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Uniform by design

August 4, 2017

Thing 1: Blogging

Why post this blog now?

I wrote this blog in December 2016 but never posted it.  This week the Scottish Social Services Council launched their 23 digital ‘things’ (innovations) to support and engage the 21st Century social care workforce (#SSSC23digital).  ‘Thing 1’ is about blogging this prompted me to post the blog, role modelling is important if I expect others to join in.

Erskine is Scotland’s foremost provider of care for veterans and their spouses, Erskine provides high quality, person and relationship centred nursing, residential, respite and dementia care within four homes across Scotland.

Last year we provided all our care staff with new uniforms.

The uniform follows a block colour design, not dissimilar to NHS Scotland’s approach.

In the press release issued to media about the uniforms I said: “The new uniforms have been rolled out to all care staff this month and they are already making a difference for our veterans. As most of our residents are elderly, with many living with dementia or a visual impairment, strong bold colours are important and can help them identify who is who within the care staff and when they need assistance.

This can make a huge difference when building personal relationships with individual staff.”

At the same time we issued new badges with staff names written in larger, bold lettering – staff wearing uniform only have their name on the badge, other staff also have their designation printed on the badge.

Erskine residents have noticed the changes and have commented on the new uniforms.  Bill, a resident of Erskine Edinburgh said: “I really like the new uniforms. They are bright and very smart but don’t ask me to wear one!” Frank, also a veteran in Erskine Edinburgh said: “I like the new badges as I can clearly see the staff names.”

Debate

When sharing this story with Geoff (Editor of Caring Times) he posed the question: “Did the veterans we care for express a preference for uniformed care staff?”

A reasonable question, but not actually one I, or my colleagues, had considered.

Earlier this year we had visitors from Maastricht, the Netherlands – they were all senior managers/staff from a number of care homes in the Maastricht area.  One of the visitors asked a similar question as the home he manages had moved to staff wearing their own clothes.

So why a uniform and not, as some others have done, allow staff to wear their own clothes? Debate anyone?

Ethos

Erskine’s underpinning ethos is to make our Homes as homely as we can for our residents. We take a human rights approach to choice and enablement, we aim to make our residents pre-eminent in everything we do.  Every resident has their own en-suite room, they wear what they want when they want, they have a choice of food and choice of when to eat (albeit I acknowledge this is within broad time parameters – this links to my point re homeliness).  Our residents fill their rooms with their own mementos; photographs and personal treasures.

The point being we do our best to ensure we create a homely environment, promoting choice and independence.

So why do we need staff to wear a uniform and create the differentiation between them and our residents?  Wouldn’t it be more ‘homely’ if staff wore their normal clothes?

Before answering let me ask a question – how many readers have ‘random’ strangers wandering around their homes?  Earlier this week my wife and I arrived home late (9pm) and proceeded to cook ourselves a meal – not a snack, not a sandwich, but a proper meal – we could do this because it was our home, our own house! More about this later.

Identification and clarity

I’d also like to share one of the underlying reasons we did change the uniforms at Erskine. I started in my post six months ago, for the first month I couldn’t tell which staff were which, from their uniforms (the old uniforms were various stripes and collar colours which soon washed out to an indistinguishable sameness). I frequently heard of residents (and relatives) asking for assistance to go to the toilet “sorry, I’m a housekeeper, I’ll get a member of care staff for you” was not an unusual response.

And so in my first month or two I felt we had confused residents, confused relatives and a confused Director of Care (only the latter of which is vaguely acceptable!).

And so to the question – why wear uniforms at all?  Uniforms aid clarity and they are practical –in terms of style, durability and suitability.  We are not left to the individual sartorial choice of staff to consider what they think is acceptable or not, nor are we faced with staff complaints that their own personal clothes are being damaged/ripped at work.

When considering infection prevention and control, they protect both our residents and our staff (and their families) – this is another reason that our uniforms have a zip rather than being removed over the head.

Wearing a uniform is straightforward, it’s a recognition that staff are here as care givers, it’s not about pretending that our Homes are the individual home of our residents.  Our staff care deeply about our residents, they go above and beyond their job roles – but at the end of the day they are here doing a job, no matter how much they love it.  Staff wearing a uniform does not get in the way of providing great care, it doesn’t create barriers between residents and staff – it portrays clarity of purpose and easy identification of those here to help.

We did, at one point before I started at Erskine, trial staff wearing dressing gowns at night in one of our Houses caring for people living with dementia.  There were some positive outcomes in terms of encouraging some residents around sleep patterns – for others there was the distressing question of why there were strangers in ‘their’ house at night.

As we know dementia interferes with a person’s ability to make new memories, a major reason why people can remember things years ago but can’t remember what was said yesterday.  Uniforms are universal, everyone has grown up knowing a uniform signals a care giver (within a health/care environment).  A uniform refers a person back to a long term memory, it is easier to explain why this ‘stranger’ is in your House, or even to explain it isn’t someone’s individual home – they are here to give/share care.

I respect that others may take a different view, but for me, and for us here at Erskine, uniforms and all the benefits they provide are here to stay.

And Geoff – no, this doesn’t relate to the military background of our residents.

 

Coach Leader

April 23, 2017

If your actions inspire others to dream more, learn more, do more and become more, you are a leader. —John Quincy Adams


The coach must believe in the possibilities for the coachee, even in the absence of belief of others or indeed at times the coachee themselves. 

The coach’s job is to support development in the coachee around ‘that which is not yet know’, this is the actual growth arena.   

In Johari’s window this is the quadrants unknown to the coachee (blind self) and often that which is unknown to the coach (hidden self). 

The work of the coach isn’t to know better, or to know first, the coaches role is to create the conditions and environment that supports transformational change in the individual and in their relationships with others. 

The coach uses a range of questions (probing, open, reflective and occasionally leading or closed questions) as an encouragement for the coachee to consider new or alternative solutions to the issue(s) they have brought to the session – and of course, as noted above in the hidden self, areas the coach themselves may not have considered emerging as a solution either, and therefore the coach also has the opportunity to grow.  

Fearless compassion

Of note when considering questions is that leading questions can, if not used carefully, suggest to the coachee that the agenda is being led by the coach, to the coach’s end point rather than an internal process of change from the coachee. Closed questions, when overused or not used carefully, can feel like an interrogation rather than exploration. 

The coach’s role is that of fearless compassion – the ability to provide honest (difficult) feedback, from a position of believing in the individual, with compassion rather than a place of criticism – a difficult balance requiring patience and skill. 

Of note however that ‘feedback’ would not normally be in the form of ‘telling’ but is more likely to take the form of probing and reflective questioning in pursuit of the coachee’s understands of self being enhanced, developed and transformed. When providing the compassionate feedback it is more productive and more likely to be ‘heard’ if positive exploration and feedback takes place before highlighting areas for development. When leading with negative feedback the coachee can ‘shut down’, feeling attacked or not validated even if then followed up with positive reflections. When leading with positive exploration the coachee’s natural desire for balance is more likely to enable them to hear the follow up less positive aspects of feedback or discovery.  

Be specific – feedback and exploration to be constructive and to be of value needs to be specific. Exploration needs to focus on specific behaviours rather than generalised feelings. This will lead to specific actions the coachee can implement after the session i.e. feedback is future focused even when learning from the past. 

Scott in her book Radical Candor (Radical Candor: Be a Kick-Ass Boss Without Losing Your Humanity) takes a similar, albeit management approach, related to the value of productive feedback rather than ‘ruinous empathy’ from which no-one learns. Although Scott’s managerial approach is likely to be more directive e.g. in an appraisal setting, the same principle of fearless compassionate feedback and exploration is recommended. 


It is not necessarily the role of the coach to understand the system in which the coachee works. If the coach is an expert in the coachee’s area of work it might lead to an outside-in approach i.e. the coach as an outside influence influencing the coachee because they (the coach) have a desired outcome in mind. The coach’s role should be that that of a transformational facilitator, and as we know transformational change always starts from the inside-out. In other words when considering what change means, it is not just about thinking differently, it is also about acting and behaving differently. The outward manifestation of inward change. 
To be an effective transformational coach the coach’s role is to support and guide the coachee to be the change they want to see – this is about role modelling of leadership beliefs and behaviours. 

Coaching influences 

A coach needs to be mindful that there are three (potentially four) areas of influence within the coaching room:

– the individual coachee, 

– the coach and their own self awareness/skills 

– and the coach:coachee relationship.  

Depending on the reason for the coaching sessions taking place there may also be the coachee’s organisation as an unseen, but ever present influence on the ‘desired, transformation. Effectively this brings a fourth influence to bear on the coach-coachee relationship, one which both coach and coachee are aware of, but one which mustn’t become the dominant influence, as was noted above this would lead to outside-in change rather than transformational inside-out change. 

The coach:coachee relationship can often determine the depth of transformational change the coachee is able to develop. Equally however the desires of the wider organisation, its values and beliefs, can impact on the desire for and outcomes of any transformation. 

NB the coach also has to be open to learning within the coach:coachee relationship – no two relationships are the same, the coach must suspend ‘knowing’ for open learning, informed, but not driven by, past experience – in relationships where the coach is pursuing an organisational agenda their own learning is likely to be less impactful. 

Reflection

For transformational change to be effective it requires the coachee to continuously reflect and revisit agreed actions and behaviours to ensure ‘older’ more comfortable ways do not re-emerge and undermine the change. Of importance when considering what change means, it is not just about thinking differently, it is also about acting and behaving differently. 

Change however comes in two stages, or two depths. Changing something you already do e.g. acknowledging and saying thanks to team members for their input/commitment and relatively easy change is to do more of this, in other words it doesn’t challenge the coachees underlying assumptions that it’s a good thing to do, it merely serves to reinforce it or make it more preeminent in your behaviours. However for someone who sees no need to say thanks e.g. they are simply doing the job they get paid to do, why is that worthy of any additional comment or thanks. The change is more fundamental and can challenge their core beliefs. 

Hawkins & Smith call this ‘second order learning’, it can be characterised by behavioural/emotional change rather than a simply intellectual change. 

This illustrates the intertwined relationship between coaching and supervision – they both focus on the needs of the individual. One ‘supervision’, focuses on the restorative, self care element of the individual, the other ‘coaching’, focuses on the individual growing professionally through change. 

Commitment

If there’s no commitment in the coaching session, there will be no commitment/action post the session. 

Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength (Gwande). Fear can initially emerge when the coachee is faced with changing behaviours and approaches that they have practiced for years – but if the coachee desires real transformational change the fear will have to be faced and overcome – it’s the coaches role to support and guide them on that journey. 

Care Homes

February 23, 2017

My thoughts on being the Director of Care at Erskine – a seven months reflection on life after 32 years working in the NHS.

This blog was first published on letstalkaboutdementia.wordpress.com

Let's Talk about Dementia

Care of the older adult has been my first passion since becoming a nurse 32 years ago.  Having left the NHS seven months ago (latterly as Associate Nurse Director/Lead Nurse in Ayrshire), I joined Erskine (aka Erskine Hospital) where I continue to work in an area of care that excites me. 

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To be realistic my knowledge of care homes was limited, my mum, who had dementia, had been in one for the last four years of her life, care there was good, but all I did was go in, visit my mum, make sure she was ok and had what she needed – she would occasionally come home for a short time, but she grew increasingly anxious when outside the care home, so the frequency of these trips out diminished.  I had little idea of the complexity of care carried out daily in the Home, in many…

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Proud to care

February 17, 2017

My blog on life after 32 years as an NHS Scotland nurse.

First posted on the AHPScot.wordpress.com blog site

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Care Homes by Derek Barron. Director of Care, Erskine.


After 32 years working in the NHS, latterly as Associate Nurse Director/Lead Nurse, I left last year and joined Erskine (aka Erskine Hospital).

So six/seven months into post what can I share, what have I learnt and what is next?

Firstly a little about Erskine, what made me want to go and work there – “it is Scotland’s foremost provider of care for veterans and their spouses, Erskine offers unrivaled nursing, residential, respite and dementia care in our four homes throughout Scotland for UK veterans”.  OK, that’s the corporate lines, but what’s it really like?

Well, let me tell you – it’s a dynamic environment which focuses on rehabilitation; the maximising of our residents abilities.



Care is founded on relationships, with an underpinning human rights approach.

More corporate jargon? What does that really mean?

It means we strive to maximise the choices…

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Interview thoughts

January 4, 2017

Attitudes and values

I once read a blog which stated when people ‘fail’ to fit into a job it’s usually not due to lack of skill, it’s more about attitudefail-to-fit-in – this strongly suggests that when interviewing we should be interviewing for attitude and values – and of course there is other evidence to support this.  The implicit thought is we can train for skills and knowledge once the person is in the role – which for me begs the question of the competence of competence based interviews!

I was mindful of this as we shortlisted for our Clinical Lead and House Manager posts last week and as I prepare to lead the interviews later this month.  nursing-roles-at-erskine

I’m also thoughtful of the message, as we can’t interview exclusively on attitude and values – we do need an element of technical competence (depending on the job role).  The key therefore is finding the balance – it’s more difficult to find that balance than you would think, or so it appears from some of the applications I read. 

A useful yardstick for me is to refer back to something that was said by Professor Paul Martin (at that time CNO Scotland in 2007 that really stuck with me – he was addressing around 100 nurses at an event in Ayrshire – “are we technicians in a caring environment, or carers in a technical environment?”  The balance between them, as I said earlier, is, for me a critical factor. 

Complexity of Care

masterSince moving to work in a care home setting (Erskine) six months ago I have been struck by the complexity of care that is delivered every day by highly skilled and knowledgable care teams – is it perfect? well no, it isn’t – but what does perfect mean?  As I reflected back on 32 years working in the NHS I couldn’t find that one area I’d worked in nhs-scotlandwhich delivered perfection – that team or service where everything was absolutely  right and nothing needed development or improvement – and I worked with someone wonderful, inspiring people and teams, but even so none were perfect. 

And so, as I return to my original train of thought and the question asked by Paul and relate it to my current quest – what I’m looking for are people who are carers, prepared and equipped to work in a technical environment.  Care however is the pre-eminent, underpinning quality that I want to see shining through. 

So what are the things I’m looking for when interviewing, and of course what are suitable questions to establish these attributes. 

Compassion

‘Tell me a time when’ question, in relation to care delivery, is both good and bad. It’s good in that it should put the interviewee in control and they can shine, this should bring out the inner warmth, it’s also a useful opportunity for the candidate to show where, in the past, they’ve influence without authority, which is of course a higher skill than being able to direct because of positional authority.  tellme-a-time

The other side, the bad aspect, as it were, of the question, is that interviews aren’t about gushing, it’s not about competence in telling stories, it’s about us, the interview panel, being able to feel the underlying care and compassion and being able to understand why this event was important to the interviewee and why it stood out. 

So, as an interview panel we are looking for leaders who are less about control and more about influence; leader who are able to transform and adapt themselves to meet a wide range of challenges.  Control is not the goal, leaders need to support and enhance their adaptive capacity and that of their team in pursuit of the organisation’s goals.

But at the very heart of what the leader does is an unbreakable golden thread taking all their actions back to the individuals for who they deliver care – if the leader can’t make those links…… !

Coachability – mentorability

Can the individual accept and action feedback from others – whether that’s their line manager, their colleagues or most importantly those they are providing care with?  How can they demonstrate this?  coachableFor me the most dangerous person to employ is the one who knows it all, they don’t need or embrace feedback – they lack insight into areas of both strength and weakness – usually because they’re brilliant at everything (or so they think)!

A key area, but one that is ‘difficult’ to measure at interview is emotional intelligence (EI). How much understanding does that individual have on their impact on others (and of course ability to regulate their own emotions).  While this may be easier to evaluate if it’s an internal candidate being interviewed, careful questioning can draw this out from all candidates e.g. what impact are they having on the panel as they engage with the interviewers – feel the impact, not just the words but the totality of engagement.

I‘ve involved those that use services on interview panels previously, in this approach aspects of the interviewees EI can be observed and experienced from different dimensions. 

One hugely successful interview I was organisers involved people living with dementia and their carers – every single ‘interviewer’ (based on feelings and engagement) picked the same candidate as the ‘technical’ interviewers. The successful candidates ability to engage with, and move between different complexities of interviews meant they were able to demonstrate their ability to judge the needs of the range of interviewers emotions. 

Motivated

Motivation – such an easy, trip of the tongue type of Q&A. Often superficial and bland. Whitney (1997) said “It’s better to be prepared for an opportunity and have none, than to have an opportunity and not be prepared”.  I used to like asking the ‘how have you prepared for this interview?’ question – unfortunately the answer it frequently elicited let candidates down.  Cramming in last minute reading and chatting to a few people is superficial and unimpressive.the-goal

When I’m interviewing I’m looking for the a description of the path that led the person to thinking this job was right for them. I always expect contact to have been made prior to interview (but I also like to see it made pre-application completion/submission). Only once the longer term path has been explained do I like to hear about the last minute reading, don’t start off there.  So can we, the panel, understand the candidates motivation?

Technical competence

Technical competence: Can the individual demonstrate they have the technical skills/knowledge and aptitude to do the job?

Herein lies the rub, even the best skills/knowledge don’t really matter if the person isn’t open to improving, if they don’t have the underlying warmth of care, if they alienate their colleagues or if their approach feels at odds with the organisational goals and values.  

Attitude/approaches that work in one culture don’t necessarily fit into another one – it is the interview panel’s role to first understand their own organisation and secondly to consider the interviewee in that unique context. 

If I think about current staff that exemplify the organisation’s values, I am likely to be looking for new staff that can continue to build on these attributes (always bearing in mind we are not looking for clones!).  What three or four things make the current exemplary staff ‘successful’?  These are likely to be factors to consider with our interviewees – how well do they match those attributes? – of course a little bit of creative differentiation can support the organisation in not becoming stagnant.  interviewHowever interviews can be an opportunity to send reaffirm messages across the organisation of the values and beliefs we expect throughout the organisation. 

So while the interviewees may be nervous as they prepare for their interview that interview panel itself should also be nervous, they have a huge responsibility – a decision they make may impact positively or negatively on the organisation for many years to come. 

Let’s hope the interviews are very difficult for the panel as all our candidates excel. No-one said it was supposed to be easy – not for the interviewees nor for the panel. 

The application Pt 1 by @dtbarron

January 4, 2016

Job application form

Over the past few months months I’ve had the privilege of shortlisting and interviewing for a number of posts ranging from band 5 to band 8a. interview

Some of the application forms have brought a smile to my face while others leave me shaking my head in disappointment.

I’m sure there are guru HR professionals would be able to articulate what I’m about to say much better than I can – however in this blog I’m going to reflect on my recent experience; if you are about to apply for a post I hope it might be helpful, if you’re about to be interviewed then my previous blogs related interviews may be of interest.

First Step

The very first step before starting the application form, think to yourself do I want this job and why do I want it.  Job Vs Career

Second thing, having decided you do want the job, look at the advert, look at the job description and start to think about what value you bring to the post – not every staff nurse or senior charge nurse job is the same.

This is going to help you when you start filling in the application form.

Third thing, and I am astonished, indeed somewhat baffled that applicants don’t do this – if the advert gives you the name of someone to contact for anContact informal discussion – why on earth would you not do so?

Do you really need a written personal invitation to make contact?

There are two major reasons for making contact at this early stage:

  • It will give you the opportunity to find out if the area is somewhere you actually want to work – what are the beliefs and values of this prospective employe?
  • It gives you an opportunity to demonstrate to the people who may or may not shortlist you that you are keen to work for us, that you’re knowledgeable about the job and have the skills required.

Shortlisting

The last round of interviews I was involved in there were 14 applications for four posts. It is highly unlikely we are going to shortlist all 14 (i.e. it’s a ‘short’ list that we’re tasked with creating), my role in shortlisting is to select the best candidates who we might be interested in employing, that means every bit of information you give the shortlisting panel is critical in you getting to the next stage. Someone who has made contact to find out about the area will, in my view and experience, have a greater chance of being shortlisted.

Only now should you be thinking about the job application form – it’s your second window for prospective employers to look into, and potentially the first one for some members of the shortlisting panel.

NHSS Job ApplicationIn my area we use standard NHS Scotland application forms, they’re not fabulous but they are what we have, so you need to make the best of them.

Let’s cut to the chase, if you can’t be bothered spending time on your application, if it’s full of mistakes and typos why would I or my colleagues want to shortlist you?

Do you really think that is the kind of nurse we want working for us?  One who’s paperwork appears to be of little interest to them, despite the importance of the form – how might that translate into their written clinical records?

I have been disappointed with the lack of or limited post registration learning and development that is evident from application forms. Within my Board there is little excuse as we have actively supported post registration education over many years, not only via our SLA with the University of the West of Scotland, but also via a variety of post registration funds including some directly given by the Scottish Government.

Job role and function

My disappointment re post registration education was nothing compared to my concerns when I read the entries related to the current ‘Role purpose/Summary of Responsibilities’ of some applicants. Telling the shortlisting panel that your role is a series of tasks that seem to have very little to do with a person centred approach to care is unlikely to impress us.screen-capture-26

These are actual examples from the past year:  I wouldn’t mind if these things were listed last, however they play an unfortunate pre-eminent place on the form.

Complete the ward diary – undertake a smooth handover between shifts – I am often left in charge of the unit – order medicines/restock medicine cupboards – run the ward efficiently, using clinical observation sheets – run my caseload efficiently – liaise with the GP – prepare for and take part in MDTs – responsible for ward off-duty – cover duty system – I provide basic nursing care.

Is any reader of this blog inspired by this list?  

I can assure you I am not, and in my recent shortlisting meeting neither were the two Senior Charge Nurses who were shortlisting with me.

ScheinSchein (2013) in his book ‘Humble Inquiry’ notes

“We think of task orientated relationship as impersonal and emotionally neutral”……. “… by contrast,  a person-orientated relationship is expected to be more emotionally charged because one or both parties are interested in each other …”

In their application forms, few explored, what I consider to be the real purpose of the nursing role, as Schein notes above “because one or both parties are interested in each other …

The caring role of the nurse should be the focus throughout the application, but it should most definitely feature prominently in your current role descriptor.   When I read an application I want to be able to ‘feel’ the nurse’s caring approach exude from the page, I want to be able to understand the values and beliefs of the nurse writing that statement.

Of course tasks are an aspect of the nurse’s role, but it shouldn’t be the first thing mentioned and it shouldn’t be the thing that takes up the most space.

Rights, Relationships and Recovery

While not wishing to suggest stock phrases that can simply be regurgitated I’m hoping  and expecting to see how you, the nurse deliver care; that you understand the preeminent place the individual who uses our service deserves to be in your application.  In 2006 (refreshed in 2010) mental health nursing had its own strategy for continuous development of our profession; it was called Rights, Relationships and Recovery.RRR Scotland

I fully expect to see in applications for a nursing role in Ayrshire & Arran that nurses know their role in upholding the rights of people in our care, that care is based on relationships with those we are in contact with and that a belief in recovery is a driving principle of the nurse writing the statement.

Also, when I read the current role that a nurse recognises the importance of engaging with carers, it can’t help but bring a smile to my face – and over the last  year I’ve read several.

A role description will be able to articulate the writers belief in involving carer, of supporting them to be involved in care episodes where possible. Carers usually know their relative much better than we, as professionals do, they can help wrap care round the individual – I really want to see view point expressed in the job application form (and of course that’s it’s demonstrated in actions).

For those of you who have filled out an NHS Scotland application form you’ll realise that I’ve only covered the first few pages.  Next week I plan to cover the rest of the application form and include some pointers of what to do, as well as what not to do.

Let me know your thoughts on the items in this blog, or if you’ve got specific questions you would like me to address.

Thanks.

Dementia – what is it? by @dtbarron

November 25, 2014

ayrshirehealth

Fear, shock and denial

Dementia, rather like the word cancer, can often stir negative emotions. There can be an element of fear, shock and/or denial when we think about it, the overwhelming thought of losing one’s identity or the impact on someone close to us can create a rising sense of panic. Despite this reaction, the term itself is not well understood. DementiaAlthough it is true to say that dementia will often be an irreversible, progressive and life long condition – that is, once you’ve got it you will always have it, it does not need to be a life limiting condition in the early stages, nor for that matter for some considerable time in most types of dementia.

In short, the earlier a diagnosis is made the better opportunity that exists to slow the progression of some dementias – medication has an important role to play in slowing down…

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