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Implications of philosophical pragmatism for nursing: Comparison of different pragmatists. 哲学实用主义对护理的影响:不同实用主义者的比较。
IF 2.2 3区 医学 Q1 NURSING Pub Date : 2023-01-01 DOI: 10.1111/nup.12414
Naoya Mayumi, Katsumasa Ota

Pragmatism emphasizes practical consequences and empirical explanations rather than introspective contemplations. However, the arguments of pragmatists are not uniform, as shown by the four prominent pragmatists presented in this article. The major difference between them is that Peirce and Haack acknowledge an objective truth, whereas James and Rorty do not. Thus, for a fuller understanding of the pragmatist view of our knowledge, both camps must be consulted. In the nursing field, pragmatism is occasionally referred to as a guiding philosophy. However, the influence of James and Rorty has been greater than that of Peirce and Haack on pragmatists, which may risk leading to a skewed understanding of pragmatism by nursing scholars. Still, the four pragmatists share naturalism, which rejects a metaphysics that defines the nature of knowledge before our enquiry and emphasizes experience and practice. Pragmatic naturalism can help ensure that nursing theory does not deviate from clinical practice. This article also explores the broad adaptability of the ideas of all four pragmatists to philosophical issues in nursing, such as mixed-methods research, epistemic relativism and realism. By showing that pragmatism can be relevant and stimulating to each of these topics, the article demonstrates that the different approaches to pragmatism can provide more inspiration for nurses and nursing researchers in the future.

实用主义强调实际的结果和经验的解释,而不是内省的思考。然而,实用主义者的观点并不统一,本文介绍的四位著名的实用主义者就表明了这一点。他们之间的主要区别在于,皮尔斯和哈克承认客观真理,而詹姆斯和罗蒂则不然。因此,为了更充分地理解实用主义对我们知识的看法,必须咨询这两个阵营。在护理领域,实用主义有时被称为指导哲学。然而,詹姆斯和罗蒂对实用主义者的影响比皮尔斯和哈克更大,这可能会导致护理学者对实用主义的误解。尽管如此,这四位实用主义者都认同自然主义,拒绝在我们探究之前定义知识本质的形而上学,强调经验和实践。实用自然主义可以帮助确保护理理论不偏离临床实践。本文还探讨了所有四位实用主义者的思想对护理哲学问题的广泛适应性,例如混合方法研究,认识论相对主义和现实主义。通过展示实用主义可以与这些主题相关和刺激,文章表明实用主义的不同方法可以为护士和护理研究人员在未来提供更多的灵感。
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引用次数: 1
'Sono solo parole': Facing challenges entailed in developing and applying terminologies to document nursing care. “Sono solo parole”:面临开发和应用术语来记录护理的挑战。
IF 2.2 3区 医学 Q1 NURSING Pub Date : 2023-01-01 DOI: 10.1111/nup.12383
Cecilia Malabusini

Nurses' need to document activities is urgent. The panorama of available terminologies is heterogeneous. It seems necessary to understand the premises of available tools and their limits and benefits to make conscious choices and shape future development. Taxonomies (e.g., North American Nursing Diagnosis Association) and 'pure terminologies' (e.g., International Classification for Nursing Practice), or nursing languages, are available tools to document nurses' activities and to produce theoretical models or reference systems. These tools respond first to a practical problem: 'translating' nursing facts into linguistic descriptions. Taxonomies make reality describable through exhaustive definitions designed inductively. Thus, I argue that their philosophical basis is naïve semantics. Their framework is a closed hierarchy, that is, a system that provides defined levels of concepts, structured through dichotomous rules. This causes the problem of determining boundaries between concepts, and thus between phenomena, which I call the problem of 'closing the concept enclosure'. Rigid metaphysical structures are unable to cope with the complexity of phenomena that nurses deal with, so they seem to be unable to describe them. I follow Wittgenstein's argument, from Philosophical Investigations, which is useful to understand this challenge: the definition of terms is not a problem of lack of suitable words or an agreed decision, but is achieved by training in practice. Pure terminologies give us another way to address the question. They are usually composed of a glossary of terms, paired with rules to combine them to manage meaning. They are more like natural language and this implies adapting more to phenomena. Then, I argue that their philosophical background is a pragmatic approach to language, and I discuss some consequences and objections. Finally, I find that the development of pure terminologies rather than taxonomies in documenting nursing activities allows us to achieve key objectives, such as improving nursing visibility and measurability in health records, without jeopardising person-centred care.

护士迫切需要记录活动。可用术语的全景是异构的。似乎有必要了解可用工具的前提及其限制和好处,以便做出有意识的选择和塑造未来的发展。分类(如北美护理诊断协会)和“纯术语”(如国际护理实践分类)或护理语言是记录护士活动和产生理论模型或参考系统的可用工具。这些工具首先回应了一个实际问题:将护理事实“翻译”成语言描述。分类法通过归纳设计的详尽定义使现实可描述。因此,我认为他们的哲学基础是naïve语义学。它们的框架是一个封闭的层次结构,也就是说,它是一个提供定义了的概念层次的系统,通过二分规则进行结构化。这就导致了概念之间以及现象之间边界的确定问题,我称之为“关闭概念圈地”的问题。僵化的形而上学结构无法处理护士处理的复杂现象,因此他们似乎无法描述这些现象。我遵循维特根斯坦(Wittgenstein)在《哲学研究》(Philosophical Investigations)中的观点,这对理解这一挑战很有用:术语的定义不是缺乏合适的词汇或一致的决定的问题,而是通过实践训练实现的。纯术语为我们提供了另一种解决问题的方法。它们通常由术语表组成,并搭配规则将它们组合起来以管理意思。它们更像是自然语言,这意味着要更多地适应现象。然后,我认为他们的哲学背景是一种实用主义的语言方法,我讨论了一些后果和反对意见。最后,我发现在记录护理活动时,发展纯粹的术语而不是分类法使我们能够实现关键目标,例如提高健康记录中的护理可见性和可测量性,而不会危及以人为本的护理。
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引用次数: 0
Understanding and formation-A process of becoming a nurse. 理解与形成——成为护士的过程。
IF 2.2 3区 医学 Q1 NURSING Pub Date : 2023-01-01 DOI: 10.1111/nup.12387
Ann-Helén Sandvik, Yvonne Hilli

Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this 'understanding' in clinical education is and how it is promoted in clinical nursing education becomes important to clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third-year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding-based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding-based, interpretative education in nursing.

护理是一个复杂而多方面的职业,对护理专业的学生提出了很高的要求。在今天的教育中,强调的往往是知识和技能,也就是认识论。在关怀科学中寻求另一种方法,一种基于人文科学的方法,其中知识将服务于更深刻的理解,即本体论。因此,临床教育中的这种“理解”是什么,以及如何在临床护理教育中促进它的问题变得很重要。因此,本研究的目的是阐明即将毕业的护理本科三年级学生在临床教育中的理解现象。本研究采用解释学方法,基于对护理本科学生焦点小组访谈的二次分析。原始材料的分析扩展提出了三个相互关联的主题,阐明了临床教育中的理解现象。这些发现通过哲学抽象得到深化和丰富。在理解过程中,知识、技术和实践可以被视为护理思想结构的固有部分。本研究提出的视角,为临床教育中认识现象及其在形成和成为的动态过程中的意义和意义增添了新的视角。临床护理教育的重点应该放在学习反思、批判性思维和成为一名护士的方式上,而不是在特定的技能上训练学生。在瞬息万变的21世纪,以理解为基础的教育是一种更有意义、更真实的教育方式。因此,建议护理教育的本体论转向,即主要焦点从传统的认识论转向为本体论服务的认识论。进一步的研究需要在发展和实施理解为基础的,解释教育护理。
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引用次数: 3
Competency frameworks, nursing perspectives, and interdisciplinary collaborations for good patient care: Delineating boundaries. 能力框架,护理观点和跨学科合作,为良好的病人护理:划定界限。
IF 2.2 3区 医学 Q1 NURSING Pub Date : 2023-01-01 DOI: 10.1111/nup.12402
Maya Zumstein-Shaha, Pamela J Grace

To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. These are some of the reasons behind current movements to develop competency frameworks that can enhance cross-disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care.

为了在现代医疗保健中存在的不可避免的复杂性条件下加强患者护理,医疗保健专业人员之间的协作至关重要。虽然每个职业对人类医疗保健需求的本质都有自己的主要关注点和观点,但仅凭这些不足以满足患者(和潜在患者)的复杂需求。个人不可避免地是情境实体,与其环境不可分割,并受到体制和社会障碍的影响,这些障碍可能减损良好护理或获得医疗保健的机会。这些是当前发展能力框架的一些原因,这些框架可以增强跨学科的沟通和协作。没有哪一种职业可以独揽全局。有效的团队合作是必不可少的,它要求不同职业的成员了解彼此的知识、技能、角色、观点和可感知的责任的性质,以便代表患者及其家属最佳地利用它们。跨学科的护理方法可以无缝地解决一个人的不同方面的需求,并通过利用不同专业的资源来促进消除障碍。此外,为了个人和社会利益,需要进行协作努力,影响政策变化,并解决健康状况不佳的根本原因,特别是因为这些问题影响到社会上最脆弱的群体。在这里,我们探讨了不加批判地接受能力框架作为加强跨学科交流的一种方式的好处和风险。我们强调锚定提出的能力领域的重要性,因为是一个给定的职业,并举例说明一种方法,这已经完成了高级实践护理。此外,我们认为,有了这种系泊,可以整合各种能力,既增强了专业道德代理,又促进了跨学科合作,以促进代表高质量患者护理的医疗保健专业的共同目标。
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引用次数: 5
Bring me my alcohol!-On the continuum of pleasure and pain. 把我的酒拿来!-快乐和痛苦的连续体。
IF 2.2 3区 医学 Q1 NURSING Pub Date : 2023-01-01 DOI: 10.1111/nup.12403
Regina Christiansen, Anette S Nielsen

Alcohol use has been recognized as a challenge in eldercare and social care, and some anticipate that problems related to alcohol use will increase in the future as the current adult generation has high alcohol consumption rates. Accordingly, it is suggested that care workers are at risk of becoming passive bystanders to the destructive lifestyles of vulnerable older adults and even facilitating these lifestyles. In the present paper, we suggest that alcohol exacerbates and underscores inherent difficulties in eldercare, such as finding an appropriate balance between the personal freedom of the older adult and the responsibility of the care worker to provide care. The specific focus in the paper regard the communication and interaction involving values between people in eldercare in cases of problematic alcohol-related situations to uncover the difficulties. We found it noteworthy that the objectives and perspectives of older adults, care workers, managers and relatives have implications regarding their interactions and communications because their varying experiences involve values that are not necessarily aligned. Sometimes, care workers have no choice but to act against what, in the public sphere and to the other care workers, is ruled out by virtue of their professional ethics. It is suggested that care workers describe and judge situations where alcohol is present paradoxically by virtue of their professional ethics, yet regulate their care to preserve the dignity of older adults, even when they find the situation to be an apparent dilemma.

酒精使用已被认为是老年人护理和社会护理的一个挑战,一些人预计,由于当前成年一代的酒精消费率很高,与酒精使用有关的问题将在未来增加。因此,有人建议,护理工作者有可能成为弱势老年人破坏性生活方式的被动旁观者,甚至助长这些生活方式。在本文中,我们认为酒精加剧并强调了老年人护理的固有困难,例如在老年人的个人自由和护理人员提供护理的责任之间找到适当的平衡。本文特别关注在酒精相关问题的情况下,老年人之间涉及价值观的沟通和互动,以揭示困难。我们发现值得注意的是,老年人、护理人员、管理人员和亲属的目标和观点对他们的互动和沟通有影响,因为他们不同的经历涉及不一定一致的价值观。有时,护理人员别无选择,只能采取行动反对公共领域和其他护理人员因其职业道德而被排除在外的事情。建议护理人员根据其职业道德来描述和判断酒精存在的矛盾情况,但规范他们的护理,以维护老年人的尊严,即使他们发现这种情况明显处于两难境地。
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引用次数: 1
Contemplating the spirituality of scholarship. 思考学术的灵性。
IF 2.2 3区 医学 Q1 NURSING Pub Date : 2023-01-01 DOI: 10.1111/nup.12386
David Coghlan

Contemplation has been defined as "taking a long loving look at the real." In the realm of the scholarship of nursing and midwifery, the pulls and counterpulls between disease and illness and between patient and person, for example, require that scholars and practitioners develop an understanding of the way their minds work and of the way they come to know. This dialogue takes a (short) loving look at the foundations of spirituality and spiritual development in human consciousness and invites readers to contemplate and appreciate their lives as scholars and practitioners.

沉思被定义为“用爱的眼光审视现实”。例如,在护理和助产学的学术领域,疾病与疾病之间、病人与人之间的相互作用和相互作用要求学者和实践者对他们的思维方式和他们的认知方式有一种理解。这段对话以一种(简短的)充满爱的方式审视了人类意识中灵性和精神发展的基础,并邀请读者以学者和实践者的身份思考和欣赏他们的生活。
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引用次数: 0
Nursing for the Chthulucene: Abolition, affirmation, antifascism. 护理Chthulucene:废除,肯定,反法西斯。
IF 2.2 3区 医学 Q1 NURSING Pub Date : 2023-01-01 DOI: 10.1111/nup.12405
Jane Hopkins-Walsh, Jessica Dillard-Wright, Brandon B Brown

Critical posthumanism as a philosophical, antifascist nonhierarchical imagination for nursing offers a liberatory passageway forward amidst environmental collapse, an epic pandemic, global authoritarianism, extreme health and wealth disparities, over-reliance on technology and empirics, and unjust societal systems based in whiteness. Drawing upon philosophical and theoretical works from Black and Indigenous scholars, Haraway's idea of the Chthulucene, Deleuze and Guattari's rhizomatic thought, and Kaba's abolitionist organizing among others, we as activist nurse scholars continue the speculative discussion outlined in prior papers. Here we further imagine how we can engage a radical philosophical mission of care for all beings human and non, walking and working alongside the people and communities nurses accompany, connected as we are on this dystopian celestial orb. Discussion is centred on critical analyses of traditional justice framing in nursing, and on the praxis possibilities found within rhizomatic thought, making kin, and just episteme while knitting filaments of nursing theory and history, humming song lyrics from collective memory, and critically dismantling received wisdoms to stumble toward a more emancipatory present future.

批判后人文主义作为一种哲学的、反法西斯的、无等级的护理想象,为环境崩溃、史诗般的流行病、全球威权主义、极端的健康和财富差距、过度依赖技术和经验,以及以白人为基础的不公正的社会制度提供了一条解放的道路。借鉴黑人和土著学者的哲学和理论著作,哈拉威的Chthulucene思想,德勒兹和瓜塔里的根茎思想,以及卡巴的废奴主义组织等,我们作为积极的护士学者继续在先前的论文中概述的思辨讨论。在这里,我们进一步想象,我们如何参与一项激进的哲学使命,即照顾所有人类和非人类,与护士陪伴的人和社区一起行走和工作,就像我们在这个反乌托邦的天体上一样。讨论集中在对护理中传统正义框架的批判性分析,以及在根治性思想中发现的实践可能性,在编织护理理论和历史的过程中创造亲缘关系和公正知识,从集体记忆中哼唱歌词,并批判性地拆除接受的智慧,以走向更解放的未来。
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引用次数: 4
Using Foucault to (re)think localisation in chronic disease care: Insights for nursing practice. 利用福柯来(重新)思考慢性病护理中的本地化:对护理实践的启示。
IF 2.2 3区 医学 Q1 NURSING Pub Date : 2023-01-01 Epub Date: 2022-04-23 DOI: 10.1111/nup.12392
Dr Margo Turnbull, Ann Reich

Ageing populations and rising rates of chronic disease globally have shifted key elements of disease management to ideas of integrated care and self-management. The associated policies and programmes often focus on intervention and support beyond the sites of the hospital and clinic. These shifts have significantly impacted the delivery and practice of nursing for both nurses and the clients with whom they work. This article argues that Foucault's comments on space, place and heterotopia (1986) are useful in exploring these changes from a philosophical perspective, to draw out the complexity of these programmes and add texture to discussions on the ways these shifts to localisation and the dominant discourses of self-management and responsibility have reconfigured nursing practices. The theoretical discussion is augmented with illustrations from an Australian integrated health care programme.

在全球范围内,人口老龄化和慢性病发病率的上升使疾病管理的关键要素转向综合护理和自我管理的理念。相关政策和计划通常侧重于医院和诊所以外的干预和支持。这些转变极大地影响了护士及其服务对象的护理服务和实践。本文认为,福柯关于空间、地点和异托邦的评论(1986 年)有助于从哲学角度探讨这些变化,以揭示这些计划的复杂性,并为关于这些向本地化的转变以及自我管理和责任的主流论述如何重构护理实践的讨论增添质感。澳大利亚的一项综合医疗保健计划对理论讨论进行了补充说明。
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引用次数: 0
Empathy, caring and compassion: Toward a Freudian critique of nursing work. 同理心、关怀和同情:对护理工作的弗洛伊德式批判。
IF 2.2 3区 医学 Q1 NURSING Pub Date : 2023-01-01 DOI: 10.1111/nup.12399
Michael Traynor

The aim of this paper is to summarize key psychoanalytic concepts first developed by Sigmund Freud and apply them to a critical exploration of three terms that are central to nursing's self-image-empathy, caring, and compassion. Looking to Menzies-Lyth's work, I suggest that the nurse's strong identification as a carer can be understood as a fantasy of being the one who is cared for; critiques by Freud and others of empathy point to the possibility of it being, in reality, a form of projective identification; reading Lacan and Žižek, I propose that repeated research into caring and repeated complaint about barriers to caring can be understood as manifestations of the death drive first posited by Freud. I conclude that psychoanalytic insights suggest that caring roles can raise profoundly ambivalent issues for those who care but they can also point the way to freedom from painful and self-destructive symptoms inherent in such work.

本文的目的是总结由西格蒙德·弗洛伊德首先提出的关键精神分析概念,并将它们应用于对护理自我形象的三个核心术语的批判性探索-移情,关怀和同情。通过门齐斯-莱斯的研究,我认为护士作为照顾者的强烈身份认同可以被理解为一种幻想,即自己是被照顾的那个人;弗洛伊德和其他人对共情的批评指出,它实际上可能是一种投射性认同;通过阅读拉康和Žižek,我提出对关怀的反复研究和对关怀障碍的反复抱怨可以被理解为弗洛伊德首先提出的死亡驱动力的表现。我的结论是,精神分析的见解表明,关怀角色可能会给那些关心的人带来深刻的矛盾问题,但它们也可以指出从这种工作固有的痛苦和自我毁灭症状中解脱出来的道路。
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引用次数: 2
Adiaphorisation and the digital nursing gaze: Liquid surveillance in long-term care. adiaphorization和数字化护理凝视:长期护理中的液体监测。
IF 2.2 3区 医学 Q1 NURSING Pub Date : 2023-01-01 DOI: 10.1111/nup.12388
Giovanni Rubeis

The nursing gaze, that is the specific ways of observing the patient in nursing practice, has been the object of ethical debates for decades. It has been argued that the specific feature of observing patients in nursing is the stereoscopic vision that allows nurses to see the patient at the same time as a subject and a body. However, with the increased use of technology in nursing and the focus on quantifiable biomedical data, some commentators see a shift from the view of the patient as subject to the patient as body, which results in a de-humanisation and objectification of patients. The new digital technologies in patient monitoring and surveillance add a further dimension to this topic. It is yet unclear how digital technologies affect the nursing gaze, and with it, nursing practice. Furthermore, the ethical implications of the digitally enhanced nursing gaze have yet to be analysed. It is the purpose of this study to make a first step in this direction. By focusing on digitally enhanced monitoring technologies in long-term care, these technologies are interpreted as liquid surveillance, an approach introduced by Zygmunt Bauman. The Baumanian concept of adiaphorisation, that is the detachment of social action from moral evaluation, is used as normative framework of the analysis. The analysis shows that the tendency to remove surveillance practices from moral evaluation by framing them as enablers of an active, healthy life and as tools for caring for the vulnerable, the stereoscopic vision of the nursing gaze is undermined.

护理凝视,即在护理实践中观察病人的具体方式,几十年来一直是伦理学争论的对象。有人认为,在护理中观察患者的具体特征是立体视觉,使护士能够同时将患者视为主体和身体。然而,随着技术在护理中的应用的增加和对可量化生物医学数据的关注,一些评论员看到了从患者作为主体到患者作为身体的观点的转变,这导致了患者的非人性化和客观化。新的数字技术在病人监测和监视增加了进一步的维度,这一主题。目前尚不清楚数字技术如何影响护理的目光,以及随之而来的护理实践。此外,数字增强护理凝视的伦理影响尚未得到分析。本研究的目的是在这个方向上迈出第一步。通过专注于长期护理中的数字增强监测技术,这些技术被解释为液体监测,这是Zygmunt Bauman引入的一种方法。鲍曼式的adiaphorisation概念,即社会行为与道德评价的分离,被用作分析的规范框架。分析表明,通过将监视行为定义为积极、健康生活的推动者和照顾弱势群体的工具,将其从道德评估中移除的趋势,削弱了护理凝视的立体视觉。
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引用次数: 2
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