Background: The assessment of physical capacity (PC) is relevant to estimate prognosis and guide ... more Background: The assessment of physical capacity (PC) is relevant to estimate prognosis and guide therapeutics for patients with chronic cardiopulmonary disease. The Veterans Specific Activity Questionnaire (VSAQ) is a self-reported tool designed to assess perceived physical capacity in METs according to a given patient’s level of physical activity limited by symptoms. The purpose of this study was to examine the validity of the score of the French-Canadian version of the VSAQ among patients suffering from cardiovascular symptoms and chronic pulmonary diseases. Methods: A total of 140 subjects referred for treadmill testing (TT group) and 134 patients with pulmonary hypertension or interstitial lung disease (PD group) were enrolled. Criterion validation was verified in the TT group by level of agreement (Bland-Altman coefficient) between the VSAQ and the workload estimated by the gold standard to assess PC, the maximal treadmill test (MTT). Convergent validation was tested using corr...
BACKGROUND Many patients in the intensive care unit (ICU) suffer from pain and are non-communicat... more BACKGROUND Many patients in the intensive care unit (ICU) suffer from pain and are non-communicative. Therefore, alternative pain measures are necessary. Although behavioral pain measures are available, physiological measures are lacking. The Nociception Level index (NOL™) provides a value from combination of multiple physiological parameters to measure pain and its use in the ICU is new. AIM To explore the use of a multiple physiological parameter measure for pain assessment, the NOL™ index, in mechanically ventilated patients able to self-report pain in the ICU. METHODS A prospective cohort study was performed. Data were collected before, during, and 15 minutes after a non-nociceptive procedure (noninvasive blood pressure using cuff inflation) and a nociceptive procedure (endotracheal suctioning). NOL index, 0 to 10 pain intensity, and Critical-Care Pain Observation Tool (CPOT) scores were also obtained. Data were analyzed using Friedman and Mann-Whitney tests. Feasibility of study procedures was described. RESULTS Out of 28 patients who consented, 17 remained eligible and data were analyzed for 15. Technical issues prevented obtaining a NOL signal in 2 patients. NOL values were higher during endotracheal suctioning (median = 41.6) compared with before (median = 11.2) and after the procedure (median = 11.8) and compared with cuff inflation (median = 15.1; Friedman test, p < .001). NOL values were associated with pain intensity and CPOT scores (Mann-Whitney tests, p < .05). CONCLUSIONS The study procedures with the NOL were found feasible; NOL values could discriminate between nociceptive and non-nociceptive procedures, and values were associated with reference pain measures. Further NOL testing is required in other ICU patient groups and procedures.
BACKGROUND The Withdrawal Assessment Tool-1 (WAT-1) has been validated for assessing iatrogenic w... more BACKGROUND The Withdrawal Assessment Tool-1 (WAT-1) has been validated for assessing iatrogenic withdrawal syndrome in critically ill children receiving mechanical ventilation, but little is known about this syndrome in critically ill adults. OBJECTIVE To evaluate the validity and reliability of the WAT-1 in critically ill adults. METHODS A prospective, observational, open-cohort pilot study of critically ill adults receiving mechanical ventilation and regular administration of opioids for at least 72 hours. Patients were assessed for withdrawal twice daily on weekdays and once daily on weekends using the WAT-1 after an opioid weaning episode. The presence of iatrogenic withdrawal syndrome was evaluated once daily using modified Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. All evaluations were blinded and performed independently. The criterion validity of the WAT-1 and the interrater reliability for WAT-1 and DSM-5 evaluations were determined. RESULTS During 8 months, 52 adults (median age, 51.5 years) were enrolled. Eight patients (15%) had at least 1 positive assessment during their intensive care unit stay using the DSM-5, compared with 19 patients (37%) using the WAT-1. The overall sensitivity of the WAT-1 was 50%, and its specificity was 65.9%. Agreement between WAT-1 and DSM-5 assessments was poor (κ = 0.102). The interrater reliability for the WAT-1 was 89.1% and for the DSM-5 was 90.1%. CONCLUSION Despite showing reliability, the WAT-1 is not a valid tool for assessing the presence of iatrogenic withdrawal syndrome in adults.
Perspective infirmière : revue officielle de l'Ordre des infirmières et infirmiers du Québec
In this descriptive/qualitative study, focus groups and individual interviews were completed with... more In this descriptive/qualitative study, focus groups and individual interviews were completed with 48 critical care nurses and 12 critical care physicians. Results showed that many indicators are used by those clinicians for pain assessment in intubated patients, whatever their level of consciousness. Nurses and physicians mentioned giving weight to the patient's self-assessmen tof pain even when intubated, communication then being by means of signs. Behavioural and physiological indicators also provide clinicians with valuable information for pain assessment. However, for the most part these indicators are not specific to pain, limiting their usefulness in this context. The study aslo suggests recommendations for nursing practice and ideas for nursing resarch.
The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical pr... more The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit serves as a living example of nurses' involvement in the development and implementation of professional guidelines. Nurses who served on this guideline-writing panel describe their experiences. Specific examples from the pain, agitation, and delirium guidelines for care are used to explore the roles of the nurse leader, nurse informaticist, staff nurse, and nurse researcher in relationship to guideline implementation.
Perspective infirmiere : revue officielle de l'Ordre des infirmieres et infirmiers du Quebec
The Faces Pain Thermometer (FPT) was developed for critically ill adults. It consists of a thermo... more The Faces Pain Thermometer (FPT) was developed for critically ill adults. It consists of a thermometer graded from 0 to 10, including six faces. The aim of this study was to examine the metric qualities of this new tool. A convenience sample of 105 cardiac surgery ICU patients participated in this study. Patients rated their pain intensity using the FPT and a validated descriptive scale at three moments : at rest (T1), during a nociceptive procedure (turning, T2), and at rest 20 minutes after the procedure (T3). A focused interview questionnaire was then completed in order to examine content validity and clinical use of the tool. The results showed that the patients positively evaluated the content and the use of the FPT. Most patients mentioned that they preferred faces to rate their level of pain. Convergent validity was supported with high Spearman correlations and Kappa coefficients between the two pain intensity scales (FPT and descriptive scale). Discriminant validity was also...
Based on a survey of the literature in human and nursing sciences and illustrated with concrete r... more Based on a survey of the literature in human and nursing sciences and illustrated with concrete research examples, we will identify promising research directions for mixed-methods studies and present strategies for applying this type of research design to the evaluation of nursing interventions. This article provides three examples of mixed-methods design that utilize schematic representation about evaluation of nursing interventions. Based on examples, the issues discussed are: (1) sufficient significance for research program to invest the required human and material resources, (2) reason for using qualitative and quantitative data simultaneously or sequentially, (3) integration of qualitative and quantitative data when the participants are from different target populations; (4) presentation of the findings.
Perspective infirmiere : revue officielle de l'Ordre des infirmieres et infirmiers du Quebec
Cancer-related fatigue (CRF) is a major reality during treatment as well as once treatment is com... more Cancer-related fatigue (CRF) is a major reality during treatment as well as once treatment is completed. For many people, CRF persists for long periods in the post-therapeutic phase and has a considerable negative impact on the quality of life. Fatigue is defined as a subjective and multidimensional phenomenon. CRF is associated with many factors, hence its complexity. The goal of this article is to summarize major findings from a review of literature in order to better understand the phenomenon of CRF itself, its progressive course, the main associated factors and some of the most promising interventions.
It is recognized that nurses regularly have to adapt their clinical practice compared to new scie... more It is recognized that nurses regularly have to adapt their clinical practice compared to new scientific breakthroughs. However, changes in practice are possible by the implementation of clinical projects but can sometimes be long and difficult to achieve in health care settings, given the context of care or the profile of the clientele, the care organization, work organization, etc. An algorithmic approach (i.e., sequence of actions) to support nurses in the evaluation of new nursing intervention projects, including other members of the interdisciplinary team, researchers, and patients and their relatives, has been developed. This algorithm considers the clinical environment in which the project will operationalize nursing interventions and involves five steps: 1) identification and description of a care problem to solve or a care practice to improve; 2) the development or adaptation of appropriate nursing intervention, and 3) the choice of evaluation design for this nursing interve...
Based on a survey of the literature in human and nursing sciences and illustrated with concrete r... more Based on a survey of the literature in human and nursing sciences and illustrated with concrete research examples, we will identify promising research directions for mixed-method studies and present strategies for applying this type of research design to the evaluation of nursing interventions. This article provides three examples of mixed-method designs that utilize schematic representation for the evaluation of nursing interventions. Based on examples, the issues discussed are: (1) the sufficient significance of the research program, warranting investment in the required human and material resources; (2) the reasons for using qualitative and quantitative data simultaneously or sequentially; (3) the integration of qualitative and quantitative data when the participants are from different target populations; and (4) a presentation of the findings.
Supplemental Digital Content is available in the text. Objective: Up to 50% of patients develop h... more Supplemental Digital Content is available in the text. Objective: Up to 50% of patients develop high-impact chronic pain after an acute care experience and many psychological variables have been identified in this process. We conducted a systematic review and meta-analysis of randomized controlled trials to assess the effect of psychological interventions within 3 months after pain onset. Methods: We searched databases for articles published from databases inceptions until July 2019. We used standardized mean differences with 95% confidence intervals to assess treatment effect. Results: In all, 18 trials were found eligible; 11 of which were included in the meta-analyses. Trials were mainly performed in back pain patients in the middle to late adulthood. Regarding pain intensity, the effect of psychological interventions compared with standard treatments was nonsignificant at 3, 6, and 12 months. We found a moderate significant effect size in favor of psychological interventions compared with standard treatments with regard to disability at 12 months and a small significant effect with regard to coping with pain at 3 months when compared with information alone. Most of meta-analysis findings were associated with a low level of evidence. Discussion: This systematic review and meta-analysis showed no significant effect of psychological interventions on pain intensity. A positive and significant trend related to these interventions was shown on disability and coping with pain, when compared with standard treatment and information, respectively. However, these findings must be interpreted with caution considering the limited sample of trials. More rigorous randomized controlled trials performed in patients with a high-risk psychological profile are required to elucidate the efficacy of psychological interventions in preventing chronic pain.
Abstract Aim Initial testing of England's Safer Nursing Care Tool for adult in‐patient acute ... more Abstract Aim Initial testing of England's Safer Nursing Care Tool for adult in‐patient acute care wards in a university‐affiliated Canadian hospital. Background Safe‐nursing staffing decisions have significant impacts on patients' safety and quality of care. The Safer Nursing Care Tool was developed in England to provide managers with a validated formula for making appropriate nursing staffing decisions. The tool has been widely used and studied in the UK but has yet to be tested in a Canadian context. Method Ten high service quality acute care wards from a university‐affiliated Canadian hospital tested the use of the Safer Nursing Care Tool. Service quality, patients' dependency/acuity and staff activity data were benchmarked against information collected in 726 comparable UK wards. Results Higher bed occupancy and patient dependency/acuity mix were found in the 10 Canadian wards compared to their UK counterparts. Overall staff activity was comparable between UK and Canadian wards. Conclusion The Safer Nursing Care Tool can be applied in this Canadian hospital, and further testing in other hospitals and specialties is required. Implication for Nursing Management The Safer Nursing Care Tool is a valid staffing tool to use that, when combined with professional judgement, can help managers to properly establish nursing staff in acute care wards.
BACKGROUND A transition from acute to chronic pain frequently occurs after major lower extremity ... more BACKGROUND A transition from acute to chronic pain frequently occurs after major lower extremity trauma. While the risk factors for developing chronic pain in this population have been extensively studied, research findings on interventions aiming to prevent chronic pain in the trauma context are scarce. Therefore, we developed a hybrid, Web-based and in-person, self-management intervention to prevent acute to chronic pain transition after major lower extremity trauma (iPACT-E-Trauma). OBJECTIVE This study aimed to assess the feasibility and acceptability of iPACT-E-Trauma. METHODS Using a descriptive design, the intervention was initiated at a supra-regional level-1 trauma center. Twenty-eight patients ≥18 years old with major lower extremity trauma, presenting with moderate to high pain intensity 24 hours post-injury were recruited. Feasibility assessment was two-fold: 1) whether the intervention components could be provided as planned to ≥80% of participants and 2) whether ≥80% o...
Background: The assessment of physical capacity (PC) is relevant to estimate prognosis and guide ... more Background: The assessment of physical capacity (PC) is relevant to estimate prognosis and guide therapeutics for patients with chronic cardiopulmonary disease. The Veterans Specific Activity Questionnaire (VSAQ) is a self-reported tool designed to assess perceived physical capacity in METs according to a given patient’s level of physical activity limited by symptoms. The purpose of this study was to examine the validity of the score of the French-Canadian version of the VSAQ among patients suffering from cardiovascular symptoms and chronic pulmonary diseases. Methods: A total of 140 subjects referred for treadmill testing (TT group) and 134 patients with pulmonary hypertension or interstitial lung disease (PD group) were enrolled. Criterion validation was verified in the TT group by level of agreement (Bland-Altman coefficient) between the VSAQ and the workload estimated by the gold standard to assess PC, the maximal treadmill test (MTT). Convergent validation was tested using corr...
BACKGROUND Many patients in the intensive care unit (ICU) suffer from pain and are non-communicat... more BACKGROUND Many patients in the intensive care unit (ICU) suffer from pain and are non-communicative. Therefore, alternative pain measures are necessary. Although behavioral pain measures are available, physiological measures are lacking. The Nociception Level index (NOL™) provides a value from combination of multiple physiological parameters to measure pain and its use in the ICU is new. AIM To explore the use of a multiple physiological parameter measure for pain assessment, the NOL™ index, in mechanically ventilated patients able to self-report pain in the ICU. METHODS A prospective cohort study was performed. Data were collected before, during, and 15 minutes after a non-nociceptive procedure (noninvasive blood pressure using cuff inflation) and a nociceptive procedure (endotracheal suctioning). NOL index, 0 to 10 pain intensity, and Critical-Care Pain Observation Tool (CPOT) scores were also obtained. Data were analyzed using Friedman and Mann-Whitney tests. Feasibility of study procedures was described. RESULTS Out of 28 patients who consented, 17 remained eligible and data were analyzed for 15. Technical issues prevented obtaining a NOL signal in 2 patients. NOL values were higher during endotracheal suctioning (median = 41.6) compared with before (median = 11.2) and after the procedure (median = 11.8) and compared with cuff inflation (median = 15.1; Friedman test, p < .001). NOL values were associated with pain intensity and CPOT scores (Mann-Whitney tests, p < .05). CONCLUSIONS The study procedures with the NOL were found feasible; NOL values could discriminate between nociceptive and non-nociceptive procedures, and values were associated with reference pain measures. Further NOL testing is required in other ICU patient groups and procedures.
BACKGROUND The Withdrawal Assessment Tool-1 (WAT-1) has been validated for assessing iatrogenic w... more BACKGROUND The Withdrawal Assessment Tool-1 (WAT-1) has been validated for assessing iatrogenic withdrawal syndrome in critically ill children receiving mechanical ventilation, but little is known about this syndrome in critically ill adults. OBJECTIVE To evaluate the validity and reliability of the WAT-1 in critically ill adults. METHODS A prospective, observational, open-cohort pilot study of critically ill adults receiving mechanical ventilation and regular administration of opioids for at least 72 hours. Patients were assessed for withdrawal twice daily on weekdays and once daily on weekends using the WAT-1 after an opioid weaning episode. The presence of iatrogenic withdrawal syndrome was evaluated once daily using modified Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. All evaluations were blinded and performed independently. The criterion validity of the WAT-1 and the interrater reliability for WAT-1 and DSM-5 evaluations were determined. RESULTS During 8 months, 52 adults (median age, 51.5 years) were enrolled. Eight patients (15%) had at least 1 positive assessment during their intensive care unit stay using the DSM-5, compared with 19 patients (37%) using the WAT-1. The overall sensitivity of the WAT-1 was 50%, and its specificity was 65.9%. Agreement between WAT-1 and DSM-5 assessments was poor (κ = 0.102). The interrater reliability for the WAT-1 was 89.1% and for the DSM-5 was 90.1%. CONCLUSION Despite showing reliability, the WAT-1 is not a valid tool for assessing the presence of iatrogenic withdrawal syndrome in adults.
Perspective infirmière : revue officielle de l'Ordre des infirmières et infirmiers du Québec
In this descriptive/qualitative study, focus groups and individual interviews were completed with... more In this descriptive/qualitative study, focus groups and individual interviews were completed with 48 critical care nurses and 12 critical care physicians. Results showed that many indicators are used by those clinicians for pain assessment in intubated patients, whatever their level of consciousness. Nurses and physicians mentioned giving weight to the patient's self-assessmen tof pain even when intubated, communication then being by means of signs. Behavioural and physiological indicators also provide clinicians with valuable information for pain assessment. However, for the most part these indicators are not specific to pain, limiting their usefulness in this context. The study aslo suggests recommendations for nursing practice and ideas for nursing resarch.
The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical pr... more The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit serves as a living example of nurses' involvement in the development and implementation of professional guidelines. Nurses who served on this guideline-writing panel describe their experiences. Specific examples from the pain, agitation, and delirium guidelines for care are used to explore the roles of the nurse leader, nurse informaticist, staff nurse, and nurse researcher in relationship to guideline implementation.
Perspective infirmiere : revue officielle de l'Ordre des infirmieres et infirmiers du Quebec
The Faces Pain Thermometer (FPT) was developed for critically ill adults. It consists of a thermo... more The Faces Pain Thermometer (FPT) was developed for critically ill adults. It consists of a thermometer graded from 0 to 10, including six faces. The aim of this study was to examine the metric qualities of this new tool. A convenience sample of 105 cardiac surgery ICU patients participated in this study. Patients rated their pain intensity using the FPT and a validated descriptive scale at three moments : at rest (T1), during a nociceptive procedure (turning, T2), and at rest 20 minutes after the procedure (T3). A focused interview questionnaire was then completed in order to examine content validity and clinical use of the tool. The results showed that the patients positively evaluated the content and the use of the FPT. Most patients mentioned that they preferred faces to rate their level of pain. Convergent validity was supported with high Spearman correlations and Kappa coefficients between the two pain intensity scales (FPT and descriptive scale). Discriminant validity was also...
Based on a survey of the literature in human and nursing sciences and illustrated with concrete r... more Based on a survey of the literature in human and nursing sciences and illustrated with concrete research examples, we will identify promising research directions for mixed-methods studies and present strategies for applying this type of research design to the evaluation of nursing interventions. This article provides three examples of mixed-methods design that utilize schematic representation about evaluation of nursing interventions. Based on examples, the issues discussed are: (1) sufficient significance for research program to invest the required human and material resources, (2) reason for using qualitative and quantitative data simultaneously or sequentially, (3) integration of qualitative and quantitative data when the participants are from different target populations; (4) presentation of the findings.
Perspective infirmiere : revue officielle de l'Ordre des infirmieres et infirmiers du Quebec
Cancer-related fatigue (CRF) is a major reality during treatment as well as once treatment is com... more Cancer-related fatigue (CRF) is a major reality during treatment as well as once treatment is completed. For many people, CRF persists for long periods in the post-therapeutic phase and has a considerable negative impact on the quality of life. Fatigue is defined as a subjective and multidimensional phenomenon. CRF is associated with many factors, hence its complexity. The goal of this article is to summarize major findings from a review of literature in order to better understand the phenomenon of CRF itself, its progressive course, the main associated factors and some of the most promising interventions.
It is recognized that nurses regularly have to adapt their clinical practice compared to new scie... more It is recognized that nurses regularly have to adapt their clinical practice compared to new scientific breakthroughs. However, changes in practice are possible by the implementation of clinical projects but can sometimes be long and difficult to achieve in health care settings, given the context of care or the profile of the clientele, the care organization, work organization, etc. An algorithmic approach (i.e., sequence of actions) to support nurses in the evaluation of new nursing intervention projects, including other members of the interdisciplinary team, researchers, and patients and their relatives, has been developed. This algorithm considers the clinical environment in which the project will operationalize nursing interventions and involves five steps: 1) identification and description of a care problem to solve or a care practice to improve; 2) the development or adaptation of appropriate nursing intervention, and 3) the choice of evaluation design for this nursing interve...
Based on a survey of the literature in human and nursing sciences and illustrated with concrete r... more Based on a survey of the literature in human and nursing sciences and illustrated with concrete research examples, we will identify promising research directions for mixed-method studies and present strategies for applying this type of research design to the evaluation of nursing interventions. This article provides three examples of mixed-method designs that utilize schematic representation for the evaluation of nursing interventions. Based on examples, the issues discussed are: (1) the sufficient significance of the research program, warranting investment in the required human and material resources; (2) the reasons for using qualitative and quantitative data simultaneously or sequentially; (3) the integration of qualitative and quantitative data when the participants are from different target populations; and (4) a presentation of the findings.
Supplemental Digital Content is available in the text. Objective: Up to 50% of patients develop h... more Supplemental Digital Content is available in the text. Objective: Up to 50% of patients develop high-impact chronic pain after an acute care experience and many psychological variables have been identified in this process. We conducted a systematic review and meta-analysis of randomized controlled trials to assess the effect of psychological interventions within 3 months after pain onset. Methods: We searched databases for articles published from databases inceptions until July 2019. We used standardized mean differences with 95% confidence intervals to assess treatment effect. Results: In all, 18 trials were found eligible; 11 of which were included in the meta-analyses. Trials were mainly performed in back pain patients in the middle to late adulthood. Regarding pain intensity, the effect of psychological interventions compared with standard treatments was nonsignificant at 3, 6, and 12 months. We found a moderate significant effect size in favor of psychological interventions compared with standard treatments with regard to disability at 12 months and a small significant effect with regard to coping with pain at 3 months when compared with information alone. Most of meta-analysis findings were associated with a low level of evidence. Discussion: This systematic review and meta-analysis showed no significant effect of psychological interventions on pain intensity. A positive and significant trend related to these interventions was shown on disability and coping with pain, when compared with standard treatment and information, respectively. However, these findings must be interpreted with caution considering the limited sample of trials. More rigorous randomized controlled trials performed in patients with a high-risk psychological profile are required to elucidate the efficacy of psychological interventions in preventing chronic pain.
Abstract Aim Initial testing of England's Safer Nursing Care Tool for adult in‐patient acute ... more Abstract Aim Initial testing of England's Safer Nursing Care Tool for adult in‐patient acute care wards in a university‐affiliated Canadian hospital. Background Safe‐nursing staffing decisions have significant impacts on patients' safety and quality of care. The Safer Nursing Care Tool was developed in England to provide managers with a validated formula for making appropriate nursing staffing decisions. The tool has been widely used and studied in the UK but has yet to be tested in a Canadian context. Method Ten high service quality acute care wards from a university‐affiliated Canadian hospital tested the use of the Safer Nursing Care Tool. Service quality, patients' dependency/acuity and staff activity data were benchmarked against information collected in 726 comparable UK wards. Results Higher bed occupancy and patient dependency/acuity mix were found in the 10 Canadian wards compared to their UK counterparts. Overall staff activity was comparable between UK and Canadian wards. Conclusion The Safer Nursing Care Tool can be applied in this Canadian hospital, and further testing in other hospitals and specialties is required. Implication for Nursing Management The Safer Nursing Care Tool is a valid staffing tool to use that, when combined with professional judgement, can help managers to properly establish nursing staff in acute care wards.
BACKGROUND A transition from acute to chronic pain frequently occurs after major lower extremity ... more BACKGROUND A transition from acute to chronic pain frequently occurs after major lower extremity trauma. While the risk factors for developing chronic pain in this population have been extensively studied, research findings on interventions aiming to prevent chronic pain in the trauma context are scarce. Therefore, we developed a hybrid, Web-based and in-person, self-management intervention to prevent acute to chronic pain transition after major lower extremity trauma (iPACT-E-Trauma). OBJECTIVE This study aimed to assess the feasibility and acceptability of iPACT-E-Trauma. METHODS Using a descriptive design, the intervention was initiated at a supra-regional level-1 trauma center. Twenty-eight patients ≥18 years old with major lower extremity trauma, presenting with moderate to high pain intensity 24 hours post-injury were recruited. Feasibility assessment was two-fold: 1) whether the intervention components could be provided as planned to ≥80% of participants and 2) whether ≥80% o...
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