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Sanders MR, Turner KMT, Baker S, Ma T, Chainey C, Horstead SK, Wimalaweera S, Gardner S, Eastwood J. Supporting Families Affected by Adversity: An Open Feasibility Trial of Family Life Skills Triple P. Behav Ther 2024; 55:621-635. [PMID: 38670673 DOI: 10.1016/j.beth.2023.09.004] [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: 04/05/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 04/28/2024]
Abstract
This pilot feasibility study examined the effects of a new trauma-informed parenting program, Family Life Skills Triple P (FLSTP), in an open uncontrolled trial conducted in a regular service delivery context via video conferencing. FLSTP was trialed as a group-delivered 10-session intervention. Program modules target positive parenting skills (4 sessions) and adult life skills including coping with emotions, taking care of relationships, self-care, dealing with the past, healthy living, and planning for the future. Participants were 50 parents with multiple vulnerabilities, due to social disadvantage or adverse childhood experiences, who had children aged 3-9 with early onset behavior problems. Outcomes were assessed across four data collection points: baseline, mid-intervention (after Session 4), post-intervention, and 3-month follow up. Findings show moderate to large intra-group effect sizes for changes in child behavior problems, parenting practices and risk of child maltreatment, and medium effect sizes for parental distress, emotion regulation and self-compassion. Parents and practitioners reported high levels of consumer satisfaction with the program. Parents with lower levels of parental self-efficacy, lower personal agency and higher baseline scores on a measure of child abuse potential were at greater risk of not completing the program. The strength of these preliminary findings indicates that a more rigorous evaluation using a randomized clinical trial is warranted.
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Affiliation(s)
- Matthew R Sanders
- Parenting and Family Support Centre, School of Psychology, The University of Queensland.
| | - Karen M T Turner
- Parenting and Family Support Centre, School of Psychology, The University of Queensland
| | - Sabine Baker
- Parenting and Family Support Centre, School of Psychology, The University of Queensland
| | - Tianyi Ma
- Parenting and Family Support Centre, School of Psychology, The University of Queensland
| | - Carys Chainey
- Parenting and Family Support Centre, School of Psychology, The University of Queensland
| | - Siân K Horstead
- Parenting and Family Support Centre, School of Psychology, The University of Queensland
| | - Subodha Wimalaweera
- Parenting and Family Support Centre, School of Psychology, The University of Queensland; Sydney Local Health District, New South Wales Health
| | - Susan Gardner
- Sydney Local Health District, New South Wales Health
| | - John Eastwood
- Sydney Local Health District, New South Wales Health
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Formulating Initial Programme Theories of the Healthy Homes and Neighbourhoods Integrated Care Initiative. Int J Integr Care 2022; 22:12. [DOI: 10.5334/ijic.6421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
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Sydney Local Health District’s Integrated Response to the COVID-19 Pandemic: A Descriptive Study. Int J Integr Care 2022; 22:23. [PMID: 36248070 PMCID: PMC9524298 DOI: 10.5334/ijic.5938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
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Honisett S, Hall T, Hiscock H, Goldfeld S. The feasibility of a Child and Family Hub within Victorian Community Health Services: a qualitative study. Aust N Z J Public Health 2022; 46:784-793. [PMID: 36126218 DOI: 10.1111/1753-6405.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Explore the feasibility of an integrated Child and Family Hub within Victorian Community Health Services (CHS) to identify and respond to family adversities as preventable determinants of child mental health problems. METHODS Thirteen Victorian CHS staff and government policy makers (PMs), recruited via snowball sampling, participated in semi-structured interviews exploring: 1) barriers and facilitators for implementing a hub; 2) feasibility of a proposed integrated hub; and 3) resources needed to scale and sustain a hub. Transcripts were analysed employing framework analysis. RESULTS 1) Barriers included inadequate and activity-based funding, inability to fund community paediatricians and inadequate workforce competencies. Facilitators included CHS engagement with vulnerable communities and readiness to act. 2) The proposed hub model was identified as feasible to implement. Local co-design, co-location, and virtual delivery would support hub implementation. 3) To sustainably scale a hub, clear policy leadership and workforce and funding model reviews are needed. CONCLUSIONS A hub was perceived as feasible when based in CHS; however, local and system-wide issues need consideration to support its sustainable scaling. IMPLICATIONS FOR PUBLIC HEALTH Findings will inform the scaling of hub models of care across Victoria and other states to potentially optimise broader child and family health outcomes.
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Affiliation(s)
- Suzy Honisett
- Centre of Research Excellence in Childhood Adversity and Mental Health, Centre for Community Child Health, Murdoch Children's Research Institute, Victoria
| | - Teresa Hall
- Centre of Research Excellence in Childhood Adversity and Mental Health, Centre for Community Child Health, Murdoch Children's Research Institute, Victoria
| | - Harriet Hiscock
- Centre of Research Excellence in Childhood Adversity and Mental Health, Centre for Community Child Health, Murdoch Children's Research Institute, Victoria.,Royal Children's Hospital, Victoria.,Department of Paediatrics, The University of Melbourne, Victoria
| | - Sharon Goldfeld
- Centre of Research Excellence in Childhood Adversity and Mental Health, Centre for Community Child Health, Murdoch Children's Research Institute, Victoria.,Royal Children's Hospital, Victoria.,Department of Paediatrics, The University of Melbourne, Victoria
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Koopmans E, Schiller DC. Understanding Causation in Healthcare: An Introduction to Critical Realism. QUALITATIVE HEALTH RESEARCH 2022; 32:1207-1214. [PMID: 35649292 PMCID: PMC9350449 DOI: 10.1177/10497323221105737] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Both healthcare providers and researchers in the health sciences are well rehearsed in asking the question 'What could be causing this'? and examining beyond the surface of observable symptoms or obvious factors to understand what is really occurring with patients and health services. Critical realism is a philosophical framework that can help in this inquiry as we attempt to make sense of the observable world. The aim of this article is to introduce critical realism and explore how it can help both healthcare providers and health science researchers to better understand causation through the mechanisms that generate events, despite those mechanisms often being unseen. The article reviews foundational concepts and examples framed in the healthcare setting to make the key principles, strengths and limitations of critical realism accessible for those who are just beginning their journey with this approach.
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Affiliation(s)
- Erica Koopmans
- School of Health Sciences, University of Northern British
Columbia, Prince George, BC, Canada
- Erica Koopmans, School of Health Sciences,
University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9.
Canada.
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Henderson L, Bain H, Allan E, Kennedy C. Integrated health and social care in the community: A critical integrative review of the experiences and well-being needs of service users and their families. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1145-1168. [PMID: 33058359 DOI: 10.1111/hsc.13179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/13/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
A need for people-centred health and social support systems is acknowledged as a global priority. Most nations face challenges in providing safe, effective, timely, affordable, coordinated care around the needs and preferences of people who access integrated health and social care (IHSC) services. Much of the current research in the field focuses on describing and evaluating specific models for delivering IHSC. Fewer studies focus on person-centred experiences, needs and preferences of people who use these services. However, current international guidance for integrated care sets a precedence of person-centred integrated care that meets the health and well-being needs of people who access IHSC services. This integrative literature review synthesises empirical literature from six databases (CINAHL; MEDLINE; AMED; TRIP; Web of Science and Science Direct; 2007-2019). This review aims to better understand the experiences and health and well-being needs of people who use IHSC services in a community setting. Twenty studies met the inclusion criteria and results were thematically analysed. Three overarching themes were identified, including relationships, promoting health and well-being and difficulty understanding systems. Findings of this review indicate that relationships hold significance in IHSC. People who access IHSC services felt that they were not always involved in planning their care and that there was a lack of clarity in navigating integrated systems; subsequently, this impacted upon their experiences of those services. However, service user and informal carer voices appear to be underrepresented in current literature and studies that included their views were found to be of low quality overall. Collectively, these findings support the need for further research that explores the person-centred experiences and needs of people who access IHSC.
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Affiliation(s)
- Louise Henderson
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Heather Bain
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Elaine Allan
- School Nursing AHSCP & NHSG Strategic Lead CEL 13 School Nursing, NHS Grampian, Aberdeen, UK
- School Nursing, School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Catriona Kennedy
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
- The University of Limerick, Limerick, Ireland
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Todd K, Eastwood JG, Fotheringham P, Salinas-Perez JA, Salvador-Carulla L. Using Geospatial Analysis to Inform Development of a Place-Based Integrated Care Initiative: The Healthy Homes and Neighbourhoods Experience. Int J Integr Care 2021; 21:23. [PMID: 34220387 PMCID: PMC8231470 DOI: 10.5334/ijic.5430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Disadvantaged families experience many barriers to accessing health and social care. The Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative was developed to address these barriers, and ensure families have their complex needs met and are kept safe and connected to society. DESCRIPTION A spatial epidemiology approach was taken, as part of the HHAN feasibility phase, to identify the geographical distribution of the "most vulnerable" families in Sydney Local Health District (SLHD). A literature review was conducted to identify indicators of family stress and disadvantage, and cluster and hotspot analyses were undertaken. Hotspots of family stress and disadvantage were mapped for SLHD and used to identify areas for HHAN place-based delivery, and for collaborative co-design. DISCUSSION The HHAN initiative called for consideration of context and the undertaking of collaborative design with communities. The spatial analysis provided a more accurate picture of family stress and disadvantage than previously available and provided a tool that could be used during consultation and planning activities. CONCLUSION When planning place-based integrated care initiatives, spatial analysis of small geographic scales can allow identification of areas of concentrated or complex disadvantage that may be masked when analysis is performed on larger areas, allowing for targeted, place-based delivery of programs to those most in need.
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Affiliation(s)
- Katherine Todd
- Community Health Services, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown NSW 2050 Australia
| | - John G. Eastwood
- Community Health Services, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown NSW 2050 Australia
- School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW 2052 Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW Australia
- Charles Perkins Centre, Menzies Centre for Health Policy, Discipline of Child and Adolescent Health, and School of Public Health, University of Sydney, Sydney, New South Wales 2006 Australia
- Sydney Institute for Women, Children and their Families, Camperdown NSW 2050 Australia
| | - Penelope Fotheringham
- Community Health Services, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown NSW 2050 Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308 Australia
| | - Jose A. Salinas-Perez
- Centre for Mental Health Research, Research School of Population Health, Australian National University. 63 Eggleston Rd. Acton, ACT 2601 Australia
- Department of Quantitative Methods, Universidad Loyola Andalucía. Avenida de las Universidades s/n. 41704 Dos Hermanas, Sevilla, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, Australian National University. 63 Eggleston Rd. Acton, ACT 2601 Australia
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Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why? Int J Integr Care 2020; 20:22. [PMID: 33335463 PMCID: PMC7716786 DOI: 10.5334/ijic.5437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Healthy Homes and Neighbourhoods (HHAN), an integrated care programme in the Sydney Local Health District (SLHD), seeks to address the needs of disadvantaged families through care coordination, as one of its components. This research aims to determine for whom, when and why the care coordination component of HHAN works, and establish the reported outcomes for clients, service-providers and partner organisations. Methods: Critical realist methodology was utilised to undertake a qualitative evaluation of the impact of care coordination. Purposive sampling was used to select a total of 37 participants for interview, including consumers, service-providers and key stakeholders. Thematic analysis was undertaken to derive the major modes of intervention of HHAN, and data representing these elements was coded and summarised under contexts, mechanisms and outcomes. Results: Analysis indicates that care coordination has a positive impact on clients’ sense of independence, self-awareness and outlook on life. Trust and favourable interpersonal relations were identified as major underlying mechanisms for a successful client-provider working relationship. The identified modes of intervention facilitating positive consumer outcomes included accessibility, flexibility and service navigation. Persistent siloes in health and systemic resistance to collaboration was seen to hinder effective care delivery. Conclusions: This study suggests that a care coordination model may be effective in engaging disadvantaged families in healthcare, assist them in navigating the health system and can lead to beneficial health and social outcomes. Successful implementation of care coordination requires flexible programme design and experienced and skilful clinicians to fulfil the care coordinator role. There is a need to appreciate the negative impact that the complex and siloed health system can have on disadvantaged families.
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Tennant E, Miller E, Costantino K, De Souza D, Coupland H, Fotheringham P, Eastwood J. A critical realist evaluation of an integrated care project for vulnerable families in Sydney, Australia. BMC Health Serv Res 2020; 20:995. [PMID: 33129332 PMCID: PMC7603742 DOI: 10.1186/s12913-020-05818-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 10/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative was established to improve the care of families with complex health and social needs who reside in Sydney Local Health District. HHAN seeks to provide long-term multi-disciplinary care coordination as well as enhance capacity building and promote integrated care. The critical realist study reported here is part of the longitudinal development and evaluation of complex integrated health and social care interventions in Sydney, Australia. METHODS We describe the qualitative component of a critical realist pilot case study aimed at exploring, explaining and refining emerging HHAN programme theories in relation to care coordination. Qualitative interviews were undertaken with HHAN clients (n = 12), staff and other stakeholders (n = 21). Interviews and coding used a context (C), mechanism (M) and outcome (O) framework. Inductive, deductive, retroductive and abductive modes of reasoning were used with the CMO heuristic tool to inform the developing programme theory. RESULTS The mechanisms underpinning effective engagement of clients by care coordinators included: building trust, leveraging other family, social and organisational relationships, meeting clients on their own terms, demonstrating staff effectiveness as quickly as possible, and client empowerment. Mechanisms for enhancing care integration included knowledge transfer activities and shared learning among collaborators, structural and cultural changes, enhancing mutual respect, co-location of multidisciplinary and/or interagency staff and cultivating faith in positive change among staff. CONCLUSIONS Use of a critical realism case study approach served to elucidate the varied influences of contexts and mechanisms on programme outcomes, to highlight what works for whom and in what context. Findings supported the initial programme theory that engagement and trust building with clients, alongside enhanced collaboration and integration of services, improved outcomes for vulnerable families with complex needs. Further research is needed to explore the cost-effectiveness of integrated care initiatives, in view of the long term nature of service provision and the risk of staff burnout.
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Affiliation(s)
- E. Tennant
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW 2052 Australia
| | - E. Miller
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
| | - K. Costantino
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
| | - D. De Souza
- Centre for Research in Education, Torrens University Australia, Flinders Street Campus, Melbourne, VIC 3000 Australia
| | - H. Coupland
- Drug Health Services, Royal Prince Alfred Hospital, Level 6, King George V Building Missenden Road, Camperdown, NSW 2050 Australia
- Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050 Australia
| | - P. Fotheringham
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
| | - J. Eastwood
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
- Population child health group, School of Women’s and Children’s Health, The University of New South Wales, Kensington, NSW 2052 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170 Australia
- Charles Perkins Centre, Menzies Centre for Health Policy, Discipline of Child and Adolescent Health, Central Clinical School, and School of Public Health, University of Sydney, Sydney, New South Wales 2006 Australia
- Sydney Institute for Women Children and their Families, Camperdown, NSW 2050 Australia
- Community Paediatrics, Croydon Community Health Centre, 24 Liverpool Road, Croydon, NSW 2132 Australia
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Abstract
Introduction The Healthy Homes and Neighbourhoods (HHAN) Integrated Care Program seeks to enhance vulnerable family engagement with health and social services through a care coordination model. Besides servicing families in Sydney, HHAN has also established place-based initiatives (PBIs) in areas of disadvantage such as Redfern. The Redfern PBI co-locates HHAN with housing, drug and alcohol services, and financial and legal services. This integration aims to facilitate service access and multi-agency support for vulnerable families in Redfern. Hence, this study aims to evaluate for whom, when and why HHAN's PBI at Redfern works, or not, and what are its outcomes. Methods The project utilises critical realist methodology to undertake a qualitative evaluation of the impact of the PBI on clients, services and the community. Purposive sampling was used to identify 21 participants including HHAN clients, HHAN staff and stakeholders (HHAN partners). In-depth, semi-structured interviews were audio-recorded, transcribed, coded and analysed using a context (C), intervention (I), mechanism (M) outcome (O) (CIMO) approach to abductive analysis. Results Five key CIMO configurations of the Redfern PBI emerged - whole-of-family involvement, flexibility, trust, building connections and co-location. Whilst each theory had specific outcomes, overall client outcomes included improved access to services, better outlook, empowerment and engagement with services. Service outcomes included increased collaboration and foundation for integration between HHAN and other services. Negative outcomes included lack of full integration, the risk associated with integration and difficulty evaluating impact. Conclusion This study successfully refined the program theory for subsequent use in later implementation of critical realist evaluation studies.
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Implementation, Mechanisms of Effect and Context of an Integrated Care Intervention for Vulnerable Families in Central Sydney Australia: A Research and Evaluation Protocol. Int J Integr Care 2019; 19:11. [PMID: 31367210 PMCID: PMC6659760 DOI: 10.5334/ijic.4217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. In response, a family-centred, population-based, integrated care initiative for vulnerable families and their children in Sydney, Australia was developed. The initiative was called Healthy Homes and Neighbourhoods. A realist translational social epidemiology programme of research and collaborative design is at the foundation of its evaluation. Theory and Method: The UK Medical Research Council (MRC) Framework for evaluating complex health interventions was adapted. This has four components, namely 1) development, 2) feasibility/piloting, 3) evaluation and 4) implementation. We adapted the Framework to include: critical realist, theory driven, and continuous improvement approaches. The modified Framework underpins this research and evaluation protocol for Healthy Homes and Neighbourhoods. Discussion: The NSW Health Monitoring and Evaluation Framework did not make provisions for assessment of the programme layers of context, or the effect of programme mechanism at each level. We therefore developed a multilevel approach that uses mixed-method research to examine not only outcomes, but also what is working for whom and why.
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