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As ineffective erythropoiesis continues, the bone marrow expands in an attempt to compensate, leading to characteristic skeletal changes such as frontal bossing, prominent cheekbones, and maxillary overgrowth causing dental malocclusion

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Perhaps surprisingly, there is no quantitative, universally accepted standard for measuring adaptation per se resulting from natural selection on phenotypic and genetic variation (Peck and Waxman, 2018