Discussion Forum 1

[kbalsara]

Based on the report, your team is also given the task to design a new intervention.

1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?
2. What indicators will you use to monitor the success of the intervention on an ongoing basis? What steps will you take to ensure adequate monitoring and evaluation of the intervention?

[[email protected]]

Well the main intervention for improving rehabilitation health services in Uganda is development of the National Strategic plan for rehabilitation and assistive technology services and the aspects of this intervention will focus on the source of information to be used, Evidence of existing rehabilitation challenges in the current health system the cost or budget required to implement the strategic plan, the advantage and adaptability of the Strategic plan especially when it comes to health worker force Uganda as a country has the required human resource.

The following indicators will be explored when monitoring the proposed Uganda National Strategic Plan for rehabilitation and assistive technology service.
1- Input indicators these will included the human resources and finances required in conducting training for the multidisciplinary team that will have meetings at the ministry of health to develop policies and guidelines regarding rehabilitation and ATs.
2- The Process and Out put indicator this will measure the whether the scheduled training for example health workers on new rehabilitation interventions took place, portion of rehabilitation health workers with improved case management as per given time interval and ministerial meetings.
3- Outcome indicator will be used to access the number patients with who rehabilitation need as been met by the rehabilitation professionals who received continuous professional development training and the Number of Assistive technology devices allocated in a given time interval.
4- Impact indicator this will help in accessing the overall health status of the target population for example the improved livelihood of individuals living with disability thus improved overall rehabilitation services in the country.

The steps of a continuous Monitoring and Evaluation process will be deployed for a better intervention and this will be guide by data acquired through the M & E system.

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1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?
A.Evidence based practices (incorporate interventions with strong evidence of efficacy in stroke rehabilitation), B.Multidisciplinary approach (teamwork required), C. Patient centered care D. Care continuum (short term and long-term outcome), E.Education and support. We will use RE AIM framework. 1. Define the target population for the intervention, including stroke patients eligible for rehabilitation services, caregivers, and healthcare providers involved in care delivery. 2. Specify the desired outcomes of the intervention, such as improvements in motor function, cognitive abilities, quality of life, and functional independence. 3. Engage healthcare providers and facilities in adopting evidence-based rehabilitation practices, establish partnerships with rehabilitation centers, and promote adherence to guidelines. 4. Develop standardized protocols for delivering rehabilitation interventions, ensure adequate training for healthcare professionals, and address barriers to implementation.5. Design strategies for sustaining the intervention’s impact over time, including long-term follow-up care, community support programs, and continuity of services post-discharge.
2. What indicators will you use to monitor the success of the intervention on an ongoing basis?
1. Rehabilitation integrated into health plans 2. Priority assistive product list 3. Rehabilitation expenditure 4. Rehabilitation personnel density 5. Rehabilitation beds and day program places 6. Rehabilitation in tertiary hospitals 7. Rehabilitation integrated secondary and primary level 8. Rehabilitation utilization and effectiveness (add one or 2 indicators) RIM WHO 2019.
What steps will you take to ensure adequate monitoring and evaluation of the intervention? 1.Define clear objective and outcome 2. Select good indicators (suitable), 3. Establish baseline 4. Regular monitoring and reporting 5. Documentation 6. Make changes and adopt

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The new intervention is “Rehabilitation Needs of City Dwellers: A RE-AIM Framework-Guided Intervention in Uganda”

1. Aspects of the Intervention to guide Planning and eventual success of the project are;
=>Target Population. Focus on vulnerable city dwellers with limited access to rehabilitation services, including the elderly, disabled, and underprivileged.
=>Evidence-Based Practices: Utilize proven rehabilitation techniques and incorporate patient-centered approaches.
=>Community Engagement: Involve community members in all stages of the intervention, from design to implementation and evaluation.
=>Sustainability Plan: Secure funding, build partnerships, and establish mechanisms for long-term operation.
=>Monitoring and Evaluation: Regularly track key indicators to assess progress and make necessary adjustments.

2. Indicators that will be used to monitor the intervention’s success:
=>Reach: Number of community-based rehabilitation centers established and people reached.
=>Effectiveness: Improvement in functional outcomes, quality of life, and patient satisfaction.
=>Adoption: Percentage of healthcare organizations and individuals using the intervention.
=>Implementation: Adherence to protocols, quality of service delivery, and staff training.
=>Maintenance: Continuation of services after the initial project period.

Monitoring and Evaluation Steps
=>Establish a dedicated monitoring and evaluation team.
=>Develop a comprehensive data collection plan and use standardized tools.
=>Conduct regular monitoring visits to track progress.
=>Analyze data and provide timely feedback to stakeholders.
=>Use evaluation findings to inform ongoing adjustments and improve intervention effectiveness.

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planning an intervention for rehabilitation, focusing on certain aspects can significantly enhance its success. Here are key aspects to consider:

Assessment and Evaluation: Conduct a thorough assessment of the individual’s needs, strengths, challenges, and goals. Use validated assessment tools and methods to gather comprehensive data.

Goal Setting: Collaboratively establish clear, measurable, achievable, relevant, and time-bound (SMART) goals with the individual and their support network. Goals should be aligned with their aspirations and rehabilitation outcomes.

Evidence-Based Practices: Utilize interventions and strategies that are supported by empirical evidence and best practices in rehabilitation. This ensures interventions are effective and tailored to individual needs.

Individualized Planning: Develop personalized intervention plans that consider the unique characteristics, preferences, and circumstances of the individual. Flexibility in planning allows for adjustments based on progress and setbacks.

Multi-disciplinary Approach: Involve a team of professionals from diverse disciplines such as physical therapy, occupational therapy, psychology, social work, and vocational counseling. This approach addresses various aspects of rehabilitation comprehensively.

Continuous Monitoring and Feedback: Regularly monitor progress towards goals and provide constructive feedback. Adjust interventions as needed based on ongoing evaluation and feedback from the individual and their support system.

Psychosocial Support: Address psychological and social aspects of rehabilitation through counseling, peer support groups, family therapy, and community integration programs. Emotional well-being and social support are integral to successful rehabilitation.

Skill Development: Focus on developing and enhancing skills that are essential for daily living, vocational activities, and social interactions. This may include adaptive skills training, job readiness programs, and leisure/recreational activities.

Transition and Aftercare Planning: Plan for transitions between different stages of rehabilitation (e.g., hospital to home, school to work). Develop aftercare plans to support continued progress and prevent relapse.

Empowerment and Motivation: Foster a sense of empowerment and motivation by involving the individual in decision-making, celebrating milestones, and promoting self-management skills. Encourage autonomy and self-efficacy throughout the rehabilitation process.

By addressing these aspects systematically and comprehensively, interventions can be more effective in promoting successful rehabilitation outcomes and improving the overall well-being of individuals undergoing rehabilitation.

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To plan and ensure the success of the intervention, a comprehensive approach involving assessment, stakeholder engagement, capacity building, infrastructure development, policy advocacy, community involvement, and continuous monitoring and evaluation is paramount.

Indicators should focus on access, quality, capacity, infrastructure, policy, community engagement, outcomes, and sustainability to comprehensively capture the success and areas for improvement.

Monitoring and Evaluation
– Establish a robust monitoring and evaluation system to track progress and outcomes.
– Use data to refine and improve intervention strategies.

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Q.1. To guide the planning and success of an intervention the following steps will be taken:
Will borrow heavily from the RE-AIM framework of Reach, effectiveness, adoption, implementation and maintenance)
-The problem will be defined and use of data sources will help justify the current situation. Sources of data will include: population survey, summary data tools, individual records, census, social registers, hospital records, service records among others.
-Select target population with varied characteristics to participate in the intervention. The settings for the intervention will be identified.
– Goals and objectives setting
-Selection of intervention(s) and possible source of resources will be identified
-Community engagement at all stages will be conducted to enhance ownership of the intervention.
-Develop activities and materials, train staff. pretest the intervention
-Implement the intervention
-Monitor and evaluate the intervention.
Q.2. The following indicators will be used to monitor the success of the intervention:
Indicators that will be used include:
-Rehabilitation expenditure to measure the rehabilitation expenditure in relation to health care expenditure,
-Rehabilitation personnel density
-Rehabilitation in tertiary hospital
-Multidisciplinary rehabilitation for people with complex needs.
-rehabilitation integrated in in health plans
Q.3. To ensure adequate monitoring and Evaluation
-Establish clear objectives and goals
-Identify good indicators to monitor progress
-set baseline and involve stakeholders
-identify data collection plan
-Create analysis plan
-Plan for dissemination and reporting
-Regular monitoring and periodic evaluation
–

[Yasmin Garcia Mendez]

Designing a new intervention.

1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?

I will focus on
1) the target population, understand its characteristics, rehabilitation needs and preferences, beliefs and culture, etc.
2) the intervention itself, the evidence supporting the effectiveness of the intervention on the target population, its design and costs, the resources, capacity and expertise needed to implement it, its advantage over other interventions, and indicators or outcome measures are recommended to measure the effectiveness of the intervention and whether outcomes are aceptable and appropriate.
3) the implementation setting characteristics, whether the intervention is feasible and aligned with the organization’s interests, if there is institutional support to implement the intervention, and whether the institution has the capacity, resources, expertise and interest to properly implement it in terms of cost and time.
4) Monitoring and evaluation, would focus also on monitoring the progress of the implementation by collecting data on the above indicators periodically to compare against established targets or goals and to timely identify problems in the implementation process and make adjustments if needed. I would also evaluate if the ultimate goal of the intervention was achieved and if the intervention has become part of routine practice of the organization and make modifications to the project if needed.

What indicators will you use to monitor the success of the intervention on an ongoing basis? What steps will you take to ensure adequate monitoring and evaluation of the intervention?

The indicators will depend on the intervention, but I will try to use indicators in the 3 data domains: health status, health system and determinants of health. The first to collect baseline data on functioning and compared with post-intervention implementation data, outcome measures on the effectiveness of the intervention to achieve its goals; the second set of indicators to measure what was needed for the intervention in terms of inputs (ex. human resources, financing), and what was obtained in terms of outputs and outcomes (ex. quality of the service, utilization) for the intervention; and finally, determinants of health to understand how these impact/affect results.

The steps I would take to ensure adequate monitoring and evaluation would be 1) definition of the research question that will guide the monitoring and evaluation efforts, 2) identification of indicators/data to collect, frequency and source, 3)identification and determination of methods to collect data indicators, analyze, compare and assess results, and 4) making recommendations and modifications/adjustments to the intervention.

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1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?
I will focus more reach since it ensures adequate representation of the population at large in the sample in which the intervention is being implemented. A good representative sample can help teams make assumptions about how a particular intervention will behave when scaled up to the entire population.
2. What indicators will you use to monitor the success of the intervention on an ongoing basis? What steps will you take to ensure adequate monitoring and evaluation of the intervention?
Rehabilitation integrated into health plan, rehabilitation expenditure and multidisciplinary rehabilitation for people with complex need, this are monitored periodically to trac the progress of the system set on rehabilitation.

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1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?
I would focus on the Reach since it ensures on adequate representation of the population at large in the same area basing on this scenario they are all within the same location and implantation is also within the the same participants.
2. What indicators will you use to monitor the success of the intervention on an ongoing basis? What steps will you take to ensure adequate monitoring and evaluation of the intervention?
multidisplinary Rehabilitation for people within complex of needs
Rehabilitation integrated program into health plan this is important as priority needs of the people is followed up time and again any other approach to rehabilitation is carefully implemented accordingly
Rehabilitation of personnel density since it involves all specialist of various cadre hence the community gets holistic Rehabilitation care from professionals like psychosocial, physiotherapy physicians Rehabilitation Nurse among others

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In order to gather useful information about the current rehabilitation needs and the current status of the health system, I would examine both quantitative and qualitative data from various sources. These sources would range from the household and community level up through the national or regional level. I would explore global levels for reference as I assess the needs of the current local situation. Data sources include patient surveys at the micro – household level, patient charts, facility registers and logbooks, district and national summary reports. Patient surveys at the household level will give a more granular, personalized look at needs, as the scope of surveillance zooms out to facility, district and national levels the data can provide information on trends, or geographic needs. This may assist in understanding equitable distribution of resources to meet the needs of the entire population, and to identify resource gaps where vulnerable populations may have increased need for services. The WHO categorizes data resources into three groups: user level, facility or program level, andpopulation level. These different groups support outcome evaluation, service and quality assurance, and policy respectively. I would also want to explore more specific data bases such as military, education data bases, NGO reports that may not be engaged in local ministry of health, social security and socia registries.
There are different data bases that indicate rigor of current health system These each have their own unique advantages and disadvantages. The WHO Global Health Observatory provides population level indicators in the dementia and post stroke populations. Multiple Indicators Cluster Surveys (MICS) by UNICEF is an international household health survey canvassing 130 indicators. This is useful to compare data across different countries but does not identify rehab specific needs – perhaps as rehab grows in importance in the health industry, this survey can be adapted to assist rehabilitation in health systems. DHS – or Demographic and Health Surveys by USAID is also commonly used for population level data but not yet specific to rehab needs. That said, it can offer insight into resource allocation as it provides indicators into public health levels across regions. I think I would utilize the MICS because it seems to have robust data that is comparable across the world. It would need adaptations that shed light on rehab specific needs. I do not have much experience in developing surveys but feel this is a key priority as we learn about assessing and strengthening the role of rehabilitation in health systems.
To assess an intervention, I would use the CFIR – or consolidated Framework for Implementation Research. This focuses on 5 areas: intervention, outer setting, inner setting, the individual and process. Monitoring is a continuous process required the reliance on the following indicators: SMART objectives, goals, key informant interviews, cost, surveys. To ensure adequate monitoring an evaluation, I would have personnel dedicated to this aspect, structure a uniform way to capture and disseminate information so the entire multidisciplinary team is aware of overall progress, or lack thereof.

[Oda Msuha]

1. First I will gather the data about the people with needs of rehabilitation services and or but have not got the service yet by using population survey and resource records that will give information on problem distribution and resource respectively which will aid on performance
-Effectiveness will be another aspect which will guide me how the intervention is effective as it bring about positive or negative results.
– Adoption as it involves institution support for the service delivery and also aid in follow up as it help in knowing patient adherence or compliance to intervention will be an aspect of focus
-Implementation of the planned intervention to ensure that the intervention is delivered properly to obtain intended outcome, as it takes into consideration on cost and time needed for intervention as well as adaptation.
-Again Maintenance of the intervention given when access to intervention at both individual and system level is given in which program and policy become part of the routine of the organization practice to bring about positive results or outcomes.

[Oda Msuha]

The following are the indicator that I will use to monitor the success of the intervention
– rehabilitation integrated into health plan which will measure number of relevant health plan that includes rehabilitation at the activity level.
– Rehabilitation expenditure that tells annual national expenditure in relation to annual Health expenditure.
-rehabilitation personnel density which gives the number of each rehabilitation team present to facilitate service delivery.
-rehabilitation bed shows total number of rehabilitation bed available example that needed for injured patients, compared to total population.
– number of rehabilitation personnel available in tertiary hospitals to ensure proper delivery of rehabilitation services.
– Availability of multidisciplinary service for people with complex needs. It measures population who can access multidisciplinary rehabilitation services due to complex needs.

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In Tanzania, like many other LMICs, there is shortage of Assistive Technology health care professionals, such as wheelchair fitting specialists. For stroke patients, having wheelchairs that enable them to obtain optimal level of functioning is an important step to re-integrate into society. The intervention I would design for this case would be to incorporate wheelchair fitting training as part of the pre-service curriculum so that OTs/PTs also have this specialized training.

Leveraging the RE-AIM framework, the parts of the intervention I would focus on are the following:
1. Effectiveness: Ensuring that there is evidence-based tools/supports (i.e. like the WHO guide for wheelchair fitting in LMICs) to deliver the intervention and ensuring there are ways to collect data, satisfaction and experience from students to understand the positive and negative consequences of the intervention
2. Adoption: Perhaps piloting the training material on one cohort to understand and evaluate the value and effectiveness will be a strategy to help broader adoption and institutionalization into pre-service training curriculum for the PT and OT cadres. Developing a business case to fully articulate the cost and benefits of this intervention may also be needed.
3. Implementation: To ensure consistency, there may be a need to have a train the trainer approach (i.e. having a specialized expert in wheelchairs deliver the training to a group of professors who can then implement across all; there should be strong guidance, data collection and evaluation of the train the trainer model to ensure consistency.

In terms of measuring success, I would use the following indicators:
1. # of teachers trained on wheelchair fitting
2. # of students in cohort who received wheelchair fitting
3. # of students who graduated in wheelchair fitting and are employed in settings where these services are delivered
4. # of patients who receive wheelchair fitting services (comparison of baseline vs. 1 year post implementation)
5. Multidisciplinary Rehab for People with Complex Needs – as per the WHO RIM
6. # of universities/programs that incorporate wheelchair fitting training into pre-service curricula (i.e. a measure of adoption)
7. Satisfaction surveys from students to understand value of this intervention and the use of this training in their daily jobs

Steps in Monitoring and Evaluation:
1. Development of a M&E plan during the design of the intervention that includes both M&E experts, researchers (if applicable), teachers, clinical staff and students
2. Development of data collection tools to capture data at the teacher level, student level, individual patient level and hospital level
3. Routine monitoring of the progress leveraging both input, output and outcome indicators; this can be then used to further adopt and scale up the intervention
2.
5. #

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Data source I will use to gather information will be:
1. The national census: (Tanzania National Census 2022) to inform me about the population and the proportion of disability within the country
2. Individual records in the health facilities (Health record system within the facility) : to get enlighten of the burden information on the health condition impairment and activity limitation
3. Social registry (Tanzania Registrar of Societies): to gather information regarding the services available in the society (e.g. registered societies for people living with disability) and the acceptability and accessibility in relation to social believes and task distribution
4. Service records (within the existing health facilities rehabilitation centers): will inform on number of services the clients receive, hence understanding the extent rehabilitation services is prescribed
5. Population survey (Tanzania National Beuro of Statistics): will inform me on resources available, resources needed, resources missing and services available
6. Resource records (from the available health facilities in the district): to examine the availability of assistive technology and human resource (availability of multidisciplinary services)
To add evidence and enhance strategies for implementation I will also include regional (east Africa, Africa) and global data

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I will use the RE-AIM framework to guide the planning and evaluation of the program

Reach: I will assess the methodology of identifying the target population and inclusion criteria for the sample size, as well as the characteristics of the participants if they meet the standards according to the existing guiding policy
Effect: here the short and long term results will be evaluated and the percentage of impact they will bring about to the society
Adoption: Is the project cost effective, are there expertise to ensure quality service delivery
Implementation: Quality of service, is the service following the laid down protocol and costs
Maintain: Will assess the individual behavior towards the service provided and the factors that ensure existence of the program (collaboration, inclusion e.t.c)

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1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?
Using the RE-AIM framework,the aspects if the intervention I will focus on to guide planning an eventual success:
Target population: ensuring adequate representation of the population where the intervention will be implemented
Efficacy: Ensuring adequate resources for intervention before the start of the intervention

2. What indicators will you use to monitor the success of the intervention on an ongoing basis?
Rehabilitation expenditure
Rehabilitation personnel density
Rehabilitation bed density

What steps will you take to ensure adequate monitoring and evaluation of the intervention?
Put processes in place for ongoing realtime feedback from the target population about the intervention.
Clearly outline the indicators, targets, outputs, and outcomes and ensure all stakeholders are carried along the monitoring process.

[Albert Erongu]

1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?
I will focus on the target population to ensure that target participants participate in the intervention (reach), adhere to the intervention approaches, and monitor the behavior change of participants and non-participants.

2. What indicators will you use to monitor the success of the intervention on an ongoing basis?
The following are the indicators I will use;
# of PHC providers trained in basic rehabilitation.
# of Community Health Workers trained in identifying and referring community members needing rehabilitation services.
# of PHC providers trained in assessment and provision of Assistive products (TAP)
# of clients who have benefited from Basic rehabilitation.
# of community members referred for rehabilitation services
# of clients who have benefited from assistive products.

What steps will you take to ensure adequate monitoring and evaluation of the intervention?
First will be the development of the M&E plan during project development.
Frequent monitoring of the project activities by the implementation team
Developing and defining the research questions for process evaluation
Conduct evaluation focusing on the project objectives.

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1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?

Resp : Aspects of the interventions to consider to guide my planning and eventual success of my interventions will be based on the RE-AIM framework and are as follow:
– how am I going to reach the targeted population (stroke patients for the city);
– how likely is my intervention going to be successful at achieving the desired outcome;
– What will be the likelihood that my intervention will be feasible in the given setting
– how likely is my intervention going to be delivered as intended;
– how am I going to incorporate my intervention to be delivered over the long term.

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2. What indicators will you use to monitor the success of the intervention on an ongoing basis? What steps will you take to ensure adequate monitoring and evaluation of the intervention?

Resp : Indicators I will use to monitor the success of the interventions will be :
– Percentage of stroke patients who have improve in functioning on the total population of stroke patients who needed Rehab and AT services
– Number of stroke patients who access rehab services across the city
– Number of rehab services available for stroke patients per level of the healthcare system
– Number and category of rehab professional (personnel) available in the multidisciplinary team of healthcare

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1. Using your knowledge of the frameworks, what aspects of the intervention will you focus on to guide your planning and eventual success of the intervention?
WHO Rehabilitation in health systems: guide for action- STARS, GRASP, FRAME, ACTOR.

2. What indicators will you use to monitor the success of the intervention on an ongoing basis?
In reference to Rehabilitation Indicator Menu-
Input- rehabilitation integrated into health plans, rehabilitation expenditure, rehabilitation personnel density, rehabilitation bed density
Output-Rehabilitation in tertiary hospitals
Outcome- Multidisciplinary rehabilitation for people with complex needs
Impact- population functioning

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Indicators to monitor success of the intervention
Data source I will use to gather information will be:
1. The national census: to inform me about the population and the proportion of disability within the country
2. Individual records in the health facilities (Health record system within the facility) : to get more information on the burden of the health condition impairment and activity limitation
3.outpatient registry to gather information on all patients who come in the clinic on a daily basis seeking for rehabilitation services
4. Service records especially the clinical records, and monthly reporting records (within the existing health facilities rehabilitation centers): will inform on number of services the clients receive, hence understanding the extent to which rehabilitation services is prescribed and up taken
5. Population household survey (Uganda National Bureau of Statistics): will inform me on resources available, resources needed, resources missing and services available
6. Resource records (from the available health facilities in the district): to examine the availability of assistive technology and human resource (availability of multidisciplinary services)

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