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Co-Director, Kaiser Permanente School of Medicine

See Warfarin in antiphospholipid antibody syndrome asthma treatment prednisone purchase discount montelukast on-line, 839­840 antiplatelet agents asthma definition in urdu buy montelukast in united states online, 821­822 aspirin asthmatic bronchitis yellow montelukast 5mg amex. See Acute arterial insufficiency Arterial oxygen content material (CaO2), 223­224 Arteriography, bronchial, 544 Artificial airway. See Endotracheal intubation Ascending cholangitis, 405, 406t Ascites, 20, 718­719, 718t Aspergillus/aspergillosis, 605, 738 Aspiration, 97, 300 Aspiration pneumonia, 149­150, 150f, 380. See additionally Cervical spinal cord accidents Azathioprine, 623 Azithromycin, 378 Azole antifungals, 93t B Babesiosis, transfusion-associated, 82t Back ache, with suspected malignancy, 455t Bacterial infections. See Infection(s) Bacterial translocation, 701 Bacteroides fragilis, 376t Balloon tamponade, 717 Band ligation, 709, 717 Barbiturates, 111. See Head harm Brain tumors, 688­690 Bromocriptine, for neuroleptic malignant syndrome, 672 Bronchial arteriography, 544 Bronchial artery embolization, 544­545 Bronchodilators for acute respiratory failure, 260­263 in pregnancy, 816 for status asthmaticus, 537 Bronchopneumonia, 147 Bronchoscopy in acute respiratory failure, 265 in hemoptysis, 543 in inhalation harm, 740 in Pneumocystis pneumonia, 601 Brown recluse spider bite, 796­797 Brown-Sйquard syndrome, 693 Bullous eruptions, drug-related, 613­614, 614t Bupivacaine, 105­106, 106t Buprenorphine, 113 Bupropion, 438 Burn heart, referral tips, 723, 724t Burn harm chemical, 749­750 electrical, 750­751, 799 thermal. See additionally Hypercalcemia; Hypocalcemia Calcium channel blockers after acute myocardial infarction, 509 in aortic dissection, 485 for heart failure, 473 in hypertensive disaster, 482 Biliary tract infection, 405, 406t Biobrane, 738­739 Biologic dressings, 738 Biotin, 122t Bismuth subsalicylate, 358 Bisphosphonates, fifty six, 459, 460t, 461 Bivalirudin for acute arterial insufficiency, 636­637, 637t for heparin-induced thrombocytopenia, 829, 829t mechanisms of motion, 831 Black widow spider bite, 796­797 Bladder obstruction, 321­322 Bleeding. See additionally Hemorrhage; Hemostasis acute platelet transfusion for, 74 purple blood cell transfusion for, 73 decrease gastrointestinal. See Gastrointestinal tract, bleeding postoperative clinical options, 522­524 differential analysis, 524 essentials of analysis, 520 etiology, 429t, 521­522 basic considerations, 520 preoperative screening, 428­430, 429t treatment, 524 posttraumatic, 430 upper gastrointestinal. See Gastrointestinal tract, bleeding Bleeding problems acquired coagulation problems, 417­420, 420t platelet dysfunction, 423­424 approach to, 427, 428t gastrointestinal hemorrhage, 427­428 inherited coagulation problems, 412, 413­414t, 415­417, 416t platelet dysfunction, 422­423, 422t perioperative screening and management, 428­430, 429t thrombocytopenia, 132, 425­427, 426t Bleeding time, 411t Blood components. See Pacemakers Cardiac tamponade clinical options, 478­479 essentials of analysis, 478 basic considerations, 478 imaging studies, 479­480, 479f postoperative, 531 849 pulmonary capillary wedge strain in, 198 surgical analysis, 533 treatment, 480 Cardiac troponins, in pulmonary embolism, 550 Cardiogenic shock after acute myocardial infarction, 510­511 causes, 242t clinical options, 242­243 differential analysis, 227t, 243 essentials of analysis, 242 basic considerations, 242 prognosis, 245 stages, 242 treatment, 243­245, 470, 471­472, 511 Cardiomyopathy, peripartum, 814 Cardiopulmonary bypass adverse results, 528­529 circuit-related issues, 527 coagulation parameters, 527 cross-clamp time and hypothermia, 527 fluid and drug administration during, 417 basic considerations, 525­527, 526f platelet dysfunction and, 424 Cardiopulmonary resuscitation, in pregnancy, 806 Cardiothoracic surgery. See Bleeding, postoperative cardiac insufficiency after, 529­533 hypercoagulability after, 522­525 Cardiovascular system age-related adjustments, 443­444, 444t in pregnancy, 802 thermal burn harm response, 724­725 Cardioversion, 106, 519­520 Carotid endarterectomy, 655, 676 Caspofungin, 378 Catheter­associated infections intravenous. See Thoracic wall problems Child-Turcotte-Pugh classification, surgical risk in cirrhosis, 720, 720t Chlordiazepoxide, 89t Chloride, 123t, 125t Cholecystectomy, 349­350 Cholecystitis acalculous, 182­184, 183f, 655 calculous, 181­182, 182f clinical options, 701 analysis, 701 emphysematous, 375 risk elements, 701 treatment, 183­184 Cholesterol embolization, 325 Cholestyramine, 124t, 769 Cholinergics. See Variceal bleeding Central venous catheters clinical purposes, 193­195, 194f, 195f issues, 140­141, 140f, 195. See additionally Botulism Clostridium difficile­associated diarrhea, 386­387 Coagulation acquired problems clinical options, 419­420, 420t differential analysis, 420 essentials of analysis, 417 basic considerations, 417­418 pathophysiology, 418­419 treatment, 420­421 inherited problems clinical options, 413­414t, 415 controversies and unresolved points, 417 differential analysis, 415 essentials of analysis, 412 basic considerations, 412 treatment, 415­417, 416t laboratory checks, 409, 411­412, 411t Coagulation elements, 410t, 418 Cocaine abstinence syndrome, 763 Cocaine toxicity, 763­764 Coccidioidomycosis, 678 Coccoides immitis, 604­605 Cockroft-Gault equation, ninety Cofactors, 410t Cognitive Test for Delirium, 432 Colitis, 175­176, 176f, 711 Colloid options for hypovolemia, 18, 18t for hypovolemic shock, 229, 230 for septic shock, 236 Colonoscopy, 711­712 Coma mind demise in, 662 clinical options historical past, 658­659 stage of consciousness, 659 localization of mind lesions, 659, 659t motor systems, 660 oculomotor system, 660 pupillary and ophthalmoscopic analysis, 659­660, 660t respiratory and circulatory adjustments, 660 differential analysis, 661­662 drug-induced, 660t basic considerations, 658 hyperglycemic hyperosmolar nonketotic, 593 metabolic, 661, 661t pathophysiology, 658 in major mind harm, 661­662 poisonous, 661 treatment, 662 Common-mode voltage, 188 Community-acquired pneumonia. See additionally Pneumonia clinical options, 363­364, 364t differential analysis, 364 essentials of analysis, 362 basic considerations, 363 microbiologic etiology, 363, 364t treatment, 364­365, 365t Compartment syndrome belly, 701 intraabdominal, 733 Compassion fatigue, 220 Complement activation, 232 Complex partial seizure, 663, 663t. See additionally Antithrombotic therapy risk elements, 822t risk stratification, 640, 640t treatment anticoagulation, 554­557, 555t, 645 inferior vena cava interruption, 558­559, 647 operative embolectomy, 647 supportive care, 559, 645 thrombolytic therapy, 557­558, 645­647 upper extremity, 642, 642t Defibrinating agents, 832 Delirium causes, 433­434, 434t, 447t clinical options, 432­433 controversies and unresolved points, 436 differential analysis, 433 drug-induced, 434t in elderly sufferers, 447­448, 447t essentials of analysis, 431 basic considerations, 431 pathophysiology, 431­432 risk elements, 447t treatment, 434­436 Delta agent, transfusion-associated, 81t Demeclocycline, for hyponatremia, 463 Dementia, 433 Depression, 433, 436­438 Dermatologic issues. See additionally Corticosteroids Dexmedetomidine, 435­436 Dextrans for acute arterial insufficiency, 636 for deep venous thrombosis prophylaxis, 644 for hypovolemic shock, 229 platelet operate and, 423, 825 Dextroamphetamine, 437­438 Dextrose, in whole parenteral diet, 129 Diabetes insipidus mind tumor and, 689 central, 30, 30t clinical options, 32 analysis, 31f, 32 nephrogenic, 30t treatment, 33 Diabetes mellitus issues in acute sickness diabetic ketoacidosis. See additionally specific drugs adverse results cardiac toxicity, 95 cutaneous reactions erythema multiforme, 615­616, 615t morbilliform, urticarial, and bullous, 612­614, 613t, 614t phenytoin hypersensitivity syndrome, 618­619 Stevens-Johnson syndrome, 616­618 poisonous epidermal necrolysis, 616­618 Diabetic ketoacidosis (Cont. See additionally Stroke Embolism in acute mesenteric ischemia, 648 air, 141, 195, 199 amniotic fluid, 811 arterial. See Thyroid storm Endorphins, 224 Endoscopy for decrease gastrointestinal bleeding, 712 for peptic ulcer bleeding, 707­708, 707t for variceal bleeding, 709 Endothelium, in hemostasis, 410t Endotoxin, 360 Endotracheal intubation air leakage, 103 airway care, 255­256 issues, 256­257 basic considerations, 102 imaging studies, 139­140 indications, 255t nasotracheal vs. See additionally Bronchoscopy Fibrin degradation merchandise, 411t Fibrin glue, 76t Fibrinogen, 410t, 411t Endotracheal intubation (Cont. See additionally Nasogastric tubes after thermal burn harm, 745 feeding tube position, 127 formulas for, 127 lipids, 127 protein, 127 vs. See Gastrointestinal tract, fistulas Enterobacteriaceae, 376t Enterococcal infections, 376t, 389­390 Envenomation marine life, 797­798 snakebite, 795­796 spider and scorpion bites/stings, 796­797 Environmental accidents chemical burn harm, 749­750 electrical shock and lightning harm, 750­751, 798­800 envenomation marine life, 797­798 snakebite, 795­796 spider and scorpion bites, 796­797 frostbite, 791­793 heat stroke, 786­788 hypothermia. See Thermal burn harm Epidural hematoma, 681, 681f Epiglottitis, 153 Epinephrine for anaphylactic shock, 240 for anaphylaxis, 563 for angioedema, 565 in hypovolemic shock, 224 for status asthmaticus, 537 Epstein-Barr virus, transfusion-associated, 81t Eptifibatide, 504, 825 Erythema multiforme, 614t, 615­616, 615t Erythromycin, 89t, 93t, 378 Erythropoietin, 76t, 85 Escharotomy, 106, 734­735, 734f Escherichia coli in dialysis-related peritonitis, 339t in pancreatic necrosis, 348 in pyelonephritis in pregnancy, 812 Esmolol, 481, 517 Esophageal perforation, 402 Esophagogastric varices, 707, 716. See Thrombolytic therapy Fick methodology, cardiac output measurement, 200­201 First-degree burns, 728, 730t. See additionally Thermal burn harm Flail chest, 286, 287 Flecainide, 487, 496 Flexion teardrop fractures, 695. See additionally Gastrointestinal tract, bleeding in hemodialysis, 338 in heparin therapy, 828 postpartum, 816­818 in thrombolytic therapy, 837­838 in warfarin therapy, 834 Hemostasis laboratory checks, 409, 411­412, 411t normal, 409, 410t preoperative analysis, 428­429, 429t Henderson-Hasselbalch equation, 57 Heparin. See Low-molecular-weight heparin; Unfractionated heparin Heparin-induced thrombocytopenia, 522, 557, 645, 828­829, 829t Heparinoids, 829t, 831­832 Glucose, 123t, 576. See Diabetes insipidus essentials of analysis, 29, 31f basic considerations, 6t, 29 pathophysiology, 29­30, 30t with polyuria, 32 treatment, 6t, 32­33 without polyuria, 32 Hyperparathyroidism, 459, 459t, 460t Hyperphosphatemia in acute renal failure, 332 clinical options, 46­47, 46t essentials of analysis, forty five basic considerations, 46 treatment, 47 in tumor lysis syndrome, 462 Hypertension in cocaine intoxication, 764 intracranial. See Preeclampsia-eclampsia in renal transplant recipients, 344 in sympathomimetic poisoning/overdose, 761 Hypertensive disaster, 480­482 Hyperthermia in cocaine intoxication, 764 in heat stroke, 787 in sympathomimetic poisoning/overdose, 761 Hyperthyroidism.

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The coating is eliminated within the alkaline duodenum asthma treatment guidelines aap discount montelukast line, and the prodrug asthma emergency treatment generic montelukast 10 mg, a weak base definition of asthma exacerbation purchase montelukast 10 mg without prescription, is absorbed and transported to the parietal cell canaliculus. Acid suppression begins inside 1 to 2 hours after the first dose of lansoprazole and barely earlier with omeprazole. There is also be|can be} an oral product containing omeprazole mixed with sodium bicarbonate for sooner absorption. It is out there in powder to be dissolved in water and brought orally nicely as|in addition to} in capsule kind. Pharmacokinetics: All these brokers are delayed-release formulations and are efficient orally. In animal studies, the incidence of gastric carcinoid tumors elevated, possibly associated to the consequences of prolonged hypochlorhydria and secondary hypergastrinemia. Increased concentrations of viable micro organism within the abdomen have been reported with continued use of those medicine. Omeprazole inhibits the metabolism of warfarin, phenytoin, diazepam, and cyclosporine. Another downside with prolonged elevation of gastric pH is that calcium carbonate merchandise require low gastric pH to be absorbed within the upper intestine. Increasing gastric pH increases the potential for incomplete absorption of calcium carbonate merchandise. An efficient possibility could be to use calcium citrate as a supply of calcium by sufferers taking prolonged acid-suppressing medicines. A deficiency of prostaglandins is thought to be involved within the pathogenesis of peptic ulcers. Like other prostaglandins, misoprostol produces uterine contractions and is contraindicated during pregnancy. Dose-related diarrhea and nausea are the most typical adverse effects and limit using of} this agent. Antimuscarinic brokers (anticholinergic agents) Muscarinic receptor stimulation increases gastrointestinal motility and secretory activity. However, its many side effects effects} (for instance, cardiac arrhythmias, dry mouth, constipation, and urinary retention) limit its use. Antacids Antacids are weak bases that react with gastric acid to kind water and a salt, thereby diminishing gastric acidity. Because pepsin is inactive at a pH larger than four, antacids also cut back pepsin activity. Chemistry of antacids: Antacid merchandise range broadly in their chemical composition, acid-neutralizing capability, sodium content material, palatability, and worth. Adverse effects: Aluminum hydroxide tends to be constipating, and magnesium hydroxide tends to produce diarrhea. Absorption of the cations from antacids (Mg2+, Al3+, Ca2+) is usually not a problem in sufferers with regular renal operate, but the sodium content material of antacids may be an essential consideration in sufferers with hypertension or congestive heart failure. Adverse effects may also occur in sufferers with renal impairment, attributable to accumulation of magnesium, calcium, sodium, and other electrolytes. Excessive consumption of calcium carbonate along with calcium foods end result in|may end up in|can lead to} hypercalcemia. Mucosal protecting brokers these compounds, identified as|often known as} cytoprotective compounds, have quantity of} actions that enhance mucosal protection mechanisms, thereby stopping mucosal injury, reducing irritation, and healing existing ulcers. Sucralfate: this advanced of aluminum hydroxide and sulfated sucrose binds to positively charged teams in proteins of each regular and necrotic mucosa. It also stimulates prostaglandin release nicely as|in addition to} mucus and bicarbonate output, and it inhibits peptic digestion. By these and other mechanisms, sucralfate successfully heals duodenal ulcers and is utilized in long-term upkeep therapy to forestall their recurrence. It may be very nicely tolerated, but might possibly} interfere with the absorption of other medicine by binding to them. Bismuth subsalicylate: Preparations of this compound successfully heal peptic ulcers. In addition to their antimicrobial actions, they inhibit the activity of pepsin, enhance secretion of mucus, and work together with glycoproteins in necrotic mucosal tissue to coat and defend the ulcer crater. Nearly 70 to eighty p.c of all sufferers who undergo chemotherapy experience nausea or vomiting.

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Lifetime prevalence of psychological disorders in Lebanon: first onset asthmatic bronchitis what is it generic montelukast 5mg, remedy definition of asthma uk cheap montelukast 4mg visa, and exposure to asthma symptoms - symptoms types purchase 5 mg montelukast free shipping struggle. Quitetheopposite,heutilisesotherstrategiestocreatea sense of solidarity with the congregation. The function of religious discourse is simple and formidable because it has contributed to the religious, cultural, literary, linguistic, and political developments of modern civilizations (2)In view of the factthatthepresentstudyisconcernedwithpreaching, primary target|the major focus} shall be on the language of sermons. Preaching is germane to the sociopragmatic research outcome of|as a outcome of} it can be be} seenasasocialcommunicativeprocess. The Pragmatic Structure of Preaching: A closer a glance at|have a glance at} the final construction of preaching serves to illustrate Corresponding Author: Dr. Inthissense,preachingcanbe viewed as a communicative course of whose purpose is to feed the congregation spiritually by offering them with religious information and by discussing the present social nicely as|in addition to} political points to help them conduct their life and making their decisions (4). Nonetheless,itisaone-way communicative course of during which the sermon is delivered in one direction from the preacher to his congregation(5). It is price mentioning here that the terminology used in developing the three preaching levels is attributed to the researchers (6). Socially talking, there are two major social variables that have an effect on} the language and the pragmatic methods utilized by preachers that are power and solidarity. They are the social components that function the preaching course of and preserve the continuation of the pragmatic methods used within the sociopragmatic model of preachinginthepresentstudy. As such, each stage shall be analysed in some detail within the forthcoming sections (9). Inbrief,itisproposedherethatpreachingisrealised asamulti-facetedsociopragmaticprocessbecauseofthe fact that that|proven truth that} it incorporates numerous pragmatic parts spread over the three levels of preaching nicely as|in addition to} a number of|numerous|a variety of} social variables that have an effect on} each stage. The sermon, which is retrieved from an official web site supply and transcribed by the researchers, is preached on the 6th of November 2016. The utterances within the extracts are numbered for the sake of ease of reference(14). Wecouldtalkalldayaboutwhatthatmightmean, however at the very least it seems to me issues aresubjecttoreviewandtheremaynotbevery many permanent truths. FortwohundredandfiftyyearssincetheAmerican colonies, plenty of issues were thought of very clear and easy. Thebeginningaboutfiftyyearsago,amovement settled in and perhaps it was needed in some sense asitisjustabouteverythingcanbequestioned. ThisisthewordoftheLord: "AstheSunwassetting,Abramfellintoadeepsleepand a thick and dreadful darkness came to visit him. Then the Lordsaidtohim"knowforcertainthatyourdescendants shall be strangers within the nation not their very own and so they willbeenslavedandmistreatedforhundredyears. In the fourth era your descendants will comebackhere,forthesinoftheAmoriteshasnotyet reached its full measure. The biblical textual content recited in extract 2 is taken from Genesis Chapter 15Verses 10-14. This textual content depicts an encounter between the Lord and his prophet, Abram, when the Lord causes Abram to fall in a deep sleep find a way to} reveal a prophecy to him in relation to the longer term run} ofhisdescendants. In consequence, Pastor Alberta resorts to this biblical textual content his religious power as a preacher and a non secular guide of the congregation (15). Similarly,theanalysisillustratestheeffectofthe social variable of power and solidarity on the pragmatic methods utilized by Pastor Alberta. Agam, "A Continuous Process for the Preparation, Characterization and Study Thermal Properties of Nickel Oxide Nanostructure,"Int. AbdullahHasanJabbar, A Maytham Qabel Hamzah, Salim Oudah Mezan, "Green Synthesis of Silver / Polystyrene Nano. First of all, preaching is a social communicativeprocesswhichoperateswiththreestages: opening stage, major stage, and concluding stage. The first stage contains two sub-stages: the preambles and thebiblicaltext,whereasthesecondconsistsofdifferent twosub-stages:presentingthemaintopicandpresenting sub-topics, and the third stage encompasses four substages: the recapitulation, the clincher, awakening constructive feelings, and the final prayer. Four techniques are 308 Indian Journal of Public Health Research & Development, January 2019, Vol. Democratictheoryandpoliticalscience: A pragmatic technique of constructive engagement. Agam,"Synthesis and Characterization of Zinc Sulphide (ZnS) Thin Film Nanoparticle for Optical Properties," Journal of Global Pharma Technology, 2018; 10(07):369-373.

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In patients with elevated airway resistance or decreased lung or chest wall compliance asthma definition mayo clinic buy generic montelukast 4mg, respiratory muscles should generate comparatively larger pressure for a given tidal quantity asthma treatment using honey purchase montelukast 10 mg on line. Often these patients have an elevated ventilatory requirement and asthma treatment herbal order montelukast 5mg visa, due to this fact, an elevated pressure-time product-an index of muscle work and potential for fatigue. Factors related to decreased muscle strength and endurance embrace electrolyte abnormalities (eg, hypokalemia and hypophosphatemia), crucial sickness polymyopathy and polyneuropathy, high-dose corticosteroid therapy, malnutrition, and recent use of nondepolarizing muscle relaxants. Predicting Successful Weaning-The underlying illness that caused a need for mechanical ventilation must be corrected first. Nevertheless, present predictors and scientific judgment of successful weaning are poor. In an important research, all patients utilizing mechanical ventilation had a day by day spontaneous respiration trial unless contraindicated (eg, apnea, hypopnea, severe hypoxemia, or excessive oxygen or minute ventilation requirements). In fact, patients who tolerate a spontaneous respiration trial of 30­120 minutes must be considered for instant extubation within the absence of contraindications. An explanation of the weaning procedure, including descriptions of attainable discomfort and an assurance of close monitoring, must be provided to the patient earlier than weaning is started. A research of a small variety of patients confirmed that a fall in gastric intramural pH, suggesting tissue ischemia, was found in patients who failed weaning, whereas those who have been successful had no change in gastric intramural pH. In any patient who has problem being weaned from mechanical ventilation, reassessment of ventilatory necessities and ventilatory capability is indicated. Evidence that intermittent mandatory ventilation helps in tough patients is lacking. T tube-The ventilator circuit is disconnected from the endotracheal tube, and humidified oxygen is supplied by a tube linked throughout the endotracheal tube connection (T tube) whereas the patient breathes spontaneously. The patient is noticed rigorously for indicators of respiratory failure, discomfort, severe dyspnea, or other intolerance. If the T tube is used for a spontaneous respiration trial and the patient tolerates the procedure for 30­120 minutes, then magnesium, and potassium), discontinuing sedatives, and minimizing irregular lung mechanics by treatment with bronchodilators and appropriate patient positioning. Ventilatory capability is assessed utilizing selection of|quite lots of|a big selection of} weaning parameters, some of which are shown in Table 12­12. These variables have glorious predictive value in patients recovering from short-term general anesthesia, however their predictive value is only marginal in patients with acute or continual lung diseases. In one research in which 58% of patients have been weaned successfully, the next variables have been found to be most carefully correlated with success:days of mechanical ventilation earlier than the weaning trial, respiratory frequency:tidal quantity ratio, maximal inspiratory pressure, maximal expiratory pressure, and important capability. Indices that combine estimates of ventilatory requirement, work of respiration, and ventilatory capability could also be} helpful. This ratio, termed the speedy shallow respiration index, proved to have larger sensitivity and specificity than other variables for prediction of weaning. Some variables used to predict success throughout weaning from mechanical ventilation. In between classes, the patient is reconnected to the mechanical ventilator within the assist-control mode. In some patients, a T-tube session could also be} as quick as 5­10 minutes at first, with very gradual lengthening. The classes could also be} repeated two to four occasions day by day depending on patient tolerance. It is important to strike a balance between excessive respiratory muscle fatigue during the classes and adequate time for the patient to assume work of respiration. A variation of the T-tube weaning technique uses the ventilator circuit and ventilator to provide the air-oxygen mixture throughout spontaneous respiration somewhat than a separate T tube. However, some ventilator circuits throughout spontaneous ventilation require far more patient effort than the traditional T tube. Some mechanical ventilators provide gas mixtures to spontaneously respiration patients with minimal work and energy through the use of steady move or bypass circuits. The variety of mechanical ventilator breaths every minute is decreased gradually over hours or days whereas the patient provides a progressively growing share of the breaths taken every minute.

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