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  • 1. Alasiry, Sharifa
    et al.
    Löfvenmark, Caroline
    Sophiahemmet University.
    Nurses' perceptions of pain assessment and pain management for patients with myocardial infarction in a coronary care unit2013In: Middle East Journal of Nursing, ISSN 1834-8750 (e-ISSN), 1834-8742 (print), Vol. 7, no 5, p. 9-22Article in journal (Refereed)
    Abstract [en]

    Background: Pain is one of the most common medical problems that occur in hospitals; in spite of its incidence, there are many patients who suffer with untreated pain. Unrelieved pain can negatively impact a person's quality of life, causing activity life disturbances like psychological distress; anxiety, depression and lack of sleep. Cardiovascular disorder is a significant global health problem, which accounts for the death of a third of people of the world. Chest pain is the most common symptom of heart attacks. However, some patients will present with pain in other areas like pain in arm, shoulder, neck, teeth, jaw and back pain. In literature there is little observational research to investigate actual pain assessment and management practices of critical care nurses in routine clinical practice for patients with myocardial infarction. Aim:The aim of this study was to explore nurses' perceptions regarding pain assessment and pain management for patients with Myocardial Infarction in a coronary care unit.

    Methodology: The study was a qualitative design, using semi structured interviews. Ten critical care nurses who work in a coronary care unit were interviewed. The author used a qualitative content analysis approach to analyze the interviews by doing the manual analyzing and having different themes.Result: Three main themes were indentified in this study and each theme had different categories which are presented as the following: Dealing with patients who have myocardial infarction pain is challenging; there are different approaches in pain assessment including subjective and the third theme is Holistic approaches to pain management.

    Conclusion: Critical care nurses need more skills and knowledge to practice good pain assessment and effective pain management when they deal with patients who have myocardial infarction pain. In this study patients who do not verbalized their pain lack the proper assessment of pain due to inability to communicate their pain. More research is needed in this area of pain assessment and management especially for patients with myocardial infarction.

  • 2. Lachmann, Hanna
    et al.
    Löfvenmark, Caroline
    Sophiahemmet University.
    Academic emotions and attitudes regarding interprofessional collaboration in health care activities: A prospective study among newly arrived physicians participating in a fourteen-week course2023In: BMC Medical Education, E-ISSN 1472-6920, Vol. 23, article id 643Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: One way of facilitating entrance into the Swedish health care system, for newly arrived physicians from outside the European Union/European Economic Area, could be to set up and offer a course aimed to enhance understanding of it. This course was offered to increase insight about clinical practices, interprofessional teamwork and topics such as, Swedish health care laws, culture, and ethics. Acceptance of, and a flexible attitude towards, interprofessional teamwork are important for maintaining both the physician's professional identity and a high quality of patient care. The aim of this study was to investigate newly arrived physicians', academic emotions, experience of stress and flow during a fourteen-week course, as well as attitudes to interprofessional collaboration, both before and after.

    METHOD: A prospective study was conducted, with participants asked to respond on one questionnaire every course day, by using the Contextual Activity Sampling System methodology. The participants were asked to complete a questionnaire comprising ten questions about ongoing activity and in what way they experience, e.g., collaboration, interprofessional teamwork, academic emotions, flow, and stress. Furthermore, the participants were asked to score their attitude towards interprofessional teamwork by using the interdisciplinary education perception scale both before and after the course.

    RESULTS: The total sample comprised 27 qualified physicians, from outside the European Union/European Economic Area. In the interdisciplinary education perception scale category, "perception of actual cooperation¨, the participants had significantly higher scores after the course. Flow and academic emotions were felt mostly during own periods of study, seminars, and lectures. The academic emotions were apathy, anxiety, and boredom. The most frequently experienced academic emotion was apathy. Course participants rated stress highest in connection with the examination.

    CONCLUSION: The results show that the course had a positive impact on the participants perception of actual cooperation. It appears that participating in this kind of course was a positive experience for the participants, since they mostly experienced high levels of flow. Collaborating with others was experienced as positive, with participants reporting a high degree of flow in activities during collaboration.

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  • 3. Lederman, Jakob
    et al.
    Lindström, Veronica
    Elmqvist, Carina
    Löfvenmark, Caroline
    Sophiahemmet University.
    Djärv, Therese
    Non-conveyance in the ambulance service: A population-based cohort study in Stockholm, Sweden2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 7, article id e036659Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Non-conveyed patients represent a significant proportion of all patients cared for by ambulance services in the western world. However, scientific knowledge on non-conveyance is sparse. Therefore, the aim of this study was to describe the prevalence of non-conveyance, investigate associations and compare patients' characteristics, drug administration, initial problems and vital signs between non-conveyed and conveyed patients.

    DESIGN: A population-based retrospective cohort study.

    SETTING: The study setting area, Stockholm, Sweden, has a population of 2.3 million inhabitants, with seven emergency hospitals. Annually, approximately 210 000 assignments are performed by 73 ambulances. All ambulance assignments performed from 1 January to 31 December 2015 were included.

    RESULTS: In total, 23 603 ambulance assignments ended in non-conveyance-13.8% of all ambulance assignments performed in 2015. Compared with conveyed patients, non-conveyed patients were younger and more often female (median age 50.1 years for non-conveyed vs 61.7 years for conveyed; female=52 %, both p values <0.001). Approximately half of all ambulance assignments ending in non-conveyance were initially prioritised and dispatched as the highest priority. Non-conveyed patients were more often assessed by ambulance clinicians as presenting non-specific symptoms or symptoms related to psychiatric problems. Low blood glucose levels were highly associated with non-conveyance (adjusted OR (AOR): 15; 95 % CI 11.18 to 20.13), although non-conveyed patients presented abnormal vital signs across all categories of vital signs. Moreover, drugs were more often administered to younger non-conveyed patients. Older patients were more often conveyed and administered drugs once conveyed (AOR: 1.29; 95 % CI 1.07 to 1.56).

    CONCLUSIONS: This study shows that non-conveyed patients represent a non-negligible proportion of all patients in contact with ambulance services. In general, most cases of non-conveyance occur at the highest dispatch level, to a large extent involve younger patients, and features problems assessed by ambulance clinicians as non-specific or related to psychiatric symptoms.

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  • 4. Lederman, Jakob
    et al.
    Lindström, Veronica
    Elmqvist, Carina
    Löfvenmark, Caroline
    Sophiahemmet University.
    Ljunggren, Gunnar
    Djärv, Therese
    Non-conveyance of older adult patients and association with subsequent clinical and adverse events after initial assessment by ambulance clinicians: A cohort analysis2021In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 21, no 1, article id 154Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Older adults (age ≥ 65 years) represent a significant proportion of all patients who are not transported to hospital after assessment by ambulance clinicians (non-conveyed patients). This study aimed to fill the knowledge gap in the understanding of the prevalence of older adult non-conveyed patients and investigate their characteristics and risk factors for subsequent and adverse events with those of younger non-conveyed patients comparatively.

    METHODS: This population-based retrospective cohort study included all adult non-conveyed patients who availed the ambulance service of Region Stockholm, Sweden in 2015; they were age-stratified into two groups: 18-64 and ≥ 65 years. Inter-group differences in short-term outcomes (i.e. emergency department visits, hospitalisations, and mortality within 7 days following non-conveyance) were assessed using multivariate regression analyses.

    RESULTS: Older adult patients comprised 48% of the 17,809 non-conveyed patients. Dispatch priority levels were generally lower among older non-conveyed patients than among younger patients. Non-conveyance among older patients occurred more often during daytime, and they were more frequently assessed by ambulance clinicians with nonspecific presenting symptoms. Approximately one in five older adults was hospitalised within 7 days following non-conveyance. Patients presenting with infectious symptoms had the highest mortality risk following non-conveyance. Oxygen saturation level < 95% or systolic blood pressure > 160 mmHg had significantly higher associations with hospitalisation within 7 days following non-conveyance in older adult patients.

    CONCLUSIONS: Older adult patients have an increased risk for adverse events following non-conveyance. In combination with a complex and variating presentation of symptoms and vital signs proved difficult for dispatch operators and ambulance clinicians to identify and assess, the identified risks raise questions on the patient safety of older adult non-conveyed patients. The results indicate a system failure that need to be managed within the ambulance service organisation to achieve higher levels of patient safety for older non-conveyed patients.

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  • 5. Lederman, Jakob
    et al.
    Löfvenmark, Caroline
    Sophiahemmet University.
    Djärv, Therese
    Lindström, Veronica
    Elmqvist, Carina
    A phenomenological interview study with patients being non-conveyed in the ambulance service2023In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 23, article id 30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Non-conveyed patients (i.e. patients who are not transported to a hospital after being assessed by ambulance clinicians) represent a significantly increasing proportion of all patients seeking ambulance care. Scientific knowledge about patients' non-conveyance experiences is sparse. This study describes the lived experiences of non-conveyed patients in an ambulance care context.

    METHODS: A reflective lifeworld research (RLR) approach founded on phenomenology is used. Data is derived from nine in-depth interviews with patients not conveyed by the ambulance service in a major Swedish region.

    RESULTS: Patients' lived experiences of becoming acutely ill or injured and not conveyed by ambulance to a hospital are characterised by several dynamic movements: losing and regaining situational and bodily control, dependence and autonomy, external competence and inner knowledge, handing over and regaining responsibility, and fear and security.

    CONCLUSIONS: Patients' lived experiences of non-conveyance are complex and versatile. Although non-conveyed patients initially experience strong fear and the loss of situational and bodily control, they gradually feel more secure when experiencing confirmation and trust, which evolves into insecurity and uncertainty. The non-conveyance situation's complexity from a patient's perspective implies the need for ambulance organisations to take measures to prevent further suffering. Non-conveyed patients must be taken seriously in their unique situations, requiring ambulance clinicians to reflect and act with a conscious ethical perspective before, during and after their visit.

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  • 6. Lederman, Jakob
    et al.
    Löfvenmark, Caroline
    Sophiahemmet University.
    Djärv, Therese
    Lindström, Veronica
    Elmqvist, Carina
    Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 9, article id e030203Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To combat overcrowding in emergency departments, ambulance clinicians (ACs) are being encouraged to make on-site assessments regarding patients' need for conveyance to hospital, and this is creating new and challenging demands for ACs. This study aimed to describe ACs' experiences of assessing non-conveyed patients.

    DESIGN: A phenomenological interview study based on a reflective lifeworld research approach.

    SETTING: The target area for the study was Stockholm, Sweden, which has a population of approximately 2.3 million inhabitants. In this area, 73 ambulances perform approximately just over 200 000 ambulance assignments annually, and approximately 25 000 patients are non-conveyed each year.

    INFORMANTS: 11 ACs.

    METHODS: In-depth open-ended interviews.

    RESULTS: ACs experience uncertainty regarding the accuracy of their assessments of non-conveyed patients. In particular, they fear conducting erroneous assessments that could harm patients. Avoiding hasty decisions is important for conducting safe patient assessments. Several challenging paradoxes were identified that complicate the non-conveyance situation, namely; responsibility, education and feedback paradoxes. The core of the responsibility paradox is that the increased responsibility associated with non-conveyance assessments is not accompanied with appropriate organisational support. Thus, frustration is experienced. The education paradox involves limited and inadequate non-conveyance education. This, in combination with limited support from non-conveyance guidelines, causes the clinical reality to be perceived as challenging and problematic. Finally, the feedback paradox relates to the obstruction of professional development as a result of an absence of learning possibilities after assessments. Additionally, ACs also described loneliness during non-conveyance situations.

    CONCLUSIONS: This study suggests that, for ACs, performing non-conveyance assessments means experiencing a paradoxical professional existence. Despite these aggravating paradoxes, however, complex non-conveyance assessments continue to be performed and accompanied with limited organisational support. To create more favourable circumstances and, hopefully, safer assessments, further studies that focus on these paradoxes and non-conveyance are needed.

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  • 7.
    Lindberg, Elisabeth
    et al.
    Sophiahemmet University.
    Löfvenmark, Caroline
    Sophiahemmet University.
    Sjuksköterskors uppfattningar om patienter från andra kulturer2002Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 8.
    Löfvenmark, Caroline
    Sophiahemmet University.
    Living with heart failure: effects of an educational programme on patients and family members2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Chronic heart failure (CHF) is a syndrome with various underlying causes and when an individual is diagnosed with CHF it affects daily life of both him/her and family members. An educational programme may have the capability to increase the knowledge and understanding of family members and improve their possibility to support the patient with CHF. In paper I the aim was to investigate perceived loneliness and social support in 149 patients with CHF and whether there was an association with gender, age, health care utilization and mortality. Loneliness was reported by 20% of the patients, who were younger and more often women. Those who perceived loneliness had fewer social contacts and emotional contacts and were less satisfied with close relationships and available social contacts. Despite not having more severe CHF, those feeling loneliness had more days in hospital and more readmissions during 12 months. In paper II and III 128 family members of patients with CHF were randomly assigned to an intervention group (IG) who received a multi-professional educational programme or to a control group (CG) receiving routine ward information. Family members filled in questionnaires three times during one year. Aim of paper II was to investigate if diseaserelated knowledge increased in family members through the educational programme and if there was an effect on healthcare utilization of the patient with CHF. Findings showed that disease-specific knowledge increased significantly in both groups from baseline and at second measurement and remained at third measurement. Family members in the IG had significantly higher knowledge at second and third measurement compared to family members in the CG. Frequency of readmission or number of days hospitalised during 18 months did not differ between the groups. In paper III the primary aim was to investigate if quality of life (QoL), anxiety and depression were affected in family members after attending an educational programme. The secondary aim was to investigate the impact of social support, family and patient related variables and sense of coherence on changes in QoL, anxiety and depression during the study period. Findings showed no significant differences in QoL, anxiety and depression between IG and CG due to the education. Adequacy of social network and baseline measurement of anxiety and depression predicted anxiety and depression at third measurement. Baseline measurement of QoL and family member‘s age were predictors for QoL at third measurement. Younger family members had higher QoL. In paper IV the aim was to describe family members’ experiences of attending an educational programme. Eleven family members were interviewed. Three main categories emerged: “making the disease comprehensible” deals with increased knowledge among family members and thereby attaining greater understanding of the person with CHF; “increasing involvement” comprises family members’ self-confidence and ability to become a resource for the ill person; “influencing family members’ wellness” deals with the positive experience of meeting others in the same situation and the importance of taking care of themselves. Several of the family members would have preferred to attend the education with the person with CHF. In conclusion Perceived loneliness in patients with CHF was most common among women and younger persons, and was associated with health care utilization, social network and support. The implemented educational programme for family members of patients with CHF seemed to have a subjectively experienced positive effect. The family members had increased knowledge, confidence and understanding of the disease, which made it easier for them to support the patient in their self-care management. The educational programme did not affect levels of QoL, anxiety and depression in family members nor health care utilization of the patients

  • 9.
    Löfvenmark, Caroline
    et al.
    Sophiahemmet University.
    Billing, Ewa
    Edner, Magnus
    Mattiasson, Anne-Cathrine
    Evaluation of an educational programme for family members of patients living with chronic heart failure2015Conference paper (Other academic)
  • 10.
    Löfvenmark, Caroline
    et al.
    Sophiahemmet University.
    Billing, Ewa
    Edner, Magnus
    Mattiasson, Anne-Cathrine
    Family members' experience of a group-based multi-professional educational programme about chronic heart failure2015In: Clinical Nursing Studies, ISSN 2324-7940 (Print) 2324-7959 (ESSN), Vol. 3, no 3, p. 9-16Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to evaluate how family members of persons with chronic heart failure (CHF) experienced a group-based multi-professional educational programme.Methods: Family members who participated in an educational programme filled in an evaluation form directly after completing the programme (n = 53). One year after the completed programme family members (n = 11) who participated in 5-6 of six sessions were interviewed about their experience. The interviews were analysed by qualitative content analysis. Results: The evaluation form showed that most family members reported satisfaction with session structure and content, but a majority would have preferred to share the education together with the ill person. Interview findings are presented in three categories and eight subcategories identified through the analysis. Results showed that family members’ increased knowledge about heart failure and thereby attained a greater understanding of the ill person’s situation with an increased tolerance. Furthermore the family members acquired a better self-confidence and became a resource for the ill person and they described that they were more actively involved in the ill person’s self-care. Family members experienced it positive to meet others in the same situation. They also gained an insight into the importance of taking care of their own health. Conclusions: The educational programme produced valuable knowledge and understanding about heart failure among family members. With this newly acquired knowledge, family members had the possibility of working out appropriate support for the ill person. Being part of a group with others in the same situation was a positive experience.

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  • 11.
    Löfvenmark, Caroline
    et al.
    Sophiahemmet University.
    Mattiasson, Anne-Cathrine
    Sophiahemmet University.
    Billing, Ewa
    Edner, Magnus
    Perceived loneliness and social support in patients with chronic heart failure2009In: European Journal of Cardiovascular Nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, ISSN 1873-1953, Vol. 8, no 4, p. 251-8Article in journal (Refereed)
    Abstract [en]

    Self-reported conditions have become increasingly important in patient care, and perceived loneliness and social relationships in patients with chronic heart failure (CHF) are not sufficiently investigated. AIM: The aim was to investigate perceived loneliness and social support in patients with CHF. Further, to investigate whether loneliness and social support might be associated with gender, age, healthcare utilization and mortality. METHODS: One hundred and forty nine patients with CHF, hospitalised at least once during a 4-month period in 2006, completed a self-reported questionnaire including measurements about loneliness and social support. Healthcare utilization was assessed prospectively by frequency of readmissions and number of days hospitalised during 1 year. RESULTS: Loneliness was reported by 29 (20%) participants. They were more often women (p<0.001) and younger (p=0.024). Patients who perceived loneliness had fewer social contacts (p=0.033), reported lower occurrence of emotional contacts (p=0.004), were less satisfied with social contacts and close relationships (p<0.001). Those reporting loneliness had more days hospitalised (p=0.044), and more readmissions to hospital (p=0.027), despite not having more severe CHF. CONCLUSION: Loneliness is a health-related risk indicator in that patients with CHF who perceived loneliness have more healthcare utilization than those who do not report loneliness despite not having more severe CHF.

  • 12.
    Löfvenmark, Caroline
    et al.
    Sophiahemmet University.
    Rydell Karlsson, Monica
    Sophiahemmet University.
    Edner, Magnus
    Billing, Ewa
    Mattiasson, Anne-Cathrine
    A group-based multi-professional education programme for family members of patients with chronic heart failure: effects on knowledge and patients' health care utilization2011In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 85, no 2, p. e162-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim was to investigate if family members of patients with chronic heart failure (CHF) increased knowledge about CHF through a group-based multi-professional educational programme and whether there was an effect on patients' health care utilization. METHODS: Family members (n=128) were randomly assigned to intervention-group (IG) who received CHF education programme or control-group (CG) who received information according to hospital routines. Programme effects were evaluated with CHF knowledge questionnaire, patient readmissions and number of days hospitalised during 18 months. RESULTS: Knowledge about CHF increased in both groups, significantly higher in IG at second assessment (IG 16±1.9 vs. CG 14.9±2.1, p=0.006), and knowledge maintained at third assessment. In IG 17 patients were re-admitted at least once and 28 patients in CG due to CHF (p=0.085). There were no differences in frequency of readmissions or number of days hospitalised. CONCLUSION: A group-based multi-professional education programme increased family members' knowledge about CHF. Despite this, effect on patient's health care utilization could not be seen during follow-up period. PRACTICAL IMPLICATIONS: We suggest that CHF education programmes for family members should be provided at clinics, with information preferably repeated 2-3 times during a period of six months to maintain knowledge level.

  • 13.
    Löfvenmark, Caroline
    et al.
    Sophiahemmet University.
    Saboonchi, Fredrik
    Sophiahemmet University.
    Edner, Magnus
    Billing, Ewa
    Mattiasson, Anne-Cathrine
    Evaluation of an educational programme for family members of patients living with heart failure: a randomised controlled trial2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 1-2, p. 115-126Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. Background.  When a person is diagnosed with heart failure, the daily life of the family members is also affected. Design.  Randomised controlled trial. Methods.  A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used. Results.  There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R(2)  = 0·35) and depression (p = 0·021, R(2)  = 0·37). Younger family members were found to have a higher quality of life (p < 0·01). Conclusion.  Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. Relevance to clinical practice.  Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.

  • 14. Söderberg, AnneCharlotte
    et al.
    Rydell Karlsson, Monica
    Sophiahemmet University.
    Löfvenmark, Caroline
    Sophiahemmet University.
    Upplevelse av trygghet och otrygghet bland patienter med hjärtsvikt som får avancerad vård i hemmet: Experience of security and insecurity among patients with heart failure in advanced home care2015In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 35, no 4, p. 203-209Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this study was to describe the experience of security and insecurity in patients with chronic heart failure who were treated by Advanced Home Care (AHC) in a city in Sweden.

    Background It is common for patients with heart failure to have frequent readmissions to hospital due to deterioration. The patients have various symptoms such as breathing problems, oedema and fatigue. Being cared for by AHC has become more common for patients with heart failure to reduce deterioration of heart failure and prevent hospitalization.

    Method A qualitative method with semi-structured interviews was used. Eight patients with heart failure participated in the study. The interviews were analysed by content analysis.

    Findings Three categories were identified: ‘home care’, ‘the social network’ and ‘internal and external resources’.

    Conclusion The experience was complex and depended on several factors both within and outside the health care situation. The need for access to a multidisciplinary team was great and it was important that the nursing staff had time to listen. It was important that the care had focus on the patient’s perspective to create security and avoid insecurity.

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