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Andrews CD, Mathur R, Massey J, Park R, Curtis HJ, Hopcroft L, Mehrkar A, Bacon S, Hickman G, Smith R, Evans D, Ward T, Davy S, Inglesby P, Dillingham I, Maude S, O'Dwyer T, Butler-Cole BFC, Bridges L, Bates C, Parry J, Hester F, Harper S, Cockburn J, Goldacre B, MacKenna B, Tomlinson LA, Walker AJ, Hulme WJ. Consistency, completeness and external validity of ethnicity recording in NHS primary care records: a cohort study in 25 million patients' records at source using OpenSAFELY. BMC Med 2024; 22:288. [PMID: 38987774 PMCID: PMC11234682 DOI: 10.1186/s12916-024-03499-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Ethnicity is known to be an important correlate of health outcomes, particularly during the COVID-19 pandemic, where some ethnic groups were shown to be at higher risk of infection and adverse outcomes. The recording of patients' ethnic groups in primary care can support research and efforts to achieve equity in service provision and outcomes; however, the coding of ethnicity is known to present complex challenges. We therefore set out to describe ethnicity coding in detail with a view to supporting the use of this data in a wide range of settings, as part of wider efforts to robustly describe and define methods of using administrative data. METHODS We describe the completeness and consistency of primary care ethnicity recording in the OpenSAFELY-TPP database, containing linked primary care and hospital records in > 25 million patients in England. We also compared the ethnic breakdown in OpenSAFELY-TPP with that of the 2021 UK census. RESULTS 78.2% of patients registered in OpenSAFELY-TPP on 1 January 2022 had their ethnicity recorded in primary care records, rising to 92.5% when supplemented with hospital data. The completeness of ethnicity recording was higher for women than for men. The rate of primary care ethnicity recording ranged from 77% in the South East of England to 82.2% in the West Midlands. Ethnicity recording rates were higher in patients with chronic or other serious health conditions. For each of the five broad ethnicity groups, primary care recorded ethnicity was within 2.9 percentage points of the population rate as recorded in the 2021 Census for England as a whole. For patients with multiple ethnicity records, 98.7% of the latest recorded ethnicities matched the most frequently coded ethnicity. Patients whose latest recorded ethnicity was categorised as Other were most likely to have a discordant ethnicity recording (32.2%). CONCLUSIONS Primary care ethnicity data in OpenSAFELY is present for over three quarters of all patients, and combined with data from other sources can achieve a high level of completeness. The overall distribution of ethnicities across all English OpenSAFELY-TPP practices was similar to the 2021 Census, with some regional variation. This report identifies the best available codelist for use in OpenSAFELY and similar electronic health record data.
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Affiliation(s)
- Colm D Andrews
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK.
| | - Rohini Mathur
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Wolfson Institute for Population Health, University of London, London, Queen Mary, E1 2AT, UK
| | - Jon Massey
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Robin Park
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Helen J Curtis
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Lisa Hopcroft
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Amir Mehrkar
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Seb Bacon
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - George Hickman
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Rebecca Smith
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - David Evans
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Tom Ward
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Simon Davy
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Peter Inglesby
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Iain Dillingham
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Steven Maude
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Thomas O'Dwyer
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Ben F C Butler-Cole
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Lucy Bridges
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Chris Bates
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - John Parry
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - Frank Hester
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - Sam Harper
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | | | - Ben Goldacre
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Brian MacKenna
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - Laurie A Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Alex J Walker
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
| | - William J Hulme
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, Oxford University, Oxford, OX2 6GG, UK
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Moorthie S, Peacey V, Evans S, Phillips V, Roman-Urrestarazu A, Brayne C, Lafortune L. A Scoping Review of Approaches to Improving Quality of Data Relating to Health Inequalities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15874. [PMID: 36497947 PMCID: PMC9740714 DOI: 10.3390/ijerph192315874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Identifying and monitoring of health inequalities requires good-quality data. The aim of this work is to systematically review the evidence base on approaches taken within the healthcare context to improve the quality of data for the identification and monitoring of health inequalities and describe the evidence base on the effectiveness of such approaches or recommendations. Peer-reviewed scientific journal publications, as well as grey literature, were included in this review if they described approaches and/or made recommendations to improve data quality relating to the identification and monitoring of health inequalities. A thematic analysis was undertaken of included papers to identify themes, and a narrative synthesis approach was used to summarise findings. Fifty-seven papers were included describing a variety of approaches. These approaches were grouped under four themes: policy and legislation, wider actions that enable implementation of policies, data collection instruments and systems, and methodological approaches. Our findings indicate that a variety of mechanisms can be used to improve the quality of data on health inequalities at different stages (prior to, during, and after data collection). These findings can inform us of actions that can be taken by those working in local health and care services on approaches to improving the quality of data on health inequalities.
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Affiliation(s)
- Sowmiya Moorthie
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge CB2 OSZ, UK
| | - Vicki Peacey
- Cambridgeshire County Council, Alconbury, Huntingdon PE28 4YE, UK
| | - Sian Evans
- Local Knowledge Intelligence Service (LKIS) East, Office for Health Improvements and Disparities, UK
| | - Veronica Phillips
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK
| | - Andres Roman-Urrestarazu
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge CB2 OSZ, UK
| | - Carol Brayne
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge CB2 OSZ, UK
| | - Louise Lafortune
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge CB2 OSZ, UK
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Dron L, Kalatharan V, Gupta A, Haggstrom J, Zariffa N, Morris AD, Arora P, Park J. Data capture and sharing in the COVID-19 pandemic: a cause for concern. Lancet Digit Health 2022; 4:e748-e756. [PMID: 36150783 PMCID: PMC9489064 DOI: 10.1016/s2589-7500(22)00147-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 12/25/2022]
Abstract
Routine health care and research have been profoundly influenced by digital-health technologies. These technologies range from primary data collection in electronic health records (EHRs) and administrative claims to web-based artificial-intelligence-driven analyses. There has been increased use of such health technologies during the COVID-19 pandemic, driven in part by the availability of these data. In some cases, this has resulted in profound and potentially long-lasting positive effects on medical research and routine health-care delivery. In other cases, high profile shortcomings have been evident, potentially attenuating the effect of-or representing a decreased appetite for-digital-health transformation. In this Series paper, we provide an overview of how facets of health technologies in routinely collected medical data (including EHRs and digital data sharing) have been used for COVID-19 research and tracking, and how these technologies might influence future pandemics and health-care research. We explore the strengths and weaknesses of digital-health research during the COVID-19 pandemic and discuss how learnings from COVID-19 might translate into new approaches in a post-pandemic era.
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Affiliation(s)
- Louis Dron
- Real World & Advanced Analytics, Cytel Health, Vancouver, BC, Canada,Correspondence to: Mr Louis Dron, Real World & Advanced Analytics, Cytel Health, Vancouver, BC V5Z 4J7, Canada
| | - Vinusha Kalatharan
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Alind Gupta
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jonas Haggstrom
- Real World & Advanced Analytics, Cytel Health, Vancouver, BC, Canada,The International COVID-19 Data Alliance (ICODA), Health Data Research UK, London, UK
| | - Nevine Zariffa
- The International COVID-19 Data Alliance (ICODA), Health Data Research UK, London, UK,NMD Group, LLC, Bala Cynwyd, PA, USA
| | - Andrew D Morris
- The International COVID-19 Data Alliance (ICODA), Health Data Research UK, London, UK
| | - Paul Arora
- Real World & Advanced Analytics, Cytel Health, Vancouver, BC, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jay Park
- Department of Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Zhang CX, Boukari Y, Pathak N, Mathur R, Katikireddi SV, Patel P, Campos-Matos I, Lewer D, Nguyen V, Hugenholtz GC, Burns R, Mulick A, Henderson A, Aldridge RW. Migrants' primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series analysis. THE LANCET REGIONAL HEALTH. EUROPE 2022; 20:100455. [PMID: 35789753 PMCID: PMC9243519 DOI: 10.1016/j.lanepe.2022.100455] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background How international migrants access and use primary care in England is poorly understood. We aimed to compare primary care consultation rates between international migrants and non-migrants in England before and during the COVID-19 pandemic (2015-2020). Methods Using data from the Clinical Practice Research Datalink (CPRD) GOLD, we identified migrants using country-of-birth, visa-status or other codes indicating international migration. We linked CPRD to Office for National Statistics deprivation data and ran a controlled interrupted time series (ITS) using negative binomial regression to compare rates before and during the pandemic. Findings In 262,644 individuals, pre-pandemic consultation rates per person-year were 4.35 (4.34-4.36) for migrants and 4.60 (4.59-4.60) for non-migrants (RR:0.94 [0.92-0.96]). Between 29 March and 26 December 2020, rates reduced to 3.54 (3.52-3.57) for migrants and 4.2 (4.17-4.23) for non-migrants (RR:0.84 [0.8-0.88]). The first year of the pandemic was associated with a widening of the gap in consultation rates between migrants and non-migrants to 0.89 (95% CI 0.84-0.94) times the ratio before the pandemic. This widening in ratios was greater for children, individuals whose first language was not English, and individuals of White British, White non-British and Black/African/Caribbean/Black British ethnicities. It was also greater in the case of telephone consultations, particularly in London. Interpretation Migrants were less likely to use primary care than non-migrants before the pandemic and the first year of the pandemic exacerbated this difference. As GP practices retain remote and hybrid models of service delivery, they must improve services and ensure primary care is accessible and responsive to migrants' healthcare needs. Funding This study was funded by the Medical Research Council (MC_PC 19070 and MR/V028375/1) and a Wellcome Clinical Research Career Development Fellowship (206602).
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Affiliation(s)
- Claire X. Zhang
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, United Kingdom
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom
| | - Yamina Boukari
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, United Kingdom
| | - Neha Pathak
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
- Guy's & St Thomas's NHS Foundation Trust, London SE1 9RT, United Kingdom
| | - Rohini Mathur
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, United Kingdom
| | - Parth Patel
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
| | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, United Kingdom
- UK Health Security Agency, Wellington House, 133–155, Waterloo Road, London SE1 8UG, United Kingdom
| | - Dan Lewer
- Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Vincent Nguyen
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
- Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Greg C.G. Hugenholtz
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
| | - Rachel Burns
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
| | - Amy Mulick
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Alasdair Henderson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Robert W. Aldridge
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
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Davidson EM, Douglas A, Villarroel N, Dimmock K, Gorman D, Bhopal RS. Raising ethnicity recording in NHS Lothian from 3% to 90% in 3 years: processes and analysis of data from Accidents and Emergencies. J Public Health (Oxf) 2021; 43:e728-e738. [PMID: 33300567 PMCID: PMC7798973 DOI: 10.1093/pubmed/fdaa202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/11/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The disproportionate burden of COVID-19 on ethnic minority populations has recently highlighted the necessity of maintaining accessible, routinely collected, ethnicity data within healthcare services. Despite 25 years of supportive legislation and policy in the UK, ethnicity data recording remains inconsistent, which has hindered needs assessment, evaluation and decision-making. We describe efforts to improve the completeness, quality and usage of ethnicity data within our regional health board, NHS Lothian. METHODS The Ethnicity Coding Task Force was established with the aim of increasing ethnicity recording within NHS Lothian secondary care services from 3 to 90% over 3 years. We subsequently analysed these data specifically focusing on Accident and Emergency (A&E) use by ethnic group. RESULTS We achieved 91%, 85% and 93% completeness of recording across inpatients, outpatients and A&E, respectively. Analysis of A&E data found a mixed pattern of attendance amongst ethnic minority populations and did not support the commonly perceived relationship between lower GP registration and higher A&E use within this population. CONCLUSIONS We identified a successful approach to increase ethnicity recording within a regional health board, which could potentially be useful in other settings, and demonstrated the utility of these data in informing assessment of healthcare delivery and future planning.
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Affiliation(s)
- Emma M Davidson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Anne Douglas
- Usher Institute, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Nazmy Villarroel
- Department of Sociological Studies, The University of Sheffield, Sheffield, S10 2TU, UK
| | - Katy Dimmock
- Directorate of Public Health and Health Policy, NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG, UK
| | - Dermot Gorman
- Directorate of Public Health and Health Policy, NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG, UK
| | - Raj S Bhopal
- Usher Institute, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh EH8 9AG, UK
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Gruer L, Bhopal RS. Mitigating ethnic disparities in covid-19 and beyond: census linkage can help tackle the data deficit. BMJ 2021; 372:n642. [PMID: 33687927 DOI: 10.1136/bmj.n642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Laurence Gruer
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
- University of Glasgow, Glasgow, UK
| | - Raj S Bhopal
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
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Bhala N, Curry G, Martineau AR, Agyemang C, Bhopal R. Sharpening the global focus on ethnicity and race in the time of COVID-19. Lancet 2020; 395:1673-1676. [PMID: 32401716 PMCID: PMC7211499 DOI: 10.1016/s0140-6736(20)31102-8] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Neeraj Bhala
- Queen Elizabeth Hospital Birmingham and Institute of Applied Health Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK.
| | - Gwenetta Curry
- Usher Institute, The University of Edinburgh, Edinburgh, UK; Department of Gender and Race Studies, College of Arts and Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Adrian R Martineau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Charles Agyemang
- Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Raj Bhopal
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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