Analysis of Medical Research Papers and Online Resources

This assignment involves analyzing a collection of medical research papers and online resources. The provided materials cover a range of topics, including the HEART Pathway randomized trial, cognitive behavior therapy, and the interdisciplinary management of acute chest pain. The assignment requires careful examination of these sources to extract relevant information, identify key concepts, and understand the implications of these studies in healthcare practice.

ENHANCING ADULT NURSING
PRACTICE THROUGH EFFECTIVE
DECISION MAKING

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Journey of patient suffering from acute chest pain................................................................1
Assessment issues...................................................................................................................2
Symptom presentation/control................................................................................................3
Therapeutic interventions.......................................................................................................4
Complex interaction of symptoms, cognitions, emotions, behaviour and the significance of
social support..........................................................................................................................5
Risk reduction through interventions and standardised approaches to care...........................6
The promotion of mental health ............................................................................................6
Partnership and collaboration in decision making and care...................................................7
National and local policy promoting person centred care closer to home.............................7
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Effective decision making plays a vital role in enhancing adult nursing practices because
it helps in determining individual’s ability to make decisions for patients as per different medical
situations. Report will outline the case study of Mr Singh who is a 56 years old Asian man who
has been presented in hospital for acute chest pain. Bio psychosocial is the model which helps in
determining attributes of diseases with regard to biological factors such as genetics, heredity,
personality, mood and medical condition (Burns and Mullen, 2015). As per Mr Singh’s
condition, it can be said that the patient is suffering from anxiety and depression due to family
separation and job. Further, he is anxious because he is dependent on smoking which regulated
control over his psychological factors. Further, it identifies his overall journey on the basis of his
symptoms, prevention measures, therapeutic intervention, etc. Thus, for assessment of acute
chest pain and medical history of patient, practitioner will implement the use of different models
such as Tanner's model because it recognizes relationship between the nursing process, critical
thinking, and the clinical judgement. Further, the nurse will make use of Airway, Breathing,
Circulation, Disability, Exposure (ABCDE) approach (Initial assessment and treatment with the
Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach, 2012). However,
when Mr Singh was presented in the hospital, he was suffering from sharp pain in chest due to
which he was restless.
MAIN BODY
Acute chest pain is the condition where the pain in human body radiates from one or both
soldiers and arms to chest which restricts the patient’s physical activity and also, leads to
vomiting and nausea (Acute chest pain, 1997). However, chest pain is related to Acute coronary
syndrome where the service users experience sweating and diaphoresis (The Interdisciplinary
Management of Acute Chest Pain, 2015). The cause of sudden acute chest pain is blockage in
heart blood vessels which reduces the flow of oxygen and blood in heart muscle. It is a severe
medical situation which holds the risk of death (Mahler, and et.al., 2015).
Journey of patient suffering from acute chest pain
Mr Singh is a 56 years old Asian man who has been presented in A & E hospital which
deals with life threatening and emergency situation. The service users were diagnosed with
Acute Chest pain and therefore, he was admitted instantly in medical ward. The present situation
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of man reflects that he was taken to A&E at 0730 hour and at 0400 hour. He was experiencing
sharp pain in the central chest pain to which he described that he was feeling something heavy on
his chest (Thompson and Stapley, 2011). He was anxious and according to him, it was the first
time when he was experiencing this pain that remained for 30 minutes where he was feeling out
of breathe. However, when Mr Singh was presented in hospital, he complained he experinced
sharp pain in chest for 30 minutes and now he is again feeling normal therefore professional
connected him to Cardiac monitor as the situation holds multiple cardiac risk factors.
Apparently, 12 lead electrocardiograms was conducted to analyse his medical condition and
signs and symptoms (Fanaroff and et.al., 2015).
Assessment issues
For assessment, it is important for the nurse to implement use of assessment tools like
Tanner and ABCDE approach to manage bio psychosocial cofactors of patient. With regard to
Mr Singh, the model will be used by practitioner for making clinical judgement over the
condition of patient. The assessment issues with the help of model approach are as follows:
 Noticing: In this, the focus of health practitioner will be on noticing condition and habits
of Mr Singh towards medication and change in different situations. In accordance with
his condition, it has been analysed that he lives alone and is separated from family.
Further, he lost his job and is dependent on the cigarettes. However, secondary aspect of
clinical judgement will be based on mental condition where he is bipolar personality and
smokes regularly regardless of the fact that he is diabetic and has hyper tension and
hyperlipidaemia.
 Interpreting: It is based on medical condition of Mr Singh which will be analysed and
interpreted with the help of diagnosis. This will include ABCDE assessment of acute
chest pain where the nurse will analyse level of airway blockage by monitoring cardiac
risk factors (.Paterson, Thorne and Russell, 2016). Further, the practitioner will focus on
analysing breathing ability and circulation issue which is common in patient diagnosed
with hyperlipidaemia and cardiogenic shock which is experienced by Mr Singh. In
addition, nurse will be focusing on determining mental health of patient which helps in
analysing individual dependency on intoxication which can be a cause of disabilities.
Apart from this, with the help of approach, health practitioner will be able to determine
level of exposure with regard to environmental triggers such as anxiety, depression,
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hyperlipidaemia and hypertension. In this, the care provider will ensure stability in
diabetes, Tropnin I percentage and mental health of patient.
 Respond: In this, focus of health practitioner will be on analysing the patient’s response
to dietary modification cognitive therapies, medication and treatment plans. However, to
assure effective response, nurse will ensure dietary modification for controlling the
diabetes. Further, the practitioner will focus on providing insulin, dietary education in
order to make Mr Singh’s understand effectiveness of maintaining healthy diet
(DiCenso, Guyatt and Ciliska, 2014). In addition, the judgement therapy will be based on
stability in blood pressure. Further, the reports will be regularly shared with physicians to
facilitate proper intervention for monitoring cardiac and ongoing medication with regard
to Tropnin I, BP, etc.
Apart from this, response to medication and treatment of Mr Singh will be based on
diabetes, hypertension, hyperlipidaemia, depression, anxiety and smoke. For controlling these
factors, the nursing will aim at education Mr Singh on smoking cessation, diagnosis, his medical
condition, treatment plan, nicotine patch and addressing concerns to make him deal with mental
health.
Reflect: Reflection is based on medication outcomes which help the nurse in deriving
further changes that are required to be managed for medication. In this, focus of nurse will be on
framing clinical judgement on the basis of blood pressure, intervention and Biopyshcosoial
conditions of Mr Singh. In this, the nurse will analyse participation of patient in treatment and
respond to medication plans. Further, in this step, the nurse will aim at analysing side effects of
medication with regard to improvement in health of service user.
Symptom presentation/control
Mr Singh was having a history of hyperlipidaemia, hypertension, type 2 diabetes,
depression and anxiety for which he has already been on medication which are Amlodipine
10mg, Sertraline 100mg daily, Fluoxetine 20mg daily, Metformin 500mg tds and Simvastatin
20mg nocte. When he was presented in hospital, he was in sharp pain in central chest pain like
something heavy is kept on his chest. From the ECG and blood test, it has been analysed that Mr
Singh is suffering from Acute Coronary syndrome and he requires proper medical attention.
However, decision making of nurse will be based on the mental health of Mr Singh which
is based on his struggles of job and family needs. It is necessary for the practitioner to establish
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well-being goals for patients by considering facts of mental health. Apparently, for decision
making, health care provider has used Tanner decision making model because it helps in
evaluating all the necessary steps regarding medication and patient response to treatment
(Tannerand Itti, 2017). However, clinical reasoning cycle presents results ion form of scientific
knowledge and scientific reasoning. The practitioner implemented use of tanner model promotes
critical thinking by keeping all the aspects in mind such as, decision making, medication plan,
patient sensitivity, diagnosis, response, expected health outcomes etc. Apparently, clinical judge
cycle help in framing effective evaluation of health outcomes but on the hand it derives complex
outcomes on the basis of which health outcomes can not be clearly defined. Tanner model will
help the nurse in developing knowledge over exact medical situations of Mr Singh that is
Biopsychosocial (Stone, and et..al 2016). Further, the nurse will perform intervention for
assessment over medication and treatment plan. Third step will be to keep a check over patient
response where nurse will ensure stability in condition of Mr Singh with regards to blood
pressure, hyper tension hyperlipidaemia, type 2 diabetes, depression and anxiety. Last step will
be monitoring the side effects, improvement in habits, etc.
Therapeutic interventions
Mr Singh was suffering acute chest pain and therefore physicians him connected to
Cardiac monitor in order to reduce risk of hard failure. As per guidelines of The device helped
medical professional practitioners in monitoring cardiac functioning of patient. Further, from
ECG setting, it has been discovered that:
 Sinus rhythm, rate 80/minute which reflects normal ECG
 Temp – 36.4
 Pulse – 80/minute
 Respiratory Rate – 16/minute
 Blood Pressure– 160/100
 O2 Saturations – 100% (on air)
 Blood glucose – 12.4mmol/l
However, blood test of Mr Singh comprises of urea, electrolytes, clotting, blood counts,
Tropnin I and liver functioning. Further, his Chest X ray was performed which was normal and
the blood test report was also normal except Tropnin I which was 0.67ng/ml whereas, average is
less than 0.03.
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Apparently, with diagnosis, it has been discovered that Mr Singh is suffering from Acute
Coronary Syndrome which is sudden reduction or blockage of blood flow to the heart. To
stabilise the health condition, medical team prescribed him Dalteparin, Clopdigrel and Aspirin
and further, he was admitted to medical admission wards where he was under observation with
cardiac monitor.
The Tropnin I test was repeated it was 5.63ng/ml, from which it has been analysed that
the person has Non ST Elevated Myocardial Infarction. However, during therapeutic
intervention, it was discovered that Mr Singh had a strong odour of Cigarette and when nurse
asked him, if he went outside for smoking for which he said yes with the excuse that it helps me
in relaxing when I am stressed. Further, he explained nurse about his anxious condition which
force him to smoke like, he lost his job 2 years back and was anxious and therefore, diagnosed as
Bi polar.
Thus, as per the overall discussion, it can be said that Mr Singh is going through vicious
condition for which he needs extra nursing care where prior responsibility of practitioner is to
make him Quit smoking. British Thoracic Society BTS guidance the nurse will able to ensure
proper documentation of diagnosis reports and medication for protecting interest of patient
against act of informed consent. Further the society aims at dealing with patient issues which are
concerned with work and society (British Thoracic Society, 2018). The society will continuously
provide recommendation improvement for health of Mr Singh as per his therapeutic
intervention. It is the habit which is damaging his airways and blocking flow of blood and
oxygen in heart (Viswanathan and et.al., 2012). Analysis of mental health of patient in this case
is the base of decision making nurse.
Complex interaction of symptoms, cognitions, emotions, behaviour and the significance of social
support
Enabling social support of service user is the foremost concern of health care providers
because it helps the health care practitioner in seeking interest of patient in health care services.
Social support to patient is given by nurses by analysing his/her condition with regard to
symptoms, cognition, emptions and behaviours (Cognitive behaviour therapy, 2018). However,
from complex interaction and social support in case of Mr Singh, the focus of health care
practitioner will be on Bio psychosocial factors. As per the symptoms and mental health of
patients, it has been analysed that it is important for care providers to support his inclusion in
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order to understand his situation like his dependency on smoke. In accordance with this, nurse
will implement use of Cognitive behaviour therapy, which helps nurse in dealing with unhelpful
and unhealthy conditions (Gnatavicius and Workman, 2015). As per the approach, it can be said
that care practices need to be tackled carefully keeping in mind two factors, that is, social support
and psychological well-being (Gilbody and et.al., 2015).
Cognitive behaviour therapy will help the nurse in meeting established goals of Mr Singh
that is stability in blood pressure and diabetes. Further, focus will be on reducing the impact of
hypertension, anxiety and depression (Tyrer and et.al., 2014). However, practitioner will make
use of this theory for boosting morale of Mr Singh over the situation which he has experienced in
his life and dragging him to unethical and unhealthy factors. This therapy will assist the
practitioner in managing psychological problems of Mr Singh that is anxiety, depression and
substance misuse, such as smoking and relationship problems.
Risk reduction through interventions and standardised approaches to care
Managing risk during therapeutic intervention plays an important role in health care
practices of nurses. It is the concern because lacking intervention can be hazardous and life
threatening for patients. Standardized care plan addresses the patient’s problems and encourages
high quality of care by assuring correct clinician’s measures for service users (Heery, Sheehan
and Coyne, 2015). However, in case of Mr Singh and his bio-psychological factors, it has been
analysed that nursing intervention will be specifically focused on improving his medical
condition and substance misuse because it is the major cause of his Acute coronary disease
where his airways are slowly blocking the passage of flow of oxygen and blood. Further, the
nurse will aim at implementing use of nicotine replacement therapy (NRT) in acute coronary
syndrome (ACS). The therapy is medically approved and has benefited people in quitting
smoking and stop chewing of tobacco. It is done through various measures such as gum, spray,
inhaler, trans-dermal patch and lozenge.
The care practices and nursing intervention of coronary disease will be focused on
relieving chest pain. Infusion of glycerol trinitrate helps the nurses in managing pain assessment
of patients. It is the intervention where nursing practices aim at regular monitoring and pain
assessment in order to manage restlessness and discomfort of patient in breathing (Austin and
et..al 2015). Further, nursing will ensure that Mr Singh has appropriate flow of oxygen because
of lack of air and blood can lead to heart failure. Thus, managing nursing intervention with
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regard to patient’s health and medication helps the practitioner in managing standardised care
services.
The promotion of mental health
Promotion of health is educating service user about their health concerns by encouraging
them for psychological development. As per the refection of condition of Mr Singh, it has been
analysed that he is suffering from anxiety and depression due to which he is dependent on
smoking which is the major cause of ACS. However, to promote mental health nurse will ensure
well-being, resilience and supportive living environment for service users. This will help the
nurse in managing effectiveness on smoking cessation intervention plan.
Apart from this, the nurse will aim at psychological development of Mr Singh where it is
important for the care providers to promote sense of living regardless of any situations
(Brownson, 2017). There are many factors which are the reasons of anxiety and depression of Mr
Singh for which the focus of health care provider will be on understanding his problems and
suggesting him different solutions to overcome lack of confidence, relationship problems and job
issues. In accordance with Mr Singh’s mental health issues, the nurse will ensure dietary
modification like nutritious meals, avoiding smoking intake of water, physical exercise and
proper sleep.
Partnership and collaboration in decision making and care
Acute coronary syndrome is a heart disease that has many normal symptoms like chest
pain, feeling of discomfort in arms and others may be too. This is a heart disease in which the
circulation of blood and heart beat is changed. There are cardiac professionals who have right
decision making plan about acute coronary syndrome. The diagnosis of this disease can provide
the actual situation of decision making (Arnold and Boggs, 2015). It depends upon the stages of
disease. If it is in early stage, there will be high blood pressure. It is necessary to find out the
plaque formation that is called Atherosclerotic plaque that make artery of heart narrow. Patients
and professionals like cardiac doctors are totally involved in decision making regarding the
treatment and care of heart coronary disease. Further, Simulation-based nursing education helps
the health practitioner in improving decision making ability in diverse medical situation by
developing pedagogical approach (Kon and et..al, 2016). However, it assists the nurse in decision on
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the basis of real life experiences. Thus, it can be said that simulation based decision is based on
educational interventions in varies domains (Kim Park and Shin, 2016).
Bad functioning of heart may cause hypertension, anxiety and depression due to improper
flow of blood in body and brain. Decision making of coronary heart syndrome will depend upon
the different stages of disease. The partnership and collaboration of patients as well as family
members with cardiac professionals in the treatment of disease are very important. If it is a case
of cardiac atherosclerosis surgery, patient’s decisions are important after all the guidelines of
doctors (Heery, Sheehan and Coyne, 2015). The hospital management is also a part of decision
making in such cases. Nurses are totally responsible for the health care of patients in hospitals.
All the advices that are given by doctors must be followed by patients.
National and local policy promoting person centred care closer to home
Implementing the use of national policies and guidelines of patient centred care assists
health practitioners in managing effectiveness in care services. In accordance with national
guidelines, the health care organisation and practitioners need to be focused on following below
given steps:
 Enabling right care and with appropriate health choices as per the medical condition of
patient is the guidelines which helps the practioners in managing effetivenss in patient
centred care. Like, in case of Mr Singh who is suffering from ACS and also has mental
health issue, the care provider was focused on following proper medication by promoting
mental health in order to boost sense of living in him. This strategy of practitioner assists
the nurse in maintaining standard of person centred care. Regular monitoring of patient in
relation to individual respond to intervention and medication is the concern which helps
the nurse in maintaining effectiveness of care services (Arnold and Boggs, 2015).
 It is necessary for the nurse to enable proper access of patient’s information to physician
and family in order to keep them aware about improvement in health outcomes of
patients.
 Mental health promotion is another guideline helps in improving patient’s centred care
where the nurses aim at developing sense of living among service users. It is done with
the help of biophyschological factors of patient. Like in case of Mr Singh, health
practitioners analyse his journey, therapeutic setting and assessment to issues. However,
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with the help of this analysis, the care provider was able to make appropriate nursing
decisions.
CONCLUSION
The report summarized about patient’s journey that is Mr Singh who was presented in
hospital for acute chest pain. With the diagnosis and therapeutic intervention, it was determined
that he was suffering from Acute coronary syndrome because of which he needs to be admitted
in the hospital. To control the cardiac risk, physician connected him to cardiac monitor to keep a
check over his blood circulation and heart functioning. The report outlined assessment issue of
Mr Singh with the help of Tanner model due to which nurse was able to make decision over
health outcomes and medication plan. The assessment assisted health practitioner in developing
understanding over his biophyschological factors. Thus, report concluded but outlining mental
health promotion and nursing intervention which helped care provider for enabling standard care
for Mr Singh.
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REFERENCES
Books and Journals
Arnold, E.C. and Boggs, K.U., 2015. Interpersonal Relationships-E-Book: Professional
Communication Skills for Nurses. Elsevier Health Sciences. DUI :
<https://evolve.elsevier.com/cs/product/9780323242813?role=student>
Austin, C.A. and et.al., 2015. Tools to promote shared decision making in serious illness: a
systematic review. JAMA internal medicine, 175(7), pp.1213-1221. DUI :
<https://www.ncbi.nlm.nih.gov/pubmed/25985438>
Brownson, R.C., 2017. Dissemination and implementation research in health: translating
science to practice. Oxford University Press. DUI:
<https://global.oup.com/academic/product/dissemination-and-implementation-research-in-
health-9780190683214?cc=in&lang=en&>
Burns, J. and Mullen, T.A., 2015. The Role of Traditional Chinese Medicine in the Management
of Chronic Pain: A Biopsychosocial Approach. Journal of Patient-Centered Research and
Reviews. 2(4). pp.192-196. DUI:
<https://digitalrepository.aurorahealthcare.org/cgi/viewcontent.cgi?article=1206&context=jpcrr>
DiCenso, A., Guyatt, G. and Ciliska, D., 2014. Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences. DUI:
<https://www.elsevier.com/books/evidence-based-nursing/dicenso/978-0-323-02591-1>
Fanaroff, A.C. and et.al., 2015. Does this patient with chest pain have acute coronary syndrome?:
the rational clinical examination systematic review. Jama. 314(18). pp.1955-1965. DUI:
<https://www.ncbi.nlm.nih.gov/pubmed/26547467>
Gilbody, S. and et.al., 2015. Computerised cognitive behaviour therapy (cCBT) as treatment for
depression in primary care (REEACT trial): large scale pragmatic randomised controlled
trial. Bmj. 351. p.h5627. DUI: <https://www.bmj.com/content/351/bmj.h5627>
Heery, E., Sheehan, A.M. and Coyne, I., 2015. Experiences and outcomes of transition from
pediatric to adult health care services for young people with congenital heart disease: a
systematic review. Congenital heart disease, 10(5), pp.413-427. DUI:
<https://www.ncbi.nlm.nih.gov/pubmed/25659600>
Ignatavicius, D.D. and Workman, M.L., 2015. Medical-Surgical Nursing-E-Book: Patient-
Centered Collaborative Care. Elsevier Health Sciences. DUI:
<https://evolve.elsevier.com/cs/product/9781455772551?role=student>
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Kim, J., Park, J.H. and Shin, S., 2016. Effectiveness of simulation-based nursing education
depending on fidelity: a meta-analysis. BMC medical education.16(1). p.152. DUI:
<https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0672-7>
Kon, A.A. and et.al., 2016. Shared decision making in intensive care units: An American College
of Critical Care Medicine and American Thoracic Society policy statement. Critical care
medicine. 44(1). p.188. DUI:<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788386/>
Mahler, S.A., and et..al, , 2015. The HEART Pathway randomized trial: identifying emergency
department patients with acute chest pain for early discharge. Circulation: Cardiovascular
Quality and Outcomes, pp.CIRCOUTCOMES-114.
DUI:<https://www.ncbi.nlm.nih.gov/pubmed/25737484>
Paterson, B., Thorne, S. and Russell, C., 2016. Disease-specific influences on meaning and
significance in self-care decision-making in chronic illness. Canadian Journal of Nursing
Research Archive. 34(3). DUI: <https://www.ncbi.nlm.nih.gov/pubmed/14658350>
Stone, C.M. and et.al., 2016. Modelling the health impact and cost-effectiveness of lymphatic
filariasis eradication under varying levels of mass drug administration scale-up and
geographic coverage. BMJ global health. 1(1). p.e000021. DUI:
<https://gh.bmj.com/content/1/1/e000021>
Tanner, J. and Itti, L., 2017. Goal relevance as a quantitative model of human task
relevance. Psychological review. 124(2). p.168.
Thompson, C. and Stapley, S., 2011. Do educational interventions improve nurses’ clinical
decision making and judgement? A systematic review. International journal of nursing
studies. 48(7). pp.881-893. DUI: <https://www.ncbi.nlm.nih.gov/pubmed/21241984>
Tyrer, P. and et.al., 2014. Clinical and cost-effectiveness of cognitive behaviour therapy for
health anxiety in medical patients: a multicentre randomised controlled trial. The Lancet.
383(9913). pp.219-225. DUI: <https://www.ncbi.nlm.nih.gov/pubmed/24139977>
Viswanathan, M. and et.al., 2012. Interventions to improve adherence to self-administered
medications for chronic diseases in the United States: a systematic review. Annals of
internal medicine. 157(11). pp.785-795. DUI:
<https://www.ncbi.nlm.nih.gov/pubmed/22964778>
Online
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Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure
(ABCDE) approach. 2012. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273374/>.
Cognitive behaviour therapy. 2018. [Online]. Available through:
<https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cognitive-behaviour-
therapy>.
British Thoracic Society. 2018. [Online]. Available through:
<https://www.nice.org.uk/about/what-we-do/accreditation/casestudies/bts>.
The Interdisciplinary Management of Acute Chest Pain. 2015. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660855/>.
Acute chest pain. 1997. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/pubmed/9313375>.
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