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Montoro-Pérez N, Montejano-Lozoya R, Escribano S, Richart-Martínez M. Factors associated with non-urgent presentations in the paediatric emergency department using Andersen's behavioural model: A cross-sectional descriptive study. J Clin Nurs 2024. [PMID: 38258512 DOI: 10.1111/jocn.17004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To explore the rate of NUPs and associated factors in the PED of the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain) using Andersen's Behavioural Model. METHODS We conducted a descriptive cross-sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain). RESULTS The study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p = 0.005), (II) lower educational attainment (OR = 3.841; p = 0.000), (III) first-time parenthood (OR = 2.335; p = 0.000) and (IV) higher parental stress (OR = 1.974; p = 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p = 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p = 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p = 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p = 0.031). CONCLUSIONS The NUP rates found in this study are similar to those found internationally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs. IMPLICATIONS FOR PRACTICE Identifying the factors associated with NUPs enables interventions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well-being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high-quality PC services. Providing support to parents during the transition to parenthood would also be beneficial. REPORTING METHOD This paper adheres to the STROBE initiative guidelines. CONTRIBUTION FROM PATIENTS OR MEMBERS OF THE PUBLIC Participants, who voluntarily agreed to take part, contributed to the study by completing a paper-based questionnaire containing all the study variables as prepared by the research team.
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Affiliation(s)
- Néstor Montoro-Pérez
- Department of Nursing, Faculty of Health Sciences, Person-Centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
- GREIACC Research Group La Fe Health Research Institute, Valencia, Spain
| | | | - Silvia Escribano
- Department of Nursing, Faculty of Health Sciences, Person-Centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
| | - Miguel Richart-Martínez
- Department of Nursing, Faculty of Health Sciences, Person-Centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
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Basis F, Tur-Sinai A, Haklai Z. Does an Overcrowded Emergency Department Reduce Moral Hazard? Lessons from Emergency Department Visits to Three Hospitals in an Israeli Metropolitan Area. Healthcare (Basel) 2022; 10:915. [PMID: 35628052 PMCID: PMC9141491 DOI: 10.3390/healthcare10050915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Metropolitan Haifa, Israel, has three hospitals: Rambam Health Care Campus, Bnai Zion Medical Center, and Carmel Medical Center. In 2007-2014, the length of stay at RHCC's emergency department increased, while the number of visits decreased. We ask whether the increase in LOS is associated with the falling numbers of visits to other EDs, whether an increase in LOS induces more referrals to competing hospitals in the metropolitan area, and whether it pays to be a crowded ED in mitigating moral hazard. Average LOS at Rambam climbed from 3.5 h in 2000-2007 to 6.4 in 2008-2018. While the number of visits to Rambam decreased significantly, those to Bnai Zion increased significantly and quite linearly. A one-way ANOVA test reveals a statistically significant difference among the three hospitals. In addition, Rambam was significantly different from Carmel but not from Bnai Zion. When LOS stabilized at Rambam from 2016 to 2018 and increased at Bnai Zion, referrals to Rambam went up again. Policymakers should instruct all hospitals to publish LOS data, regulate referrals to EDs, and find an optimal LOS that will reduce competition, non-urgent visits, and moral hazard.
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Affiliation(s)
- Fuad Basis
- Rambam Health Care Campus, Haifa 3109601, Israel
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel;
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3525433, Israel
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel;
- School of Nursing, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Ziona Haklai
- Health Information Division, Ministry of Health, Jerusalem 9359102, Israel;
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Kirby S, Wooten W, Spanier AJ. Pediatric Primary Care Relationships and Non-Urgent Emergency Department Use in Children. Acad Pediatr 2021; 21:900-906. [PMID: 33813066 PMCID: PMC8263464 DOI: 10.1016/j.acap.2021.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Non-urgent emergency department (ED) use contributes to healthcare costs and disrupts continuity of care. Factors influencing patient/guardian decision-making in non-urgent situations are poorly understood. We sought to determine the association of patient/guardian - primary care provider (PCP) relationship with non-urgent ED usage and explore related factors. METHODS In an urban practice, we recruited 218 parent-child pairs and administered a survey with the PCP relationship (PDRQ-9), caregiver knowledge of office resources, and care-seeking behavior. We performed a 12-month retrospective chart review to document non-urgent ED visits. We evaluated the association of PDRQ9 and non-urgent ED usage by regression analysis. RESULTS Mean child age was 7.0 ± 5 years, and 32.6% of children had at least one non-urgent ED visit. Mean PDRQ9 score was 39.8 ± 7.3 and was not associated with non-urgent ED use (P = .46). Lower child age (P < .001) and shorter time coming to the PCP practice (P < .001) were both associated with increased non-urgent ED use. Only 36.4% reported usually going to their PCP when they are sick. Knowledge of office resources was limited, and when prompted with acute, non-urgent medical scenarios, in 4 of 5 scenarios, 50% or more of participants chose to go to the ED over communicating with or going to their PCP. CONCLUSIONS We did not find an association between patient-doctor relationship strength and non-urgent ED usage. Many patients/guardians were unaware of the practice's resources and selected the ED as first choice for acute, non-urgent medical scenarios. Additional work is needed to determine interventions to reduce non-urgent ED use.
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Affiliation(s)
- Shannon Kirby
- Medical Student, University of Maryland, School of Medicine, Baltimore, MD, 655 West Baltimore St, Suite M-019, Baltimore, MD 21201
| | - William Wooten
- Department of Biostatistics, University of Maryland, School of Medicine, Baltimore, MD, 660 W. Redwood St, Howard Hall Suite 200, Baltimore, MD 21201
| | - Adam J. Spanier
- Department of Pediatrics, University of Maryland, School of Medicine, Baltimore, MD, 22 S. Greene Street, Rm N5E17, Baltimore, MD 21201
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Jimenez MLC, Manzanera R, Carascal MB, Figueras MD, Wong JQ, Moya D, Mira JJ. Factors affecting the non-urgent consultations in the emergency department of a tertiary hospital in the Philippines: A cross-sectional study. Emerg Med Australas 2021; 33:349-356. [PMID: 33470060 DOI: 10.1111/1742-6723.13725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The non-standard emergency medicine services and the limited utilisation of primary care providers in the Philippines may contribute towards the ED being a preferred area for patients with non-urgent conditions. Our study aims to determine the factors associated with non-urgent consultations in the ED of a tertiary hospital in the Philippines. METHODS From 7 January to 15 February 2020, we surveyed non-urgent ED patients (n = 757) presenting to a tertiary hospital in the Philippines. We evaluated the data using descriptive statistics, while chi-squared and multivariate analyses versus urgent ED patients (n = 281) were used to show the association of factors. RESULTS Our recruited non-urgent patients were mostly 21-40 years old (n = 576 [76%]), single (n = 437 [58%]), with full-time employment (n = 654 [86%]), have Health Maintenance Organization coverage (n = 684 [90%]), self-referred (n = 498 [66%]), and have private means of getting to ED (n = 414 [55%]). They had moderate scores of social support-seeking behaviours (mean 3.92/5; 95% confidence interval [CI] 3.88-3.96), health literacy (mean 3.58/5; 95% CI 3.56-3.61), self-efficacy (mean 3.09/5; 95% CI 3.56-3.61), whereas their ED access score (mean 4.10/5; 95% CI 4.06-4.14) was high. They had moderate self-assessed severity (mean 3.75/6; 95% CI 3.70-3.80), urgency (mean 3.83/6; 95% CI 3.78-3.88), and anxiety (mean 3.88/6; 95% CI 3.83-3.93) scores and high ED satisfaction rating (mean 4.73/6; 95% CI 4.69-4.77). They mostly had digestive (n = 203 [26.8%]) and infection-related (n = 172 [22.7%]) chief complaints and final diagnoses (n = 198 [26.2%] and n = 145 [19.2%], respectively), without previous consultations (n = 577 [76%]), and eventually discharged (n = 755 [99%]). Our urgent patients had similar characteristics, but with higher assessed patient severity, urgency, anxiety and satisfaction with ED services (P < 0.001). CONCLUSION Non-urgent consultations in ED are attributed to multiple factors encompassing socio-demographic, socio-economic and psychosocial dimensions. These factors must be considered in improving the current healthcare management system for the appropriate utilisation of ED in the Philippines.
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Affiliation(s)
- Ma Lourdes Cd Jimenez
- Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Pasig City, Philippines.,Department of Emergency Medicine, The Medical City, Pasig City, Philippines
| | | | - Mark B Carascal
- Department of Emergency Medicine, The Medical City, Pasig City, Philippines.,Institute of Biology, University of the Philippines Diliman, Quezon City, Philippines
| | - Marlouie Dl Figueras
- Department of Emergency Medicine, The Medical City, Pasig City, Philippines.,College of Nursing, Trinity University of Asia, Quezon City, Philippines
| | - John Q Wong
- Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Pasig City, Philippines
| | - Diego Moya
- Health and Economic Benefits Area, MC Mutual, Barcelona, Spain
| | - Jose J Mira
- Health Psychology Department, Universidad Miguel Hernández, Elche, Spain.,Alicante-Sant Joan Health District, Alicante, Spain
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Abstract
Background In Turkey, family physicians serve only during office hours, while emergency services have 7/24 free access. Non-urgent patients commonly use Paediatric Emergency departments (PEDs). In Turkey, there is little evidence as to why emergency services are used instead of family medicine for non-urgent paediatric healthcare. Objectives To evaluate the causes and factors affecting non-urgent PED visits. To determine the reason for non-use of family medicine for non-urgent paediatric healthcare. Methods We conducted a cross-sectional study at Gaziantep University PED between April and May 2019. We administered a questionnaire to the parents of children (from one month to 16 years) triaged to non-urgent (level-5) using a 5-level triage system. Results A total of 457 parents were surveyed. The average patient age was 6.5 ± 4.7 years and 24.5% had a chronic disease. One-third of the parents (33.7%) considered their children’s condition ‘very urgent’. The most important reason for preferring PED (42.5%) instead of family physician or alternative health facilities was the thought that the condition of children would worsen. Two hundred fifty-three (55.4%) of the patients presented outside working hours. Although 58.9% of parents were satisfied with the family physician, most (67.8%) stated that they preferred other specialists rather than family physicians when the child had health problems. Fathers who were primary school graduates were more likely to prefer other specialists than family physicians. Conclusion Parents’ perception of urgency and the thought that their child’s condition will worsen are the main reasons for non-urgent using PED.
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Affiliation(s)
- Hatice Tuba Akbayram
- Department of Family Medicine, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Enes Coskun
- Department of Pediatrics, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
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Mowbray FI, Omar AE, Pfaff K, El-Masri MM. Exploring the factors associated with non-urgent emergency department utilisation for mental health care. J Res Nurs 2019; 24:663-674. [PMID: 34394591 DOI: 10.1177/1744987119845020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Emergency department visits for mental health care are on the rise across North America. Patients with mental illness are at an increased risk for frequent and non-urgent emergency department visitation. Aims The purpose of this study was to examine the independent predictors of non-urgent emergency department use for mental health care. Methods A secondary data analysis was conducted with archived data provided by the Erie St. Clair Local Health Integration Network in Ontario. Results A total of 13,114 mental health-related emergency department visits were analysed using logistic regression with generalised estimating equations modelling. The findings suggest the following characteristics are predictive of non-urgent emergency department use for mental health care: age, season, time of day, access to primary health care, mode of arrival, hospital type, referral source and patient diagnosis. Conclusions The findings of this study can be utilised to assist clinicians and policy makers in identifying and managing patients using the emergency department for non-urgent mental health care.
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Affiliation(s)
- Fabrice I Mowbray
- PhD student, Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Abeer E Omar
- Research Associate, Faculty of Nursing, University of Windsor, Canada
| | - Kathyrn Pfaff
- Associate Professor, Faculty of Nursing, University of Windsor, Canada
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Alele FO, Emeto TI, Callander EJ, Watt K. Non-urgent paediatric emergency department presentation: A systematic review. J Paediatr Child Health 2019; 55:271-277. [PMID: 30570182 DOI: 10.1111/jpc.14352] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/17/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
There has been an increase in the use of the emergency department (ED) for non-urgent presentations. The aim of this systematic review was to identify the proportion, criteria and predictors of non-urgent ED presentations in paediatric populations. A search of multiple databases was conducted for articles published from inception of the databases to 20 August 2018, which reported the proportion, criteria and predictors of non-urgent ED presentation in paediatric populations. Thirty-one articles met the inclusion criteria. The mean proportion of non-urgent paediatric ED presentations was 41.06 ± 15.16%. There appears to be a weak association between predisposing, enabling and needs factors and non-urgent ED use in paediatric populations. The findings of this review suggest that non-urgent ED use in paediatric populations is high. However, non-urgent ED use and the reasons for the visits in paediatric populations remain understudied.
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Affiliation(s)
- Faith O Alele
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Theophilus I Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Emily J Callander
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Kerrianne Watt
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Hsia RY, Niedzwiecki M. Avoidable emergency department visits: a starting point. Int J Qual Health Care 2018; 29:642-645. [PMID: 28992158 DOI: 10.1093/intqhc/mzx081] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 08/14/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To better characterize and understand the nature of a very conservative definition of 'avoidable' emergency department (ED) visits in the United States to provide policymakers insight into what interventions can target non-urgent ED visits. Design/setting We performed a retrospective analysis of a very conservative definition of 'avoidable' ED visits using data from the National Hospital Ambulatory Medical Care Survey from 2005 to 2011. Participants We examined a total of 115 081 records, representing 424 million ED visits made by patients aged 18-64 years who were seen in the ED and discharged home. Main outcome measures We defined 'avoidable' as ED visits that did not require any diagnostic or screening services, procedures or medications, and were discharged home. Results In total, 3.3% (95% CI: 3.0-3.7) of all ED visits were 'avoidable.' The top five chief complaints included toothache, back pain, headache, other symptoms/problems related to psychosis and throat soreness. Alcohol abuse, dental disorders and depressive disorders were among the top three ICD-9 discharge diagnoses. Alcohol-related disorders and mood disorders accounted for 6.8% (95% CI: 5.7-8.0) of avoidable visits, and dental disorders accounted for 3.9% (95% CI: 3.0-4.8) of CCS-grouped discharge diagnoses. Conclusions A significant number of 'avoidable' ED visits were for mental health and dental conditions, which the ED is not fully equipped to treat. Our findings provide a better understanding of what policy initiatives could potentially reduce these 'avoidable' ED visits to address the gaps in our healthcare system, such as increased access to mental health and dental care.
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Affiliation(s)
- Renee Y Hsia
- Department of Emergency Medicine, University of California at San Francisco, 1001 Potrero Ave, 1E21, San Francisco, CA 94110, USA.,Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, 3333 California St, San Francisco, CA 94118, USA
| | - Matthew Niedzwiecki
- Department of Emergency Medicine, University of California at San Francisco, 1001 Potrero Ave, 1E21, San Francisco, CA 94110, USA.,Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, 3333 California St, San Francisco, CA 94118, USA
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Keizer E, Maassen I, Smits M, Wensing M, Giesen P. Reducing the use of out-of-hours primary care services: A survey among Dutch general practitioners. Eur J Gen Pract 2016; 22:189-95. [PMID: 27248713 DOI: 10.1080/13814788.2016.1178718] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Out-of-hours primary care services have a high general practitioner (GP) workload with increasing costs, while half of all contacts are non-urgent. OBJECTIVES To identify views of GPs to influence the use of the out-of-hours GP cooperatives. METHODS Cross-sectional survey study among a random sample of 800 GPs in the Netherlands. RESULTS Of the 428 respondents (53.5% response rate), 86.5% confirmed an increase in their workload and 91.8% felt that the number of patient contacts could be reduced. A total of 75.4% GP respondents reported that the 24-h service society was a 'very important' reason why patients with non-urgent problems attended the GP cooperative; the equivalent for worry or anxiety was 65.8%, and for easy accessibility, 60.1%. Many GPs (83.9%) believed that the way telephone triage is currently performed contributes to the high use of GP cooperatives. Measures that GPs believed were both desirable and effective in reducing the use of GP cooperatives included co-payment for patients, stricter triage, and a larger role for the telephone consultation doctor. GPs considered patient education, improved telephone accessibility of daytime general practices, more possibilities for same-day appointments, as well as feedback concerning the use of GP cooperatives to practices and triage nurses also desirable, but less effective. CONCLUSION This study provides several clues for influencing the use of GP cooperatives. Further research is needed to examine the impact and safety of these strategies. [Box: see text].
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Affiliation(s)
- Ellen Keizer
- a Radboud University Medical Center, Radboud Institute for Health Sciences , IQ Healthcare , Nijmegen , The Netherlands
| | - Irene Maassen
- a Radboud University Medical Center, Radboud Institute for Health Sciences , IQ Healthcare , Nijmegen , The Netherlands
| | - Marleen Smits
- a Radboud University Medical Center, Radboud Institute for Health Sciences , IQ Healthcare , Nijmegen , The Netherlands
| | - Michel Wensing
- a Radboud University Medical Center, Radboud Institute for Health Sciences , IQ Healthcare , Nijmegen , The Netherlands
| | - Paul Giesen
- a Radboud University Medical Center, Radboud Institute for Health Sciences , IQ Healthcare , Nijmegen , The Netherlands
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