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Introduction of back ground

This research is centered on HEC model in the long term care acute setting.  Long-term care acute is a hospital setting that cares for patients that are discharged from the acute hospital setting for extended medical and rehabilitative care those with various acute or chronic health problems. Acute care is a stem of secondary health care, where a patient obtains dynamic, yet temporary healing for a cruel damage or incident of sickness, an insistent medical state, or throughout recuperation from operation. In therapeutic terms, care for acute health situations, is the contrary of persistent care, or long-standing care.

Acute care examinations are normally executed by teams of health care experts from a selection of therapeutic and surgical spheres. Acute care might urges the patient for a stay in a hospital emergency division, ambulatory operation center, urgent care section or other temporary stay center, together with the aid of analytical services, operation, or record outpatient care within the society.Hospitals dealing with acute care naturally have the target of releasing patients, the moment they are considered to be well and secure. Acute care locales comprise but are not restricted to: emergency sector, intensive care division, coronary-heart care, cardiology unit, and numerous wide-ranging aspects where the patient might turn out to be intensely in poor health and need soothing and relocation to a different senior reliance division for advance treatment.

Most number of patients are elderly with preexisting health conditions.  Examples of diagnosis of the patients are HIV, diabetes, arthritis, Anarsaca, C-diff, MRSA, respiratory failure, pneumonia, cancer, wound infection, CHF and COPD just to mention a few.

Based on this setting the primary focus has been on the patient’s physical needs although it is acknowledged that the patient has emotional and spiritual components. The approach is of the treatment of disease, fixing a patients problem and focusing on the outcomes instead of looking at the patient as a whole. The health care system is currently struggling out of the medical paradigm. The medical paradigm has dominated in the health care system thereby crippling nursing to consider and focus its responsibilities from the medical stand point of view. It has been regarded as the only lens through which to view the care of patients (Zust, 2006).The paradigm of health is viewed as the absence of disease that has resulted to view those without health as inferior (Newman, 1999).  “The futility of always trying to make people well or prevent of their getting sick was transcended by this concept of health” (Picard & Jones, 2005, p.xiv)

Health as expanding consciousness can be applied to the long term care acute and different settings in the health care for those whose health without of disease is not possible. Health of all people is included regardless of the presence or absence of the disease (Newman, 2011). The nurse has a more holistic view of the client’s health experience (Newman, 1999).  

This research paper will discuss about the purpose of the HEC, the overview of the theory, the review of literature, the synthesis of the theory, the application of the model and conclusion.

Purpose of study

The purpose of this study is to provide an in-depth understanding of the HEC model and its application in the long term acute setting. The model is focused on the nurse and client relationship in examining and identifying client behavioral patterns. (The process of identifying the clients unfolding pattern). Nurses who embrace this theory are contributing to the significance of nursing theory and we will be discussed the significant rewards that can be attained using this model and will discuss how this relates to the patient through pattern recognition  and  could be used in the long term care setting . In addition, benefits realized by employing this model are discussed in relation to patients through pattern recognition in a LTC setting.  

The wholistic acceptance of the HEC model by nurses may lead to meaningful and transformative relationship between nurses and clients while ignoring the clients’ different views on health. Both the participating clients and nurses lives have been transformed due to the adoption of the HEC model.

The center of Newman’s theory of health as expanding consciousness sheds light on q surfacing channel for all health-oriented regulations. Through the pursuit for accepting the trend of health, this exceptional perception of health, defies nurses to create a distinction and an impression in nursing observation, via the submission of this premise.

Significance of purpose

Nurses may hold on to this unitary standpoint, and go through important transformative association with their customers, apart from each client’s opinion on health. The significance of nursing care and that knowledge of nursing are distinct from knowledge of medicine. The nurses who embrace health as expanding consciousness are contributing to nursing care. HEC has made a difference in the lives of the participating clients and also the lives of the nurses who are themselves transformed.   The impact of these HEC based care models have promoted patient comfort, enriched practice, increased nurse satisfaction, and promoted theory guided patient care.

• A human being in every circumstance, regardless of how chaotic and desperate, is a key entity of the collective method of expanding consciousness.
• The expanding consciousness depicts a practice, in which a person regains his actual self, as he acquires superior significance in his life and those around him.
• In an individual’s quest for him/her genuine self, the person’s consciousness expands to involve the concerns and benefits of those people surrounding him and everything else.
• Self-wakefulness might ultimately bring about recognition of one's self and one's conditions and restraints.
• With self-consciousness and self-approval, a thoroughly perception of one's status might overlay the route for an individual to employ into activities resulting in constructive development excellence.

Overview of the theory

Health as a Whole

Person as unitary being resulted in the new view of health that eliminates the view of health and disease as dichotomies. Health and disease are not separate entities (George, 2011). Health and illness should be viewed equally as expressions of the life process with the understanding of life process in its totality (Newman, 1999). Reconsideration of the synthesized view that incorporates disease as meaningful aspect of health means that health includes disease and disease includes health revealing a new concept of health as a pattern of the whole (Newman, 1999). Health as a pattern of a whole is consistent with the theory of implicate and explicate models. Implicate includes the unseen or basis of all things and explicate includes the tangible of our world, the things we can see, touch, hear, feel  which are so much real than the unseen that we think the explicate order is the primary but the opposite is true the implicate is the primary. The explicate arises periodically from the implicate like waves appearing and disappearing on the surface of the ocean. The explicate, whatever form it may take is temporary manifestation of a total undivided pattern. In the context of the theory of implicate order the manifest health, encompassing disease and non-disease can be regarded as the explication of the underlying pattern of person-environment (Newman, 1999). Observable phenomenon like body temperatures, blood pressure, heart rate, immune reactions, diet, exercise, family relations are explicate manifestations of the pattern of the whole. Viewing these manifestations as reflections of the underlying, dynamic pattern makes it possible for us to see the pattern of the whole and thereby begin to understand it, seeing health and illness as a unitary process, a fluctuating pattern of rhythmic phenomenon (Newman, 1999). Sickness can provide a kind of shock that reorganizes the relationship of the person’s pattern in a more harmonious way. For example, consider the function of a high fever or an emotional crisis, or the accident that occurs at a particular crucial time. These and other critical incidents may provide the shock that facilitates a jump from one pattern to another presumably at a higher level of organization. If disease is viewed as something negative to be avoided or eliminated, we may be ruling out the factor that can bring about the unfolding of the life process that the person is naturally seeking. Illness may accomplish for people what they secretly want but are not able to acknowledge even to themselves (Newman, 1999). The paradigm shift pattern is from treatment of symptoms to a search for patterns; from viewing pain and disease as negative to view that pain and disease are information; from seeing the body as a machine in good or bad refers to seeing the body as dynamic field of energy continuous with larger field, from seeing disease as an entity to seeing it as a process (Newman, 1999). Viewing disease as a manifestation of pattern can help people become aware of their pattern of person-environment interaction. The insight that is gained can be transforming, both for the person and for the family (George, 2011).

A New Paradigm of Health

Disease is viewed as the manifestation of health. To view disease as health dichotomous of polarized view of health and disease. Referring to the diagram it illustrated a new synthesized view. Disease fuses with its opposite, absence of disease, and non-disease and brings forth a new concept of health. This would mean that health includes disease and disease includes health (Newman, 2011). 

Concepts of HEC

Newman’s hypothesis reproduces a paradigm shift. Vital is the notion that sickness is not a different task; however is an element of a developing model of patient-setting interface. The four major concepts in nursing’s metaparadigm in health as an expanding consciousness are health, person, nursing and environment. Health as expanding consciousness is the pattern of the whole. Health includes disease and disease includes health resulting in a synthesis of disease and no disease. Disease is a meaningful aspect of health (Newman, 1999). Heath and disease are not separate entities but are “each reflections of the larger whole” (Newman, 199, p. 9). This wholeness cannot be gained or lost but the patterns of wholeness can take on different forms (Brown, 2011) Human or person are unitary with the environment with no boundaries and identified by their patterns. Human beings are open systems constantly interacting and evolving with each other and the environment. Human are continuously active in evolving their own pattern of the whole which is health (Newman, 2011). Humans are intuitive, affective and cognitive being more than the sum of their parts (George, 2011). Caring is a moral imperative for nursing and it reflects the whole of the person and requires one to be open. Without caring nursing does not occur (George, 2011). Environment is the universe of open systems interacting with person in an evolving pattern which is viewed as a process of expanding consciousness. It is also the pattern of consciousness (Newman, 1999).

Assumptions of HEC

Consciousness is the information of the pattern of the whole and further defined as informational capacity of a person to interact with the environment which can be seen in the quality and diversity of interactions between persons and their environment. Consciousness is not just something individual possess but individuals are consciousness but individual are consciousness as all matter is (Brown, 2011). Expanding consciousness is viewed as a process whereby a person becomes more of one self, finds greater meaning in life and reaches new connectedness with other people and the world in which they live (Brown, 2011). Pattern is a central aspect of nursing practice and research. Each person has a unique pattern of interaction between self and environment. Insight into patterns provides information of life meaning and understanding of the whole. Movement, space, time, and consciousness are a synthesis of pattern. The interaction between nurse-client processes for recognizing pattern that focuses on relationship, events, interaction and the meaning of these in people’s lives (Brown, 2011). Identifying and recognizing patterns opens new possibilities for action and expansion of consciousness. Pattern recognition is by the observer, the nurse relates and resonates with the client through periods of disequilibrium and chaos until a new rhythm emerges from the client center of consciousness leading into the identification of the old patterns leads to possibilities of new patterns or interaction and relationships that are indicative of expanding consciousness and therefore increasing health (Brown, 2011). Disorganization relates to change in pattern. Pattern becomes more highly organized as information increases though sometimes information such as illness does not fit into the existing pattern and pattern becomes less orderly, disorganized. Disorganization provides an indication that change is necessary. Disorganization and choice may lead to transformation which is change that occurs all at once rather than in a gradual and linear fashion (Newman, 1999). Disease is a process of life toward higher level of consciousness. Sometimes this process is smooth, pleasant or harmonious; other times it is difficult as in disease. Disease may be a way in which one gets in touch with his or her own pattern, it may provide an important disequilibrium in the growth process and therefore may be regarded as a facilitator of that process (Newman, 1999). Movement, time and space are merging patterns of consciousness that represent the person as a center of consciousness. Movement is a means whereby the space and time become a reality and therefore is a means of becoming aware of self. Time is a function of movement that relates the rhythm of living phenomenon. Time is the unbounded three-dimensional expanse in which all matter exists (Newman, 1999).

Literature Review

The theory of health as expanding consciousness branches from Rogers’ hypothesis of elementary individuals. Rogers’ suppositions as regards to the modeling of human beings in communication with the surroundings are essential to the perception that consciousness is a demonstration of a growing approach of contact between the person and his environment.

Consciousness is identified as the informational aptitude of the organism (in this case, the person); namely, the capacity of the structure to interrelate with his surroundings (Bentov, 1978).  Consciousness involves not merely the cognitive and emotional wakefulness usually linked to consciousness, however, as well the integration of the whole existing human life, which comprises physiochemical preservation and development progressions in addition to immunity.  This model of information, which is the consciousness of the individual, is a segment of a bigger, entire sample of a growing world.

Rogers’ perseverance that health and sickness are just expressions of the metrical vacillations of the life course is the groundwork for perceiving health and illness as an elementary process, progressing through differences in regular-irregular. From this point of view, one can no longer consider health and sickness in the dichotomous pattern described by medical science; i.e., health as nonexistence of illness or health as a range from wellbeing to illness. Health is the same as the developing model of consciousness.

An individual is defined by his/ her pattern, which reveals the model of the human being within the bigger model of the environment. The pattern is growing throughout diverse transformations of order/regular and disorder/irregular, counting what in daily talking is termed wellbeing and sickness. Pattern recognition surfaces from a course of detecting significance and meaning in a human’s existence. Meaning is intrinsic in pattern, and the other way round holds true.

David Bohm’s theory of actuality as unbroken entirety, maintains the perception of health and sickness being a whole process (Bohm, 1980). Bohm speculates an unobserved, core model, termed the associate order, as the chief order of realism. All the concrete objects of the universe are clarifications of the associate or implicate order. Illness, and all further evident expressions of individual operation, can be viewed as the explanation of the implicate or associate order. From this viewpoint, sickness is deemed a manifestation of the unity of the fundamental model, not a disconnected body. The observation of health as the growing pattern of the whole needs a non-disconnected universal recognition. Disease and healthiness are merely distinct perspectives of a bigger truth. They cannot be detached from the whole, but under a disconnected pattern of seeing them.

The state of affairs that takes a human being to the notice of a nurse, reflects a time in people’s life whenever the traditional regulations don’t any longer function, an occasion when a person should possess a preference. The mission is to hear how things operate, to determine the new set of laws, and to progress into a further stage of being, and consideration. Both Gregory Bateson (1979) and Arthur Young (1976) accentuated this charge, as the reason of existence. It represents the root of conditions, in which nursing can aid people in their quest for realization of the developing and rising pattern within and of their lives. A human circulates into phases of awareness, including the deprivation from freedom in the expansion of self-character, in anticipation of a defining moment (Young, 1976). At the moment, the aspects that held true and executed in the past, do not any longer function. What was measured as progress is not anymore deemed as evolution. It is at this juncture, that the purpose is to acquire the new regulations. There is an understanding of self-restraint that leads the makeover that makes it likely to surpass oneself in evolving consciousness. The affinity of the nurse-patient affiliation, smoothes the progress of this insight and change.

The conversion that takes place at the defining moment might be identified from the position of Ilya Prigogine’s theory of change (Prigogine, Allen & Herman, 1977). Prigogine declares that the customary variations of deterministic methods interrelate with likelihood occasions to produce a type of massive vacillation that thrusts the structure to a further, superior level of association and performance. Disarray and confusion exert a pressure on the living system, and is opposed by the structure. If the power of the variation is adequate, the system is urged to alter and penetrate a provisionally disordered state, into an upper order. Transformation happens when the human being deviates from balance. The action at the decisive end of the fluctuation has the prospective to go off in various directions, and it is not viable to recognize which path it will take. Sometime, one course triumphs over, and a new order is modeled. 

Movement during the stage of disturbance, ineffectiveness and indecision, is aided by the company of a caring and thoughtful other. Present research certifies the significance of a nurse’s compassionate affiliation with the customer or patient in permitting the progression of expanding consciousness to disclose.

• The physical condition of a human being is awhole aspect, a surfacing model of human-surroundings (Rogers, 1970).
• Existence is a course of expanding consciousness. Consciousness is the “informational capacity” of the human being, and can be perceived in the value of communication amongst the system and his environment (Bentov, 1978).
• The explicate order reflects a demonstration of the implicate order (Bohm, 1980).

Newman refers to Bentov (1978) as identifying consciousness “as the informational capacity of the system”, and affirmed, “this system has the capacity to interact with the environment” (Newman, 1999). The structure does not comprise of only reflection and expressive consciousness, but also embraces all the relational elements that subsist between an individual, involving the complete continuum of biochemical operations, and the “bigger, expanding model of the world” (Newman, 1999). Newman quotes Rogers’ perception that health and disease are enclosed within what is named a unitary or whole route, purely signifying that human beings are correlated to the larger universe (Newman, 1999). Health and disease are not anymore viewed or deemed as a facet of a range, and no longer disconnected.

Synthesis of the theory and the approach chosen

The Essentials of Master’s Education for Advanced Practice Nursing (American Association of Colleges of Nursing (AACN, 1996) authorizes that APNs (advanced practice nurse), counting NPs, employ conjectures from nursing and additional occupations in medical activity, and that concern stresses on the “whole of a person’s health and illness experiences” (AACN, 1996). By permitting “the nursing clinician to develop a comprehensive and holistic approach to healthcare” (AACN, 1996), APNs are guided to implement nursing theories in healthcare communities.

Margaret Newman’s nursing conjecture, Health as Expanding Consciousness (HEC), is suggested to direct primary care approach within this scheme. For those who are not acquainted with Newman’s theory, HEC needs a wider, more embracing perception, and less disconnected worldview to structure care. Opposite to the course of the biomedical pattern, Newman’s theory is not directed and focused on interference. Newman deems her theory as an addition of Martha Roger’s Science of Unitary Beings, which regards the “modeling of individuals in contact with the surroundings as necessary to the notion that consciousness is a demonstration of a developing model of person-environment interaction” (Newman).

Fawcett (2001), LoBiondo-Wood & Haber (2002), McEwen & Wills (2002), and Robinson & Kish (2002) categorize Newman’s conjecture as an impressive theory. Impressive theories are wide in compass, and all-inclusive to cover “all the perceptions that concern nurses–persons, environment, and health” (LoBiondo-Wood & Haber, 2002). Newman categorized her theory as a whole-transformative imposing theory. The theory presumes that individuals are: 1) Whole beings that cannot be identified by the total of their components; 2) Autonomous and self-developing; 3) Incorporated in and intermingling with the bigger power structure accepted as the universe; 4) Identified for their patterns of being, models of energy, and sharpness from others (Newman, 1992). The thought that strength is a higher condition of consciousness, and disease is a lower condition of illness is inappropriate.

One of the unique aspects of Newman’s theory is the expanded dimension of the ways that nurses, and in the case of this paper FNPs, can become aware of what it is that they really know, and how it is that they know. Newman (1995) wrote that beyond the knowing the client’s overall pattern is the process of “sensing into one’s own field”. The FNP is required to be aware of the internal experience and trust that the information being received in the moment is valid. When the clinician does this, what develops is an increased capacity to be part of the healing energy that is created within the intentional relationship. It is necessary to reflect on the meaning and choice within the particular relationship with openness and curiosity.

Inside HEC, the nurse-patient association is not divided or hierarchical; it is a corporation that urges the discovery of models that subsist for the human’s experiences, amongst them are the state of wellbeing and expanding consciousness.  Newman was inclined towards Teilhard de Chardin’s (1965) “belief that a person’s consciousness continues to develop beyond the physical life and becomes a part of the universal consciousness” (Newman, 1999). Thus, sickness does not weaken a human being. If consciousness prolongs after bereavement, it appears that consciousness does not stop to increase with ill health. Since the NP is a nurse, the NPs task involves aiding the customer to comprehend the largely growing patterns. Symptoms are elements of the general pattern, and also, HEC is not founded on the requirements or interference. Meaning, the NP assists the client to view him or herself further than merely his or her condition. The pattern of health is a fraction of a wider portrait of existence and awareness. A strong unique feature of the premise is that NPs and patients feel the fact of being altered or transformed through this method. The nurse employs the member (patient) in a conversation regarding occurrences that are indispensable to them, and the nurse produces an opportunity for “manifestation, consciousness, and probable insight” (Picard & Jones, 2005). Newman (1999) highlights that the traditional approach of nurse-patient affiliation was circulated around the thought that individuals are constituted of disconnected components of the biomedical structure. Mind, body, and soul are strongly associated and must not be deemed discretely from each other. (Hamric, Spross, & Hanson, 2000). Holism acknowledges that the person “is more than the sum of its parts” (Smuts, 1926), operates as a single unit inside of the larger world, and cannot be fragmented into fixed units (Hamric, et al., 2000; Smuts, 1926). Every human being is a unique, intricate system within the broader structures of family, society, and world. In the biomedical scheme, the clinician’s liability is to realize what is incorrectand to tackle the dilemma. When HEC directs activity, the aim is to comprehend what approach actually takes part, and involve the pattern as both clinician and patient expand consciousness. The standpoint realizes patient proficiency, and the significance of the sickness or health experience (Newman, 1999). Movement, deliberation, and pattern recognition are fundamental to attaining awareness.

Application of the model on my setting

The following is a case study by Margaret Newman. This case study accentuates and demonstrates what I have mentioned before in this section, as HEC model being vital for the long-term care setting. Even if a patient has got better and needed no more hospital, the nurse’s role is critical for his long-term assessment and welfare.

Case Study

John Castro, a 56-year-old white male, residing in Makati City,  with his beloved wife Chelsie. They have three adult children who live next to them. Mr. Castro is a heavy smoker and has suffered angina for the last several years. He is now off for the weekend after an exhausting  trip that he has had lately. His wife asks him to go to the store and get the necessary groceries in order for his wife to do him the food he prefers. John had to shovel the driveway before he kicks off to the store. While he was doing the shoveling, he started to feel a tightness in his chest, then the pain spread to his arm and jaw. Out of a sudden, his wife saw him collapsed and directly called 8888910. John had striked a “Choice Point”, and in order to hold up John while he is assessing his life, the nurse would supply appropriate information concerning nutrition and smoking  cessation and work with him to expand suitable changes.

The MI and near death experience had a great impact on John. He re-assessed his life and decided he had some major changes to  to execute. John began exercising, consuming healthier food, and he decided to refrain from smoking. John diminished the long runs he took so that he could get better sleep more frequently.

Nurses who form relationships with their clients can help them identify problematic patterns, move to a choice point, then to a higher level of consciousness, resulting in a reduction in problematic patterns of behavior.

Assessment

John : 57-year-old, white male, Hx of angina, Smoker, Truck Driver, Inactive lifestyle, Poor eating lifestyle, Poor sleeping lifestyle, wedded, with 3 grown-up children, resides in Makati (countryside area), Latest MI almost led to a probable death circumstance.

Plan

While valuing the patient’s choices, the nurse helps the patient in discovering resources for transformation. Argue with patient possible alterations to identify health lifestyles that are no longer operating and discuss new ways to correlate them. Work with patient, not make your mind up on behalf of the client.

Implement

Client will reveal enhanced nutrition habits by implementing Food guide to Healthy Eating. Client will display improved physical activity while exercising 25 minutes every single day. Client will show better sleeping habits by resting at least 8hours/night. Client will express suitable employment of Nitro-glycerin, by keeping hold of a usable bottle continually. Client will initiate a smoking cessation plan.

Evaluation

The nurse checks up the patient’s changed connection, and how communication surmounted relationship and how the communication surmounted the health test. Client has shown enhanced nutrition lifestyle. Client has boosted physical activity. Client has proven ameliorated sleeping habits. Client has furthermore shown proper exploitation of Nitro-glycerin. Client has initiated a smoking termination. A novel acceptance has evolved on how his surroundings associate with his health.

HEC practice is not focused on simply treating disease, but rather on attending to how the current situation fits into the patient’s evolving pattern of interaction with that which is meaningful to her or him, and how the patient chooses to move forward. It attends to the whole of a person’s experience and being. It centers on recognizing life patterns. HEC practice gives insight not only to individual life patterns, but also to the pattern of the community interacting with the individual. Caring in the HEC perspective is nonjudgmental, noninterventionist, and involves being with rather than just doing for. It is caring in its deepest, most respectful sense

The theory of health as expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible. Nurses often relate to such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness. The theory has progressed to include the health of all persons regardless of the presence or absence of disease. The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness – a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world.

Nurses practicing within this perspective experience the joy of participating in the expanding process of others and find that their own lives are enhanced and transformed. Pattern recognition is central to both research and practice, which reflects a hermeneutic, dialectic praxis approach (George, 1995).

Summary and conclusion

Clarity
Semantic precision is apparent in the descriptions, explanations, and dimensions of the theory notions.
Simplicity
The more profound connotation of the theory of health as expanding consciousness is composite. The entire theory must be comprehended, not just the remote notions. If a person desired to exploit a positivist practice, Newman’s original suggestions would provide massive insights, as guides for theory progress. Nevertheless, investigators who tested that approach have decided that it is insufficient to scrutinize the theory. As Newman has supported in the 1994 publication of her book, Health as Expanding Consciousness, the holistic method of the hermeneutic dialectic approach is reliable with the theory and necessitates a significant level of consideration of the theory in observation (Tomey, 2006).

Generality
The notions in Newman’s theory are wide in range, since they all involve health. The theory has been implemented in quite a few diverse civilizations, and is appropriate across the continuum of nursing care conditions. This makes her hypothesis comprehensive.

Empirical Precision
In the early phases of expansion, facets of the theory were employed and tested in an old scientific method. Nevertheless, quantitative methods are insufficient in confining the active, changing environment of this conjecture.

Derivable Consequences
The center of Newman’s theory of health as expanding consciousness generates an evolving direction for all health-oriented controls. In the pursuit for comprehension of the trend of health, this exclusive perception of health, challenges nurses to deploy some distinction in nursing activity via the implementation of this theory.

The nurse's task is to realize the people’s exceptional pattern of life, and to operate within that model with the individual to attain the person's objectives (Weingourt, 1998).

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