NURS 6531 Final, part one

NURS 6531 Final, part one with verified answers n n n n n n n




A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as
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a Level 1 ACO. What is part of this designation? p. 2
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a. Bonuses based on achievement of benchmarks
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b. Care coordination for chronic diseases
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c. Standards for minimum cash reserves
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d. Strict requirements for financial reporting - Answer ✔✔ - ANS: A
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A Level 1 ACO has the least amount of financial risk and requirements, but receives shared
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savings bonuses based on achievement of benchmarks for quality measures and
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expenditures. Care coordination and minimum cash reserves standards are part of Level 2
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ACO requirements. Level 3 ACOs have strict requirements for financial reporting.
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What was an important finding of the Advisory Board survey of 2014 about primary care
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preferences of patients? p. 2
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a. Associations with area hospitals
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b. Costs of ambulatory care
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c. Ease of access to care
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d. The ratio of providers to patients - Answer ✔✔ - ANS: C
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As part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access to
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care, walk-in settings and the ability to be seen within 30 minutes, and care that is close to
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home. Associations with hospitals, costs of care, and the ratio of providers to patients were not
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part of these results.
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Which assessments of care providers are performed as part of the value-based purchasing
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(VBP) initiative? (Select all that apply.) p. 1
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a. Appraising costs per case of care for Medicare patients
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b. Assessing patients' satisfaction with hospital care
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,c. Evaluating available evidence to guide clinical care guidelines
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d. Monitoring mortality rates of all patients with pneumonia
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e. Requiring advanced IT standards and minimum cash reserves - Answer ✔✔ - ANS: A, B,
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D
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Value-based purchasing looks at five domain areas of processes of care, including efficiency
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of care (cost per case), experience of care (patient satisfaction measures), and outcomes of
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care (mortality rates for certain conditions). Evaluation of evidence to guide clinical care is part
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of evidence-based practice. The requirements for IT standards and financial status are
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part of Accountable Care Organization standards
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What is the purpose of Level II research? p. 6
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a. To define characteristics of interest of groups of patients
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b. To demonstrate the effectiveness of an intervention or treatment
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c. To describe relationships among characteristics or variables
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d. To evaluate the nature of relationships between two variables - Answer ✔✔ - ANS: C
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Level II research is concerned with describing the relationships among characteristics or
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nvariables. Level I research is conducted to define the characteristics of groups of patients.
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nLevel II research evaluates the nature of the relationships between variables. Level IV
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research is conducted to demonstrate the effectiveness of interventions or treatments.
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Which is the most appropriate research design for a Level III research study? p. 6
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a. Epidemiological studies
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b. Experimental design
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c. Qualitative studies
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d. Randomized clinical trials - Answer ✔✔ - ANS: B
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The experimental design is the most appropriate design for a Level III study. Epidemiological
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studies are appropriate for Level II studies. Qualitative designs are useful for Level I studies.
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Randomized clinical trials are used for Level IV studies.
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What is the purpose of clinical research trials in the spectrum of translational research? p. 6
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a. Adoption of interventions and clinical practices into routine clinical care
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b. Determination of the basis of disease and various treatment options
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c. Examination of safety and effectiveness of various interventions
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d. Exploration of fundamental mechanisms of biology, disease, or behavior - Answer ✔✔ -
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ANS: C
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Clinical research trials are concerned with determining the safety and effectiveness of
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interventions. Adoption of interventions and practices is part of clinical implementation.
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Determination of the basis of disease and treatment options is part of the preclinical research
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phase. Exploration of the fundamental mechanisms of biology, disease, or behavior is part
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of the basic research stage.
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Which statement made by a health care provider demonstrates the most appropriate
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understanding for the goal of a performance report?
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a. "This process allows me to critique the performance of the rest of the staff."
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b. "Most organizations require staff to undergo a performance evaluation yearly."
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c. "It is hard to be personally criticized but that's how we learn to change."
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d. "The comments should help me improve my management skills." - Answer ✔✔ - ANS: D
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The goal of the performance report is to provide guidance to staff in the areas of professional
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development, mentoring, and leadership development. A peer review is written by others who
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perform similar skills (peers). The remaining options may be true but do not provide evidence
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of understanding of the goal of this professional requirement.
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,Which assessment question would a health care provider ask when engaging in the previsit
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stage of the new model for primary care? (Select all that apply.)
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a. "Are you ready to discuss some of the community resources that are available?"
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b. "Are you experiencing any side effects from your newly prescribed medications?"
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c. "Do you anticipate any problems with adhering to your treatment plan?"
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d. "Are you ready to discuss the results of your laboratory tests?"
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e. "Do you have any questions about the lab tests that have been ordered for you?" - Answer
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✔✔ - ANS: B, C, E
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The nursing responsibilities in the previsit stage include assessing the patient's tolerance of
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prescribed medications, understanding of existing treatment plan, and education about
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required lab testing. The primary care provider is responsible for screening lab data and
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discussing community resources during the actual visit.
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What is the Quadruple Aim? p. 15 - Answer ✔✔ - 1) Improved patient satisfaction
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2) Reduce per capita costs
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3) Improve population health
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4) Improve patient care team experience
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To reduce adverse events associated with care transitions, the Centers for Medicare and
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Medicaid Service have implemented which policy?
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a. Mandates for communication among primary caregivers and hospitalists
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b. Penalties for failure to perform medication reconciliations at time of discharge
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c. Reduction of payments for patients readmitted within 30 days after discharge
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d. Requirements for written discharge instructions for patients and caregivers - Answer ✔✔ -
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ANS: C
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As a component of the Affordable Care Act, the Centers for Medicare and Medicaid Service
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developed the Readmissions Reduction Program reducing payments for certain patients
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readmitted within 30 days of discharge. The CMS did not mandate communication, institute
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penalties for failure to perform medication reconciliations, or require written discharge
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instructions.
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According to multiple research studies, which intervention has resulted in lower costs and
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fewer rehospitalizations in high-risk older patients?
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a. Coordination of posthospital care by advanced practice health care providers
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b. Frequent posthospital clinic visits with a primary care provider
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c. Inclusion of extended family members in the outpatient plan of care
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d. Telephone follow-up by the pharmacist to assess medication compliance - Answer ✔✔ -
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ANS: A
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Research studies provided evidence that high-risk older patients who had posthospital care
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coordinated by an APN had reduced rehospitalization rates. It did not include clinic visits with
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a primary care provider, inclusion of extended family members in the plan of care, or
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telephone follow-up by a pharmacist
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1. Which advantages are provided to the chronically ill patient by personal electronic
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monitoring devices? (Select all that apply.)
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a. Helps provide more patient control their health and lifestyle
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b. Eliminates need for regular medical and nursing follow-up visits
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c. Helps the early identification of patient health-related problems
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d. Helps health care providers in keeping track of the patient's health status
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e. Cost is often covered by Medicare - Answer ✔✔ - ANS: A, C, D, E
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, A primary care provider administers the "Newest Vital Sign" health literacy test to a patient
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newly diagnosed with a chronic disease. What information is gained by administering this test?
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a. Ability to calculate data, along with general knowledge about health
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b. Ease of using technology and understanding of graphic data
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c. Reading comprehension and reception of oral communication
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d. Understanding of and ability to discuss health care concerns - Answer ✔✔ - ANS: A
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The "Newest Vital Sign" tests asks patients to look at information on an ice cream container
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label and answer questions that evaluate ability to calculate caloric data and to grasp general
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knowledge about food allergies. It does not test understanding of technology or directly
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measure reading comprehension. It does not assess oral communication. The "Ask Me 3" tool
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teaches patients to ask three primary questions about their health care and management.
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What is the main reason for using the REALM-SF instrument to evaluate health literacy? p. 27
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a. It assesses numeracy skills.
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b. It enhances patient-provider communication.
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c. It evaluates medical word recognition.
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d. It measures technology knowledge. - Answer ✔✔ - ANS: C
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The Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) is an easy and fast
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tool that measures medical word recognition. It does not evaluate numeracy. The "Ask Me 3"
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tool enhances patient-provider communication. This tool does not evaluate understanding of
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technology.
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A female patient who is from the Middle East schedules an appointment in a primary care
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noffice. To provide culturally responsive care, what will the clinic personnel do when
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meeting this patient for the first time? n n n n n n


a. Ensure that she is seen by a female provider.
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b. Include a male family member in discussions about health care.
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c. Inquire about the patient's beliefs about health and treatment.
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d. Research middle eastern cultural beliefs about health care. - Answer ✔✔ - ANS: C
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It is important not to make assumptions about beliefs and practices associated with health care
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nand to ask the patient about these. While certain practices are common in some cultural and
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nethnic groups, assuming that all members of those groups follow those norms is not culturally
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nresponsive.

A primary care provider is providing care for a postsurgical client who recently immigrated to
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nthe United States and speaks English only marginally. What intervention will provide the most
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neffective means of communicating postdischarge information to the client?
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a. Postpone discharge until the client is fully recovered from the surgery.
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b. Requesting that a family member who speaks English be present during the
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teaching session n


c. Providing the necessary information in written form in the client's native language
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d. Requesting the services of a professional interpreter fluent in the client's native
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language - Answer ✔✔ - ANS: D n n n n nnn n


Only approved, professional interpreters experienced in health care interpretation are
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nappropriate interpreters for patients. Family members or friends should not be used as
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ninterpreters. Use of family members or friends may create misinterpretation or
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misunderstanding between the provider and the patient. Family members may not understand n n n n n n n n n n n


nmedical terms or may interpret only what they feel is important, or patients might feel
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nuncomfortable divulging personal information to the person interpreting. Written information in
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nthe client's native language may be a means of reinforcing instructions but are not a substitute
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nof person-to-person education. It is neither realistic nor necessary to postpone discharge for
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nthis reason. n