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1.
Nurs Res ; 68(6): E8-E12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693558

RESUMO

BACKGROUND: Scarce and differing reasons for including closing questions in qualitative research exist, but how data generated from these questions are used remains uncertain. OBJECTIVES: The purpose of the study was to understand if and how researchers use closing questions in qualitative research, specifically the research questions were: (a) "Why do qualitative researchers include or exclude closing questions during interviews?" and (b) "How do qualitative researchers use data from closing questions?" METHODS: A qualitative descriptive design using a single, asynchronous, web-based, investigator-designed survey containing 14 items was used to collect data. Convenience and snowball sampling were used to recruit participants. Data were analyzed using descriptive statistics and qualitative content analysis. Codes were developed from the qualitative data. Subcategories were derived from similar codes, and these subcategories were further scrutinized and were used to create broad categories. RESULTS: The number of respondents per question ranged from 76 to 99; most identified nursing and sociology as their academic disciplines, lived in the United States, and were involved in qualitative research for 1-10 years. Data, the interview, the interviewee, and the interviewer were broad categories to emerge as reasons for including closing questions. Only one respondent reported a reason for excluding closing questions. The uses of closing question data were described in four broad categories: analysis, data, the interview guide, and inquiry. DISCUSSION: Researchers frequently included closing questions in qualitative studies. The reasons for including these questions and how data are used vary, and support limited previously published literature. One unique reason, adding "new breath" to the interview, emerged. Study findings can aid qualitative researchers in deciding whether to include closing questions.


Assuntos
Internet , Entrevistas como Assunto , Pesquisa Qualitativa , Inquéritos e Questionários , Tomada de Decisões , Humanos
2.
Aging Ment Health ; : 1-8, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31549521

RESUMO

Objectives: While ways to reduce caregiver burden have dominated dementia care research, there is little understanding of daily communication and its relationship to caregiver burden and depression. In this study, we sought to: (1) describe the frequency of harsh communication used by caregivers; (2) examine the relationship between harsh communication, caregiver and person with dementia characteristics; and (3) determine the contributions of caregiver depression and burden on such communication. Method: Cross-sectional baseline data were drawn from 250 dyads, who participated in the Dementia Behavior Study (NCT01892579). Hierarchical linear regression models were used to examine the relationship between dyad characteristics and harsh communication scores (using the 6-item Negative Communication Scale), controlling for three groups of covariates: sociodemographic, relationship characteristics and health factors. Results: More than half of the caregivers (mean age = 65.4, 81.2% women, 45.6% spouses) reported they felt like screaming/yelling (N = 138, 55.2%) or used a harsh tone (N = 129, 51.6%) at persons with dementia (Mini Mental Status Examination mean = 14.3, SD: 7.8) at least sometimes. When controlling for all covariates, for each unit increase in caregiver burden, harsh communication increased by 0.486 units (p < 0.001); similarly, for each unit increase in caregiver depression, harsh communication increased by 0.301units (p < 0.001). Conclusion: Over half of dementia caregivers reported they felt like or used one or more harsh forms of communication. Caregiver burden and depression were incrementally associated with greater use of negative communication. Providing caregivers with knowledge, support and specific communication skills may lessen the frequency of harsh communication and possibly reduce burden and depression.

3.
Nurs Outlook ; 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31420181

RESUMO

BACKGROUND: Our health care system is facing unprecedented and complex challenges in caring for older adults and their families. A paradigm shift is needed that recognizes new roles and competencies for nurses to play a leadership role in the design and implementation of high value care models. PURPOSE: The purpose of this paper is to introduce a series of recommendations for leveraging nurses to generate innovative tools and solutions for the delivery of value-based care for older adults living with complex health and social needs and their families. METHODS: These recommendations were generated by a Think-Tank of national experts based on review of current evidence and focus groups with older adults. DISCUSSION: The generated recommendations focus on positioning nurses to assume leadership roles in implementing evidence-based care models, preparing nurses to serve as health innovators and catalysts of system transformation, and fostering system-level infrastructure that leverages the contributions of nurses for current and emerging roles. CONCLUSION: Nurses as innovators can address the challenges in providing high quality care for older adults with complex needs and their families. System-level infrastructure, including resources for training and implementation of well-established programs, is necessary to leverage the contributions of nurses and facilitate innovative approaches to care.

4.
Res Gerontol Nurs ; 12(5): 217-226, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31283831

RESUMO

Sensory impairment, explicitly vision and hearing impairment, among nursing home (NH) residents decreases their ability to socially engage. However, it is not known to what extent visual, hearing, or dual impairment is associated with social engagement. The aims of the current retrospective, cross-sectional descriptive study were to determine the relationship between social engagement and (a) levels of sensory impairment (vision, hearing, and dual); (b) depression; and (c) cognition. The authors analyzed baseline data from 213 NH residents with sensory impairment from the I-SEE study. Multivariable model results demonstrated that sensory impairment was not associated with social engagement when adjusting for all covariates. Greater social engagement was associated with less depression, better cognition, and greater comorbidity. Clinicians should be aware of these risks to social engagement in NH residents with sensory impairment and monitor for decreased social engagement and isolation in residents with less comorbidities, higher depression levels, and poorer cognition. [Res Gerontol Nurs. 2019; 12(5):217-226.].

5.
Artigo em Inglês | MEDLINE | ID: mdl-31261862

RESUMO

Health benefits have been linked to spending time outdoors in nature and green space. However, there is some evidence of inequities to accessing safe outdoor space, particularly in low-resource communities. The primary aim of this study is to assess attitudes towards nature and use of green space in urban areas. A secondary aim is to describe perceptions of physician-initiated nature prescriptions that target local pediatric populations. We conducted six focus group interviews with 42 residents who were guardians or caretakers of children living in low-resource neighborhoods in Philadelphia, PA. We analyzed interview data using a conventional content analysis approach. Three major themes emerged: (1) perceived benefits of being in nature (physical and mental health benefits), (2) barriers to time spent in nature (unsafe and undesirable conditions of local parks), and (3) desired features of outdoor green spaces (amenities that would increase park use). Additionally, we describe participants' reactions to the idea of a pediatrician-delivered prescription for outdoor green space exposure for a child in their care. Adherence to nature prescriptions programs may hinge on local green space resources, as well as experiential and perceptual barriers and facilitators to nature and park accessibility among caregivers tasked with fulfilling a nature prescription for a child in their care.


Assuntos
Parques Recreativos , Características de Residência , Adolescente , Adulto , Idoso , Atitude , Exercício , Feminino , Grupos Focais , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Philadelphia , População Urbana , Adulto Jovem
6.
West J Nurs Res ; : 193945919861380, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31256749

RESUMO

Recent research has recognized the value of participatory arts, including choirs, as a strategy to engage older adults in the community. Less is known about the participation of minority older adults of low socioeconomic status (SES) in choirs. The purpose of this qualitative descriptive study was to explore the perceived benefits of choral singing among older adults from Program of All-Inclusive Care for the Elderly (PACE) day centers. We elicited perceptions from 19 choir participants from three focus groups, the majority of whom were Black or African American (N =17/19), each held at a different PACE center. One main theme emerged, "Something for us to do that we love," with two subthemes, "Joyful time together" and "Uplifting experience performing for others." These study findings have implications for promoting choir singing in older adults to serve as a place for engagement in social interactions in a lifelong activity they love.

7.
Res Gerontol Nurs ; 12(4): 184-192, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31158297

RESUMO

There is a dearth of evidence on safely transporting frail older adults in the community. Therefore, the purpose of the current study was to gain a better understanding of behavioral expression exhibited by older adults during van transportation and to learn what actions van assistants and van drivers take to prevent or address behavioral expressions, which can create potential challenges to safe transportation. A qualitative descriptive approach was used and included four focus groups of van assistants and van drivers (N = 32) at one urban Program of All-Inclusive Care for the Elderly (PACE), which routinely transports approximately 90% of enrollees to and from the PACE center. Conventional content analysis was used to analyze the data. Four themes emerged. The first two themes were common behaviors: Removing Seat Belts and Verbal Behaviors. The remaining two themes addressed unusual behaviors that left lasting impressions: Physical Aggression and Conflict Between Passengers. Van assistants and van drivers used redirection and reassurance as preventive interventions to keep everyone safe. Transportation of PACE enrollees requires well-trained and astute van assistants and van drivers skilled with preventing and diffusing potentially unsafe behaviors. [Res Gerontol Nurs. 2019; 12(4):184-192.].

8.
Pain Manag Nurs ; 20(3): 253-260, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31085096

RESUMO

PURPOSE: The Mobilization-Observation-Behavior-Intensity-Dementia (MOBID) Pain Scale is an observational tool in which raters estimate pain intensity on a 0-10 scale following five standardized movements. The tool has been shown to be valid and reliable in northern European samples and could be useful in the United States (US) for research and clinical purposes. The goal of this study was to examine the validity and reliability of the MOBID among English-speaking nursing home residents in the US. DESIGN: Cross-sectional study. SETTINGS: Sixteen nursing homes in Pennsylvania, New Jersey, Georgia and Alabama. PARTICIPANTS: One hundred thirty-eight older adults with dementia and moderate to severe cognitive impairment. METHODS: Validity was evaluated using Spearman correlations between the MOBID overall pain intensity score and 1) an expert clinician's pain intensity rating (ECPIR), 2) nursing staff surrogate pain intensity ratings, and 3) known correlates of pain. We assessed internal consistency by Cronbach's alpha. RESULTS: MOBID overall scores were significantly associated with expert clinician's rating of current and worst pain in the past week (rho = 0.54, and 0.57; p < .001, respectively). Statistically significant associations also were found between the MOBID overall score and nursing staff current and worst pain intensity ratings as well as the Cornell Scale for Depression in Dementia (rho = 0.29; p < .001). Internal consistency was acceptable (α = 0.83). CONCLUSIONS AND CLINICAL IMPLICATIONS: Result of this study support the use of the MOBID in English-speaking staff and residents in the US. Findings also suggest that the tool can be completed by trained, nonclinical staff.

9.
Int Psychogeriatr ; 31(5): 667-683, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30303058

RESUMO

ABSTRACTBackground:Nursing home (NH) residents with dementia commonly exhibit persistent vocalizations (PVs), otherwise known in the literature as disruptive or problematic vocalizations. Having a better understanding of PVs and the research completed to date on this phenomenon is important to guide further research and clinical practice in NHs. This integrative review examines the current literature on the phenomenon of PVs among NH residents with dementia. METHODS: We conducted a search in the PubMed, Scopus, Ovid Medline, and CINAHL databases for articles published in English. Articles were included if the focus was specifically on research involving vocal behaviors of older adults with dementia residing in NHs. RESULTS: Our literature search revealed eight research articles that met the inclusion criteria. These studies were published in 2011 or earlier and involved small sample sizes. Seven of these studies were descriptive and the eighth was a non-pharmacological intervention study for PVs exhibited by NH residents with dementia. These studies were vastly different in their labeling, definitions, and categorization of the PVs as well as methods of measuring PVs. CONCLUSION: The heterogeneity of the evidence limits the ability to make recommendations for practice. Given the paucity of research on this phenomenon; recommendations for additional research are given.

10.
Clin Nurs Res ; 27(3): 258-277, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28038504

RESUMO

The purpose of this study was to explore participants' experience in the Health Quality Partners (HQP) Care Coordination Program that contributed to their continued engagement. Older adults with multiple chronic conditions often have limited engagement in health care services and face fragmented health care delivery. This can lead to increased risk for disability, mortality, poor quality of life, and increased health care utilization. A qualitative descriptive design with two focus groups was conducted with a total of 20 older adults enrolled in HQP's Care Coordination Program. Conventional content analysis was the analytical technique. The overarching theme resulting from the analysis was "in our corner," with subthemes "opportunities to learn and socialize" and "dedicated nurses," suggesting that these are the primary contributing factors to engagement in HQP's Care Coordination Program. Study findings suggest that nurses play an integral role in patient engagement among older adults enrolled in a care coordination program.


Assuntos
Enfermagem em Saúde Comunitária , Serviços de Saúde Comunitária/métodos , Relações Enfermeiro-Paciente , Participação do Paciente/psicologia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/psicologia , Feminino , Grupos Focais , Promoção da Saúde , Humanos , Gravidez , Pesquisa Qualitativa , Qualidade de Vida
11.
Clin Nurs Res ; 27(1): 61-80, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28918654

RESUMO

Creative solutions are needed to support community-dwelling older adults residing in a variety of settings including their house, apartment, or Supportive Apartment Living (SAL) to promote independence and reduce the risk of nursing home replacement. The objective of this study was to gain an understanding of older adults' needs for physical, mental, and social activities to support the design and functionality of a low-cost mobile assistive robot. A qualitative descriptive study was designed which included three stakeholder focus groups (caregivers, clinicians, and older adults). We held three focus groups with a total of 19 participants: one with paid caregivers ( n = 6), one with interdisciplinary clinicians ( n = 8), and one with older adults residing in SAL ( n = 5). Conventional content analysis was the analytical technique. Four themes emerged: (a) Accomplishing Everyday Tasks: activities of daily living (ADLs) and instrumental activities of daily living (IADLs) were important from the perspectives of all three groups for the older adults to accomplish daily, as well as the "use it or lose it" attitude of the older adults; (b) Personal Connections and Meaningful Activities: for the older adults, it was important for them to engage in socialization and leisure activities, and for the caregivers and clinicians, they work to build personal relationships with the older adults; (c) Cognitive Interventions: the clinicians provided cognitive tools (including reminders, routine and designing interventions) to older adults so they can remain as safe and independent as possible in the SAL; and (d) Safety Measures: encompassed clinicians addressing safety and injury prevention and the caregivers checking in on the older adults in their SAL apartments. This work contributed to the design and functionality specifications for an autonomous low-cost mobile robot for deployment to increase the independence of older adults.


Assuntos
Vida Independente , Percepção , Robótica , Equipamentos de Autoajuda , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Feminino , Grupos Focais , Pessoal de Saúde/psicologia , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
12.
Nurs Outlook ; 65(5): 515-529, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28826872

RESUMO

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases. PURPOSE: In this scoping review the Kales, Gitlin and Lykestos framework is used to answer the question: What high quality evidence exists for the patient, caregiver and environmental determinants of five specific BPSD: aggression, agitation, apathy, depression and psychosis? METHOD: An a priori review protocol was developed; 692 of 6013 articles retrieved in the search were deemed eligible for review. Gough's Weight of Evidence Framework and the Cochrane Collaboration's tool for assessing risk of bias were used. The findings from 56 high quality/low bias articles are summarized. DISCUSSION: Each symptom had its own set of determinants, but many were common across several symptoms: neurodegeneration, type of dementia, severity of cognitive impairments, and declining functional abilities, and to a lesser extent, caregiver burden and communication. CONCLUSION: Research and policy implications are relevant to the National Plan to Address Alzheimer's Disease.


Assuntos
Agressão , Doença de Alzheimer/fisiopatologia , Apatia , Demência/fisiopatologia , Depressão/fisiopatologia , Agitação Psicomotora/fisiopatologia , Transtornos Psicóticos/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Demência/complicações , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agitação Psicomotora/etiologia , Transtornos Psicóticos/etiologia
13.
Geriatr Nurs ; 38(6): 510-519, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28479081

RESUMO

Preventing adverse events among chronically ill older adults living in the community is a national health priority. The purpose of this study was to generate distinct risk profiles and compare these profiles in time to: hospitalization, emergency department (ED) visit or death in 371 community-dwelling older adults enrolled in a Medicare demonstration project. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted using Latent Class Analysis to generate the risk profiles with Kaplan Meier methodology and log rank statistics to compare risk profiles. The Vuong-Lo-Mendell-Rubin Likelihood Ratio Test demonstrated optimal fit for three risk profiles (High, Medium, and Low Risk). The High Risk profile had significantly shorter time to hospitalization, ED visit, and death (p < 0.001 for each). These findings provide a road map for generating risk profiles that could enable more effective targeting of interventions and be instrumental in reducing health care costs for subgroups of chronically ill community-dwelling older adults.


Assuntos
Doença Crônica/enfermagem , Vida Independente , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização , Humanos , Masculino , Medicare , Medição de Risco , Estados Unidos
14.
Dementia (London) ; 16(3): 388-403, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26205144

RESUMO

The physical and mental health of older adults with dementia is affected by levels of social integration. The development of dementia special care units (D-SCU) arose, in part, to facilitate more meaningful social interactions among residents implying greater social integration of D-SCU residents as compared to residents in a traditional nursing home (TNH). But, it is unknown whether D-SCU residents are receiving equal or greater benefits from living on a segregated unit intended to enhance their social environment and integration through both design and staff involvement. The purpose of this study was to pilot test a comprehensive objective assessment to measure social integration among nursing home residents with dementia and to compare levels of integration of residents living on a D-SCU to those living in a TNH. A total of 29 residents participated (15 D-SCU and 14 TNH) and data were gathered from medical charts, visitor logs, and through direct observations. Over 1700 interactions were recorded during 143 h of observation. Specifically, the location, context, type, quantity, and quality of residents' interactions were recorded. Overall, the majority of resident interactions were verbal and initiated by staff. Interactions were social in context, and occurred in public areas, such as the common room with a large screen TV. Average interactions lasted less than 1 min and did not change the resident's affect. Residents spent between 10% and 17% of their time interacting with other people on average. D-SCU staff were significantly more likely to initiate interactions with residents than TNH staff. D-SCU residents also experienced more interactions in the afternoons and expressed more pleasure and anxiety than residents in the TNH. This study helps to lay the groundwork necessary to comprehensively and objectively measure social integration among people with dementia in order to evaluate care environments.


Assuntos
Demência/psicologia , Relações Interpessoais , Casas de Saúde , Percepção Social , Idoso de 80 Anos ou mais , Humanos , Projetos Piloto , Qualidade da Assistência à Saúde
15.
Nurse Educ Today ; 50: 8-11, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28002756

RESUMO

BACKGROUND: Situated in a research-intensive School of Nursing, the Advanced Qualitative Collective (AQC) provides an innovative educational forum for the study of qualitative research by doctoral and postdoctoral scholars. This long-standing collective is guided by a faculty facilitator using a collaborative co-learning approach to address individual and group needs, from the conception of research projects through dissemination of completed qualitative research. This article describes the dynamics of the AQC and the ways a co-created pedagogical entity supports professional development among its diverse members. The informal, participatory style, and dynamic content used by the AQC resists a course structure typical of doctoral education in health sciences, and promotes engagement and self-direction. The AQC provides opportunities for members to examine theoretical frameworks and methodologies rarely addressed within a positivism-dominant learning environment while simultaneously serving as an alternative exemplar for the pedagogy of research.


Assuntos
Docentes/psicologia , Aprendizagem , Pesquisa Qualitativa , Projetos de Pesquisa , Comportamento Cooperativo , Currículo , Educação de Pós-Graduação em Enfermagem , Humanos , Pesquisa em Educação de Enfermagem , Estudantes de Enfermagem
16.
Res Nurs Health ; 40(1): 23-42, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27686751

RESUMO

Qualitative description (QD) is a term that is widely used to describe qualitative studies of health care and nursing-related phenomena. However, limited discussions regarding QD are found in the existing literature. In this systematic review, we identified characteristics of methods and findings reported in research articles published in 2014 whose authors identified the work as QD. After searching and screening, data were extracted from the sample of 55 QD articles and examined to characterize research objectives, design justification, theoretical/philosophical frameworks, sampling and sample size, data collection and sources, data analysis, and presentation of findings. In this review, three primary findings were identified. First, although there were some inconsistencies, most articles included characteristics consistent with the limited available QD definitions and descriptions. Next, flexibility or variability of methods was common and effective for obtaining rich data and achieving understanding of a phenomenon. Finally, justification for how a QD approach was chosen and why it would be an appropriate fit for a particular study was limited in the sample and, therefore, in need of increased attention. Based on these findings, recommendations include encouragement to researchers to provide as many details as possible regarding the methods of their QD studies so that readers can determine whether the methods used were reasonable and effective in producing useful findings. © 2016 Wiley Periodicals, Inc.


Assuntos
Pesquisa Qualitativa , Projetos de Pesquisa/estatística & dados numéricos , Humanos
17.
Geriatr Nurs ; 38(3): 238-243, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27964972

RESUMO

The most common post-acute care (PAC) services available to patients after hospital discharge include home care, skilled nursing facilities, nursing homes, inpatient rehabilitation, and hospice. Patients who need PAC and receive services have better outcomes, however almost one-third of those offered services decline. Little research exists on PAC decision-making and why patients may decline services. This qualitative descriptive study explored the responses of thirty older adults to the question: "Can you, from the patient point of view, tell me why someone would not want post hospital care?" Three themes emerged. Participants may decline due to 1) previous negative experiences with PAC, or 2) a preference to be home. Some participants stated, "I'd be there" and would not decline services. Participants also discussed 3) why other patients might decline PAC which included patients' past experiences, lack of understanding/preconceived ideas, and preferences. Clinical implications include assessing patients' knowledge and experience before providing recommendations.


Assuntos
Assistência ao Convalescente/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Alta do Paciente , Assistência ao Convalescente/psicologia , Idoso , Tomada de Decisões , Feminino , Serviços de Assistência Domiciliar , Hospitais para Doentes Terminais , Humanos , Masculino , Casas de Saúde , Pesquisa Qualitativa , Instituições de Cuidados Especializados de Enfermagem
19.
Res Gerontol Nurs ; 9(4): 175-82, 2016 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-26815304

RESUMO

The purpose of the current study was to explore what hospitalized patients would like to know about post-acute care (PAC) services to ultimately help them make an informed decision when offered PAC options. Thirty hospitalized adults 55 and older in a Northeastern U.S. academic medical center participated in a qualitative descriptive study with conventional content analysis as the analytical technique. Three themes emerged: (a) receiving practical information about the services, (b) understanding "how it relates to me," and (c) having opportunities to understand PAC options. Study findings inform clinicians what information should be included when discussing PAC options with older adults. Improving the quality of discharge planning discussions may better inform patient decision making and, as a result, increase the numbers of patients who accept a plan of care that supports recovery, meets their needs, and results in improved quality of life and fewer readmissions. [Res Gerontol Nurs. 2016; 9(4):175-182.].


Assuntos
Assistência ao Convalescente/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Planejamento de Assistência ao Paciente/organização & administração , Alta do Paciente , Educação de Pacientes como Assunto , Preferência do Paciente , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New England , Pesquisa Qualitativa
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