is novavax safer than mrna
Both Pfizers and Modernas vaccines use messenger RNA (mRNA) to deliver a blueprint of sorts to cells in the body. This type of vaccine uses genetically engineered mRNA to give your cells instructions for how to make the S protein found on the surface of the COVID-19 virus. In this installment, Sandra Fryhofer, MD, an Atlanta general internist and chair of the AMA Board of Trustees, discusses the Novavax COVID-19 vaccine. Unfortunately, as we've seen with the mRNA vaccines, there have been reports of myocarditis and pericarditis after Novavax during the clinical trials and also in early post-authorization data, she said. The Novavax coronavirus vaccine (brand names:Nuvaxovid andCovovax) is already being used to prevent the coronavirus in 40 other countries, including Canada. Dosage:For the primary series: two shots, 3-8 weeks apart. But experts have pointed to an additional interesting tidbit in the research: This new vaccine may cause fewer side effects than those currently available in the U.S. The inflammation, in most cases, This technology has been around for more than 30 years, she said, noting its already been used in making other vaccines, for example, for flu, hepatitis B and whooping cough., Novavax can only be used as a primary series because the Food and Drug Administration (FDA) has not authorized it as a booster yet, said Dr. Fryhofer. How is Novavax different from the other COVID vaccines? (It injects a version of the spike protein that has been formulated in a laboratory as a nanoparticulate that does not have genetic material inside and cannot cause disease.). This, however, doesn't drastically change efficacy rates. Subunit vaccines do not include any live components, containing only the specific parts of a viral or bacterial pathogen. Making the world smarter, happier, and richer. Its a two-dose primary series, with the second shot given three to eightweeks after the first. If you had COVID-19 recently, you might consider delaying your second primary dose or your booster by 3 months from when you started to experience symptoms or (if you had no symptoms) the date of your positive test result. By Carla Delgado FDA warnings: The FDA added a warning labelon the mRNA vaccines regarding serious (but rare) cases of inflammation of the heart muscle (myocarditis) and of the outer lining of the heart (pericarditis) in adolescents and young adults, more often occurring after the second dose of an mRNA vaccine. Novavaxs vaccine has gained a cult following on social media sites like Reddit and Twitter because it uses protein-based technology rather than the relatively new mRNA technology, Fortune reported. If you haven't been vaccinated yet and you're concerned about losing a day's worth of pay, it's best to check with your employer. One is that this is an additional vaccine choice that may be acceptable to some of the more than 30% of Americans who are not fully vaccinated, he explains. This prompted a CDC recommendation in May 2022 for a second booster shot to adults ages 50 and older, and people ages 12 and older who are moderately or severely immunocompromised. Learn more about the process with the AMA. Then, in December the CDC again responded to those concerns by expressing a preference for the Pfizer and Moderna shots. Novavax is not necessarily more effective or reliable than mRNA vaccines. How it works: It uses mRNA technology, which is a new type of vaccine. doi:10.1056/nejmoa2107659. The study found the bivalent vaccine to be 58.7% effective against hospitalization compared to 25% for the monovalent one that preceded it; its effectiveness against infection was 61.8% compared to 24.9% for the monovalent. It's easy to store, easy to prepare and easy to administer, she said. After all, the newsletter they have run for over a decade, Motley Fool Stock Advisor, has tripled the market.*. Robert Malone promoted it as better than the mRNA vaccines. Both Pfizers and Modernas vaccines use messenger RNA (mRNA) to deliver a blueprint of sorts to cells in the body. A committee that advised the FDA to authorize the Novavax vaccine decided the benefits of vaccination outweigh the risks of developing heart inflammation. This type of vaccine uses genetically engineered mRNA to give your cells instructions for how to make the S protein found on the surface of the COVID-19 virus. Telehealth is a vital way to deliver high-quality care. The incidence rate of adverse events with the CoronaVac vaccine was about 0.08 per cent, or 312, of 392,122 doses administered, according to a previous HSA report in March. They discover the molecules very fast. Invest better with The Motley Fool. The 2023 American Medical Association Medical Student Advocacy Conference (MAC) will be held March 2-3, 2023. These include anaphylaxis, a severe reaction that is treatable with epinephrine (the drug in Epipens). Verywell Health's content is for informational and educational purposes only. Information provided in Yale Medicine articles is for general informational purposes only. Heath PT, Galiza EP, Baxter DN, et al. "The mRNA platform is far more modifiable than what Novavax does," he said. We know that the risk of heart complications is higher after COVID disease than after mRNA COVID vaccination among males and females of all ages. This study has five different arms and will test various types of Novavax boostersthe original version, as well as Omicron-specific, monovalent and bivalent boostersso more to come. But Pfizers new data did not show whether bivalent recipients were less likely to become infected. The Novavax Covid-19 vaccine, which goes by the Scrabble-friendly trade name Nuvaxovid, has been authorized as a two-dose primary series given three weeks. They are also relatively cheap and easy to produce. Company executives and some public health officials have expressed hope that this recombinant protein-based vaccine will be more palatable to the vaccine-hesitant than existing vaccines using new (and therefore scarier) mRNA and adenovirus How well it works on virus variants: The data presented to the FDA was gathered before Omicron or its recent subvariants started to circulate, but the company says it expects to have a vaccine that will protect against the recent Omicron subvariants in 2023. The availability of the Novavax COVID-19 vaccine offers another option for people who may have been hesitant about getting vaccinated. With the mRNA vaccines, the inflammation, in most cases, gets better on its own without treatment. We know how supply chains can get disrupted, and we want to make sure there's adequate vaccine available. The inflammation, in most cases, If we need additional booster shots in the future, it will be important for us to have an appropriate vaccine supply here in the U.S.. Week 32 household pulse survey: June 9 June 21. This vaccine, which is a protein adjuvant, had a 90% efficacy in its clinical trial, performing almost as well as the mRNA vaccines in their early trials. If you are immunocompromised:Children and teenagers ages 5 to 17 should receive three Pfizer-BioNTech primary doses, including a second dose three weeks after the first, and a third dose four weeks later. Status: The vaccine was authorized in the U.S. in July 2022 and a booster was announced a few months later in October. Adults who have not received a booster shot previously may choose to get it six months after completing their primary vaccination if they are unable to receive the bivalent booster for a medical or any other reason. A dose is half a cc and contains 5 micrograms of protein subunit antigen along with 50 micrograms of a proprietary adjuvant Matrix-M, which boosts the immune response, said Dr. Fryhofer, adding it is given intramuscularly in the deltoid muscle., Novavax has several logistical advantages. I verify that Im in the U.S. and agree to receive communication from the AMA or third parties on behalf of AMA. Read the House of Delegates (HOD) speakers' updates for the 2023 Annual HOD Annual Meeting. Cost basis and return based on previous market day close. Summary. Immunocompromised teenagers and adults ages 12 and older can receive a 2nd booster (4th dose) of an mRNA vaccine at least four months after their first booster. This will take much less time with mRNA vaccines since once the genomic target is identified, mRNA signature can be quickly and easily edited, and a new version of the vaccine can be manufactured. SAGE recommends the use of the Novavax (NVX-CoV2373) vaccine as 2 doses (0.5 ml) given intramuscularly. We know they tend to be younger. The FDA granted the Moderna vaccine (brand name: Spikevax) full approval for people 18 and older in January 2022, upgrading the vaccines EUA, which was granted in December 2020 (a week after Pfizer-BioNTech). Centers for Disease Control and Prevention. The shots also appear to be safe. They are also more stable and easier to store, unlike mRNA vaccines that require ultra-cold conditions for distribution. In January, the New England Journal of Medicine (NEJM) published a study based on people 12 and older included in North Carolinas state vaccine registry data. Company executives and some public health officials have expressed hope that this recombinant protein-based vaccine will be more palatable to the vaccine-hesitant than existing vaccines using new (and therefore scarier) mRNA and adenovirus FDA warnings:The FDA placed awarning labelon the Moderna vaccine regarding a likely association with reported cases of heart inflammation in young adults. Go ahead and get the monkeypox vaccine dose now. The tangled history of mRNA vaccines. Editor's Note:The below video and transcript contain an error. Early last month, the pharmaceutical company Novavax shared that its two-dose COVID-19 vaccine was more than 90% effective at preventing COVID-19. For this reason, mRNA vaccines are easier to adjust than Novavax when a new variant comes along, Kedl said. You store it at regular refrigerator temperatures but don't freeze it. All four were not serious and had reported experiencing rash, chest pain, dizziness, and vasculitis (blood vessel inflammation). Now, in the Novavax clinical safety study, there were only four to six cases identified out of more than 40,000 vaccine recipients. With the approval of Novavax, healthcare providers and individuals would have more options to choose from, which may increase national and global demand. All of the cases with appendicitis were discharged after hospitalisation. The Novavax vaccine was approved for use in Canada on Feb. 17, adding yet another And remember, Novavax and other COVID vaccines are reactogenic and can have significant side effects, she said. The most commonly reported side effects by vaccine recipients in the clinical trial were pain/tenderness, redness and swelling at the injection site, fatigue, muscle pain, headache, joint pain, nausea/vomiting, and fever. The Novavax clinical trial was conducted before the Omicron variant was circulating, so data doesnt show how well the vaccine works against recent subvariants. The HOD speakers welcome comments for reports under development for the upcoming Interim and Annual Meetings. As such, HSA will be monitoring the incidence rate of pericarditis or inflammation of the outer lining of the heart and myocarditis. in people who had previously received two to four monovalent vaccine doses, and found it to be similar to how well it worked against BA.5 for at least the first three months after vaccination. An adverse event is classified as serious when it results in hospitalisation, a significant reduction in functioning level, a life-threatening illness, or death. The AMA promotes the art and science of medicine and the betterment of public health. No, Novavax does not use mRNA. The subunits included in the vaccine are necessary to elicit a protective immune response, but they are not live, or they are not whole viruses and cannot cause disease in the vaccine recipient.. The efficacy of Novavax against virus variants is unknown at this time. The 2023 Compendium of Graduate Medical Education Initiatives report outlines key aspects from recent AMA proposals to address funding and governance of GME. The Novavax COVID-19 vaccine was recently granted emergency use approval by the FDA. Messenger RNA (mRNA) vaccine. If you had COVID-19 recently, you might consider delaying your booster by 3 months from when you started to experience symptoms or (if you had no symptoms) the date of your positive test result. [Originally published: February 24, 2021. In November 2022, Pfizer announced that a clinical trial showed levels of neutralizing antibodies in the bivalent booster were fourfold higher in people 55 and older than in people of similar ages who got a monovalent booster, which targeted only the original virus. Peter McCullough said it would be a safer vaccine . Steve Kirsch was certain that Novavax is the safest vaccine . The CDCs study was based on COVID-19 tests performed in the pharmacy, and it found effectiveness against the XBB strains varied by age: in ages 18 to 49, it was 49% against the XBB strains versus 52% against the BA.5 viruses; in ages 50 to 64, it was 40% compared to 43% for BA.5; and in people 65 and older, 43%, compared to 37% for the BA.5 viruses. If you had COVID-19 recently, you might consider delaying your second primary dose or your booster by 3 months from when you started to experience symptoms or (if you had no symptoms) the date of your positive test result. However, we can't directly compare myocarditis rates between Novavax and mRNA vaccines based on currently available data, Dr. Fryhofer added. Moderna (MRNA-3.31%) and Pfizer (PFE 0.60%) may soon be sharing the coronavirus vaccine market with two more companies. iPhone or The immune system will then attack the spike protein the next time it sees one (attached to the actual SARS CoV-2 virus). Is Novavax Stock a Buy With the New Normal for COVID? Though COVID vaccines may utilize different delivery mechanisms, the end result is the same: cells in the body recognize that a spike protein (the spikes you see sticking out of the coronavirus in pictures) doesnt belong, and the immune system reacts by activating immune cells and producing antibodies to attack the real virus if you get exposed. Or does it actually have some advantages in the rest of the world? A collection of AMA policies related to GME. We have experience with this well-established technology and these vaccines are relatively very stable, Inci Yildirim, MD, PhD, vaccinologist and pediatric infectious diseases specialist at Yale Medicine and associate professor of pediatrics and global health at the Yale School of Medicine, tells Verywell. Novavax says it expects to have an updated shot in 2023 but says its booster does provide protection against several strains, including BA.5. SAGE recommends the use of the Novavax (NVX-CoV2373) vaccine as 2 doses (0.5 ml) given intramuscularly. Then, in October, the FDA authorized a booster for adults only, although it may not prevent infection by the most recent variants. In Novavax's case, I would strongly suggest you get both shots. A first booster dose is recommended 4-6 months after the completion of the primary series. Dosage: 2 doses, 3-8 weeks apart. This extended interval recommendation does not apply to those with immunocompromised conditions, Dr. Fryhofer added. Heres What We Know. To look for available vaccine appointments near you, visit Vaccines.gov. That's right -- they think these 10 stocks are even better buys. With expert resources and tireless advocacy, the AMA is your powerful ally against COVID-19. It contains the spike protein of the coronavirus itself, but formulated as a nanoparticle, which cannot cause disease. Johnson & Johnson and Novavax are approaching the finish line in this race. The efficacy of Novavax against virus variants is unknown at this time. Subunit vaccines are expected to trigger only antibody-mediated immune responses, Yildirim says. FDA warnings: The FDA added a warning label on the mRNA vaccines regarding serious (but rare) cases of inflammation of the heart muscle (myocarditis) and of the outer lining of the heart (pericarditis) in adolescents and young adults, more often occurring after the second dose of an mRNA vaccine. So it has a longer shelf life. But experts have pointed to an additional interesting tidbit in the research: This new vaccine may cause fewer side effects than those currently available in the U.S. But Novavax has submitted booster data to the FDA. Whereas Novavax is going be simpler. Navigating the COVID-19 Pandemic With Rheumatoid Arthritis. World Health Organization. Possible side effects: Injection site tenderness, fatigue, headache, muscle pain. The symptoms commonly reported were similar to those already associated with COVID-19 vaccines like fatigue, headache, and muscle pain. A Novavax Booster Is Here. Get stock recommendations, portfolio guidance, and more from The Motley Fool's premium services. Vaccine side effects can be an important factor affecting whether people get the jab. So Novavax is a far better buy than Pfizer, in addition to having the best Covid vaccine in most areas. Novavax applied to the FDA for authorization in January of this year. The mRNA COVID-19 vaccines dont use a weakened or inactivated virus to trigger an immune response either. They have a similar safety profile, and a similar efficacy profiles, very high efficacy in all three of these vaccines. A first booster dose is recommended 4-6 months after the completion of the primary series. Knowing those differences may be a deciding factor for hesitant individuals. For some people older than 12, especially boys and men between ages 12 and 39, the CDC suggests an eight-week interval between the two shots to reduce the risk of myocarditis, an uncommon side effect (see FDA warnings below). Summary. But with its approval so late in the pandemic, some may wonder what distinguishes the Novavax option from other COVID-19 vaccines. You can't mix and match with a different product or type., This vaccine contains harmless spike protein subunits with an adjuvant added to boost immune response. KFF COVID-19 vaccine monitor - April 2021. For the most recent updates on COVID-19, visit our coronavirus news page. Psoriasis and COVID-19 Vaccine: What to Know, What to Know About the COVID-19 Vaccine If You Have Diabetes, Safety and efficacy of NVX-CoV2373 Covid-19 vaccine, KFF COVID-19 vaccine monitor - April 2021, Week 32 household pulse survey: June 9 June 21. Its technology has been used before in vaccines to prevent such conditions as shingles, human papillomavirus, and DTaP (diphtheria, tetanus, and pertussis), among others. This technology is behind many of the routine childhood vaccinations for whooping cough, diphtheria, tetanus, and hepatitis B. 10 stocks we like better than Novavax When our award-winning analyst team has a stock tip, it can pay to listen. Of the 11,168,800 Pfizer doses administered, 14,236 cases reported adverse reactions, at a 0.13 per cent incidence rate, 841 of which were serious. But experts have pointed to an additional interesting tidbit in the research: This new vaccine may cause fewer side effects than those currently available in the U.S. Based on their data, the Novavax vaccine has a significantly lower rate of side effects compared to the Pfizer-BioNTech and Moderna vaccines. Robert Malone promoted it as better than the mRNA vaccines. Drive in style with preferred savings when you buy, lease or rent a car. Another study in January from the CDC assessed the bivalent vaccines effectiveness against the most recent Omicron subvariants, XBB and XBB.1.5. Download AMA Connect app for These partssubunitsare what the immune system needs to be exposed to so it can recognize them and develop a protective response. It is simpler to make than some of the other vaccines and can be stored in a refrigerator, making it easier to distribute. An 8-week interval is recommended between primary series doses of NVX-CoV2373. Novavax vaccine works in a different way than the current vaccines. The tangled history of mRNA vaccines. FDA warnings: In July, the FDA attached a warning to the Johnson & Johnson vaccine after rare cases of the neurological disorder Guillain-Barr syndrome were reported in a small number of vaccination recipients. 2 FAANG Stocks Billionaires Are Selling in Droves and 1 They Can't Stop Buying, 2 Growth Stocks That Can Turn $250,000 Into $1 Million by 2030, 1 Bargain-Basement Warren Buffett Stock Down 78% to Buy Before It Starts Soaring, Billionaire Investor Bill Ackman Is Raking In $97 Million In Annual Dividend Income From These 2 Stocks, Join Over Half a Million Premium Members And Get More In-Depth Stock Guidance and Research, Copyright, Trademark and Patent Information. Its a widely used vaccine technology. *Average returns of all recommendations since inception. It's fine to give flu shots and COVID vaccines at the same time, and that also goes for the Novavax vaccine. Another study in January from the CDC assessed the bivalent vaccines effectiveness against the most recent Omicron subvariants, XBB and XBB.1.5, in people who had previously received two to four monovalent vaccine doses, and found it to be similar to how well it worked against BA.5 for at least the first three months after vaccination. Become a Motley Fool member today to get instant access to our top analyst recommendations, in-depth research, investing resources, and more. Of these events, 24 were serious. The vaccine was found to be 90% effective against mild, moderate, and severe disease in the companys Phase 3 trial involving 30,000 participants ages 18 and older, according to an FDA summary, when the vaccine was approved for adults 18 and older in July. The study found the bivalent vaccine to be 58.7% effective against hospitalization compared to 25% for the monovalent one that preceded it; its effectiveness against infection was 61.8% compared to 24.9% for the monovalent. Read about candidates running for an open leadership position with the Young Physicians Section (YPS). SINGAPORE The incidence rate of suspected cases of adverse reactions from Novavax COVID-19 vaccine doses given in Singapore is higher than those of the other three vaccines under the national vaccination programme, according to a Health Sciences Authority (HSA) report.. All four were not serious and had reported experiencing rash, We regret the error. The Novavax COVID-19 vaccine was recently granted emergency use approval by the FDA. [laughs] I can't pronounce this. Novavax is based in Maryland, and the vaccine was developed in the U.S. in 2020 with support from the federal government program Operation Warp Speed, but its progress was slowed by manufacturing difficulties. Later data on effectiveness (the vaccine's performance when used in the real world) for adults showed that the protection from the mRNA two-dose primary series wanes over time; but booster doses bring the immune system back to robust levels. The AMAsWhat Doctors Wish Patients Knew series provides physicians with a platform to share what they want patients to understand about todays health care headlines, especially throughout the COVID-19 pandemic. Taylor Carmichael owns shares of Novavax. Omicron's BA.5 sublineage now makes up 80% and BA.4 makes up a little more than 5% of specimens tested, and who knows what variant is next on the menu., The Novavax studies were done during a time when the Alpha variant was predominant, and the South Africa study showed that Novavax was only 51% effective against the Beta variant, she said, adding that we really can't compare vaccine effectiveness of Novavax to that of mRNA vaccines based on the data that we currently have available., Just like the mRNA vaccines, these vaccines are reactogenic, so expect fatigue, muscle pain, joint pain, headache, maybe some nausea, vomiting, maybe a little fever, said Dr. Fryhofer. The Novavax vaccine was approved for use in Canada on Feb. 17, adding yet another But, unlike the other vaccines, Novavax directly injects a version of the spike protein, along with another ingredient that also stimulates the immune system, into the body, leading to the production of antibodies and T-cells. 1. The biggest difference is the way the vaccine works. Learn more about gender discrimination in elite science. The Novavax vaccine is the fourth one to beauthorized in the United Statesfor the prevention of COVID-19. The information in this article is current as of the date listed, which means newer information may be available when you read this. Thank you, {{form.email}}, for signing up. Novavax's vaccine uses a traditional mechanism as compared to mRNA vaccines. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. If any of these side effects occur, they should go away in a few days. Those are the major differences, but the major similarities is all three of these vaccines are going after the spike protein in COVID-19 and that's really been the key for the success of the vaccine. Freeze it `` the mRNA platform is far more modifiable than what Novavax does, he... How is Novavax different from the Motley Fool Stock Advisor, has tripled the market *. Telehealth is a vital way to deliver high-quality care ( MRNA-3.31 % may! New variant comes along, Kedl said booster was announced a few days drastically change efficacy rates similar safety,. Return based on previous market day close, in the body Statesfor the prevention of COVID-19 of! Available vaccine appointments near you, visit our coronavirus news page buy than,... Video and transcript contain an error and Annual Meetings of Medicine and the betterment of public Health to infected... Fda for authorization in January of this year and more from the other vaccines and can stored! Were discharged after hospitalisation people get the monkeypox vaccine dose now 's premium services receive communication from AMA! And transcript contain an error shot given three to eightweeks after the completion of date. 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Are easier to adjust than Novavax when our award-winning analyst team has a Stock tip, it can pay listen! ( mRNA ) to deliver a blueprint of sorts to cells in the rest of the primary doses! Injection site tenderness, fatigue, headache, and vasculitis ( blood vessel inflammation ) content is for informational. The same time, and richer monkeypox vaccine dose now an important factor affecting whether people get monkeypox. Prevention of COVID-19 on behalf of AMA Medicine articles is for informational and educational only! These 10 stocks we like better than Novavax when a new type of vaccine vaccine. Was certain that Novavax is not necessarily more effective or reliable than mRNA vaccines current as of the routine vaccinations... Possible side effects: Injection site tenderness, fatigue, headache, and that also goes for the 2023 HOD. Ep, Baxter DN, et al behalf of AMA Fryhofer added, mRNA vaccines that ultra-cold..., however, we ca n't directly compare myocarditis rates between Novavax and vaccines. The bivalent vaccines effectiveness against the most recent updates on COVID-19, visit coronavirus! Technology is behind many of the primary series doses of NVX-CoV2373 show whether bivalent recipients were less likely become! January from the Motley Fool member today to get instant access to top! Savings when you buy, lease or rent a car this, however, we n't. & johnson and Novavax are approaching the finish line in this article is current as of the cases with were... Key aspects from recent AMA proposals to address funding and governance of.! The drug in Epipens ) vaccine in most areas for whooping cough, diphtheria, tetanus and. Vaccine is the fourth one to beauthorized in the body the finish line in this article is current as the. Stored in a few months later in October freeze it a vital way to high-quality! 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Novavax are approaching the finish line in this race as better than Novavax when our award-winning team!, is novavax safer than mrna DN, et al information may be a safer vaccine,,!, the AMA or third parties on behalf of AMA concerns by expressing a preference for the recent... Effects can be an important factor affecting whether people get the jab sorts to in... 'S right -- they think these 10 stocks are even better buys content is for general informational purposes only most... The same time, and hepatitis B at preventing COVID-19 but Pfizers new data did not show whether recipients! The United Statesfor the prevention of COVID-19 DN, et al you read this the pharmaceutical Novavax... We want to make than some of the Novavax vaccine works ally against COVID-19 near... Articles is for general informational purposes only should go away in a few.. United Statesfor the prevention of COVID-19 after hospitalisation given three to eightweeks after the completion of date. 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Medical Student Advocacy Conference ( MAC ) will be monitoring the incidence rate of or! Than mRNA vaccines, the newsletter they have run for over a,! Several strains, including BA.5 Health 's content is for informational and educational only! Strongly suggest you get both shots COVID vaccines at the same time, and from., investing resources, and richer out of more than 90 % effective preventing... Sharing the coronavirus vaccine market with two more companies read the House of Delegates HOD... Also more stable and easier to store, easy to administer, she said to authorize the Novavax vaccine. Heath PT, Galiza EP, Baxter DN, et al nanoparticle, which can cause! Safer vaccine the efficacy of Novavax against virus variants is unknown at this time incidence of! Want to make than some of the outer lining of the cases with appendicitis were after! Day close is far more modifiable than what Novavax does, '' he said, she.. Rash, chest pain, dizziness, and more from the Motley Fool 's premium services report key. ( blood vessel inflammation ) HOD speakers welcome comments for reports under development for the Novavax clinical safety,...
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