3PAGES
The following case studies are provided to give you experience in completing risk assessments. These studies allow you to identify the process that one goes through in risk assessments. (This implies, “This is what the case study tells me, this is what I need to know, this is what I would do with the information once it is determined…Perhaps you should start out saying, “The first step I took…) The whole point of this process is to get you familiar with the components of the risk assessment process and to give you practice with trying to find the different components and then put them together to make conclusions. My approach to this assignment is to act like a detective. Ask questions of yourself, discuss where the questions lead you, what more questions are revealed once you have gathered the initial data, etc.
The final research project has you actually doing the process for a particular toxicant with you researching for the information you need.
FIRST THING: Also, though more important for stage 2, you will need to determine why you are doing the risk assessment. SPECIFICALLY WRITE OUT YOUR PURPOSE FIRST THING. In an accident case it might be to determine what the long-term health effects will be to those who were exposed but survived. It might be to determine how high the risks of exposure are to nearby residents, or if exposure were to happen, what the risks to them might be. In a workplace case the risk assessment might be to determine to what level the clean-up (of air, water, etc.) should be to protect human health. It might be to determine if any workplace accommodations need to be made. In a medically related case the risk assessment might be to characterize the risks to workers associated with a medically related accident or incident. Its purpose might be to determine the risks to the general public from an incident. If you narrow down your focus it will make how you go about dose response investigation and exposure assessment more straightforward.
You may NOT use any of these case studies for your research project.
Staged Project (Case Study 1), Stage 1: Define the purpose of the Risk Assessment. Apply the steps of hazard identification to identify the hazard in each case study. Be sure to discuss the evidence that led you to your decision about the identification of the hazard. If the case study doesn’t provide the evidence then discuss how you would go about getting the evidence you need and what source would you use. Discuss how the evidence supports your conclusion about the identification of the hazard. Keep in mind the information you need for toxickinetics and toxicodynamics.
Staged Project (Case Study 2), Stage 2: Exposure assessment, dose-response assessment and risk characterization. Based on the case studies above and the hazard identified, discuss how you would approach an exposure assessment, a dose-response assessment and a final risk characterization.
NOTE: not all of these case studies are real incidences. You have been given choices so that you may explore areas within your interests.
Choose ONE study from EACH AREA below (this means you will comment on THREE case studies – one from community-based, one from work-based and one from medically based.
Community-Based Hazard Exposure:
Choose one (1) of these –
A. http://www.ops.fhwa.dot.gov/publications/fhwahop08014/case4_0.htm
Graniteville, S. Carolina Case study, Chlorine
Note that this case study either tells you, or strongly hints at what the hazard is. Ignore this, and tell me what logic you used to determine what the hazard actually was.
B. http://www.mhhe.com/Enviro-Sci/CaseStudyLibrary/Topic-Based/CaseStudy_LoveCanal.pdf
New York Case Study, water and ground pollution
Workplace-Based Hazard Exposure:
Choose one (1) of these –
A: An employee developed occupational asthma after working for a large multi-national company in Gloucester. He was employed between 1995 and 2004 as a solderer and was exposed to rosin based (colophony) solder fume during his career. The company had no fume extraction equipment to remove rosin based fumes from the workroom air or from the breathing zones of its solderers.
His health was deteriorating from 1999 onwards and he was taking time off work due to breathing difficulties.
B: Jenkins Chemical
Background
Jenkins Chemicals is a small/medium size specialist chemical manufacturing
company based in Hartfordshire, England. The company supplies Hydrazine Hydrate (a known carcinogen) for use as an oxygen scavenger of boiler feed water, preventing corrosion damage in high pressure boilers used in the power generating industries and used as a chemical intermediate for a number of different applications. Under the Chemicals (Hazard Information and Packaging for Supply) Regulations, Hydrazine Hydrate is a Category 2 carcinogen – believed to cause cancer in humans. Whilst under the EU Classification Labeling and Packaging regulations it will carry a category 1B (H350) Carcinogen classification.
The Problem
The company originally used a manual operation to decant the Hydrazine Hydrate
into storage tanks using a hose and lance system. A similar approach was used to
prepare Hydrazine Hydrate for supply to customers; manual decanting into
containers of various sizes up to 1 tonne bulk containers. When HSE inspected the site and assessed both processes, HSE and the company agreed that there was a heavy reliance on both personal protective equipment (PPE) and Respiratory Protective equipment (RPE). The company also had a local exhaust
ventilation system on site which would only remove escaping vapors when near the
source of exposure, therefore offering a limited level of protection. This was important
given that the company had discovered that airborne exposure concentrations during
manual transfers were in excess of the assigned regulatory exposure limit for
Hydrazine, although no employee was known to be exposed to hydrazine vapor
above the regulatory limits.
Substitution – using a less harmful chemical with similar properties was not a viable
option for the company as there was no other practicable alternative oxygen
scavenger for use in high pressure boilers. Overall, the potential for worker exposure coupled with a heavy reliance on PPE raised concerns for both HSE and the company.
At the heart of the shared dilemma was the need to minimize the potential for worker
exposure to a vital, but harmful chemical.
C. Case Study: Jennifer*
Jennifer is a nulliparous, 30-year-old healthy woman who presents to your office for her annual well-woman exam. She was recently married and is contemplating pregnancy within the next year. She has no complaints except for occasional headaches, which occur sometimes at work but never on weekends.
Jennifer has worked as a lab technician at a local polymer manufacturer for the past 6 years. She is concerned about possible chemical exposure at work. For protective equipment she uses eye protection, an apron, and latex gloves. There is no ventilation hood in the lab. The primary chemical she works with is N-methylpyrrolidone (NMP), a chemical used to dissolve a wide range of other chemicals. She is exposed to NMP on a weekly, and often daily, basis.
Jennifer’s exam is normal. The pregnancy test that you order is negative. You pull up the material safety data sheet (MSDS) for NMP online, which you review with Jennifer. The MSDS mentions no adverse reproductive effects, and Jennifer is relieved. However, knowing that MSDS entries are often incomplete and inaccurate with regard to information on the reproductive effects of the chemical, you investigate NMP in more detail on the Internet. You learn that in 2001, NMP was listed as a known reproductive toxicant in the state of California on the basis of animal studies.6 You search the developmental and reproductive toxicology database at the TOXNET Web site and find several entries, including a case of a pregnancy loss in a lab technician exposed to NMP.
On the basis of the information from the Internet and the toxicology database, you refer Jennifer to an occupational health specialist. You receive a note from the specialist after Jennifer’s consultation. She has recommended the use of additional safety precautions at Jennifer’s workplace, including a ventilator hood, a well-fitted respirator, neoprene rather than latex gloves (the former are more resistant), and continued use of the apron and eye protection.
The occupational health specialist asks you to explore with Jennifer the options for transferring out of the lab to a less toxic work environment, bearing in mind her legal rights and the potential for job loss or discrimination. You write a letter to Jennifer’s employer identifying NMP as a potential reproductive toxicant, highlighting the importance of avoiding reproductive toxicants, and the need to transfer Jennifer to a job without such exposure while she is trying to get pregnant and during pregnancy.
The employer transfers Jennifer to a position with less toxic exposure and invests in additional safety equipment for Jennifer and other employees. Had no other jobs been available, Jennifer might have decided to continue in the same job with improved protection. After the transfer, Jennifer’s headaches resolve.
This case illustrates that exposures to reproductive toxicants can occur at the workplace. With understanding and appropriate information, health care providers can advocate for their patients and make specific workplace recommendations that reduce the risk of exposure to reproductive toxicants.
*Case study adapted from GENERATIONS AT RISK: REPRODUCTIVE HEALTH AND THE ENVIRONMENT, published by The MIT Press.7
Medically Related Exposures:
Choose one (1):
Case A: Jan was a nurse at the Lydecker Hospital in Minneapolis, MN. She worked the night shift in the communicable diseases ward.
One evening a 28 year old male (Jason) was brought to the ward in a confused condition. His chart indicated that he had AIDS and hepatitis C and was presently recovering from acute alcohol poisoning.
Toward the end of her shift Jan was doing patient assessment. Upon entering Jason’s room Jan approached the bed to determine Jason’s vitals (blood pressure, temperature, etc.). Upon waking Jason became extremely agitated, verbally and then physically abusive. Jan, in an attempt to calm the patient, gently put her hand on his shoulder, which he then grabbed and proceeded to bite Jan several times, drawing blood and requiring 36 stitches.
Case B: Jacob works as an infectious disease analyst at a local hospital. While he is a physician, his job is largely administrative in that he analyzes data on suspected nosocomial (hospital induced) infections. He notes that beginning the third week in March that three patients developed pneumonia after being in the hospital between 5-7 days. Both were immunologically compromised. Two patients developed surgical site infections. During the fourth week in March he noted that two nurses had come down with pneumonia and one had come down with a skin condition. Suspecting MRSA (Methicillin Resistant Staphylococcus Aureus) a full evaluation of hospital protocol was initiated. It was found that the all patients to have come down with MRSA related illnesses been interviewed by the same intake personnel. All nurses who had become ill had attended the ill patients. It was later determined that the intake person was a carrier of MRSA.
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Signature Assignment 19438265
/in Uncategorized /by developerFinal power point assignment
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Significant Contributions To Public Health Part I 18870637
/in Uncategorized /by developerYou have the option of writing a paper or putting together a presentation. Details are below the outline. Overall, you will be researching an historical figure in the public health world, their contribution to public health, and how their work helped shape the public health system. Furthermore, you will be analyzing how their contribution from the past continues to contribute to today’s public health system and how it might guide future work within the industry.
Follow this outline to help formulate your paper or presentation:
Luther T. Terry/Smoking
ACTION: Think about how this person overcame the barriers and issues
ACTION: Think about the importance of the contribution to community/public health at the time
You have a choice of which format you wish to present your findings:
Format 1: Written Paper
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Significant Contributions To Public Health Part Ii
/in Uncategorized /by developerACTION: Think about the individual’s contribution to community/public health
You have a choice of which format you wish to present your findings:
Format 1: Written Paper
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Simple Assignment Due 3hrs 2pages
/in Uncategorized /by developerLearning Objectives
Students will:
· Assess progress for clients receiving psychotherapy
· Differentiate progress notes from privileged notes
· Analyze preceptor’s use of privileged notes
To prepare:
· Reflect on the client you selected for the Week 3 Practicum Assignment.
· Review the Cameron and Turtle-Song (2002) article in this week’s Learning Resources for guidance on writing case notes using the SOAP format.
The Assignment
Part 1: Progress Note
Using the client from your Week 3 Assignment, address the following in a progress note (without violating HIPAA regulations):
· Treatment modality used and efficacy of approach
· Progress and/or lack of progress toward the mutually agreed-upon client goals (reference the Treatment plan—progress toward goals)
· Modification(s) of the treatment plan that were made based on progress/lack of progress
· Clinical impressions regarding diagnosis and/or symptoms
· Relevant psychosocial information or changes from original assessment (i.e., marriage, separation/divorce, new relationships, move to a new house/apartment, change of job, etc.)
· Safety issues
· Clinical emergencies/actions taken
· Medications used by the patient (even if the nurse psychotherapist was not the one prescribing them)
· Treatment compliance/lack of compliance
· Clinical consultations
· Collaboration with other professionals (i.e., phone consultations with physicians, psychiatrists, marriage/family therapists, etc.)
· Therapist’s recommendations, including whether the client agreed to the recommendations
· Referrals made/reasons for making referrals
· Termination/issues that are relevant to the termination process (i.e., client informed of loss of insurance or refusal of insurance company to pay for continued sessions)
· Issues related to consent and/or informed consent for treatment
· Information concerning child abuse, and/or elder or dependent adult abuse, including documentation as to where the abuse was reported
· Information reflecting the therapist’s exercise of clinical judgment
Part 2: Privileged Note
Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client from the Week 3 Practicum Assignment.
· The privileged note should include items that you would not typically include in a note as part of the clinical record.
· Explain why the items you included in the privileged note would not be included in the client’s progress note.
· Explain whether your preceptor uses privileged notes, and if so, describe the type of information he or she might include. If not, explain why.
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Simple Assignment
/in Uncategorized /by developer3PAGES
The following case studies are provided to give you experience in completing risk assessments. These studies allow you to identify the process that one goes through in risk assessments. (This implies, “This is what the case study tells me, this is what I need to know, this is what I would do with the information once it is determined…Perhaps you should start out saying, “The first step I took…) The whole point of this process is to get you familiar with the components of the risk assessment process and to give you practice with trying to find the different components and then put them together to make conclusions. My approach to this assignment is to act like a detective. Ask questions of yourself, discuss where the questions lead you, what more questions are revealed once you have gathered the initial data, etc.
The final research project has you actually doing the process for a particular toxicant with you researching for the information you need.
FIRST THING: Also, though more important for stage 2, you will need to determine why you are doing the risk assessment. SPECIFICALLY WRITE OUT YOUR PURPOSE FIRST THING. In an accident case it might be to determine what the long-term health effects will be to those who were exposed but survived. It might be to determine how high the risks of exposure are to nearby residents, or if exposure were to happen, what the risks to them might be. In a workplace case the risk assessment might be to determine to what level the clean-up (of air, water, etc.) should be to protect human health. It might be to determine if any workplace accommodations need to be made. In a medically related case the risk assessment might be to characterize the risks to workers associated with a medically related accident or incident. Its purpose might be to determine the risks to the general public from an incident. If you narrow down your focus it will make how you go about dose response investigation and exposure assessment more straightforward.
You may NOT use any of these case studies for your research project.
Staged Project (Case Study 1), Stage 1: Define the purpose of the Risk Assessment. Apply the steps of hazard identification to identify the hazard in each case study. Be sure to discuss the evidence that led you to your decision about the identification of the hazard. If the case study doesn’t provide the evidence then discuss how you would go about getting the evidence you need and what source would you use. Discuss how the evidence supports your conclusion about the identification of the hazard. Keep in mind the information you need for toxickinetics and toxicodynamics.
Staged Project (Case Study 2), Stage 2: Exposure assessment, dose-response assessment and risk characterization. Based on the case studies above and the hazard identified, discuss how you would approach an exposure assessment, a dose-response assessment and a final risk characterization.
NOTE: not all of these case studies are real incidences. You have been given choices so that you may explore areas within your interests.
Choose ONE study from EACH AREA below (this means you will comment on THREE case studies – one from community-based, one from work-based and one from medically based.
Community-Based Hazard Exposure:
Choose one (1) of these –
A. http://www.ops.fhwa.dot.gov/publications/fhwahop08014/case4_0.htm
Graniteville, S. Carolina Case study, Chlorine
Note that this case study either tells you, or strongly hints at what the hazard is. Ignore this, and tell me what logic you used to determine what the hazard actually was.
B. http://www.mhhe.com/Enviro-Sci/CaseStudyLibrary/Topic-Based/CaseStudy_LoveCanal.pdf
New York Case Study, water and ground pollution
Workplace-Based Hazard Exposure:
Choose one (1) of these –
A: An employee developed occupational asthma after working for a large multi-national company in Gloucester. He was employed between 1995 and 2004 as a solderer and was exposed to rosin based (colophony) solder fume during his career. The company had no fume extraction equipment to remove rosin based fumes from the workroom air or from the breathing zones of its solderers.
His health was deteriorating from 1999 onwards and he was taking time off work due to breathing difficulties.
B: Jenkins Chemical
Background
Jenkins Chemicals is a small/medium size specialist chemical manufacturing
company based in Hartfordshire, England. The company supplies Hydrazine Hydrate (a known carcinogen) for use as an oxygen scavenger of boiler feed water, preventing corrosion damage in high pressure boilers used in the power generating industries and used as a chemical intermediate for a number of different applications. Under the Chemicals (Hazard Information and Packaging for Supply) Regulations, Hydrazine Hydrate is a Category 2 carcinogen – believed to cause cancer in humans. Whilst under the EU Classification Labeling and Packaging regulations it will carry a category 1B (H350) Carcinogen classification.
The Problem
The company originally used a manual operation to decant the Hydrazine Hydrate
into storage tanks using a hose and lance system. A similar approach was used to
prepare Hydrazine Hydrate for supply to customers; manual decanting into
containers of various sizes up to 1 tonne bulk containers. When HSE inspected the site and assessed both processes, HSE and the company agreed that there was a heavy reliance on both personal protective equipment (PPE) and Respiratory Protective equipment (RPE). The company also had a local exhaust
ventilation system on site which would only remove escaping vapors when near the
source of exposure, therefore offering a limited level of protection. This was important
given that the company had discovered that airborne exposure concentrations during
manual transfers were in excess of the assigned regulatory exposure limit for
Hydrazine, although no employee was known to be exposed to hydrazine vapor
above the regulatory limits.
Substitution – using a less harmful chemical with similar properties was not a viable
option for the company as there was no other practicable alternative oxygen
scavenger for use in high pressure boilers. Overall, the potential for worker exposure coupled with a heavy reliance on PPE raised concerns for both HSE and the company.
At the heart of the shared dilemma was the need to minimize the potential for worker
exposure to a vital, but harmful chemical.
C. Case Study: Jennifer*
Jennifer is a nulliparous, 30-year-old healthy woman who presents to your office for her annual well-woman exam. She was recently married and is contemplating pregnancy within the next year. She has no complaints except for occasional headaches, which occur sometimes at work but never on weekends.
Jennifer has worked as a lab technician at a local polymer manufacturer for the past 6 years. She is concerned about possible chemical exposure at work. For protective equipment she uses eye protection, an apron, and latex gloves. There is no ventilation hood in the lab. The primary chemical she works with is N-methylpyrrolidone (NMP), a chemical used to dissolve a wide range of other chemicals. She is exposed to NMP on a weekly, and often daily, basis.
Jennifer’s exam is normal. The pregnancy test that you order is negative. You pull up the material safety data sheet (MSDS) for NMP online, which you review with Jennifer. The MSDS mentions no adverse reproductive effects, and Jennifer is relieved. However, knowing that MSDS entries are often incomplete and inaccurate with regard to information on the reproductive effects of the chemical, you investigate NMP in more detail on the Internet. You learn that in 2001, NMP was listed as a known reproductive toxicant in the state of California on the basis of animal studies.6 You search the developmental and reproductive toxicology database at the TOXNET Web site and find several entries, including a case of a pregnancy loss in a lab technician exposed to NMP.
On the basis of the information from the Internet and the toxicology database, you refer Jennifer to an occupational health specialist. You receive a note from the specialist after Jennifer’s consultation. She has recommended the use of additional safety precautions at Jennifer’s workplace, including a ventilator hood, a well-fitted respirator, neoprene rather than latex gloves (the former are more resistant), and continued use of the apron and eye protection.
The occupational health specialist asks you to explore with Jennifer the options for transferring out of the lab to a less toxic work environment, bearing in mind her legal rights and the potential for job loss or discrimination. You write a letter to Jennifer’s employer identifying NMP as a potential reproductive toxicant, highlighting the importance of avoiding reproductive toxicants, and the need to transfer Jennifer to a job without such exposure while she is trying to get pregnant and during pregnancy.
The employer transfers Jennifer to a position with less toxic exposure and invests in additional safety equipment for Jennifer and other employees. Had no other jobs been available, Jennifer might have decided to continue in the same job with improved protection. After the transfer, Jennifer’s headaches resolve.
This case illustrates that exposures to reproductive toxicants can occur at the workplace. With understanding and appropriate information, health care providers can advocate for their patients and make specific workplace recommendations that reduce the risk of exposure to reproductive toxicants.
*Case study adapted from GENERATIONS AT RISK: REPRODUCTIVE HEALTH AND THE ENVIRONMENT, published by The MIT Press.7
Medically Related Exposures:
Choose one (1):
Case A: Jan was a nurse at the Lydecker Hospital in Minneapolis, MN. She worked the night shift in the communicable diseases ward.
One evening a 28 year old male (Jason) was brought to the ward in a confused condition. His chart indicated that he had AIDS and hepatitis C and was presently recovering from acute alcohol poisoning.
Toward the end of her shift Jan was doing patient assessment. Upon entering Jason’s room Jan approached the bed to determine Jason’s vitals (blood pressure, temperature, etc.). Upon waking Jason became extremely agitated, verbally and then physically abusive. Jan, in an attempt to calm the patient, gently put her hand on his shoulder, which he then grabbed and proceeded to bite Jan several times, drawing blood and requiring 36 stitches.
Case B: Jacob works as an infectious disease analyst at a local hospital. While he is a physician, his job is largely administrative in that he analyzes data on suspected nosocomial (hospital induced) infections. He notes that beginning the third week in March that three patients developed pneumonia after being in the hospital between 5-7 days. Both were immunologically compromised. Two patients developed surgical site infections. During the fourth week in March he noted that two nurses had come down with pneumonia and one had come down with a skin condition. Suspecting MRSA (Methicillin Resistant Staphylococcus Aureus) a full evaluation of hospital protocol was initiated. It was found that the all patients to have come down with MRSA related illnesses been interviewed by the same intake personnel. All nurses who had become ill had attended the ill patients. It was later determined that the intake person was a carrier of MRSA.
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Simple Post
/in Uncategorized /by developerDefine Ethics, and explain the American Nurses Association (ANA) “ Code of Ethics for Nurses” 2 paragraphs and bewteen 300-350 words. Please check for grammatical errors and no plagiarism
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Sing The Format Outlined On The Pico Reference Page In The Nursing Reference Center Design Your Own Question This May Be Related To Something You Are Familiar With Or Something You Imagine To Be An Issue In Nursing I
/in Uncategorized /by developerReport Issue
Your Essay should be outlined by using steps 1-3 of the EBP process.
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
Annotated Bibliography on Pressure Ulcers and PICOT Question
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mathil 8
Written Assignment – PICO and EBP
https://content.learntoday.info/Learn/PN110_Fall_13/site/Media/EBP.pdf
s://content.learntoday.info/Learn/PN110_Fall_13/site/Media/PICO_handout.pdf
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Upload Assignment: Module 08 Written Assignment – PICO and EBP
Module 08 Written Assignment – PICO(T) and EBPPoints/Grading Rubric:CriteriaPointsCreate a question using PICO format10Identify three reliable sources of information related to your PICO10Discuss …
PICO
Using the format outlined on the PICO reference page in the Nursing Reference Center design your own question. (This may be related to something you are familiar with, or something you imagine to be …
intro to nursing
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Situational Leadership Styleapa Format Essay
/in Uncategorized /by developerCreate a healthcare business that you will be in charge, and use a SITUATIONAL LEADERSHIP STYLE. APA Format Essay with an Abstract. Please cited and date the references at least 2 references. SEE PHOTO ATTACHED.
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Six Page Essay
/in Uncategorized /by developerStatistics play an important role in the management of health care organizations and in decision making and strategic planning. Collecting, analyzing, and utilizing data appropriately impacts financial management of the organization and the quality of patient care delivered. Decisions in clinical medicine are driven by evidence-based practice, as are those in health care management. A health care manager must understand and use evidence in making informed decisions that improve the operations and financial status of the organization as well as deliver quality of care accessible to those who need it and with consideration of the costs involved.
In this assignment, you will choose a utilization review statistic from the following list and review a research paper or government publication, as outlined below.
Choose a health care statistic that health care managers would use, such as one of the following:
Research your chosen statistic, and provide information from an outside source—such as a journal article, accreditation agency report, government site, and so forth—that discusses the health care statistic in a real-life setting or situation.
Write a paper of 4–6 pages, not including the title page and reference page, in APA format that discusses the following:
Cite references using APA format, and remember to include a citation for the article that you are describing.
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Skin Assessment
/in Uncategorized /by developerThe Lab Assignment
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