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FlatteringConnemara6104

Uploaded by FlatteringConnemara6104

The Hashemite University

2020

Saja Hamed, Ph.D

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skin cleansing history of soap personal hygiene

Summary

This presentation details the history of skin cleansing, from ancient methods to modern practices, including the use of soap and hand sanitizers. It covers the chemical processes involved in soap creation.

Full Transcript

Skin Cleansing Saja Hamed, Ph.D 11/20/2020 Saja Hamed, Ph.D 1 History  Salt (Chinese, Egyptians, Greeks)  Manufacture of Soap: - 2800 BC in ancient Babylon: boil fats with ashes and water - Greek: Strigil to scrape off the oil and dirt also used clay and sand 1...

Skin Cleansing Saja Hamed, Ph.D 11/20/2020 Saja Hamed, Ph.D 1 History  Salt (Chinese, Egyptians, Greeks)  Manufacture of Soap: - 2800 BC in ancient Babylon: boil fats with ashes and water - Greek: Strigil to scrape off the oil and dirt also used clay and sand 11/20/2020 Saja Hamed, Ph.D 2  Roman lived in a water-rich area  They built in aqueducts to bring clean water and bathing become very popular 11/20/2020 Saja Hamed, Ph.D 3 Ancient Roman Legend  Soap name originated from Mount Sapo (Rome) where burnt animal were sacrified  Rain washed a mixture of melted animal fat and wood ashes down into the clay soil along Tiber river  Women found that this clay mixture made their washes cleaner with much less effort 11/20/2020 Saja Hamed, Ph.D 4 After the fall of Rome  Bathing declined  Poor sanitary  Hygiene related diseases  Black death of the 14 century  the Plague  the deaths of an 75 to 200 million people  In Europe from 1347 to 1351  Personal cleanliness become popular again in the 17th century 11/20/2020 Saja Hamed, Ph.D 5 11/20/2020 Saja Hamed, Ph.D 6 Hand Sanitizers  Although the public belief is that hand sanitizers may replace hand washing, the CDC recommends that hand sanitizers should not be used in place of soap and water but only as adjunct  The first concerns about the importance of hand sanitizers as part of the infection control arose in mid-1800s 11/20/2020 Saja Hamed, Ph.D 7 Hand Sanitizers (alcohol based and non-alcohol based)  Savior of mother  Prof. Ignaz Semmelweis (Hungarian obstetrician  Childbed fever  Two departments  Ward 1 for doctors and 2 for Midwives  Ward 1was high in death incidence  Ordered hand washing in a chlorine solution before examining women 11/20/2020 Saja Hamed, Ph.D 8 Skin Cleansing 11/20/2020 Saja Hamed, Ph.D 9 Skin Cleansers  Skin cleansers are used to remove dirt, make up, environmental pollution, germs, and other type of soilage from the skin - Facial cleansers - Bath and shower products - Hand cleansing products: -Hand sanitizers 11/20/2020 Saja Hamed, Ph.D 10 What is the dirt that has to be removed? The skin becomes soiled with various solid particles which are stuck to it by the sebum: 1. Skin scales: which have become loosened but not fallen away 2. Dust 3. Soot: fine particles of carbon from smoke 4. Salt and urea: left on the skin after the evaporation of sweat 5. Bacteria 6. Residues of cosmetics and make-up that were applied onto the skin 7. Other substances carried in the air, which vary depending on the geographical location and the environment 11/20/2020 Saja Hamed, Ph.D 11 What is the dirt that has to be removed?  All of the mentioned substances stick to the thin, oily layer on the surface of the skin  Water is repelled by the oil  Washing with water is not sufficient to cleanse the skin  Soap or detergents are needed to remove the oily layer that contain the dirt 11/20/2020 Saja Hamed, Ph.D 12 Removal of grease from the skin: There are three ways of removing grease from the skin: 1. Emulsify it with a soap or surfactant (example of products contain surfactants: shower gels, shampoos and cleansing lotions) 2. Dissolve it with more oil: cleansing cream and body oils remove grease by dissolving it in oil 3. Absorb it with an absorbent material: Some cleansing masks is made from oil-absorbent powders such as kaolin 11/20/2020 Saja Hamed, Ph.D 13 1.Soap as a cleanser:  Soap is made by reacting animal and vegetable fats and oils with alkali  Hard soap = sodium salt of fatty acids that are derived from either animal or vegetable sources  Sodium stearate  Soft soap (liquid soap)= potassium salt of fatty acids  Soap name originates from Roman Legend  History 11/20/2020 Saja Hamed, Ph.D 14 1.Soap as a cleanser: Soft soap (liquid soap) Hard soap Synthesis of soap: How does soap work?  The soap particles ‘coat’ the fat droplets in which the dirt is embedded, and allowed them to be washed off the skin with water 11/20/2020 Saja Hamed, Ph.D 17 Disadvantages of regular soap: 1. In hard water they form a scum of an insoluble soap:  Tap water (hard water) contains calcium and magnesium  Soap + hard water Calcium and magnesium salts of fatty acids are formed  Calcium and magnesium salts of fatty acids = salts that are not soluble  (a) stick on the skin surface and (b) may lead to irritation 11/20/2020 Saja Hamed, Ph.D 18 Disadvantages of regular soap: Disadvantages of regular soap: 2. Because they are salts of a weak acid (the fatty acid) and a strong alkali they have a high pH (pH= 9-10) higher than skin pH (pH= 4-6.5)  may cause skin irritation 11/20/2020 Saja Hamed, Ph.D 20 2. Surfactants as cleansers:  Water is not effective as a cleanser for greasy surfaces  It is repelled by the greasy surface  The surfactant is a molecule composed of two parts: part of the molecule likes water and part likes oil.  With a surfactant the water will spread over the greasy surface and wet it 11/20/2020 Saja Hamed, Ph.D 21 2. Surfactants as cleansers: Surfactants are used widely in cosmetic and toiletries formulations for their detergency, foaming, conditioning, solubilization and emulsification properties  The selection of a surfactant for a cosmetics should take into account the functions to be fulfilled (detergency, emulsification, foam quality, mildness for skin, skin feel..etc) They contain polar (hydrophilic) and non- polar (hydrophobic) regions in the same molecule  The non-polar portion is usually a long chain (straight or branched) hydrocarbon  The hydrophilic and hydrophobic parts of the molecules must be of comparable “strength”  If the strength of either part overwhelms the other, the substance will have little or no surfactant property  e.g. ethanol is strongly hydrophilic that it is completely water soluble  e.g. stearic acid molecule is too hydrophobic which makes it insoluble in water 2. Surfactants as cleansers: Synthetic soaps (Soapless soap)  Made of surfactants (surface-active agents)  May be in solids or liquids form  There are four group of surfactants: - The nature of each group is determined by its chemical charge: Note: Sodium salts of fatty acids (Soap) = anionic surfactant group 11/20/2020 Saja Hamed, Ph.D 26 Detergent:  Agent to remove dirt  Many different detergent  (mild, strong, ionic, non- ionic)  depending on type of dirt and surface Three properties of the detergent are essential:  -it must wet the surface  -It must displace dirt from the surface  -It must sollubilize the dirt in solution The cleansing action of a detergent  Cleansing process: 1. Wetting: the detergent reduces the surface tension of water so it is able to spread over and wet the greasy surface 2. Emulsification: the detergent molecules embed their hydrophobic/lipophilic “tail” in the grease and gradually rise it off the surface 3. Rinsing: rinsing with clean water washes away the emulsified grease and loosened dirt to leave the surface clean  The emulsification of the grease is helped by: a. Warm water to melt the grease and help it form into droplets b. Certain amount of agitation to move away the droplets of emulsified grease and bring fresh detergent to the surface to emulsify the next layer of grease Surfactant classes  Anionic Sulfates, phosphates, carboxylates.  Cationic Quaternary ammonium salts  Zwitterionic or Amphoteric Amino Propionates, glycinates  Nonionic Ethoxylates ANIONIC SURFACTANTS  SODIUM LAURYL SULFATE (C12) CH3CH2CH2CH2CH2CH2CH2CH2CH2CH2CH2 CH2OSO3- NA+ A DETERGENT  SODIUM C12-15 PARETH-15-SULFONATE CH3(CH2)11-14-(OCH2CH2)15-SO3Na A DETERGENT CATIONIC SURFACTANTS HEXADECYL(CETYL) TRIMELTHYL AMMONIUM BROMIDE CH3  + CH3(CH2)15 - N - CH3 Br- _ | CH3 Cationic surfactant  Quaternary ammonium compounds  Not good cleansers or emulsifiers and they do not foam well  Valuable as: - Conditioners for hair and textile fibers - Have a bactericidal action (cetrimide is used in antiseptic/disinfectant products such as Savlon) AMPHOTERIC SURFACTANT  In acidic conditions it is a cationic  In alkaline conditions it is an anionic COCOAMPHOGLYCINATE O CH2CH2OH   RC - NH CH2CH2 - N + H  CH2COO - Betaines Betaines are used in baby shampoo and also used to build lather and viscosity in lauryl sulfate based shampoos. NONIONIC SURFACTANTS SORBITAN ESTERS: Tweens, Spans - There are no incompatibility problems with other ingredients Classification of Surfactants by functionalities (Table) Functions  The most commonly desired properties for surfactants in cosmetic formulations include: - Detergency - Foaming - Conditioning - Solubilization - emulsification Functions  Anionic surfactants is commonly chosen where detergency is the main consideration  Amphoteric, also detergent, tend to be milder than anionics and thus more suitable for primary detergents in “mild” cleansing formulation  Nonionics provide very poor foaming. They are most commonly used as solubilizers  Cationics tend to be irritating at very low levels. Because their positive charge makes them substantive to damaged skin and hair, they are generally used as conditioners Surfactants uses:  In kitchen detergents  In shampoos  In bath and shower cleansers  In facial cleansers 2. Surfactants as cleansers:  Dove soap is not actually soap but a synthetic surfactant bar (synthetic soap). 11/20/2020 Saja Hamed, Ph.D 41 Advantages of synthetic soaps (Surfactants):  Usually cause less skin irritation than regular soap (depend on formulation and way of use)  The pH of the synthetic soaps can be adjusted to that of normal skin by the addition of citric acid or lactic acid 11/20/2020 Saja Hamed, Ph.D 42 Lather and foam: How a foam forms 11/20/2020 Saja Hamed, Ph.D 43 Lather and foam:  Lather plays little or no part in the actual cleansing action of a surfactant  In the following applications lather is not preferable: (a) In floor washing: the lather from a high- lathering detergent cannot be washed away easily  special ‘low-lather products are available 11/20/2020 Saja Hamed, Ph.D 44 Lather and foam: (b) In an automatic washing machine: - The ‘wash’ stage of the program uses a high concentration of detergent in a small amount of water - If a high-lathering detergent is used all the water will be incorporated in the foam leaving none to do actual washing - A ‘low-lather’ detergent specially designed for automatic machine must be used 11/20/2020 Saja Hamed, Ph.D 45  Useful purpose: 1.As an indicator that detergent activity remains 2.A foam may hold the cleanser on the surface. e.g. soap and water on the face or shampoo on the head 3.A psychological indicator of cleansing power What does soap and cleansers contain other than the active ingredient?  Moisturizers  Preservatives  Coloring agents  Fragrances  Antibacterial substances  Substances that alter the pH (e.g. citric acid)  Other ingredients 11/20/2020 Saja Hamed, Ph.D 47 What does soap and cleansers contain other than the active ingredient?  Moisturizers: - Soaps and cleaners tend to remove the oily layer on the skin surface - It removes both the oil containing the dirt particles and some of the natural oily layer and lipids on the skin skin dryness and irritation - Moisturizing agents such as: glycerin, lanolin, and various vegetable fats are added to counteract the drying effect of soap Hints: The action of soap and rinsing with water remove moisturizers from the skin surface if you have a tendency to dry skin  Do not rely on the use of soaps containing moisturizers Use moisturizing creams or lotions after washing with soap 11/20/2020 Saja Hamed, Ph.D 48 What does soap contain other than the active ingredient?  Soaps for use on oily skin contain either minimal amounts or no moisturizing agents  Oily skin and someone with acne  no need for moisturizing soap unless for acne if you use irritating product  Dry skin  use soap with moisturizer 11/20/2020 Saja Hamed, Ph.D 49 What does soap contain other than the active ingredient?  Transparent soap: - Contain a higher concentration of glycerin - The high glycerin content gives the soap its transparent appearance - Considered mild soap 11/20/2020 Saja Hamed, Ph.D 50 What does soap contain other than the active ingredient?  Antibacterial substances: - ‘antibacterial soaps’ usually contain antibacterial substances such as triclosan - Some of these substances remain on the skin surface after washing and inhibit the growth of bacteria - Uses: 1. Prevent body odor 2. For acne (contain benzoyl peroxide as an antibacterial agent) 3. For infection of hair follicles 4. Following exposure to dirt or any source of contamination 11/20/2020 Saja Hamed, Ph.D 51 What does soap contain other than the active ingredient?  Other ingredients: - Such as vitamins and a variety of natural ingredients - These additives are of no documented medical value Hints: (a) Soap is in contact with the skin for a brief period only and (b) those additives would be quickly washed off the skin 11/20/2020 Saja Hamed, Ph.D 52 What does soap contain other than the active ingredient?  ‘Mild’/hypoallergenic soap: (a) For people with sensitive skin and for infants (b) Usually contain no fragrances and coloring agents (c) Usually contain certain type of surfactant from the betaine group (amphoteric surfactants) that are known to be relatively mild and do not tend to cause stinging of the skin or eyes 11/20/2020 Saja Hamed, Ph.D 53 Soaps versus Soapless (Surfactant) cleansers Differ in: (1) Their behavior in hard water: Soap + hard water  fail to lather and will have no cleansing action and soap scum form a sticky deposit on surfaces and is difficult to rinse away Soapless detergent (surfactant) + hard water form lather and will not form scum 11/20/2020 Saja Hamed, Ph.D 54 Soaps versus soapless cleansers (2) The pH of soapless cleansers can be adjusted to that of normal skin  cause less skin irritation lotions and liquid preparations for facial cleansing 11/20/2020 Saja Hamed, Ph.D 56 lotions and liquid preparations for facial cleansing: oil in water emulsion  They are composed of oils, water, and cleansing substances (surfactants)  Oil in water emulsion: the oil is in the form of droplets and the water form the continuous phase  Baby oil can be used as cleansers  disadvantage: difficult to remove from the skin 11/20/2020 Saja Hamed, Ph.D 57 lotions and liquid preparations for facial cleansing: oil in water emulsion  The oil mix and dissolve the grease on the skin so that it is removed when the cream is wiped away  Easily wiped off the skin because they are water-based  Can be used away from bathroom situation  The difference between a cream and a liquid emulsion is in their degree of viscosity 11/20/2020 Saja Hamed, Ph.D 58 lotions and liquid preparations for facial cleansing: oil in water emulsion  Fresh-up pads or tissues: are tissues impregnated with cleansing lotion and stored in air tight containers 11/20/2020 Saja Hamed, Ph.D 59 What possible advantages are there in creams and liquid preparations for facial cleansing?  Remove make up preparation more easily  Are more appropriate for people with dry skin because they contain oils 11/20/2020 Saja Hamed, Ph.D 60 Cleansing cream should not be used as moisturizing cream:  They should be removed from the skin as soon as possible since they contain surfactant that may cause skin irritation if left on the skin  Thus, it is preferable to wash cleansing creams and emulsion with water and not just wipe them off the skin with a tissue. lotions and liquid preparations for facial cleansing : Abrasive cleansers (Scrub)  Abrasive cleansers are creams or emulsions designed for cleaning the face by containing tiny granules  By massaging the cream over the face  help remove the outermost layer of the skin Note:  healthy normal skin does not require such treatment because the outermost layers of skin are normally peeling off and do not need any assistance doing so  There is a possibility of damage to the epidermis if these abrasive cleaning rubbed vigorously (rub gently)  This type of cleansing should not be carried out more than once a week lotions and liquid preparations for facial cleansing: Solutions of surfactant in water  No oil phase  Useful on greasy (oily) skin  Typical formulation: Ingredients Percentage Surfactant 5% Water 93% Perfume, color, preservative q.s. 11/20/2020 Saja Hamed, Ph.D 63 11/20/2020 Saja Hamed, Ph.D 64 11/20/2020 Saja Hamed, Ph.D 65 11/20/2020 Saja Hamed, Ph.D 66 11/20/2020 Saja Hamed, Ph.D 67 11/20/2020 Saja Hamed, Ph.D 68 11/20/2020 Saja Hamed, Ph.D 69 11/20/2020 Saja Hamed, Ph.D 70 11/20/2020 Saja Hamed, Ph.D 71 11/20/2020 Saja Hamed, Ph.D 72 Ingredients causing safety concerns: Parabens  The use of mixtures of parabens: lower individual levels and higher preservative efficacy  Summary of main findings: - CIR initially reviewed the safety of most commonly used parabens in 1984 and concluded that they were safe for use in cosmetics at levels up to 25% (typically used in lesser than 1%) 11/20/2020 Saja Hamed, Ph.D 73 Ingredients causing safety concerns: Parabens  In the early 21st Century the CIR re- examined the safety of parabens due to increasing concerns regarding safety. A study in 2004 linked parabens to breast cancer based on animal experiments (estrogen like properties of parabens). The study has sever limitation and rejected by most cancer research organizations 11/20/2020 Saja Hamed, Ph.D 74 Ingredients causing safety concerns: Parabens  Studies have shown that even the most potent paraben (butyl paraben) produces an estrogen like activity 10,000-100,000 times weaker than the that naturally produced estrogen  In 2006 CIR concluded that there is no need to change its original conclusion from 1984 11/20/2020 Saja Hamed, Ph.D 75 Ingredients causing safety concerns: Parabens  In 2011 the European Commission’s Scientific Committee on Consumer Safety (SCCS) also investigated the safety of parabens. It concluded that methylparaben and ethyl paraben were safe at current levels (0.4% if used alone or 0.8% if used in combination 11/20/2020 Saja Hamed, Ph.D 76 Ingredients causing safety concerns: Parabens  It recommended that the levels of propylparaben and butylparaben (the two most potent parabens) should be reduced so that the sum of their individual concentration does not exceed 0.19%  As for other parabens, it stated that human risk cannot be evaluated due to lack of data 11/20/2020 Saja Hamed, Ph.D 77 Ingredients causing safety concerns: Parabens  In Denmark, the government introduced a ban on 15-3-2011 against the use of propyl and butylparaben in cosmetic products aimed at children under 3 years old.  The Danish ban triggered a new SCCS assessment which led to a ban on parabens in leave on products for the nappy area in children under 6 months old 11/20/2020 Saja Hamed, Ph.D 78 Ingredients causing safety concerns: Parabens  Although no studies have confirmed the potential risk of using parabens on human health, the claims that they can cause breast cancer and endocrine disruption have been widely spread, forcing cosmetic manufacturers to remove this ingredients from their formulations. 11/20/2020 Saja Hamed, Ph.D 79 11/20/2020 Saja Hamed, Ph.D 80 Ingredients causing safety concerns: Triclosan  Antibacterial in personal care products (cleansing, deodorant, toothpaste)  Not clearly demonstrated that triclosan is clinically beneficial for patients.  Studies have found that triclosan does not have any added benefit over non- antibacterial hand soaps in reducing bacterial counts on hands 11/20/2020 Saja Hamed, Ph.D 81 Ingredients causing safety concerns: Triclosan  Differences were seen only if the hands were washed for a longer time with soap containing relatively higher concentrations of triclosan  A further concern is that it may contribute to development of antimicrobial resistance burden as well as high cost in healthcare  May have hormonal effects 11/20/2020 Saja Hamed, Ph.D 82 Ingredients causing safety concerns: Triclosan  Triclosan is currently under the radar of the FDA which is reevaluating its safety and efficacy in antibacterial cleansing product 11/20/2020 Saja Hamed, Ph.D 83 11/20/2020 Saja Hamed, Ph.D 84 11/20/2020 Saja Hamed, Ph.D 85 Ingredients causing safety concerns: SLS  also known as Sodium dodecyl sulfate, Sodium Lauryl Sulfate  Irritative ingredient may cause dermatitis  May irritate the eyes and mucous membranes  Used as a positive control in studies evaluating the irritation potential of chemicals  Heavily disposed on the skin and hair follicles which may lead to damage and hair loss 11/20/2020 Saja Hamed, Ph.D 86 Ingredients causing safety concerns: SLS  Concerns: Potential penetration through the skin Comedogenic potential Carcinogenicity???? SO The safety of SLS has been reviewed by EPA, CIR Expert Panel (1983,2005) and FDA 11/20/2020 Saja Hamed, Ph.D 87 Ingredients causing safety concerns: SLS  Major findings: - Studies on rat skin found heavy deposition of SLS on the skin surface and in hair follicles. It has been reported that 1-5% SLS produced significant number of comedones in rabbits 11/20/2020 Saja Hamed, Ph.D 88 Ingredients causing safety concerns: SLS - Animal studies did not show SLS to be carcinogenic, however, it has been shown that it causes sever epidermal changes to the area of the skin to which it was applied - SLS can cause skin irritation in some users. This effect is dependent on the level and duration of exposure 11/20/2020 Saja Hamed, Ph.D 89  SLS appears to be safe when used for short periods of time followed by thorough rinsing off the skin surface  In leave-on products, concentrations should not exceed 1% 11/20/2020 Saja Hamed, Ph.D 90 Sodium Laureth Sulfate (SLES) 11/20/2020 Saja Hamed, Ph.D 91 Ingredients causing safety concerns: Microbeads  Tiny particles used in scrubs  Can be natural or synthetics (plastics)  Plastics beads lead to environmental concerns  Travel through wastewater system go through preliminary treatment screens and enter oceans 11/20/2020 Saja Hamed, Ph.D 92 Ingredients: Aqua / Water, Cyclopentasiloxane, Isohexadecane, Argania Spinosa Oil / Argania Spinosa Kernel Oil, Benzyl Alcohol, Benzyl Salicylate, Butyl Methoxydibenzoylmethane, CI 60725 / Violet 2, Decyl Glucoside, Dipotassium Phosphate, Disodium EDTA, Ethylhexyl Methoxycinnamate, Geraniol, Haematococcus Pluvialis / Haematococcus Pluvialis Extract, Hexylene Glycol, Limonene, Linalool, Pentaerythrityl Tetra-Di-T-Butyl Hydroxyhydrocinnamate, Polyaminopropyl Biguanide, Potassium Phosphate, Sodium Chloride, Parfum / Fragrance 11/20/2020 Saja Hamed, Ph.D 93 https://ec.europa.eu/growth/tools- databases/cosing/index.cfm?fuseaction=s earch.results 11/20/2020 Saja Hamed, Ph.D 94 https://www.in- cosmetics.com/products/ingredients- database/ 11/20/2020 Saja Hamed, Ph.D 95 https://cosmeticsinfo.org/search/node /Cyclopentasiloxane 11/20/2020 Saja Hamed, Ph.D 96 https://ec.europa.eu/growth/tools- databases/cosing/index.cfm?fuseacti on=search.details_v2&id=34654 11/20/2020 Saja Hamed, Ph.D 97 https://www.in-cosmetics.com/products/ingredients- database/#url=%2Fproduct%2Fi-rita-ritacane-ih 11/20/2020 Saja Hamed, Ph.D 98 https://ec.europa.eu/growth/tools- databases/cosing/index.cfm?fuseaction=search.details_v2&id=28326 11/20/2020 Saja Hamed, Ph.D 99 11/20/2020 Saja Hamed, Ph.D 100 Ingredients Water, Glycerin, PEG-200 Hydrogenated Glyceryl Palmate, Butylene Glycol, Sodium Lauroyl Sarcosinate, Acrylates/Steareth-20 Methacrylate Copolymer, PEG-7 Glyceryl Cocoate, Sodium Laureth Sulfate, Phenoxyethanol, Masking Fragrance, Panthenol, PEG-60 Hydrogenated Castor Oil, Disodium EDTA, Methylparaben 11/20/2020 Saja Hamed, Ph.D 101  https://ec.europa.eu/growth/tools- databases/cosing/index.cfm?fuseaction=a pp.welcome  https://www.in- cosmetics.com/products/ingredients- database/  Cosmeticsinfo.org  https://www.cir-safety.org/ingredients 11/20/2020 Saja Hamed, Ph.D 102 11/20/2020 Saja Hamed, Ph.D 103 11/20/2020 Saja Hamed, Ph.D 104 11/20/2020 Saja Hamed, Ph.D 105 11/20/2020 Saja Hamed, Ph.D 106 11/20/2020 Saja Hamed, Ph.D 107 11/20/2020 Saja Hamed, Ph.D 108 11/20/2020 Saja Hamed, Ph.D 109 11/20/2020 Saja Hamed, Ph.D 110 11/20/2020 Saja Hamed, Ph.D 111 11/20/2020 Saja Hamed, Ph.D 112 11/20/2020 Saja Hamed, Ph.D 113

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