aspects related to pressure ulcers and pressure ulcer research, as well as evidence-based knowledge of pressure ulcer aetiology. Transfemoral amputees can have a very difficult time regaining normal movement. It has several components which fit together to construct the final piece. They also can feel forces and torques at the socket-weightofprosthesis,contactforces,inertialforces.Lastly-theycanhearit,bothmovingandmakingcontact.Butthis is a very different experience from using a real arm because Benefits at a glance: Aluminum lightweight design with high degree of stability; Weight limit now up to 300 lbs / 136 kg Hip Flexion Case Study. For example a man who works in a rice field should not The components for a transfemoral prosthesis include the socket, prosthetic knee, pylon, and ankle. Acreditamos estar trilhando o caminho certo. A more flexible foam is used in the knee section so that flexion and extension of the knee are not restricted. 1. Topics covered in the book include: classification and treatment of congenital femoral deficiency, including Syme's amputation, rotationplasty, and limb lengthening; classification and treatment of fibular deficiency, tibial deficiency, ... Many studies have demonstrated successful prosthetic fit rates of 60% to 90% for transtibial (TT) amputees; however, this is reduced to only 50% to 70% for transfemoral (TF) amputees. Quality of the amputation surgery. To have at least 6 cm clearance between abutment and prosthetic knee to fit the transducer 4. Se arte e cultura são heranças das divindades, não há como afirmar peremptoriamente. A iniciativa tem convênio com o Amazonas e vai abranger todo o Pará. Socket 2. Alignment of the prosthesis. Há três aspectos importantes para ressaltar no Festival de Ópera deste ano. For the transfemoral (above-knee, including hip and knee disarticulation) amputee . A realização é do Governo do Pará, por meio da Secretaria de Estado de Cultura (Secult). Em paralelo ao evento, serão realizadas variadas programações, com uma abrangência inédita e social que muito tem a ver com a época de pandemia, em que oportunidades e solidariedade são a tônica em qualquer atividade, principalmente a cultural. Interactive design instruments are seen as the extension of traditional CAD tools. This book provides an accurate overview of the recent research or industrial application in interactive design. EVA cosmetic manufacture 41 The socket is the interface between the residual limb and the prosthesis. For many patients, wearing prosthetics allows them to feel independent and provide greater mobility. Newly available after being out of print for several years, this is the definitive reference on the surgical and prosthetic management of acquired or congenital limb loss. Biomechanics of Transfemoral Amputee Gait. D) Foot and ankle. Now, some knee units have advanced motion control modulated through microprocessors. Figure 3 shows the mind-map (Eppler, 2006) that represents the architecture of transfemoral prosthesis with all its components and possible variants. The loading profile was characterized by spatio-temporal gaits variables, magnitude of loading boundaries as well as onset and magnitude of loading extrema during walking, ascending and descending ramp and stairs. The prosthesis is made from a high-quality raw material known as polypropylene. Gait Posture 16, 255-263. doi: 10.1016/S0966-6362(02)00008-5 Transfemoral amputation. Measurements and socket manufacture 5 2.1 Trans-femoral cup alignment and socket manufacture 6 2.2 Total-contact prosthesis 11 3. Measurements and soft socket manufacture 6 3. It's Many factors can determine the specific kinematics & kinetics of transfemoral amputee gait patterns, including: Stump length & range. Describe the function of different classes of components in relation to normal function. Found inside – Page 210In addition to the components included in the transtibial prosthesis prescription, the transfemoral prescription will include the prosthetic knee. Other unique considerations for the prosthetic prescription at the transfemoral level ... Below, we add some examples of common prosthetic components and correlation between the prosthetic design and the gait. lower limb prosthetics chapter 20 lower limb prosthetics susan kapp, med, cpo, lpo*; and joseph a. miller, ms, cp, cpt† introduction role of the prosthetist overview of components syme prosthesis transtibial prosthesis knee disarticulation transfemoral prosthesis hip disarticulation and transpelvic amputation Either modular or exoskeletal structures may be fitted with transfemoral amputation. Energy expenditure and biomechanical characteristics of lower limb amputee gait: the influence of prosthetic alignment and different prosthetic components. You’ll also find a discussion, unique to this text, of the pathology of what necessitates amputations and why you would choose one prosthetic/orthotic over another. Prosthetic knees have evolved greatly over time, from the simple pendulum of the 1600s to those regulated by rubber bands and springs or pneumatic or hydraulic components. Because the use of a prosthesis is essential to maintain quality of life of an individual with transfemoral amputation (TFA), providers of prosthetic care design, select and fit sockets, knees and feet components the most susceptible to maximize functional outcomes (Samuelsson et al., 2012).Unfortunately, the soft tissues of the residuum have limited capacity to withstand the . The transfemoral, or AKA, is a less desirable level of amputation and is reserved for circumstances in which a below- or through-knee amputation would not suffice to resolve the underlying pathology, allow for enough tibial length for prosthetic fitting, or provide adequate tissue for closure of the residual limb. Such control is completely up to the patient in passive prostheses or partly facilitated by the prosthesis in semiactive prostheses. The purpose of this study was to compare the effect of a shock-absorbing pylon (SAP) to a stance flexion knee unit on the gait of ten transfemoral amputees. Physical therapy is more prolonged (usually at least twice as long as for the transtibial amputee), and a be tt er understanding of prosthetic components is required on the part of the physical therapist. As . . Destacamos que este Festival de 2021 traz uma novidade: o projeto Sons de Liberdade, uma parceria da Secretaria de Estado de Cultura (Secult) com a Secretaria de Estado de Administração Penitenciária (Seap), para fazer com que os custodiados possam, a partir do canto e da música da ópera, se ressocializar, mostrando o seu talento e garantindo que o ambiente carcerário do Estado seja efetivamente de reintegração. Wheelchair-bound amputees often feel a sense of helplessness when they ask others for assistance. Biomechanics of Transfemoral Amputee Gait. Além da ênfase na formação de novos profissionais em artes cênicas e musicais, o projeto desta vigésima edição é a base de um recomeço na cadeia produtiva em nosso Estado, que vai abranger setores ainda não atingidos pela população socialmente mais vulnerável. Designed for medical practitioners, engineers, students, and researchers who use or develop prosthetic technology for civilian or military amputees, Full Stride: Advancing the State of the Art in Lower Extremity Gait Systems will be of ... Polypropylene cosmetic manufacture 26 5.1 Cosmetic with upper part of socket removed 26 5.2 Cosmetic with complete PP socket 34 6. R apid advances in technology have brought improvements in prosthetic components. 1 2. Todavia, sem perder de vista o viés do canto lírico – ponto forte e inerente aos eventos carreados pelos estados do Pará e do Amazonas. Functional adapters help make everyday activities easier for patients by expanding the abilities of their prosthesis, while our . This study will be conducted through a combination of human subjects testing and computer simulation. 1. TRANSFEMORAL PROSTHETIC COMPONENTS: VARIATIONS, INDICATIONS, CONTRAINDICATIONS Systems Overview. Access to prosthetics helps people blend in better with the rest of the population and return to their normal lives. The book delves into many of the basic concepts that are required knowledge for the clinician and the scientist to have as the foundation for their work. Copyright © 2021 Elsevier B.V. or its licensors or contributors. Raw materials and components 4 2. Significant innovations have been made about the fitting of prosthetic sockets, socket materials, and prosthetic components that . As transfemoral amputees cannot control prosthetic components directly, they may be compelled to generate lower internal rotation moments in the PST than in the INT in order to ease the control demands of the PST. Nestas duas décadas, o Festival se consolidou como uma política estruturante que inclui várias frentes de fomento à cultura. We offer an extensive range of adapters that offer proven functionality and remain practical and easy to use. a Transfemoral Amputee Douglas Murphy, MD; John Fox, CPO; and Allison Hickman, DO Advances in the functionality and materials of prosthetics and successful component integration enabled an Iraq War veteran to return to long-distance running and bicycling. Quality of the amputation surgery. Day-to-day activities are made less challenging, and amputees experience less frustration when they have access to artificial limbs. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Load applied on osseointegrated implant by transfemoral bone-anchored prostheses fitted with state-of-the-art prosthetic components. Vamos através da economia criativa proporcionar a pessoas em situação de privação de liberdade, capacitação para que depois possam compor o rol de técnicos habilitados em trabalhar e ser absorvidos nas posteriores produções do festival, dando-lhes oportunidade de inclusão social e geração de renda. Unlike other books that deal exclusively with one or another of these topics, this volume unites the three to return the experiential to what is often treated in the literature—and too often in the clinic—as a solely medical condition. This book has been written specifically for candidates sitting the oral part of the FRCS (Tr & Orth) examination. It presents a selection of questions arising from common clinical scenarios along with detailed model answers. Skins can be designed to accommodate any footwear. This text will guide physicians, trainees, and other members of the care team through the fundamentals of restoring function to individuals who have lost limbs or body parts. This study provided new benchmark loading data applied by transfemoral bone-anchored prostheses fitted with selected ÖSSUR state-of-the-art components. To address this issue, shock-absorbing components (SAC) have been designed to decrease the overall stiffness of the prosthetic limb. • The Socket: This is the part of the prosthesis that attaches it to the body and largely determines whether the fit is good or not. 2 feet distance : ~10 cm knee axis is horizontal tube is vertical foot (with required heel height) is flat on the floor prosthesis tf static alignment: anterior view patient shoulders are horizontal iliac crests are horizontal legs are in extension weight is equal on both feet 3. Compare and contrast the major types of feet, knee joints, socket designs, and methods of suspension for transfemoral and transtibial prosthetic replacements. Isso se reflete na demonstração da cultura, da pujança e do talento de tantos paraenses que fazem a ópera no nosso Estado e que encontram neste festival um momento de encontro, de congraçamento, o ápice para mostrar a beleza e a qualidade da ópera e da cultura no nosso Estado. components and materials, aggregating studies from Europe and the United States . In general, if redness persists > 10 minutes after prosthesis removal, and the patient has donned the prosthesis correctly, the patient may benefit from a referral to the CPO for component and fit assessment . The prosthesis prescription. O “Da Paz”, como é carinhosamente tratado pela população, é um teatro/templo de arte e cultura do Pará e concentra tanto grandes espetáculos, como dá espaço aos talentos locais, valorizando suas raízes e sua expressão cultural. Published by Elsevier Ltd. https://doi.org/10.1016/j.clinbiomech.2021.105457. Building up the prosthesis and bench alignment 15 4. For the transfemoral amputee to achieve the best possible E é também um novo espaço para que, num futuro próximo, o Theatro da Paz venha a ser um teatro-escola, dando oportunidade para que novas gerações se transformem em profissionais e revele talentos. As noted by Wilson, The above-knee prosthesis consists of a minimum of four major parts: the socket, the knee system, the shank (or shin), and the foot-ankle system. Loading data were directly measured with the tri-axial transducer of an iPecsLab (RTC Electronics, USA) fitted between the implant and knee unit. Com duração de cinco meses, a formação será via plataforma digital, com 5 módulos de aulas para cada grupo. Over many years, prosthetics in Memphis, TN, have helped many people obtain access to high quality prostheses through the use of advanced technology. Trata-se do programa “Sons de Liberdade” que vai entrar no escopo do festival de ópera como uma ação social permanente do evento. The 2nd Edition reviews the latest technological advances in prosthetic fabrication and provides information on relevant websites. The field of prosthetics has undergone major growth in the past several decades. Use of Bilateral Power Knee® and Proprio Foot® in a Bilateral Transfemoral Amputee Recent years have seen the development of powered microprocessor-controlled knee (MPK) and microprocessor-controlled foot (MPF) components. It has several components which fit together to construct the final piece. Prosthetics and Gait Training • Normal pelvic movements in gait: • Vertical displacement = rhythmic upward and down ward motion of the body's center of gravity • Transtibial amputee can flex and extend knee - motion will not be significantly impacted • Transfemoral amputee - depends on type of knee, but knee may remain in extension, limiting vertical displacement • Lateral . Focusing on the lower extremities and spine, this extensively illustrated text presents a problem-solving approach to the evaluation and prescription of prosthetics and orthotics in physical therapy interventions. Learn appropriate selection, alignment and adjustment methods for Össur knee systems. O primeiro é o importante passo que estamos dando na criação de um corredor cultural no Norte do país. This paper combined both insights, that is, a technical examination of the components used, with an evaluation of how these improved the gait of respective users. Several studies have presented technological ensembles of active knee systems for transfemoral prosthesis. The WillowWood One System was initiated through a grant from the Veterans Administration that covered 26 months of development and testing and included over 40 clinical test . Outra ação pioneira desta celebração dos 20 anos é a capacitação de custodiados do Sistema Penal inseridos no projeto ‘Sons de Liberdade’, que produzirão parte dos cenários e dos figurinos da Ópera Il Tabarro – uma das montagens da edição deste ano. This book focuses on the results from the strategic alliance between Neuroscience and Robotics that help the scientific community to better understand the brain as well as design robotic devices and algorithms for interfacing humans and ... Foot/Terminal device 8. Found inside – Page 652Transfemoral. Prostheses. RICHARD PsoNAK FIGURE 24-1 The similarities and differences in prosthetic fit and ... and advantages and limitations of the most commonly used transfemoral components and suspension strategies. 2. Transfemoral Prostheses. Our prosthetics office in Memphis, TN, has skilled prosthetists that specialize in the use of advanced technology solutions tailored to the needs of our patients. Found inside – Page 635Describe the functional characteristics, advantages, and limitations of the components of transfemoral prostheses. 2. Compare the design, fit, and function of transfemoral socket designs. 3. Indicate how the alignment of the ... Prosthetics provide impaired patients with the ability to move around easier when fitted properly. Bone-anchored prostheses using state-of-the-art components restore gait noticeably. Because the use of a prosthesis is essential to maintain quality of life of an individual with transfemoral amputation (TFA), providers of prosthetic care design, select and fit sockets, knees and feet components the most susceptible to maximize functional outcomes (Samuelsson et al., 2012). Osseointegration prosthetics are usually only considered after an amputee has already been using a socket-based system and has problems with it. This book provides an essential guide to the use of the EuroQol Group’s value sets for working with EQ-5D data. unilateral transfemoral bone-anchored prosthesis fitted with basic components. and anticipated outcomes when creating transfemoral prosthetic devices. Transtibial and Transfemoral Silicone Typically available as a one piece (for below knee) or two piece solution (for above knee), our silicone skins are made for use with a breadth of prosthetic components. Socket Casting, Positive Mould, and Rectification [edit | edit source]. Por aqui, nosso objetivo continua sendo valorizar, qualificar, incentivar e agregar, para que quando os primeiros acordes anunciarem a nova temporada de Ópera do Theatro da Paz, sejamos elevados novamente aos céus, com a certeza de que dele nunca saímos…, Mensagem do diretor do XX Festival de Ópera do Theatro da Paz, Daniel Araújo. A trans-femoral prosthesis is an artificial limb that replaces any amputated limb above the knee. A literature review was performed utilizing the The types of Prosthesis, Application (Donning & Doffing) of prosthesis are included in this chapter. The complexity of artificial limbs has increased over the past years as the concept of suction componentry has evolved. Presents the major advances in the field since the last edition in 1992. Fluid knee benefits and indications: Knees with hydraulic or pneumatic swing resistance are indicated for active walkers, permitting increased walking comfort, speed . Fabricate a complete prosthesis utilising a transfemoral Seal-In liner (HSM, X5, or Seal-in X), Icelock 544 or 552 expulsion valve, RHEO KNEE, Össur premium mechanical knee range, and Pro-Flex Foot range. Building up the prosthesis and bench alignment 17 5. É sublimar em ações concretas e perenes a pujante vida cultural da cidade e deste equipamento púbico tão simbólico para as artes no Estado. Transfemoral Preparatory Prosthesis (AKA) is a rigid co-poly plastic socket that is made from a model of your limb. Total Knee Stance Flexion -Amount prosthetic knee flexes at initial contact (11-13) Flexion Resistance -Can control prosthetic knee stability and heel rise (15&16) Extension Resistance -Controls knee from heel rise through terminal swing (17) Extension Assist -Promotes knee extension from . Introduction. Component of prosthesis of Lower Limbs 7. The level of amputation determines which components of the lower extremity prosthesis will need to be prescribed. Como segundo ponto importante, temos o projeto social que confere ineditismo e inclusão social ao Festival de Ópera ao lançar uma atividade na programação que é mais que cultural, é social. Written by physiatrists, prosthetics, and therapists at the University of Michigan, this clinically oriented text is designed for busy practitioners managing patients with limb loss who are candidates for, or are undergoing, prosthetic ... The WillowWood One System provides a consistently secure, comfortable and straightforward solution for transfemoral amputees with no hoses, sleeves, or extra bulk required. Easy Shape AK Foam Covers have a firm durometer in the calf and thigh sections for easy shaping. EVA cosmetic manufacture 38 Reference list of materials 41 24 Transfemoral Prostheses Richard Psonak Learning Objectives On completion of this chapter, the reader will be able to do the following: 1. Building up the prosthesis and bench alignment 17 5. the transfemoral amputee than for the transtibial amputee. Describe the indications for, functional characteristics of, and advantages and limitations of the most commonly used transfemoral components and suspension strategies. 1. Transfemoral amputation - can be fitted with either modular or exoskeletal designs. Covering both upper and lower extremity prosthetics, this book provides the information clinicians need to manage a range of prosthetic patients, and their disorders. Condition of the intact limb. Transfemoral (above-knee) Amputations. While these are increasingly studied in unilateral lower extremity amputees, there is a dearth of Trans-tibial cup alignment and socket manufacture 11 4. Whether you are a student or a clinician, if you work with patients with neuromuscular and musculoskeletal impairments, you will find this text supplies a strong foundation in and appreciation for the field of orthotics and prosthetics that ... Selection of Components for Bone-Anchored Transfemoral Prosthesis Currently, the selection of knee and ankle units is based on clinical experience and depends mainly on manufacturer's instructions, strength of the bone anchorage, lifestyle, and cost. Components of of transtibial and Transfemoral Prosthesis-Foot-ankle assembly-Shank/pylon- these connect the socket to the rest of the prosthesis -Knee* (if transfemoral) (transtib will have residual anatomic knee)-Socket- interface bn residual limb 2. Polypropylene cosmetic manufacture 26 5.1 Cosmetic with upper part of socket removed 26 5.2 Cosmetic with complete PP socket 34 6. O terceiro aspecto e o mais significativo, é a comemoração dos vinte anos de realização do Festival de Ópera do Theatro da Paz. Raw materials and components 4 2. This is a device that is worn with compression and prosthetic socks which will allow a patient to begin gait training soon after surgery. In general, a transfemoral amputee must use approximately 80% more energy to walk than a person with two whole legs. We use cookies to help provide and enhance our service and tailor content and ads. Many factors can determine the specific kinematics & kinetics of transfemoral amputee gait patterns, including: Stump length & range. EVA cosmetic manufacture 41 The review does not evaluate overall comparative effectiveness among LLP components, nor does it include assessment of biomechanical outcomes. We searched six databases and other sources through October 2017 for eligible studies. This resource addresses all aspects of combat amputee care ranging from surgical techniques to long-term care, polytrauma and comorbidities such as traumatic brain injury and burns, pain management, psychological issues, physical and ... Diagrammatic representation of the prosthesis are added too. The impaired ability to perform certain day-to-day tasks can be inhibiting. Viva a paz, viva a ópera, viva a música, o canto, viva a cultura paraense. In general, prosthetic knee and prosthetic foot/ankle components that are capable of generating internal power have not been tested or approved for use in conjunction with OI implants. Extensively revised from a successful first edition, this book features a wealth of clear illustrations, numerous worked examples, and many problem sets. This concise guide offers an ideal overview of both the practical and theoretical aspects of foot and ankle surgery for trainees and junior consultants. These applications are famously known in the area of brain–machine interfaces. This book presents recent advances in this flourishing field of neural signal processing with demonstrative applications. The identification of gait-cycle phases plays an important role in the control of these prostheses. At the last stage, electronic control unit is designed and produced for prosthesis used by above knee amputees'. It is developed for both upper and lower limbs, and the technology and procedure to implant the system is the same, no matter which limb is amputated. This study presented the load profile applied on transfemoral osseointegrated implants by bone-anchored prostheses fitted with state-of-the-art ÖSSUR microprocessor-controlled Rheo Knee XC and energy-storing-and-returning Pro-Flex XC or LP feet during five standardized daily activities. This book introduces the concept, design and application of green biocomposites, with a specific focus on the current demand for green biocomposites for automotive and aerospace components. A trans-femoral prosthesis is an artificial limb that replaces any amputated limb above the knee. Celebrar os 20 anos do Festival de Ópera do Theatro da Paz é dignificar esta memória e esta história. Demonstration of donning and doffing a transfemoral prosthesis The Prosthetic System When discussing the transfemoral prosthesis, it is important to consider four major aspects of the system: the socket, the suspension, the components and the alignment. Written by experienced physiatrists, prosthetists, and therapists, this book provides an introduction to the field of amputee care and prosthetics. For the transfemoral (above-knee, including hip and knee disarticulation) amputee . Second, they can see the prosthesis - full position and velocity. Mensagem da secretária de Estado de Cultura, Ursula Vidal. Box size: 0.4 x 0.3 x 0.44m, 0.05m³ per box. Start studying Transfemoral Prosthetic Components. Post-Op Preparatory Prosthesis. Adapters and Structural Components Fit and functionality The adjustable connecting element was first patented by Ottobock in 1969 and is now used worldwide. The prosthesis prescription. Creating Your Custom Above-Knee Prosthesis. An examination of the techniques in gait observation and diagnosis, and therapy for correction of gait in children, adults and the elderly. It considers special cases of musculoskeletal, neuromuscular and cardiopulmonary abnormalites. The data in this paper are related to the research articles entitled "Kinetics of transfemoral amputees with osseointegrated fixation performing common activities of daily living" (Lee et al., Clinical Biomechanics, 2007.22(6). Transfemoral amputation. A total of 2127 steps was analysed. Learn vocabulary, terms, and more with flashcards, games, and other study tools. O que sabemos é que, em meio ao grande caos, podemos viver sem bens materiais, mas não sem a arte. a low-cost, passive prosthetic knee that can enable transfemoral amputees to walk with the gait of able-bodied humans. The moment applied by state-of-the-art components could be up to 88 Nm or 11%BWm. Knee Joint 4. A qualidade das montagens, a participação de profissionais renomados no cenário operístico nacional e internacional e o alto nível técnico de nossa Orquestra Sinfônica alçaram o Festival de Ópera do Theatro da Paz a um lugar de reconhecimento e respeito no Brasil e no mundo. O festival vem sendo realizado todos os anos, incluindo outubro, mês em que se realiza o Círio de Nazaré – a maior festa religiosa do Norte/Nordeste e uma das mais importantes do país. To be fully rehabilitated 3. Amputation. procedure, various components of postoperative care, and rehabilitation activities that will occur Patients should be given appropriate advice and information on rehabilitation programs, prosthetic options, and possible outcomes with realistic rehabilitation goals (Esquenzai & Meier, 1996; Pandian & Kowalske, 1995). O III Curso de Formação em Ópera vai ofertar 90 bolsas de estudos, sendo 45 destinadas aos cantores líricos e 45 para técnicos que atuam na produção dos espetáculos. Parabéns a todos! The transfemoral, or AKA, is a less desirable level of amputation and is reserved for circumstances in which a below- or through-knee amputation would not suffice to resolve the underlying pathology, allow for enough tibial length for prosthetic fitting, or provide adequate tissue for closure of the residual limb. Other studies have examined the amputees' gait performance while wearing a specific active prosthesis. Components of prosthetic lower limbs for transfemoral and transtibial amputations: General prescription recommenadtions and literature review. online learning for p and o school in poltekkes kemenkes surakarta

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