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Mimmo L, Woolfenden S, Travaglia J, Harrison R. Partnerships for safe care: A meta-narrative of the experience for the parent of a child with Intellectual Disability in hospital. Health Expect 2019; 22:1199-1212. [PMID: 31560839 PMCID: PMC6882263 DOI: 10.1111/hex.12968] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/18/2019] [Accepted: 08/30/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To systematically identify and synthesize peer-reviewed qualitative evidence of the parental experience of hospitalization with a child with Intellectual Disability. SEARCH STRATEGY Key words, synonyms and MeSH subject headings that related to the three key concepts of parental experience, children with Intellectual Disability and hospital settings were applied to six electronic databases: Medline, CINAHL, Embase, PsycINFO, Scopus and Web of Science. Titles and abstracts of publications between January 2000 and February 2019 were screened for relevance. INCLUSION CRITERIA Empirical qualitative research involved participants aged 0-18 years, involved children with Intellectual Disability, involved participants hospitalized as an in-patient and involved participants focused on parent perspective. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesized using a meta-narrative approach. RESULTS Eleven publications met the inclusion criteria. Data synthesis revealed three research traditions contributing to this meta-narrative: Paediatric Nursing Practice, Intellectual Disability Healthcare and Patient Experience. A total of five themes were identified: (a) being more than a parent, (b) importance of role negotiation, (c) building trust and relationships, (d) the cumulative effect of previous experiences of hospitalization and (e) knowing the child as an individual. DISCUSSION AND CONCLUSION This review presents a working model for professional-parent partnership for the safe care of children with Intellectual Disability in hospital. Shifting paediatric healthcare to whole of hospital/multidisciplinary models of care that centre on the child will necessitate partnerships with the parent to identify and manage the needs of the child with Intellectual Disability, in order to achieve safe and equitable care for these children.
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Affiliation(s)
- Laurel Mimmo
- Faculty of MedicineSchool of Public Health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Clinical Governance UnitSydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Susan Woolfenden
- Community Child HealthSydney Children's HospitalSydneyNew South WalesAustralia
- Faculty of MedicineSchool of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Joanne Travaglia
- Faculty of HealthCentre for Health Services ManagementUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Reema Harrison
- Faculty of MedicineSchool of Public Health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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Madden C, Lydon S, Curran C, Murphy AW, O'Connor P. Potential value of patient record review to assess and improve patient safety in general practice: A systematic review. Eur J Gen Pract 2019; 24:192-201. [PMID: 30112925 PMCID: PMC6104614 DOI: 10.1080/13814788.2018.1491963] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: There is limited research, and guidance, on how to address safety in general practice proactively. Objectives: This review aimed to synthesize the literature describing the use of patient record review (PRR) to measure and improve patient safety in primary care. The PRR methodologies utilized and the resulting outcomes were examined. Methods: Searches were conducted using Medline, Embase, CINAHL and PsycINFO in February 2017. Reference lists of included studies and existing review papers were also screened. English language, peer-reviewed studies that utilized PRR to identify patient safety incidents (PSIs) occurring in general practice were included. Two researchers independently extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs. Results: A total of 3265 studies were screened, with 15 included. Trigger tools were the most frequent method used for the PRRs (n = 6). The mean number of safety incidents per 100 records was 12.6. Within studies, a mean of 30.6% of incidents were associated with severe harm (range 8.6–50%), and a mean of 55.6% of incidents was considered preventable (range 32.7–93.5%). The most commonly identified types of PSIs related to medication and prescribing, diagnosis, communication and treatment. Three studies reported on improvement actions taken after the PRRs. Conclusion: This review suggests that PRR may be a promising means of proactively identifying patient safety incidents and informing improvements.
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Affiliation(s)
- Caoimhe Madden
- a Department of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland.,b HRB Primary Care Clinical Trials Network Ireland , National University of Ireland Galway , Galway , Ireland
| | - Sinéad Lydon
- c School of Medicine , National University of Ireland Galway , Galway , Ireland
| | - Ciara Curran
- a Department of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland
| | - Andrew W Murphy
- a Department of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland.,b HRB Primary Care Clinical Trials Network Ireland , National University of Ireland Galway , Galway , Ireland
| | - Paul O'Connor
- a Department of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland.,b HRB Primary Care Clinical Trials Network Ireland , National University of Ireland Galway , Galway , Ireland
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Abstract
An important domain of patient safety is the management of medications in home and community settings by patients and their caregiving network. This study applied human factors/ergonomics theories and methods to data about medication adherence collected from 61 patients with heart failure accompanied by 31 informal caregivers living in the US. Seventy non-adherence events were identified, described, and analysed for performance shaping factors. Half were classified as errors and half as violations. Performance shaping factors included elements of the person or team (e.g. patient limitations), task (e.g. complexity), tools and technologies (e.g. tool quality) and organisational, physical, and social context (e.g. resources, support, social influence). Study findings resulted in a dynamic systems model of medication safety applicable to patient medication adherence and the medication management process. Findings and the resulting model offer implications for future research on medication adherence, medication safety interventions, and resilience in home and community settings. Practitioner Summary: We describe situational and habitual errors and violations in medication use among older patients and their family members. Multiple factors pushed performance towards risk and harm. These factors can be the target for redesign or various forms of support, such as education, changes to the plan of care, and technology design.
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Affiliation(s)
- Robin Sue Mickelson
- a Vanderbilt School of Nursing , Vanderbilt University , Nashville , TN , USA
- b The Center for Research and Innovation in Systems Safety (CRISS) , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Richard J Holden
- c Department of BioHealth Informatics , Indiana University School of Informatics and Computing , Indianapolis , IN , USA
- d Indiana University Center for Aging Research , Regenstrief Institute, Inc. , Indianapolis , IN , USA
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Hibbert PD, Healey F, Lamont T, Marela WM, Warner B, Runciman WB. Patient safety's missing link: using clinical expertise to recognize, respond to and reduce risks at a population level. Int J Qual Health Care 2016; 28:114-21. [PMID: 26573789 PMCID: PMC4767046 DOI: 10.1093/intqhc/mzv091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2015] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Although incident reporting systems are widespread in health care as a strategy to reduce harm to patients, the focus has been on reporting incidents rather than responding to them. Systems containing large numbers of incidents are uniquely placed to raise awareness of, and then characterize and respond to infrequent, but significant risks. The aim of this paper is to outline a framework for the surveillance of such risks, their systematic analysis, and for the development and dissemination of population-based preventive and corrective strategies using clinical and human factors expertise. REQUIREMENTS FOR A POPULATION-LEVEL RESPONSE The framework outlines four system requirements: to report incidents; to aggregate them; to support and conduct a risk surveillance, review and response process; and to disseminate recommendations. Personnel requirements include a non-hierarchical multidisciplinary team comprising clinicians and subject-matter and human factors experts to provide interpretation and high-level judgement from a range of perspectives. The risk surveillance, review and response process includes searching of large incident and other databases for how and why things have gone wrong, narrative analysis by clinical experts, consultation with the health care sector, and development and pilot testing of corrective strategies. Criteria for deciding which incidents require a population-level response are outlined. DISCUSSION The incremental cost of a population-based response function is modest compared with the 'reporting' element. Combining clinical and human factors expertise and a systematic approach underpins the creation of credible risk identification processes and the development of preventive and corrective strategies.
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Affiliation(s)
- Peter D. Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Visiting Research Fellow, Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia
| | | | - Tara Lamont
- National Institute for Health Research, London, UK
- Health Services and Delivery Research Programme, University of Southampton, Southampton, UK
| | | | - Bruce Warner
- Deputy Chief Pharmaceutical Officer, NHS England, London, UK
| | - William B. Runciman
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
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MacKinnon RJ, Kennedy C, Doherty C, Shepherd M, Cole J, Stenfors-Hayes T. Fitness for purpose study of the Field Assessment Conditioning Tool (FACT): a research protocol. BMJ Open 2015; 5:e006386. [PMID: 25869682 PMCID: PMC4401849 DOI: 10.1136/bmjopen-2014-006386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION As part of a programme of research aiming to improve the outcomes of traumatically injured children, a multisource healthcare advocacy tool has been developed to allow trauma team members and hospital governance administrators to reflect and to act on complex trauma team-hospital systems interactions. We have termed this tool a Field Assessment Conditioning Tool (FACT). The FACT draws on quantitative data including clinical care points in addition to self-reflective qualitative data. The FACT is designed to provide feedback on this assessment data both horizontally across fellow potential team members and vertically to the hospital/organisation governance structure, enabling process gap identification and allowing an agenda of improvements to be realised. The aim of the study described in this paper is to explore the perceived fitness for purpose of the FACT to provide an opportunity for healthcare advocacy by healthcare professionals caring for traumatically injured children. METHODS AND ANALYSIS The FACT will be implemented and studied in three district hospitals, each around a major trauma centre in the UK, USA and New Zealand. Using a qualitative approach with standardised semi-structured interviews and thematic analysis we will explore the following question: Is the FACT fit for purpose in terms of providing a framework to evaluate, reflect and act on the individual hospital's own performance (trauma team-hospital interactions) in terms of readiness to receive traumatically injured children? ETHICS AND DISSEMINATION Ethics opinion was sought for each research host organisation participating and deemed not required. The results will be disseminated to participating sites, networks and published in high-impact journals.
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Affiliation(s)
- Ralph James MacKinnon
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK
| | - Chris Kennedy
- Emergency & Urgent Care, Children's Mercy Hospital, Kansas City, Kansas, USA
| | - Catherine Doherty
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK
| | - Michael Shepherd
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Joanne Cole
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Terese Stenfors-Hayes
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Abou Elnour A, Hernan AL, Ford D, Clark S, Fuller J, Johnson JK, Dunbar JA. Surveyors' perceptions of the impact of accreditation on patient safety in general practice. Med J Aust 2014; 201:S56-9. [PMID: 25047883 DOI: 10.5694/mja14.00198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/21/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore Australian General Practice Accreditation Limited (AGPAL) surveyors' perceptions of the impact of accreditation on patient safety and to elicit suggestions for improving patient safety in Australian general practices. DESIGN, SETTING AND PARTICIPANTS We conducted semi-structured telephone interviews with a purposive national sample of 10 AGPAL surveyors from 2 July to 14 December 2012. All interviews were audio recorded, transcribed and summarised. RESULTS All participants agreed that accreditation has improved general practices' performance in quality and safety. Participants noted specific areas that need further attention, including sufficient evidence for clinical risk management, which half the participants estimated occurs in about 5%-10% of Australian general practices. Tangible evidence of patient safety activities included having a significant incidents register, providing documentation of near misses, slips, lapses or mistakes, and engaging in regular clinical meetings to discuss incidents and how to avoid them in the future. Participants agreed that the accreditation process could be improved through the inclusion of tighter clinical safety indicators and the requirement of verifiable evidence of a working clinical risk management system. CONCLUSIONS Accreditation has had a positive role in improving quality and safety in general practice. The inclusion of tighter indicators that require verifiable evidence will be a step forward. The Australian Primary Care Collaboratives (APCC) Program has an opportunity to build on its previous success in general practice quality improvement to further enhance patient safety in general practice.
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Affiliation(s)
- Amr Abou Elnour
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, VIC, Australia.
| | - Andrea L Hernan
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, VIC, Australia
| | - Dale Ford
- Improvement Foundation Australia, Adelaide, SA, Australia
| | - Stephen Clark
- Australian General Practice Accreditation Limited, Brisbane, QLD, Australia
| | - Jeffrey Fuller
- School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia
| | - Julie K Johnson
- Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - James A Dunbar
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, VIC, Australia
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Leotsakos A, Zheng H, Croteau R, Loeb JM, Sherman H, Hoffman C, Morganstein L, O'Leary D, Bruneau C, Lee P, Duguid M, Thomeczek C, Schrieck-De Loos EVD, Munier B. Standardization in patient safety: the WHO High 5s project. Int J Qual Health Care 2014; 26:109-16. [DOI: 10.1093/intqhc/mzu010] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carter P, Ozieranski P, McNicol S, Power M, Dixon-Woods M. How collaborative are quality improvement collaboratives: a qualitative study in stroke care. Implement Sci 2014; 9:32. [PMID: 24612637 PMCID: PMC3983902 DOI: 10.1186/1748-5908-9-32] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/05/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Quality improvement collaboratives (QICs) continue to be widely used, yet evidence for their effectiveness is equivocal. We sought to explain what happened in Stroke 90:10, a QIC designed to improve stroke care in 24 hospitals in the North West of England. Our study drew in part on the literature on collective action and inter-organizational collaboration. This literature has been relatively neglected in evaluations of QICs, even though they are founded on principles of co-operation and sharing. METHODS We interviewed 32 professionals in hospitals that participated in Stroke 90:10, conducted a focus group with the QIC faculty team, and reviewed purposively sampled documents including reports and newsletters. Analysis was based on a modified form of Framework Analysis, combining sensitizing constructs derived from the literature and new, empirically derived thematic categories. RESULTS Improvements in stroke care were attributed to QIC participation by many professionals. They described how the QIC fostered a sense of community and increased attention to stroke care within their organizations. However, participants' experiences of the QIC varied. Starting positions were different; some organizations were achieving higher levels of performance than others before the QIC began, and some had more pre-existing experience of quality improvement methods. Some participants had more to learn, others more to teach. Some evidence of free-riding was found. Benchmarking improvement was variously experienced as friendly rivalry or as time-consuming and stressful. Participants' competitive desire to demonstrate success sometimes conflicted with collaborative aims; some experienced competing organizational pressures or saw the QIC as duplication of effort. Experiences of inter-organizational collaboration were influenced by variations in intra-organizational support. CONCLUSIONS Collaboration is not the only mode of behavior likely to occur within a QIC. Our study revealed a mixed picture of collaboration, free-riding and competition. QICs should learn from work on the challenges of collective action; set realistic goals; account for context; ensure sufficient time and resources are made available; and carefully manage the collaborative to mitigate the risks of collaborative inertia and unhelpful competitive or anti-cooperative behaviors. Individual organizations should assess the costs and benefits of collaboration as a means of attaining quality improvement.
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Affiliation(s)
- Pam Carter
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group & East Midlands, Research Design Service, Department of Health Sciences, University of Leicester, 28 Princess Road West, Leicester LE1 6TP, UK
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath BA2 7AY, UK
| | - Sarah McNicol
- Education and Social Research Institute, Manchester Metropolitan University, 799 Wilmslow Road, Didsbury, Manchester M20 2RR, UK
| | - Maxine Power
- Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| | - Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK
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Runciman WB, Hunt TD, Hannaford NA, Hibbert PD, Westbrook JI, Coiera EW, Day RO, Hindmarsh DM, McGlynn EA, Braithwaite J. CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust 2012; 197:100-5. [DOI: 10.5694/mja12.10510] [Citation(s) in RCA: 286] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- William B Runciman
- University of South Australia, Adelaide, SA
- Australian Patient Safety Foundation, Adelaide, SA
| | | | - Natalie A Hannaford
- University of South Australia, Adelaide, SA
- Australian Patient Safety Foundation, Adelaide, SA
| | - Peter D Hibbert
- Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW
| | - Enrico W Coiera
- Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW
| | - Richard O Day
- St Vincent's Clinical School and School of Medical Sciences, University of New South Wales, Sydney, NSW
| | - Diane M Hindmarsh
- Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW
| | | | - Jeffrey Braithwaite
- Australian Patient Safety Foundation, Adelaide, SA
- Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW
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Lawton R, McEachan RRC, Giles SJ, Sirriyeh R, Watt IS, Wright J. Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review. BMJ Qual Saf 2012; 21:369-80. [PMID: 22421911 PMCID: PMC3332004 DOI: 10.1136/bmjqs-2011-000443] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this systematic review was to develop a 'contributory factors framework' from a synthesis of empirical work which summarises factors contributing to patient safety incidents in hospital settings. DESIGN A mixed-methods systematic review of the literature was conducted. DATA SOURCES Electronic databases (Medline, PsycInfo, ISI Web of knowledge, CINAHL and EMBASE), article reference lists, patient safety websites, registered study databases and author contacts. ELIGIBILITY CRITERIA Studies were included that reported data from primary research in secondary care aiming to identify the contributory factors to error or threats to patient safety. RESULTS 1502 potential articles were identified. 95 papers (representing 83 studies) which met the inclusion criteria were included, and 1676 contributory factors extracted. Initial coding of contributory factors by two independent reviewers resulted in 20 domains (eg, team factors, supervision and leadership). Each contributory factor was then coded by two reviewers to one of these 20 domains. The majority of studies identified active failures (errors and violations) as factors contributing to patient safety incidents. Individual factors, communication, and equipment and supplies were the other most frequently reported factors within the existing evidence base. CONCLUSIONS This review has culminated in an empirically based framework of the factors contributing to patient safety incidents. This framework has the potential to be applied across hospital settings to improve the identification and prevention of factors that cause harm to patients.
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Affiliation(s)
- Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, Leeds, UK.
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Improving patient experiences of health care. INT J EVID-BASED HEA 2008. [DOI: 10.1097/01258363-200812000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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