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3.
Age Ageing ; 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33006601

RESUMO

BACKGROUND AND OBJECTIVES: despite growing support for the clinical application of frailty, including regular frailty screening for older adults, little is known about how older adults perceive frailty screening. The purpose of this study was to examine older adults' perspectives on frailty screening to inform knowledge translation and service improvements for older adults with frailty. RESEARCH DESIGN: interpretive descriptive qualitative design. PARTICIPANTS: a total of 39 non-frail (18%), pre-frail (33%) and frail or very frail (49%) South Australian older adults aged 62-99 years, sampled from community, assisted living and residential aged care settings. METHODS: seven focus groups were conducted and analysed by two independent investigators using inductive thematic analysis. RESULTS: three themes were identified. First, older adults question the necessity and logic of an objective frailty measure. Second, older adults believe any efforts at frailty screening need to culminate in an action. Third, older adults emphasise that frailty screening needs to be conducted sensitively given negative perceptions of the term frailty and the potential adverse effects of frailty labelling. DISCUSSION AND IMPLICATIONS: previous screening experiences and underlying beliefs about the nature of frailty as inevitable shaped openness to, and acceptance of, frailty screening. Findings correspond with previous research illuminating the lack of public awareness of frailty and the nascent stage of frailty screening implementation. Incorporating consumer perspectives, along with perspectives of other stakeholder groups when considering implementing frailty screening, is likely to impact uptake and optimise suitability-important considerations in person-centred care provision.

4.
Can J Diabetes ; 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-33046403

RESUMO

In this study, we identify existing interactive knowledge translation tools that could help patients and health-care professionals to prevent diabetes complications in the Canadian context. We conducted an environmental scan in collaboration with researchers and 4 patient partners across Canada. We conducted searches among the research team members, their networks and Twitter, and through searches in databases and Google. To be included, interactive knowledge translation tools had to meet the following criteria: used to prevent diabetes complications; used in a real-life setting; used any instructional method or material; had relevance in the Canadian context, written in English or French; developed and/or published by experts in diabetes complications or by a recognized organization; created in 2013 or after; and accessibility online or on paper. Two reviewers independently screened each record for selection and extracted the following data: authorship, objective(s), patients' characteristics, type of diabetes complications targeted, type of knowledge users targeted and tool characteristics. We used simple descriptive statistics to summarize our results. Thirty-one of the 1,700 potentially eligible interactive knowledge translation tools were included in the scan. Tool formats included personal notebook, interactive case study, risk assessment tool, clinical pathway, decision support tool, knowledge quiz and checklist. Diabetes complications targeted by the tools included foot-related neuropathy, cardiovascular diseases, mental disorders and distress and any complications related to diabetes and kidney disease. Our results inform Canadian stakeholders interested in the prevention of diabetes complications to avoid unnecessary duplication, identify gaps in knowledge and support implementation of these tools in clinical and patients' decision-making.

5.
Appl Physiol Nutr Metab ; 45(10 (Suppl. 2)): S103-S124, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33054331

RESUMO

Establishing a step-by-step process that provides practitioners with a blueprint for translating movement guidelines into action stands to optimize the investment in guideline development, improve guideline promotion and uptake, and ultimately enhance population health. The purpose of this paper is to describe how the Knowledge-to-Action framework and integrated knowledge translation were operationalized to systematically inform our knowledge translation (KT) efforts for the Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older. In October 2018, the need for a KT Process, operating in tandem with the Guideline Development Process, led to the establishment of a KT team with a specific structure and terms of reference. The KT team collaboratively agreed on decision-making principles prior to selecting target audiences to focus their efforts. We undertook formative research to assess the local context and determinants of guideline dissemination and implementation efforts among target audiences. Plans for the subsequent steps and research are outlined. We highlight recommendations and lessons learned for applying the process in other settings. Novelty We outline a collaborative and systematic process and research program for the knowledge translation of movement guidelines. This paper provides an innovative and replicable blueprint to optimize future movement guideline knowledge translation efforts.

6.
J Adv Nurs ; 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33058281

RESUMO

AIM: To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice. DESIGN: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines. METHODS: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials. DISCUSSION: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme. IMPACT: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.

7.
BMC Palliat Care ; 19(1): 159, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33059655

RESUMO

BACKGROUND: Volunteer navigation is an innovative way to help older persons get connected to resources in their community that they may not know about or have difficulty accessing. Nav-CARE is an intervention in which volunteers, who are trained in navigation, provide services for older persons living at home with chronic illness to improve their quality of life. The goal of this study was to evaluate the impact of Nav-CARE on volunteers, older persons, and family participating across eight Canadian sites. METHODS: Nav-CARE was implemented using a knowledge translation approach in eight sites using a 12- or 18-month intervention period. A mixed method evaluation was used to understand the outcomes upon older person engagement; volunteer self-efficacy; and older person, family, and volunteer quality of life and satisfaction with the intervention. RESULTS: Older persons and family were highly satisfied with the intervention, citing benefits of social connection and support, help with negotiating the social aspects of healthcare, access to cost-effective resources, and family respite. They were less satisfied with the practical help available for transportation and errands. Older persons self-reported knowledge of the services available to them and confidence in making decisions about their healthcare showed statistically significant improvements (P < .05) over 12-18 months. Volunteers reported satisfaction with their role, particularly as it related to building relationships over time, and good self-efficacy. Volunteer attrition was a result of not recruiting older persons in a timely manner. There was no statistically significant improvement in quality of life for older persons, family or volunteers from baseline to study completion. CONCLUSIONS: Findings from this study support a developing body of evidence showing the contributions volunteers make to enhanced older person and family well-being in the context of chronic illness. Statistically significant improvements were documented in aspects of client engagement. However, there were no statistically significant improvements in quality of life scores even though qualitative data illustrated very specific positive outcomes of the intervention. Similar findings in other volunteer-led intervention studies raise the question of whether there is a need for targeted volunteer-sensitive outcome measures.

8.
Int J Public Health ; 2020 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-33068122

RESUMO

OBJECTIVES: We describe the knowledge translation strategies in two projects and share lessons learned about knowledge sharing and uptake. METHODS: To generate findings for dissemination: (1) the Republic of Côte d'Ivoire (RCI) project relied on a multiple case study design to document barriers and facilitators to implementing a community-led prevention strategy targeting Ebola virus disease; and (2) the Tunisia project used several designs to assess a mental health training's effectiveness, and a case study design to explore contextual factors that may influence anticipated outcomes. RESULTS: To share findings with participants, the RCI project relied on workshops and a pamphlet, and the Tunisia project relied on a structured half-day dissemination workshop and research summary. Facilitators that may have encouraged sharing and using findings include involving champions in dissemination activities, ongoing collaboration, and developing/implementing context-specific knowledge sharing strategies. Barriers include omitting to assess strategies, limited consideration of a wider audience, and the exclusion of a knowledge translation training component. CONCLUSIONS: Our experiences might be useful to contexts involved in global and public health research that wish to address the "know-do gap."

9.
PLoS One ; 15(9): e0238512, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870931

RESUMO

BACKGROUND: Dissemination of accurate health research information to patients and families has become increasingly important with the rise of the internet as a means of finding health information. However, the public faces several barriers to accessing research information, including paywalls and technical jargon. One method to bridge this gap between patients, families, and research is using lay summaries. SCAsource is an online knowledge translation platform where peer-reviewed research papers on ataxia are translated into lay summaries. This online platform was launched in September 2018, with the goal of making ataxia research more accessible and understandable to patients and families. A secondary goal is to provide opportunities for ataxia researchers to develop and hone their knowledge translation skills, altogether improving the quality of patient communication in the ataxia community. AIM: The aim of this study was to measure the impact of SCAsource on its readers and volunteer contributors after one year of activity. This is to ensure SCAsource is meeting its goals of (1) improving access and understanding of ataxia research to lay audiences, and (2) improving knowledge translation skills of volunteer contributors. METHODS: Two online surveys were launched, one for readers and one for volunteers. Each survey had a combination of multiple-choice, Likert-scale type, and open-ended short-answer questions. Descriptive quantitative analysis was used for respondent characteristics and Likert-type data. A grounded theory coding approach was used to analyze narrative feedback data. RESULTS: We found that SCAsource has mutually beneficial outcomes for both lay person readers and volunteer contributors. Readers have an increased understanding of ataxia research and access to up-to-date information on recent publications. Volunteers develop knowledge translation skills and have increased confidence in communicating results to lay audiences. Areas of improvement were identified to be incorporated into the platform. CONCLUSION: We demonstrated that SCAsource improves access to information and understanding of research to lay audiences, while providing opportunities for researchers to develop knowledge translation skills. This framework can potentially be used by other rare disease organizations to launch and evaluate their own knowledge translation websites.

10.
Can J Public Health ; 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32902831

RESUMO

OBJECTIVES: Despite extensive evidence demonstrating the benefits of prenatal physical activity (PA), inefficient knowledge translation may contribute to low rates of PA during pregnancy. This study aimed to examine the impact of the 2019 Canadian Guideline for Physical Activity throughout Pregnancy (hereafter Guideline) on knowledge transmission via Twitter. METHODS: Tweets containing keywords regarding prenatal PA were mined using the Twitter Application Programming Interface 1 month prior to (PRE), and 2 months following (POST-Month1 and Month2) Guideline release (October 18, 2018). The volume, user and location of Tweets relevant to prenatal PA were analyzed. RESULTS: In this 3-month period, 19,944 Tweets were collected. After randomization to select 10% of the sample, 1995 Tweets were analyzed. Tweets related to prenatal PA increased following Guideline release (PRE = 318/674 [45%]; POST-Month1 = 377/755 [50%]); however, this was not sustained into POST-Month2 (202/566 [36%]). The main users Tweeting about prenatal PA were categorized as 'General Population' (33%), whereas top users Tweeting about the Guideline were 'Academics' (25%), 'Exercise Specialists' (27%) and 'Medical Professionals' (20%). POST-Guideline, Tweets originated from users in 42 countries (PRE = 28). CONCLUSIONS: Twitter can be an effective tool for knowledge transmission of PA guidelines to a variety of end-users around the globe.

11.
J Am Coll Nutr ; : 1-10, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32915695

RESUMO

OBJECTIVE: Knowledge Translation (KT) is the exchange, synthesis, and ethically-sound application of knowledge. A case study methodology is used to examine KT at the organizational level of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. METHOD: The study used purposeful sampling to select WIC informants from state WIC agencies to participate in semi-structured interviews about their individual experiences during the 2009 WIC regulation change process. Thematic coding of retrospective semi-structured interviews with key informants from WIC state agencies revealed key components of the state-level WIC regulation implementation process, and key constructs of Organizational Readiness for Knowledge Translation in the WIC program. RESULTS: WIC informants highlight that decisions made by WIC state agencies regarding how to appraise, synthesize, and adapt evidence or regulation change are constrained by the KT decisions made by federal agencies. WIC state agencies should assess their level of readiness for KT in terms of 1) innovation readiness; 2) personal readiness; and 3) institutional readiness. CONCLUSIONS: This WIC case study can help decision-makers to understand the KT process of implementing evidence-informed regulation changes, identify factors that could influence states' ability to be prepared for implementing changes, and gauge "practicality" of future WIC regulation changes.

12.
J Contin Educ Health Prof ; 40(3): 169-175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898122

RESUMO

INTRODUCTION: Increases in opioid use during pregnancy fueled concerns among reproductive health advocates, policy makers, and providers in North Carolina, United States. A stakeholder group designed a set of knowledge translation (KT) interventions to increase the use of evidence-based practices across relevant health care and social service arenas. Efforts to decrease stigma was included as a best practice. Understanding the process and the contexts in which KT intervention activities occur can help increase their effectiveness. Toward that end, this study examined how stigma was addressed and how audiences responded to evidence-based messages. METHODS: Data were collected over a seven-year period and included observations of KT activities (conferences, workshops, and community meetings), focus groups and interviews conducted with providers, and a review of publicly available documents, including KT intervention materials. Clarke's situational mapping was initially applied, and stigma emerged as a critical contextual element. Data were then analyzed to identify how stigma was addressed and how evidence-based messages were received. RESULTS: Despite direct stigma-reduction messages, biases against maternal drug use and ambivalence toward evidence-based recommendations of harm reduction principles were found in audience responses. Findings also revealed tensions around the interpretation of knowledge and the appropriate implementation of best practices between "experts" and among practitioners. DISCUSSION: Stigma and professional biases may serve as significant barriers to KT activities. Results suggest that even under the best of circumstances, evidence-based practices for highly stigmatized and controversial issues are difficult to disseminate and may require unique approaches.

13.
Dementia (London) ; : 1471301220957805, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32893679

RESUMO

The benefits of physical activities for those living with moderate to advanced dementia are well documented and include improved well-being and quality of life. What is less well known is how best to deliver such activities to make them meaningful for those taking part and, more generally, how to develop good practice guidance for working with this group. This article reports on an observational study of a physical activity programme in a residential care setting, Mobile Me, and on the process used to develop good practice guidance from it, which included input from a range of stakeholders. Learnings from this study conclude that changes in delivery and setting can contribute to a difference in the quality of the experience for participants and their levels of well-being during sessions. The findings from the study were consolidated into four themes for disseminating best practice: promoting the right atmosphere, environment, communication, and adaptations. These form part of a new multimedia best practice guide for delivering physical activities to those living with moderate to advanced dementia.

14.
BMJ Open Qual ; 9(3)2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32943430

RESUMO

Ineffective knowledge dissemination contributes to clinical practice and service improvements not being realised. Meaningful knowledge translation can occur through the understanding and matching of appropriate communication mediums that are relevant for different stakeholders or audiences. To this end, we present a dissemination instrument, the 'REAch and Diffusion of health iMprovement Evidence' (README) checklist, for the communication of research findings, integrating both traditional and newer communication mediums. Additionally, we propose a 'Strategic Translation and Engagement Planning' (STEP) tool, for use when deciding which mediums to select. The STEP tool challenges the need for communicating complex and simple information against the desire for passive or active stakeholder interaction. Used collaboratively by academics and health professionals, README and STEP can promote co-production of research, subsequent diffusion of knowledge, and develop the capacity and skills of all stakeholders.

15.
Australas Emerg Care ; 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32950439

RESUMO

BACKGROUND: Undetected clinical deterioration is a major cause of high mortality events in Emergency Department (ED) patients. Yet, there is no known model to guide the recognition and response to clinical deterioration in the ED, integrating internal and external resources. METHODS: An integrative review was firstly conducted to identify the critical components of recognising and responding to clinical deterioration in the ED. Components identified from the review were analysed by clinical experts and informed the development of an ED Clinical Emergency Response System (EDCERS). RESULTS: Twenty four eligible studies were included in the review. Eight core components were identified: 1) vital sign monitoring; 2) track and trigger system; 3) communication plan; 4) response time; 5) emergency nurse response; 6) emergency physician response; 7) critical care team response; and 8) specialty team response. These components informed the development of the EDCERS protocol, integrating responses from staff internal and external to the ED. CONCLUSIONS: EDCERS was based on the best available evidence and considered the cultural context of care. Future research is needed to determine the useability and impact of EDCERS on patient and health outcomes.

16.
Artigo em Inglês | MEDLINE | ID: mdl-32890661

RESUMO

PURPOSE: Although level 1 evidence supports the use of single-fraction radiation therapy (SFRT) compared with multiple-fraction radiation therapy (MFRT) for the palliative management of bone metastases, SFRT is underused. In early 2017, the Canadian Partnership Against Cancer and CancerCare Manitoba undertook a comprehensive knowledge translation campaign in Manitoba, Canada featuring educational outreach visits, local consensus meetings, and audit and feedback interventions to encourage greater use of SFRT. This study assessed the impact of this campaign on SFRT use and identified variables associated with MFRT usage. METHODS AND MATERIALS: This retrospective, population-based cohort study identified all patients treated with palliative radiation therapy for bone metastases in Manitoba, Canada, from January 1, 2017, to December 31, 2017, using the provincial radiation therapy database. Baseline characteristics were extracted and tabulated by fractionation schedule. The proportion of patients treated with SFRT in 2017 (postintervention) was compared with the 2016 (preintervention) levels. Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with MFRT use. RESULTS: In 2017, 927 patients received palliative radiation therapy for bone metastasis, of which 548 (59.1%) received SFRT, a 21.1% absolute increase in SFRT use compared with 2016 levels (38.0%). With use of multivariable analysis, variables associated with receipt of MFRT included: complicated bone metastasis, soft tissue extension, hematological primary malignancy, and treatment at a subsidiary center. CONCLUSION: The comprehensive knowledge translation campaign carried out in Manitoba resulted in a significant increase in SFRT use for bone metastases. Continued audit/feedback strategies are recommended to further reinforce knowledge translation efforts supporting SFRT use in the future.

17.
Health Res Policy Syst ; 18(1): 108, 2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-32967674

RESUMO

Sex and gender considerations are understood as essential components of knowledge translation in the design, implementation and reporting of interventions. Integrating sex and gender ensures more relevant evidence for translating into the real world. Canada offers specific funding opportunities for knowledge translation projects that integrate sex and gender. This Commentary reflects on the challenges and solutions for integrating sex and gender encountered in six funded knowledge translation projects. In 2018, six research teams funded by the Canadian Institutes of Health Research's Institute of Gender and Health met in Ottawa to discuss these challenges and solutions. Eighteen participants, including researchers, healthcare professionals, trainees and members of the Institute of Gender and Health, were divided into two groups. Two authors conducted qualitative coding and thematic analysis of the material discussed. Six themes emerged, namely Consensus building, Guidance, Design and outcomes effectiveness, Searches and recruitment, Data access and collection, and Intersection with other determinants of health. Solutions included educating stakeholders on the use of sex and gender concepts, triangulating perspectives of researchers and end-users, and participating in organisations and committees to influence policies and practices. Unresolved challenges included difficulty integrating sex and gender considerations with principles of patient-oriented research, a lack of validated measurement tools for gender, and a paucity of experts in intersectionality. We discuss our findings in the light of observations of similar initiatives elsewhere to inform the further progress of integrating sex and gender into the knowledge translation of health services research findings.

19.
J Transl Med ; 18(1): 354, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933530

RESUMO

BACKGROUND: Severe COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. METHODS: Electronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020-1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion. RESULTS: Of the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age ≥ 70 years (p < 0.001), past medical history of cognitive impairment (p ≤ 0.001), previous delirium (p < 0.001), clinical frailty score > 3 (p < 0.001), hypertension (p < 0.05), heart failure (p < 0.01), national early warning score (NEWS) > 4 (p < 0.01), positive CXR (p < 0.01), and subsequent positive COVID-19 swab (p ≤ 0.001) were associated with 30-day mortality. CRP > 80 mg/L (p < 0.05), albumin < 35 g/L (p < 0.05), peri-operative Glasgow Prognostic Score (poGPS) (p < 0.05), lymphocytes < 1.5 109/l (p < 0.05), neutrophil lymphocyte ratio (p ≤ 0.001), haematocrit (< 0.40 L/L (male)/ < 0.37 L/L (female)) (p ≤ 0.01), urea > 7.5 mmol/L (p < 0.001), creatinine > 130 mmol/L (p < 0.05) and elevated urea: albumin ratio (< 0.001) were also associated with 30-day mortality. On multivariate analysis, age ≥ 70 years (O.R. 3.9, 95% C.I. 1.4-8.2, p < 0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2-19.3, p < 0.05), NEWS > 4 (O.R. 2.4, 95% C.I. 1.1-4.4, p < 0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p < 0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1-4.4, p < 0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n = 122), age ≥ 70 years (O.R. 4.7, 95% C.I. 2.0-11.3, p < 0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2-20.5, p < 0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1-5.1, p < 0.05) remained independently associated with 30-days mortality. CONCLUSION: Age ≥ 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Pandemias , Pneumonia Viral/fisiopatologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Feminino , Mortalidade Hospitalar , Hospitalização , Hospitais de Ensino , Hospitais Urbanos , Humanos , Inflamação/fisiopatologia , Linfócitos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neutrófilos , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Prognóstico , Escócia/epidemiologia , Pesquisa Médica Translacional
20.
Artigo em Inglês | MEDLINE | ID: mdl-32772012

RESUMO

This comment reflects on an article by Oortwijn, Jansen, and Baltussen about the use and features of 'evidence-informed deliberative processes' (EDPs) among health technology assessment (HTA) agencies around the world and the need for more guidance. First, we highlight procedural aspects that are relevant across key steps of EDP, focusing on conflict of interest, the different roles of stakeholders throughout a HTA and public justification of decisions. Second, we discuss new knowledge and models needed to maximize the value of deliberative processes at the expanding frontiers of HTA, paying special attention to when HTA is applied in primary care, employed for public health interventions, and is produced through international collaboration.

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