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Interpretation: Hematopoietic growth factors are naturally occurring substances produced by all humans generic 50mg minomycin amex 6 bacteria. Interpretation: Acute dialysis is performed for abrupt loss of kidney function and may be necessary on only a short-term basis buy 100 mg minomycin otc bacterial nanowires. Chronic hemodialysis is performed on a long-term basis because kidney function is significantly impaired or absent 50 mg minomycin bacteria die when they are refrigerated or frozen. Coverage includes equipment buy cheap minomycin 50 mg on line antibiotic joke, supplies and administrative services provided by a hospital or freestanding dialysis facility. Medicare: Medicare becomes the primary payer for chronic hemodialysis services after the initial 30 months of dialysis. The 30 months in which Medicare is the secondary payer is called the coordination period. The 3 month waiting period plus the 30 month coordination period would make Medicare the secondary payer for 33 months after the month in which dialysis began. The three-month waiting period is waived in certain situations: If the member takes a course in self-dialysis, the 3 month waiting period is eliminated. The coordination period in which Medicare would be secondary would be 30 months rather than 33 months. If the member has a kidney transplant during the first three months of dialysis, the waiting period is shortened and entitlement begins the month in which the transplant occurred. The coordination period begins the month of the transplant and ends 30 months later. Hepatitis B vaccination required by the state for school attendance is in benefit. There should be medical reasons why services cannot be provided in the office or other ambulatory setting. Coordinated Home Care Program means an organized skilled patient care program in which care is provided in the home. Care may be provided by a Hospital’s licensed home health department or by other licensed home health agencies. The member must be homebound (that is unable to leave home without assistance and requiring supportive devices or special transportation) and must require Skilled Nursing Service on an intermittent basis under the direction of a Physician. This program includes Skilled Nursing Service by a registered professional nurse, the services of physical, occupational and speech therapists, hospital laboratories and necessary medical supplies. The program does not include and is not intended to provide benefits for Private Duty Nursing Service. It also does not cover services for activities of daily living (personal hygiene, cleaning, cooking, etc. A home health care visit is considered an intermittent skilled nursing visit of not more than two hours duration that may be ordered multiple times per day or week at a specified interval. Outpatient private duty nursing may not be in benefit (see Benefit Interpretation – for Private Duty Nursing). The procedure utilizes a sensor that is attached to the member’s abdomen and which records and stores uterine activity for subsequent telephone transmission to a monitoring center. The monitoring center analyzes the transmitted data, assesses the need for additional medical intervention and provides this data to the attending obstetrician. A daily nursing contact as well as availability of nursing consultation on a 24-hour basis is an essential component of this service. Home uterine activity monitoring services have become a component of many pre term labor treatment regimes. The American College of Obstetricians and Gynecologists in May of 1996, after review of all available studies concluded that it does not recommend the use of this system of care. The physician must document both life expectancy estimate and appropriateness of hospice care. Interpretation: Hospice care is a coordinated program of palliative and supportive services. It provides physical, psychological, social and spiritual care for dying persons and their families. For hospice services to be in benefit, the following conditions should be documented: the physician certifies that the member has a terminal illness and a life expectancy of less than one year. The following services are covered under the Hospice Care Program: Coordinated Home Care Program Medical supplies and dressings Medication Nursing Services: Skilled and non-skilled Occupational Therapy Pain management services Physical Therapy Physician visits Social and spiritual services Respite Care Services the following services are generally not covered under the Hospice Care Program, but may remain a covered benefit – see note below. While these traditional services are not eligible under this Hospice Care Program section, they may be Covered Services under other sections of the medical coverage. Benefits are subject to the same provisions and day limitations as specified in the Benefit Matrix, depending upon the particular Provider involved (Hospital, Skilled Nursing Facility, Coordinated Home Care Program or Physician). Interpretation: Hospital beds must be medically necessary as determined by the physician. The severity and frequency of symptoms pertinent to use of a hospital bed for positioning must be described. Special attachments must be medically necessary, and documentation of this necessity should be as specific as possible. Electric powered hospital beds are covered only when frequent or immediate changes in body position are necessary, and when no delay in such repositioning is tolerable. See the instructions located on the Introduction page of this section of the Provider Manual. The employer group numbers affected are: H06800, H06801, H06802, H06803, B06800, B06801, B06802 and B06803.

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I understand that these medications may not get rid of my pain but may decrease the pain and increase my level of activity that I am able to do each day purchase 50 mg minomycin bacteria pseudomonas aeruginosa. I understand that the Pain Management Clinic will deal with my chronic pain and will not deal with any of my other medical conditions 50mg minomycin mastercard antibiotics for uti while on birth control. I understand that will be my pain management provider and the only provider who will be ordering my pain medications for my chronic pain buy generic minomycin 100mg online infection bladder. I understand that I have the following responsibilities (initial each item you agree to): I will only take the medications at the amount and frequency as ordered generic minomycin 100 mg amex best antibiotic for gbs uti. Pharmacy: Phone Number: I will allow my pain management provider to provide a copy of this agreement to my pharmacy. I will notify my physician of any changes in my health care and / or changes in my providers. Provider: Clinic: Phone Number: Provider: Clinic: Phone Number: Patient Signature Sample Patient Contract Opiate Contract Pain Management Agreement the purpose of this agreement is to prevent misunderstandings about certain medications you will be taking for pain management. This is to help you and your doctor to comply with the law regarding controlled pharmaceuticals. Use of alcohol will be limited to time when I am not driving, operating machinery and will be infrequent. I agree to use: (Name of Pharmacy), Located at:, Tele number: for filling my prescriptions for all of my pain medicine. I authorize my doctor to provide a copy of this Agreement to my pharmacy, primary care physician and local emergency room. I agree to waive any applicable privilege or right of privacy or confidentiality with respect to these authorizations. All of my questions and concerns regarding treatment have been adequately answered. Patient signature: Physician signature: Witnessed by: Sample Patient Contract for Using Opioid Pain Medication in Chronic Pain this is an agreement between (the patient) and Dr. The medication will probably not completely eliminate my pain, but is expected to reduce it enough that I may become more functional and improve my quality of life. I understand that opioid analgesics are strong medications for pain relief and have been informed of the risks and side effects involved with taking them. In particular, I understand that opioid analgesics could cause physical dependence. If I suddenly stop or decrease the medication, I could have withdrawal symptoms (flu-like syndrome such as nausea, vomiting, diarrhea, aches, sweats, chills) that may occur within 24-48 hours of the last dose. I understand that opioid withdrawal is quite uncomfortable, but not a life-threatening condition. I understand that if I am pregnant or become pregnant while taking these opioid medications, my child would be physically dependent on the opioids and withdrawal can be life-threatening for a baby. Overdose on this medication may cause death by stopping my breathing; this can be reversed by emergency medical personnel if they know I have taken narcotic pain-killers. It is suggested that I wear a medical alert bracelet or necklace that contains this information. I understand it is my responsibility to inform the doctor of any and all side effects I have from this medication. I agree to take this medication as prescribed and not to change the amount or frequency of the medication without discussing it with the prescribing doctor. Running out early, needing early refills, escalating doses without permission and losing prescriptions may be signs of misuse of the medication and may be reasons for the doctor to discontinue prescribing to me. I agree that the opioids will be prescribed by only one doctor and I agree to fill my prescriptions at only one pharmacy. I agree not to take any pain medication or mind-altering medication prescribed by any other physician without first discussing it with the above-named doctor. I give permission for the doctor to verify that I am not seeing other doctors for opioid medication or going to other pharmacies. I agree not to drink alcohol or take other mood-altering drugs while I am taking opioid analgesic medication. I agree to submit a urine specimen at any time that my doctor requests and give my permission for it to be tested for alcohol and drugs. I agree that I will attend all required follow-up visits with the doctor to monitor this medication and I understand that failure to do so will result in discontinuation of this treatment. I also agree to participate in other chronic pain treatment modalities recommended by my doctor. This means that I might become psychologically dependent on the medication, using it to change my mood or get high, or be unable to control my use of it. People with past history of alcohol or drug abuse problems are more susceptible to addiction. If this occurs, the medication will be discontinued and I will be referred to a drug treatment program for help with this problem. If I violate the agreement, I know that the doctor may discontinue this form of treatment. Patient signature: Doctor signature: Date Addendum Sample Statement that could be in this agreement or included in chart at each visit: I understand that the medication is prescribed as follows: Type of medication Number of pills and frequency Total number of pills Next refill due Patient signature: Doctor signature: this could avoid confusion if you are out of the office, if the patient is calling in for early refill, or if the patient says that you told them something different. Attachment C: Sample Discharge/Follow-Up Care Instructions Controlled Substance Information Sheet You have a received a prescription for a controlled substance. Controlled substances include certain prescription medications which are regulated by the government for safety due to their signicant side effects and addiction potential. Side Effects: Ingestion of controlled substances may lead to: confusion, drowsiness, dizziness, nausea, constipation. However, on rare occasions patients will experience an allergic reaction which may include: swelling of the face or throat, chest tightness, hives or shortness of breath.

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Such criteria might include specific chemical compositions order minomycin 100mg amex antibiotics in meat, dimensional attributes (e buy minomycin 100 mg without prescription infection tooth extraction. A coherent risk management approach that fully incorporates an understanding of the toxicity of particles could then be developed to minimize the potential for disease in exposed individuals and populations discount minomycin 50mg amex antibiotic 3142. It has not been formally disseminated by the National Institute for Occupational Safety and Health generic 100 mg minomycin fast delivery bacteria 1 negative hpf. It does not represent and should not be construed to represent any agency determination or policy. It has not been formally disseminated by the National Institute for Occupational Safety and Health. It does not represent and should not be construed to represent any agency determination or policy. Their input has been reviewed, considered, and addressed as appropriate to develop this draft of the Roadmap. It has not been formally disseminated by the National Institute for Occupational Safety and Health. It does not represent and should not be construed to represent any agency determination or policy. Document History Throughout its development, this Roadmap has undergone substantial public comment and scientific peer review with subsequent revision. A listing of the various draft versions disseminated for public comment and/or scientific peer review is presented here. February 2007 –Draft entitled Asbestos and Other Mineral Fibers: A Roadmap for Scientific Research was disseminated for public comment and scientific peer review. It has not been formally disseminated by the National Institute for Occupational Safety and Health. It does not represent and should not be construed to represent any agency determination or policy. It has not been formally disseminated by the National Institute for Occupational Safety and Health. It does not represent and should not be construed to represent any agency determination or policy. It has not been formally disseminated by the National Institute for Occupational Safety and Health. It does not represent and should not be construed to represent any agency determination or policy. Nevertheless, 18 important uncertainties remain to be resolved to fully inform possible revision of existing 19 federal policies and/or development of new federal policies to protect workers from 20 health effects caused by occupational exposure to airborne asbestos fibers. Further 21 research is warranted to develop the science-based knowledge needed to inform the 22 development of new or revised occupational health policies and regulations concerning 23 asbestos fibers. Also, studies of human populations 34 exposed to airborne fibers of erionite, a fibrous mineral that is neither asbestos nor 35 amphibole, have documented high rates of malignant mesothelioma (a cancer most 36 commonly associated with exposure to asbestos fibers). It has not been formally disseminated by the National Institute for Occupational Safety and Health. It does not represent and should not be construed to represent any agency determination or policy. The nature of occupational exposures to asbestos has changed 10 over the last several decades. Once dominated by chronic exposures in asbestos textile 11 mills, friction product manufacturing, cement pipe fabrication, and insulation 12 manufacture and installation, current occupational exposures to asbestos in the United 13 States primarily occur during maintenance activities or remediation of buildings 14 containing asbestos. These current occupational exposure scenarios frequently 17 involve short-term, intermittent exposures, and proportionately fewer long fibers than 18 workers were exposed to in the past. The generally lower current exposures give added 19 significance to the question of whether or not there is an asbestos exposure threshold 20 below which workers would incur no risk of adverse health outcomes. The large number 21 of potentially exposed workers and these changed exposure scenarios also give rise to the 22 need to better understand whether appropriate protection is provided by the current 23 occupational exposure recommendations and regulations. Key 39 to this approach will be the active involvement of stakeholders representing parties with 40 differing views, expert study groups specifying and guiding various components of the 41 research program, and a multidisciplinary group providing careful ongoing review and 42 oversight to ensure relevance, coordination, and impact of the overall research program. It has not been formally disseminated by the National Institute for Occupational Safety and Health. It does not represent and should not be construed to represent any agency determination or policy. Rather, it is expected that these more detailed aspects of 2 the program will be most effectively developed with collaborative input from scientists, 3 policy experts, and managers from various agencies, as well as from other interested 4 stakeholders. It has not been formally disseminated by the National Institute for Occupational Safety and Health. It does not represent and should not be construed to represent any agency determination or policy. The asbestos 19 minerals, as well as other types of fibrous minerals, are typically associated with other 20 minerals in geologic formations at various locations in the United States [Van Gosen 21 2007]. The biological significance of occupational exposure to airborne particles remains 22 unknown for many of these minerals and will be difficult to ascertain given the mixed 23 and sporadic nature of exposure in many work environments and the general lack of well 24 characterized exposure information. To help reduce 29 such confusion and uncertainty about the content of this Roadmap, several new terms are 30 used in the Roadmap and defined in the Glossary (Section 6). However, the lack of 31 uniformity in the use of terms and the lack of precision in the definitions for many of the 32 scientific terms remain issues which cannot be resolved in this Roadmap. Definitions for 33 mineralogical and other scientific terms used in the Roadmap are provided from a variety 34 of sources.

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This means that the most important disciplines involved in blood transfusions should be represented in this committee 50 mg minomycin fast delivery antibiotics for sinus infection online. The working group is of the opinion that in each hospital discount minomycin 100mg fast delivery bacteria brutal, a blood transfusion committee is charged with protocol development cheap 100 mg minomycin antibiotic resistant bv, testing of the implementation of the agreements in the policy minomycin 100mg generic infection zombie movie, evaluation of blood transfusions and the drafting of quality standards for a training plan for all involved employees in the hospital and the testing of this plan. Background and variation in quality of care No similar research has been performed from which one could conclude that an active blood transfusion committee improves the quality of blood transfusions. However, in order to achieve adequate implementation and regular evaluation of the guideline in every care facility, a central blood transfusion committee appears to be an obvious choice. The institution (Board of Directors) is responsible for ensuring that the medical staff of the institution evaluates the quality of the blood transfusions performed. The aim should be to guarantee the quality of all blood transfusions performed in the Netherlands by a local committee. Possibilities for improvement If no blood transfusion committee exists (indicator 1A), one can be appointed. If a blood transfusion committee does exist, but they meet less than 4 times per year, benchmarking of indicator 1B can contribute to making the committee more active. The working group expects that most hospitals will have a blood transfusion committee, but that this committee convenes less than 4 times per year. Minimal bias / description of relevant case mix No meaningful case mix problems are expected. Haemovigilance employee Relationship to Haemovigilance is the complex of measures required to gain insight into quality the safety and quality of the blood transfusion chain. Haemovigilance aims to provide this insight in order to improve the quality of the blood transfusion chain and thus the relevant care. The responsibility for haemovigilance rests on all professionals involved in blood transfusion, each in his or her own field. The local blood transfusion committee is responsible for the transfusion policy in the hospital and the quality control. On record should be who is responsible for which link in the chain and how feedback is arranged. On record should be who is (ultimately) responsible for the data collection surrounding blood transfusion and the reporting of related complaints and deviations. The current Blood Transfusion Guideline recommends the appointment of a haemovigilance employee in institutions where blood transfusions are administered (see paragraph 9. A haemovigilance employee is a person whose task it is to implement the above-mentioned aspects. Structural indicator Quality domain Efficacy, safety and efficiency the aim of the indicator the aim of the indicator is to determine whether the institution has a haemovigilance employee whose task it is to perform the series of measures required to obtain insight into the safety and quality of the blood transfusion chain. Haemovigilance and the activities of a haemovigilance employee are aimed at learning from these measures in order to improve Blood Transfusion Guideline, 2011 389 389 the quality of this care. Therefore, the working group expects a positive correlation between the activities of a haemovigilance employee in an institution and a positive/good score on the other indicators the organisational link to which the indicator is related the indicator is related to all departments and other business sections of care facilities that are involved in the blood transfusion chain in the care facility. Background and variation in quality of care the Care Facility Quality Law demands systematic monitoring, control and improvement of the quality of care. In order to achieve this, the entire transfusion chain must be documented from donor to patient. The working group is of the opinion that an adequate hospital haemovigilance system and the appointment of a haemovigilance employee are important factors that can contribute to this systematic monitoring, control and improvement of the quality of (Dutch) blood transfusion practice. Possibilities for improvement the working group expects that – in the Netherlands – not every hospital will have a haemovigilance employee employed for at least 8 hours per week. It is also expected that there will be opportunities for improvement of this point. Minimal bias / description of relevant case mix the indicator is a structural indicator that does not depend on the case mix. Finally, the working group does not think it necessary to monitor for differences in demographic and socio-economic composition or health status of patient groups. Relationship to Without an electronic Hospital Information System and an electronic quality information system of the Blood Transfusion Laboratory, the sampling of process indicators is a lot of work that will hardly – if ever – take place in practice. The working group is of the opinion that process indicators, such as indicators 5 through 7 are an extremely useful tool to chart and where necessary improve the quality of the blood transfusion chain in a hospital. Operationalisation Which of the following process indicators can you generate using your hospital or (blood transfusion) laboratory information system The derivative aim is to achieve optimum arrangement of the registration of data allowing for a targeted search for quality indicators. The organisational link to which the indicator is related this indicator is related to all care facilities in which blood components are administered to patients. Background and variation in quality of care Without an electronic Hospital Information System and an electronic information system of the Blood Transfusion Laboratory, the sampling of process indicators is a lot of work that will hardly – if ever – take place in practice. The working group is of the opinion that process indicators mentioned in the operationalisation are an extremely useful tool to chart and, where necessary, improve the quality of the blood transfusion chain in a hospital. Possibilities for improvement the working group expects there to be many opportunities for improvement in the (Dutch) hospitals in the field of optimisation of registration of care-related parameters, such as process indicators for the quality of the transfusion chain in the hospital. Guideline on the Administration of Blood Components British Committee for Standards in Haematology 2009. Electronic pre-transfusion identification check Relationship to Experience with quality systems in countries such as the United quality Kingdom, France and the Netherlands shows that a significant proportion of the severe transfusion reactions is caused by administrative errors, mix-ups and human error. The current Blood Transfusion guideline recommends that an electronic identification check is performed on patients and units of blood components prior to blood transfusions (see Chapter 3).

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Some of the key complications identified in recent times include scapular notching 50 mg minomycin free shipping virus image, infection discount 50mg minomycin with visa antimicrobial agents antibiotics, instability minomycin 50 mg otc antibiotic honey, and acromial fractures order minomycin 50mg visa infection under crown. In addition, limited implant longevity and a lack of long-term functional outcomes data continue to restrain the widespread adoption of this technique. With increasing surgical confidence and experience levels of surgeons, complication rates are expected to reduce in the coming years. Some clinical studies from the past decade indicate a moderate reduction in complication rates. After adjusting for Constant-Murley scores lower than 30, 10-year survivorship decreased to 72%. With shoulder arthroplasty implants demonstrating long-term survival rates (over 15–20 years) of about 85%, there is increased impetus in the adoption of these procedures. With the younger population leading an active life, which can often include interest in sports involving the shoulder, there is an increased demand for treatments that bring pain relief and a long-lasting improvement in function. Even though patients with rotator cuff arthroplasty can be managed without surgery, the need for a higher quality of life continues to push patients towards opting for shoulder arthroplasty. Rehabilitation regimes, counseling, and education can help younger patients manage the non-intact cuff and live in moderate to low discomfort. Total shoulder arthroplasty continues to demonstrate positive results in young patients with adequate glenoid bone stock and healthy soft tissue, such as a functioning rotator cuff to help prevent misalignment of the glenoid component implant. In carefully selected young patients, this procedure has been able to offer successful results often preferable in the long term to a hemiarthroplasty or partial replacement procedure. Furthermore, with improvements in implant designs, including the availability of ultrashort stem implants and bone-preserving glenoid components, these procedures can be performed in a less invasive manner compared to traditional techniques. Also referred to as canal-sparing implants, stemless shoulder implants are designed for metaphyseal fixation to minimize humeral bone removal, avoid intraoperative and post-operative humeral fracture complications, and decrease morbidity associated with revision operations. Since stem-free arthroplasty implants have been available to surgeons worldwide for only a relatively short amount of time, there are few published studies evaluating this technique. In addition, no evidence of osteolysis, stress shielding, or radiolucent lines surrounding the corolla were present in their most recent post-operative radiographs. As indicated in their publication, the use of the stemless shoulder prosthesis yielded acceptable results which, at a mid-term follow-up, were comparable with those provided by a standard anatomical shoulder prosthesis. Additionally, the lack of metal in the ultra short stem designs reduces the risk of mid-shaft humerus fractures, which is a major concern in traditional shoulder implants. Given the increased satisfaction rates among young and active patients due to the preservation of native bones, reduced blood loss, and shorter procedure time, the demand for stemless arthroplasty is likely to increase at a rapid pace in the coming years. Increasing applications of reverse shoulder arthroplasty in musculoskeletal oncology indications aiding growth in total procedure volumes In recent years, there has been a significant increase in the number of indications for shoulder arthroplasty. Musculoskeletal oncology is one such emerging application for reverse shoulder arthroplasty, as the proximal humerus is the third most common site for the occurrence of bone tumors (Puri A, 2011). The incidence of soft tissue sarcomas and new bone and cartilage malignancies is approximately 1. A majority of the limb salvage procedures to manage such tumors are complicated and may require the sacrifice of the proximal humerus and the surrounding tissues to achieve tumor resection. Reverse shoulder arthroplasty has been able to demonstrate improved results and success rates in short-term studies. Use of trabecular metal technology in reverse shoulder arthroplasty implants driving procedural growth the use of trabecular metal implants in reverse shoulder arthroplasty has been on the rise over the past five years. The increased adoption rate is largely attributed to the fact that these implants have been able to consistently provide the initial stability necessary to achieve biological ingrowth, thus enabling long-term fixation over a wide range of bone properties. In a study published in the Journal of Shoulder and Elbow Surgery in 2013, Bogle et al. Zimmer’s Trabecular Metal Reverse Shoulder System has continued to demonstrate sustained penetration across global markets, helping their extremities business grow by 5% in 2014 over the previous year, prior to the completion of the merger with Biomet (Zimmer Annual Report, 2014). Overall cost-effectiveness of the procedure aiding adoption rates for total shoulder arthroplasty With increasing instances of revision arthroplasty, there has been an increased focus across hospitals to look for cost-effective measures in joint arthroplasty procedures. Re-admissions and additional hospital stays have also been adding to the overall burden. It is estimated that the cost of an extra day in hospital for a shoulder patient over 65 years of age is about $12,600 a day (Pfuntner A, 2013). A 2013 study of the cost utility for reverse shoulder arthroplasty determined that the procedure was moderately to highly cost effective. In a study published in the Journal of Shoulder and Elbow Surgery, Chalmers et al. Owing to its initial constrained design and lateralized glenohumeral center of rotation, the implant exerted excessive shear stress that led to the failure of the glenoid component. In acknowledgment of this design drawback, modern implants were designed to have a larger radius of curvature of the glenoid component and greater movement of the center of shoulder rotation, medially and distally. This helped in creating a more stable and efficient fulcrum that further reduced shear forces at the glenoid-bone interface. However, owing to high complication rates and the technically demanding nature of the procedure, successful outcomes with this procedure required experienced surgeons. With increasing exposure and better results, especially in the presence of rotator cuff deficiency, adoption of reverse shoulder arthroplasty has been increasing (Brian C, 2016). Exhibit 4-8 presents the global combined market forecast for shoulder arthroplasty implants by country/region for the years 2015 through 2020. Exhibits 4-9 through 4-14 present the market forecast for shoulder arthroplasty implants by individual countries for the years 2015 through 2020. Shoulder implant sales were driven by the uptake of Zimmer’s Trabecular Metal Reverse Shoulder System and Comprehensive Total Shoulder System. Wright Medical Group was the third largest supplier of shoulder arthroplasty implants globally. The Rest of the World segment includes product sales from Africa, the Middle East, Asia-Pacific, Europe, and North and South America and excludes product sales for Germany, France, Italy, the United Kingdom, Spain, Japan, and the United States.

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