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Management of Children with the Trisomy 18 and Trisomy 13 Syndromes: Is there a Shift in the Paradigm of Care?

Authors:
John C Carey

Am J Perinatol 2021 Jul 26. Epub 2021 Jul 26.

Department of Pediatrics, Division of Medical Genetics, University of Utah Health, Salt Lake City, Utah.

Objective:  The conventional view toward the management of infants with the trisomy 18 and trisomy 13 syndromes has been to recommend pure comfort care and the avoidance of technological interventions. This commentary aims to address the recently raised question about whether there has been a shift in the paradigm of the management of infants with the two conditions.

Study Design:  The study design includes narrative review of the literature. Read More

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Influencers of women's choice and experience of exclusive formula feeding in hospital.

Midwifery 2021 Jul 14;103:103093. Epub 2021 Jul 14.

Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, Western Australia 6008, Australia; School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102, Australia.

Objectives: Explore what influenced women's decision to exclusively formula feed, and their experiences with formula feeding within a maternity hospital environment.

Design: This mixed methods study used a cross-sectional exploratory survey design. Short surveys were administered by telephone in the postpartum period. Read More

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Long-term analgesic and opioid prescription after surgery under general or neuraxial anesthesia: A retrospective nationwide sampling study.

J Clin Anesth 2021 Jul 24;75:110438. Epub 2021 Jul 24.

Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, Taiwan. Electronic address:

Study Objective: Chronic postsurgical pain (CPSP) is a common and underreported but significant outcome following surgery. Pharmacological treatment with analgesics, including non-opioids and opioids, is frequently used. It has been debated whether neuraxial anesthesia can reduce persistent analgesic use. Read More

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Significant treatment gap and co-morbidities identified in an epidemiological survey of pediatric epilepsy in rural suburbs of India.

Seizure 2021 Jul 18;91:417-424. Epub 2021 Jul 18.

State Health Systems Resource Center, Pune, Maharashtra, India.

Purpose: A cross-sectional epidemiological survey of children was conducted in two rural clusters to estimate the point prevalence and study various aspects of childhood epilepsy.

Material And Methods: In the first stage, a house-to-house survey was conducted by health workers using a screening questionnaire, which was pre-validated in a pilot study. All screen positive houses were visited by pediatric neurologist for detailed evaluation. Read More

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Impact of the COVID-19 Pandemic on Labor & Delivery Research Operations.

Am J Obstet Gynecol MFM 2021 Jul 23:100443. Epub 2021 Jul 23.

Department of Obstetrics and Gynecology, Washington University in St Louis.

Objective: Many research studies in the United States came to an abrupt halt when the World Health Organization declared the Coronavirus 2019 (COVID-19) pandemic in March 2020, including ongoing perinatal studies addressing national rates of maternal and fetal morbidity. Research on Labor & Delivery units (L&D) was particularly vulnerable to setbacks due to universal COVID-19 testing policies and asymptomatic infection rates almost 16 times higher than that of other surgical units. We evaluated the impact of the COVID-19 pandemic on L&D research operations and recruitment at a single center. Read More

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Hepatitis C treatment as prevention in the prison setting: Assessments of acceptability of treatment scale up efforts by prison correctional and health personnel.

Int J Drug Policy 2021 Jul 23;98:103379. Epub 2021 Jul 23.

Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney 2052 NSW, Australia.

Background: Hepatitis C (HCV) infection is prevalent in the prison setting, with sharing of unsterile injecting equipment the most common mode of transmission in high income countries. Mathematical modelling suggests that HCV treatment scale-up could prevent onward transmission, known as treatment as prevention. Direct-acting antivirals have enabled rapid scale up of HCV treatment, underpinning the first clinical trial of treatment as prevention in the prison setting. Read More

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International peanut allergy prevention, six years after LEAP.

J Allergy Clin Immunol Pract 2021 Jul 23. Epub 2021 Jul 23.

McMaster University, Department of Pediatrics, Hamilton, ON, Canada, Halton Pediatric Allergy, 5500 North Service Road, Suite 106, Burlington ON, Canada, L7L 6W6.

Six years ago, the Learning Early About Peanut (LEAP) trial findings helped fundamentally shift the paradigm of peanut allergy prevention. Though the results of LEAP are well accepted, policymakers, caregivers and clinicians still struggle with how best to implement and apply the study's key findings in clinical practice. There are differences in guidelines that highlight issues related to peanut allergy prevention implementation including caregiver acceptability, cost, fidelity, feasibility, appropriateness, and adoption. Read More

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Independent and interactive effects of air pollutants and ambient heat exposure on congenital heart defects.

Reprod Toxicol 2021 Jul 23. Epub 2021 Jul 23.

Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China. Electronic address:

Accumulating studies have been focused on the independent effects of air pollutants and ambient heat exposure on congenital heart defects (CHDs) but with inconsistent results, and their interactive effect remains unclear. A case-control study including 921 cases and 9210 controls was conducted in Changsha, China in warm season in 2015-2018. The gravidas were assigned monthly averages of daily air pollutants and daily maximum temperature using the nearest monitoring station method and city-wide average method, respectively, during the first trimester of pregnancy. Read More

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TRPC3 promotes tumorigenesis of gastric cancer via the CNB2/GSK3β/NFATc2 signaling pathway.

Cancer Lett 2021 Jul 23. Epub 2021 Jul 23.

The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China. Electronic address:

The transient receptor potential canonical (TRPC) channels have been implicated in various types of malignancies including gastric cancer (GC). However, the detailed mechanisms of TRPC channels underlying cell proliferation and apoptosis of GC cells remain largely unknown. Here, we report that TRPC3 was highly expressed in clinical GC specimens and correlated with GC malignant progression and poor prognosis. Read More

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Advancing precision medicine for acute respiratory distress syndrome.

Lancet Respir Med 2021 Jul 23. Epub 2021 Jul 23.

Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, and Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA.

Acute respiratory distress syndrome (ARDS) is a heterogeneous clinical syndrome. Understanding of the complex pathways involved in lung injury pathogenesis, resolution, and repair has grown considerably in recent decades. Nevertheless, to date, only therapies targeting ventilation-induced lung injury have consistently proven beneficial, and despite these gains, ARDS morbidity and mortality remain high. Read More

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Year in review 2020: Nutrition and gastrointestinal disease in cystic fibrosis.

Pediatr Pulmonol 2021 Jul 26. Epub 2021 Jul 26.

Division of Pulmonary Medicine, Department of Pediatrics, Tulane University School of Medicine, Children's Hospital of New Orleans, New Orleans, Louisiana, USA.

The multisystemic manifestations of cystic fibrosis (CF) involve all parts of the gastrointestinal (GI) system, including the pancreas, intestine, and liver. As providers who care for people with CF, knowledge of the manifestations, treatment, and research related to nutrition and GI disease are important. This review is the last installment of the CF year in review 2020 series, focusing on nutritional, GI, and hepatobiliary articles from Pediatric Pulmonology and other journals of particular interest to clinicians. Read More

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Life with pediatric home ventilation: Expectations versus experience.

Pediatr Pulmonol 2021 Jul 26. Epub 2021 Jul 26.

Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.

Objectives: To explore the family experience of home ventilation through a comparison of anticipated home life changes with subsequent experiences.

Study Design: Guided interviews with parents across three states who chose home ventilation for their child within the last 5 years.

Patient-subject Selection: Purposive sampling of parents who chose home ventilation for their child within the last 5 years. Read More

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Pulmonary Metastasectomy in Colorectal Cancer burden of care study: analysis of local treatments for lung metastases and systemic chemotherapy in 220 patients in the PulMiCC cohort.

Colorectal Dis 2021 Jul 26. Epub 2021 Jul 26.

Sussex Health Outcomes Research & Education in Cancer (SHORE-C), University of Sussex, Falmer, UK.

Aim: To examine the burden of further treatments in patients with colorectal cancer (CRC) following a decision about lung metastasectomy.

Methods: Five teams participating in the study of Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) provided details on subsequent local treatments for lung metastases including the use of chemotherapy. For patients in three groups (no metastasectomy, one metastasectomy or multiple local interventions), baseline factors and selection criteria for additional treatments were examined. Read More

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Trauma-informed qualitative research: Some methodological and practical considerations.

Authors:
Sophie Isobel

Int J Ment Health Nurs 2021 Jul 26. Epub 2021 Jul 26.

Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.

Mental health nurses who engage in research are likely to undertake research on sensitive topics, related to experiences of illness, care delivery and treatment. With recognition of the high prevalence of trauma in the lives of people who interact with mental health services, it is likely that many research participants will have experienced trauma in their lives and that while this may not be the focus of the research, sensitivity and awareness are required. Reference to 'trauma-informed' approaches in research design and practice is emerging in fields such as trauma-focused research and social sciences; however, it has not yet been applied to nurses. Read More

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The scope of nursing practice in a psychiatric unit: a time and motion study.

J Psychiatr Ment Health Nurs 2021 Jul 26. Epub 2021 Jul 26.

La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Switzerland.

Introduction: The evaluation of nursing care practices poses many challenges, including identifying all the aspects of the care given. However, few studies have examined the scope of nursing practice in psychiatry.

Aim: The aim of this study was to describe the intensity of nursing activities on a psychiatric unit based on the adaptation of Déry and D'Amour's (2017) Scope of Nursing Practice Model. Read More

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Patient preferences and priorities for haemophilia gene therapy in the US: A discrete choice experiment.

Haemophilia 2021 Jul 26. Epub 2021 Jul 26.

uniQure Inc, Lexington, Massachusetts, USA.

Introduction: Gene therapy has shown promise in clinical trials for patients with haemophilia, but patient preference studies have focused on factor replacement treatments.

Aim: We conducted a discrete choice experiment (DCE) to investigate the relative importance and differential preferences patients provide for gene therapy attributes.

Methods: We surveyed male adults with haemophilia in the United States recruited from patient panels including the National Hemophilia Foundation Community Voices in Research platform using an online survey over 4 months in 2020/21. Read More

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An integrated safety analysis of treatment-emergent fungal infections in patients with psoriasis treated with ixekizumab from 16 clinical studies.

J Eur Acad Dermatol Venereol 2021 Jul 26. Epub 2021 Jul 26.

Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Interleukin (IL)-17 plays a role in host defense against common extracellular pathogens, including fungi. Biologics that selectively target IL-17 have shown efficacy in the treatment of psoriasis.. Read More

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Direct Oral Anticoagulants in Patients with Non-valvular Atrial Fibrillation and Extreme Body Weight.

Eur J Clin Invest 2021 Jul 26:e13658. Epub 2021 Jul 26.

Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.

Background: Limited clinical data exist describing the use of Direct Oral Anticoagulants (DOACs) in patient with extreme body weight. Thus, the International Society of Thrombosis and Haemostasis (ISTH) recommends avoiding DOACs in patients with weight >120 Kg, on the other hand no restrictions exist for underweight patients.

Objective: To evaluate the effects of extreme body weight on DOACs activity and to compare the clinical outcomes of patients with an extreme body weight versus patients with a normal weight (61-119 Kg) treated with DOACs. Read More

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Building community and resilience in Massachusetts nursing homes during the COVID-19 pandemic.

J Am Geriatr Soc 2021 Jul 26. Epub 2021 Jul 26.

Harvard Medical School.

During the COVID-19 pandemic, frontline nursing home staff faced extraordinary stressors including high infection and mortality rates and ever-changing and sometimes conflicting federal and state regulations. To support nursing homes in evidence-based infection control practices, the Massachusetts Senior Care Association and Hebrew SeniorLife partnered with the Agency for Healthcare Research and Quality AHRQ ECHO National Nursing Home COVID-19 Action Network (the Network). This educational program provided 16 weeks of free weekly virtual sessions to 295 eligible nursing homes, grouped into 9 cohorts of 30-33 nursing homes. Read More

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Field evaluation of a prototype tuberculosis lipoarabinomannan lateral flow assay on HIV-positive and HIV-negative patients.

PLoS One 2021 26;16(7):e0254156. Epub 2021 Jul 26.

Global Good Fund, Intellectual Ventures, Bellevue, Washington, United States of America.

Detection of tuberculosis at the point-of-care (POC) is limited by the low sensitivity of current commercially available tests. We describe a diagnostic accuracy field evaluation of a prototype urine Tuberculosis Lipoarabinomannan Lateral Flow Assay (TB-LAM LFA) in both HIV-positive and HIV-negative patients using fresh samples with sensitivity and specificity as the measures of accuracy. This prototype combines a proprietary concentration system with a sensitive LFA. Read More

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Covasim: An agent-based model of COVID-19 dynamics and interventions.

PLoS Comput Biol 2021 Jul 26;17(7):e1009149. Epub 2021 Jul 26.

Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America.

The COVID-19 pandemic has created an urgent need for models that can project epidemic trends, explore intervention scenarios, and estimate resource needs. Here we describe the methodology of Covasim (COVID-19 Agent-based Simulator), an open-source model developed to help address these questions. Covasim includes country-specific demographic information on age structure and population size; realistic transmission networks in different social layers, including households, schools, workplaces, long-term care facilities, and communities; age-specific disease outcomes; and intrahost viral dynamics, including viral-load-based transmissibility. Read More

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The Cough Cold and Fever Clinic: A Model for the Safe Management of Ambulatory Patients With Suspected COVID-19.

Qual Manag Health Care 2021 Jul 23. Epub 2021 Jul 23.

Weill Cornell Medicine/New York Presbyterian Hospital, New York City (Drs Gingras, Pelzman, and Tung); and New York Presbyterian Hospital, New York City (Mr Marquez and Mr Arias).

Background And Objective: When the coronavirus disease-2019 (COVID-19) pandemic swept through New York City, hospital systems became quickly overwhelmed and ambulatory strategies were needed. We designed and implemented an innovative program called the Cough Cold and Fever (CCF) Clinic to safely triage, evaluate, treat, and follow up patients with symptoms concerning for COVID-19.

Methods: The CCF Clinic was launched on March 13, 2020, in the ambulatory internal medicine office of New York Presbyterian-Weill Cornell Medicine. Read More

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COVID-19 related stressors, sex behaviors, and HIV status neutral care among Black men who have sex with men and transgender women in Chicago, USA.

J Acquir Immune Defic Syndr 2021 Jul 22. Epub 2021 Jul 22.

Department of Public Health, William Paterson University of New Jersey, Wayne, New Jersey Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois Department of Medicine, University of Chicago, Chicago, Illinois Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York Survey Lab, University of Chicago, Chicago, Illinois Department of Public Health Sciences, University of Chicago, Chicago, Illinois Crown School of Social Work, University of Chicago, Chicago, Illinois.

Background: COVID-19 has disproportionately impacted vulnerable populations, including Black men who have sex with men (BMSM) and transgender women (BTW). We investigated associations of COVID-19 stressors and sex behaviors with pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) among BMSM and BTW.

Methods: As part of the Neighborhoods and Networks (N2) study, we conducted virtual interviews during peak COVID-19 infectivity in Chicago among BMSM and BTW (April-July 2020). Read More

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Engaging Diverse Older Adults With Cognitive Impairment and Caregivers in Advance Care Planning: A Pilot Study of the Interactive PREPARE Website.

Alzheimer Dis Assoc Disord 2021 Jul 23. Epub 2021 Jul 23.

Department of Medicine, Division of Geriatrics, San Francisco School of Medicine Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences Department of Epidemiology and Biostatistics, University of California Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical, San Francisco, CA.

Introduction: Engaging patients with cognitive impairment in advance care planning (ACP), including completing advance directives and naming health care proxies, before they lose decision-making capacity is important.

Methods: We determined the feasibility of the PREPAREforYourCare.org ACP program among 20 diverse older adults with mild-to-moderate cognitive impairment and their caregivers in a 1-week, pre-post pilot. Read More

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Quality of Oncology Nursing Care as Perceived by Patients With Cancer: Results From Three Arab Countries.

Cancer Nurs 2021 Jul 24. Epub 2021 Jul 24.

Author Affiliations: Department of Nursing, Al Zaytoonah University of Jordan (Drs Abu Sharour and Bani Salameh), Amman; Department of Adult Health and Critical Care, Sultan Qaboos University (Drs Al Sabei, Al Harrasi, and Al Qadire), Muscat, Oman; and Department of Adult Health and Critical Care, Alexandria University (Dr Anwar), Egypt.

Background: Patient satisfaction was defined as expectation and perception of the patients about real nursing care they receive.

Objective: The aim of this study was to evaluate the quality of oncology nursing care as perceived by patients with cancer in 3 Arabic countries (Jordan, Oman, and Egypt).

Methods: A cross-sectional design with convenience sampling approach was used. Read More

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Answering the Call to Action: A Multimodal Wellness Response to Psychological Distress in Health Care Workers During the COVID-19 Pandemic in the Bronx.

Am J Med Qual 2021 Jul 21. Epub 2021 Jul 21.

NYC Health + Hospitals/Jacobi Bronx, NY, USA NYC Health + Hospitals/Central Office, New York, NY, USA.

The emotional and psychological toll of the COVID-19 pandemic has been characterized as a parallel pandemic, disproportionately affecting health care workers when compared to the general population. Recognizing the tragic effects that the pandemic was having on the psyche of our health care workers, a multidisciplinary peer-support program called Helping Healers Heal was augmented to address these complex needs in a large, urban, academic medical center in the Bronx, NY. A multimodal approach including wellness events, emotional support rounds, fast-tracked connections with therapeutic support, and coalition building was used to reach 80% of staff from May through August, 2020. Read More

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Integrating Physicians Into Lean Quality Improvement Through a Structured Educational Program: The ECLIPSE Program.

Am J Med Qual 2021 Jul 21. Epub 2021 Jul 21.

Chicago Department of Public Health, Chicago, IL University of Chicago Medical Center, Chicago, IL Emory University Medical Center, Atlanta, GA URochester Medicine at Highland Hospital, Rochester, NY New York University Langone Health, New York, NY.

In the increasingly complex health care system, physicians require skills and knowledge to participate with multidisciplinary team members in quality improvement (QI) that adds value to health care organizations. The Educational and Clinical Leaders Improving Performance with Structured E3L training (ECLIPSE) program was developed to address this challenge. Clinically relevant components of lean management were leveraged to create an online, flipped-classroom curriculum, and this was paired with Kaizen adapted specifically for physicians and multidisciplinary clinicians to promote experiential skills utilization. Read More

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Coronavirus disease 2019 respiratory failure: what is the best supportive care for patients who require ICU admission?

Curr Opin Crit Care 2021 Jul 22. Epub 2021 Jul 22.

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA.

Purpose Of Review: Currently, there is no cure for SARS-CoV-2 infection, yet hospital mortality rates for COVID-19 have improved over the course of the pandemic and may be due in part to improved supportive care in the ICU. This review highlights the evidence for and against various ICU supportive therapies for the treatment of critically ill patients with COVID-19.

Recent Findings: Early in the pandemic, there was great interest in novel ICU supportive care, both for the benefit of the patient, and the safety of clinicians. Read More

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Nonmedical barriers to early steps in kidney transplantation among underrepresented groups in the United States.

Curr Opin Organ Transplant 2021 Jul 23. Epub 2021 Jul 23.

Division of Transplantation, Department of Surgery Department of Medicine, Emory University School of Medicine Department of Epidemiology, Rollins School of Public Health, Emory University Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA.

Purpose Of Review: Despite numerous targeted interventions and policy reforms, underrepresented minorities and patients with low socioeconomic status (SES) continue to have unequal access to kidney transplant. In this review, we summarize the most recent evidence on barriers to early kidney transplant steps (i.e. Read More

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"When I Heard the Word Palliative": Obscuring and Clarifying Factors Affecting the Stigma Around Palliative Care Referral in Oncology.

JCO Oncol Pract 2021 Jul 26:OP2100088. Epub 2021 Jul 26.

Department of Population Health, University of Kansas School of Medicine, Kansas City, KS.

Purpose: Palliative care (PC) can help patients with cancer manage symptoms and achieve a greater quality of life. However, there are many barriers to patients with cancer receiving referrals to PC, including the stigmatizing association of PC with end of life. This study explores factors that obscure or clarify the stigma around PC referrals and its associations with end of life in cancer care. Read More

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