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  1. Article ; Online: Perceived ability to comply with national COVID-19 mitigation strategies and their impact on household finances, food security, and mental well-being of medical and pharmacy students in Liberia.

    Davis, Elvis J / Amorim, Gustavo / Dahn, Bernice / Moon, Troy D

    PloS one

    2021  Volume 16, Issue 7, Page(s) e0254446

    Abstract: Introduction: From the outset of the COVID-19 pandemic, guidance from WHO has promoted social distancing, wearing face masks, frequent hand washing, and staying-at-home as measures to prevent the spread of COVID-19. For many across Africa, compliance ... ...

    Abstract Introduction: From the outset of the COVID-19 pandemic, guidance from WHO has promoted social distancing, wearing face masks, frequent hand washing, and staying-at-home as measures to prevent the spread of COVID-19. For many across Africa, compliance can be difficult. The aim of this study was to 1) understand the impact of student's household's ability to comply with COVID-19 mitigation strategies, 2) identify predictors of mitigation strategy compliance, and 3) describe the impact of COVID-19 on household economics, food-security, and mental well-being.
    Materials and methods: We conducted an email-based survey among current medical and pharmacy students of the University of Liberia College of Health Sciences between July and October 2020. The questionnaire was designed to explore their household's ability to comply with current mitigation strategies, as well as the pandemic´s impact on the student's household's finances and food security. Descriptive statistics were used to delineate demographic characteristics. Logistic regression was used to model factors associated with ability to comply with COVID-19 mitigation strategies, as well as participant's food security.
    Results: 113 persons responded to the questionnaire. Seventy-six (67∙3%) reported income losses as a result of the pandemic, with 93 (82∙3%) reporting being "somewhat" or "very worried" about their households' finances. Seventy-seven (68∙1%) participants reported food stocks that were sufficient for one-week or less. Forty (35%) participants reported eating less preferred foods or skipping meals in the past week. Overall, 20 participants (19∙4%) had a positive depression screen.
    Conclusions: Study participants showed mixed results in being able to adhere to national COVID-19 mitigation strategies, with household level stressors experienced around finances and food security. Until Liberia has access to vaccinations for most of its citizens, COVID-19 response measures need to provide social protections that address basic needs (shelter, clothing and food), and which specifically targets food insecurity. Preventative interventions for mental health problems must be incorporated into Liberia's response to the pandemic.
    MeSH term(s) Adult ; COVID-19/economics ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19/psychology ; Family Characteristics ; Female ; Food Insecurity/economics ; Food Security ; Humans ; Liberia/epidemiology ; Male ; Mental Health ; Pandemics/economics ; SARS-CoV-2 ; Surveys and Questionnaires
    Language English
    Publishing date 2021-07-09
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0254446
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Multidrug-Resistant Bacterial Infections Among Very Low Birthweight Infants With Late-Onset Sepsis in Johannesburg, South Africa.

    Licona, Genesis / Ballot, Daynia / Moon, Troy D / Banerjee, Ritu / Amorim, Gustavo / Agthe, Alexander G / Weitkamp, Jörn-Hendrik

    Open forum infectious diseases

    2023  Volume 10, Issue 8, Page(s) ofad362

    Abstract: Background: An estimated 2.4 million babies died within the first 28 days of life in 2020. The third leading cause of neonatal death continues to be neonatal sepsis. Sepsis-causing bacterial pathogens vary temporally and geographically and, with a rise ... ...

    Abstract Background: An estimated 2.4 million babies died within the first 28 days of life in 2020. The third leading cause of neonatal death continues to be neonatal sepsis. Sepsis-causing bacterial pathogens vary temporally and geographically and, with a rise in multidrug-resistant organisms (MDROs), pose a threat to the neonatal population.
    Methods: This was a single-center, retrospective study of very low birth weight (VLBW) infants with late-onset sepsis (LOS) admitted to a neonatal unit in South Africa. We aimed to calculate the prevalence of multidrug-resistant (MDR) infections in this population. The data collected included demographic and clinical characteristics, length of hospital stay, risk factors for MDRO and mortality, and microbiology results. Logistic regression was used to assess the association between prespecified risk factors with MDR infections and mortality.
    Results: Of 2570 VLBW infants admitted, 34% had LOS, of which 33% was caused by MDROs. Infection with
    Conclusions: More than one-third of LOS cases in VLBW infants were caused by MDROs in this study. MDR infections cause substantial neonatal mortality. Antimicrobial stewardship programs, infection control protocols, and ongoing surveillance are needed to prevent further emergence and spread of MDR infections worldwide.
    Language English
    Publishing date 2023-07-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2757767-3
    ISSN 2328-8957
    ISSN 2328-8957
    DOI 10.1093/ofid/ofad362
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  3. Article ; Online: Evaluation of acute flaccid paralysis surveillance performance before and during the 2014-2015 Ebola virus disease outbreak in Guinea and Liberia.

    Umutesi, Grace / Moon, Troy D / Makam, Jeevan Kumar / Diomande, Fabien / Cherry, Charlotte Buehler / Tuopileyi Ii, Roland No / Zakari, Wambai / Craig, Allen Scott

    The Pan African medical journal

    2023  Volume 45, Page(s) 190

    Abstract: Introduction: the number of wild poliomyelitis cases, worldwide, dropped from 350,000 cases in 1988 to 33 in 2018. Acute flaccid paralysis (AFP) surveillance is a key strategy toward achieving global polio eradication. The 2014 Ebola virus disease (EVD) ...

    Abstract Introduction: the number of wild poliomyelitis cases, worldwide, dropped from 350,000 cases in 1988 to 33 in 2018. Acute flaccid paralysis (AFP) surveillance is a key strategy toward achieving global polio eradication. The 2014 Ebola virus disease (EVD) epidemic in West Africa infected over 28,000 people and had devastating effects on health systems in Guinea, Liberia, and Sierra Leone. We sought to assess the effects of the 2014 Ebola outbreak on AFP surveillance in Guinea and Liberia.
    Methods: a retrospective cross-sectional analysis was performed for Guinea and Liberia to evaluate EVD´s impact on World Health Organization (WHO) AFP surveillance performance indicators during 2012-2015.
    Results: both Guinea and Liberia met the WHO target non-polio AFP incidence rate nationally, and generally sub-nationally, prior to the EVD outbreak; rates decreased substantially during the outbreak in seven of eight regions in Guinea and 11 of 15 counties in Liberia. Throughout the study period, both Guinea and Liberia attained appropriate overall targets nationally for "notification" and "stool adequacy" indicators, but each country experienced periods of poor regional/county-specific indicator performance.
    Conclusion: these findings mirrored the negative effect of the Ebola outbreak on polio elimination activities in both countries and highlights the need to reinforce this surveillance system during times of crisis.
    MeSH term(s) Humans ; Hemorrhagic Fever, Ebola/epidemiology ; Liberia/epidemiology ; Guinea/epidemiology ; Retrospective Studies ; Cross-Sectional Studies ; alpha-Fetoproteins ; Population Surveillance ; Poliomyelitis/epidemiology ; Poliomyelitis/prevention & control ; Disease Outbreaks ; Paralysis/epidemiology ; Paralysis/etiology
    Chemical Substances alpha-Fetoproteins
    Language English
    Publishing date 2023-08-30
    Publishing country Uganda
    Document type Journal Article
    ZDB-ID 2514347-5
    ISSN 1937-8688 ; 1937-8688
    ISSN (online) 1937-8688
    ISSN 1937-8688
    DOI 10.11604/pamj.2023.45.190.21480
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Strengthening research capacity through an intensive training program for biomedical investigators from low- and middle-income countries: the Vanderbilt Institute for Research Development and Ethics (VIRDE).

    Cassell, Holly M / Rose, Elizabeth S / Moon, Troy D / Bello-Manga, Halima / Aliyu, Muktar H / Mutale, Wilbroad

    BMC medical education

    2022  Volume 22, Issue 1, Page(s) 97

    Abstract: Background: Capacity strengthening initiatives aimed at increasing research knowledge and skills of investigators in low- and middle-income countries (LMICs) have been implemented over the last several decades. With increased capacity, local ... ...

    Abstract Background: Capacity strengthening initiatives aimed at increasing research knowledge and skills of investigators in low- and middle-income countries (LMICs) have been implemented over the last several decades. With increased capacity, local investigators will have greater leadership in defining research priorities and impact policy change to help improve health outcomes. Evaluations of models of capacity strengthening programs are often limited to short-term impact. Noting the limitations of traditional output-based evaluations, we utilized a broader framework to evaluate the long-term impact of the Vanderbilt Institute in Research Development and Ethics (VIRDE), a decade-old intensive grant development practicum specifically tailored for investigators from LMICs.
    Methods: To assess the impact of VIRDE on the research careers of alumni over the past 10 years, we surveyed alumni on research engagement, grant productivity, career trajectory, and knowledge gained in grant writing. Descriptive statistics, including means and total counts, and paired sample t-tests were used to analyze the data.
    Results: Forty-six of 58 alumni completed the survey. All respondents returned to their home countries and are currently engaged in research. Post-VIRDE grant writing knowledge ratings were significantly greater than pre-VIRDE. The number of respondents submitting grants post-VIRDE was 2.6 times higher than before the program. Eighty-three percent of respondents submitted a total of 147 grants post-VIRDE, of which 45.6% were awarded. Respondents acknowledged VIRDE's positive impact on career growth and leadership, with 88% advancing in career stage.
    Conclusions: Gains in grant writing knowledge and grant productivity suggest that VIRDE scholars built skills and confidence in grant writing during the program. A substantial proportion of respondents have advanced in their careers and continue to work in academia in their country of origin. Results show a sustained impact on the research careers of VIRDE alumni. The broader framework for research capacity strengthening resulted in an expansive assessment of the VIRDE program and alumni, illuminating successful program elements and implications that can inform similar capacity strengthening programs.
    MeSH term(s) Academies and Institutes ; Biomedical Research ; Developing Countries ; Ethics, Research ; Humans ; Research Personnel
    Language English
    Publishing date 2022-02-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2044473-4
    ISSN 1472-6920 ; 1472-6920
    ISSN (online) 1472-6920
    ISSN 1472-6920
    DOI 10.1186/s12909-022-03162-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Prevalence and determinants of contraception utilization over time in Migori County, Kenya: Repeated cross-sectional household surveys.

    Li, Andria N / Starnes, Joseph R / Omondi, Alyn / Were, Vincent / Vill, Beffy / Were, Lawrence P O / Oyugi, Samuel / Edelquinn, Mumma / Mudhune, Sandra / Mbeya, Julius / Rogers, Ash / Wamai, Richard / Moon, Troy D

    African journal of reproductive health

    2023  Volume 27, Issue 6, Page(s) 17–26

    Abstract: Contraception use and family planning have been shown to save lives and benefit women, their families, and their communities. We conducted a cross-sectional study analyzing data from a 2021 survey that was conducted across eight different regions in ... ...

    Abstract Contraception use and family planning have been shown to save lives and benefit women, their families, and their communities. We conducted a cross-sectional study analyzing data from a 2021 survey that was conducted across eight different regions in Migori County, Kenya to examine the potential role that different factors play in meeting family planning targets. Comparisons are made to data collected in 2018/2019 in order to estimate the change over time of contraception uptake. Descriptive statistics were calculated, the Cochran-Mantel-Haenszel test was used to compare contraception use over time, and multivariable logistic regression was used to model determinants of contraceptive use. Sixty-four percent of respondents in 2021 reported that they currently use some form of contraception, and implants are the most popular contraceptive method. Factors associated with higher contraception usage were region, ages 25-34 years, and marital status. Contraception uptake increased significantly in East Kamagambo following a community-driven sexual and reproductive health intervention by the Lwala Community Alliance, suggesting that increased investment in family planning may be influential. We recommend targeted outreach to population groups with low uptake of contraception and investment in both demand- and supply-side interventions to increase contraceptive uptake. Additional research, especially for populations under 18, is needed to further inform effective investment and policy.
    MeSH term(s) Female ; Humans ; Cross-Sectional Studies ; Kenya ; Prevalence ; Contraception ; Contraceptive Agents
    Chemical Substances Contraceptive Agents
    Language English
    Publishing date 2023-07-31
    Publishing country Nigeria
    Document type Journal Article
    ZDB-ID 2111906-5
    ISSN 1118-4841
    ISSN 1118-4841
    DOI 10.29063/ajrh2023/v27i6.2
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  6. Article ; Online: Respiratory virus surveillance in hospitalized children less than two-years of age in Kenema, Sierra Leone during the COVID-19 pandemic (October 2020- October 2021).

    Samuels, Robert J / Sumah, Ibrahim / Alhasan, Foday / McHenry, Rendie / Short, Laura / Chappell, James D / Haddadin, Zaid / Halasa, Natasha B / Valério, Inaê D / Amorim, Gustavo / Grant, Donald S / Schieffelin, John S / Moon, Troy D

    PloS one

    2023  Volume 18, Issue 10, Page(s) e0292652

    Abstract: Globally, viral pathogens are the leading cause of acute respiratory infection in children under-five years. We aim to describe the epidemiology of viral respiratory pathogens in hospitalized children under-two years of age in Eastern Province of Sierra ... ...

    Abstract Globally, viral pathogens are the leading cause of acute respiratory infection in children under-five years. We aim to describe the epidemiology of viral respiratory pathogens in hospitalized children under-two years of age in Eastern Province of Sierra Leone, during the second year of the SARS-CoV-2 pandemic. We conducted a prospective study of children hospitalized with respiratory symptoms between October 2020 and October 2021. We collected demographic and clinical characteristics and calculated each participant´s respiratory symptom severity. Nose and throat swabs were collected at enrollment. Total nucleic acid was purified and tested for multiple respiratory viruses. Statistical analysis was performed using R version 4.2.0 software. 502 children less than two-years of age were enrolled. 376 (74.9%) had at least one respiratory virus detected. The most common viruses isolated were HRV/EV (28.2%), RSV (19.5%) and PIV (13.1%). Influenza and SARS-CoV-2 were identified in only 9.2% and 3.9% of children, respectively. Viral co-detection was common. Human metapneumovirus and RSV had more than two-fold higher odds of requiring O2 therapy while hospitalized. Viral pathogen prevalence was high (74.9%) in our study population. Despite this, 100% of children received antibiotics, underscoring a need to expand laboratory diagnostic capacity and to revisit clinical guidelines implementation in these children. Continuous surveillance and serologic studies among more diverse age groups, with greater geographic breadth, are needed in Sierra Leone to better characterize the long-term impact of COVID-19 on respiratory virus prevalence and to better characterize the seasonality of respiratory viruses in Sierra Leone.
    MeSH term(s) Child ; Humans ; Infant ; Pandemics ; Child, Hospitalized ; Prospective Studies ; Sierra Leone/epidemiology ; Respiratory Syncytial Virus, Human ; COVID-19/epidemiology ; SARS-CoV-2 ; Viruses ; Respiratory Tract Infections/epidemiology
    Language English
    Publishing date 2023-10-10
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0292652
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  7. Article ; Online: Antibiotic prescribing practices for acute respiratory illness in children less than 24 months of age in Kenema, Sierra Leone: is it time to move beyond algorithm driven decision making?

    Moon, Troy D / Sumah, Ibrahim / Amorim, Gustavo / Alhasan, Foday / Howard, Leigh M / Myers, Harriett / Green, Ann F / Grant, Donald S / Schieffelin, John S / Samuels, Robert J

    BMC infectious diseases

    2023  Volume 23, Issue 1, Page(s) 626

    Abstract: Background: Lower respiratory tract infections are the leading cause of mortality in young children globally. In many resource-limited settings clinicians rely on guidelines such as IMCI or ETAT + that promote empiric antibiotic utilization for ... ...

    Abstract Background: Lower respiratory tract infections are the leading cause of mortality in young children globally. In many resource-limited settings clinicians rely on guidelines such as IMCI or ETAT + that promote empiric antibiotic utilization for management of acute respiratory illness (ARI). Numerous evaluations of both guidelines have shown an overall positive response however, several challenges have also been reported, including the potential for over-prescribing of unnecessary antibiotics. The aims of this study were to describe the antibiotic prescribing practices for children less than 24 months of age with symptoms of ARI, that were admitted to Kenema Government Hospital (KGH) in the Eastern Province of Sierra Leone, and to identify the number of children empirically prescribed antibiotics who were admitted to hospital with ARI, as well as their clinical signs, symptoms, and outcomes.
    Methods: We conducted a prospective study of children < 24 months of age admitted to the KGH pediatric ward with respiratory symptoms between October 1, 2020 and May 31, 2022. Study nurses collected data on demographic information, medical and medication history, and information on clinical course while hospitalized.
    Results: A total of 777 children were enrolled. Prior to arrival at the hospital, 224 children (28.8%) reported taking an antibiotic for this illness without improvement. Only 15 (1.9%) children received a chest radiograph to aid in diagnosis and 100% of patients were placed on antibiotics during their hospital stay.
    Conclusions: Despite the lives saved, reliance on clinical decision-support tools such as IMCI and ETAT + for pediatric ARI, is resulting in the likely over-prescribing of antibiotics. Greater uptake of implementation research is needed to develop strategies and tools designed to optimize antibiotic use for ARI in LMIC settings. Additionally, much greater priority needs to be given to ensuring clinicians have the basic tools for clinical diagnosis, as well as greater investments in essential laboratory and radiographic diagnostics that help LMIC clinicians move beyond the sole reliance on algorithm based clinical decision making.
    MeSH term(s) Humans ; Child ; Child, Preschool ; Sierra Leone ; Prospective Studies ; Algorithms ; Anti-Bacterial Agents/therapeutic use ; Hospitals, Public ; Decision Making
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-09-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041550-3
    ISSN 1471-2334 ; 1471-2334
    ISSN (online) 1471-2334
    ISSN 1471-2334
    DOI 10.1186/s12879-023-08606-0
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  8. Article ; Online: Response to Rejoinder to "Ethical issue in the use of SMS messaging in HIV care and treatment in low- and middle-income countries: case examples from Mozambique".

    Ossemane, Ezequiel B / Moon, Troy D / Were, Martin C / Heitman, Elizabeth

    Journal of the American Medical Informatics Association : JAMIA

    2018  Volume 25, Issue 9, Page(s) 1268

    Language English
    Publishing date 2018-05-31
    Publishing country England
    Document type Letter
    ZDB-ID 1205156-1
    ISSN 1527-974X ; 1067-5027
    ISSN (online) 1527-974X
    ISSN 1067-5027
    DOI 10.1093/jamia/ocy062
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  9. Article: Impact of Per Capita Income on the Effectiveness of School-Based Health Education Programs to Promote Cervical Cancer Screening Uptake in Southern Mozambique.

    Amimo, Floriano / Moon, Troy D / Magit, Anthony / Sacarlal, Jahit

    Journal of global infectious diseases

    2018  Volume 10, Issue 3, Page(s) 152–158

    Abstract: Context: In the face of rising mortality rates from cervical cancer (CC) among women of reproductive age, a nationwide screening program based on visual inspection with acetic acid was introduced in Mozambique in 2009.: Objective: The objective of ... ...

    Abstract Context: In the face of rising mortality rates from cervical cancer (CC) among women of reproductive age, a nationwide screening program based on visual inspection with acetic acid was introduced in Mozambique in 2009.
    Objective: The objective of the study is to examine the impact of per capita income on the effectiveness of school-based health education programs to promote the utilization of CC screening services.
    Materials and methods: We conducted a cross-sectional study in 2013 involving 105 women randomly selected from households of different economic backgrounds. Marginal effect estimates derived from a logit model were used to explore the patterns in the effectiveness of school-based health education to promote CC screening uptake according to household per capita income, based on purchasing power parity.
    Results: We found a CC screening uptake of 16.1% (95% confidence interval [CI], 9.7%-24.6%) even though 64.6% (95% CI, 54.2%-74.1%) of women had heard of it. There are important economic differentials in the effectiveness of school-based health education to influence women's decision to receive CC screening. Among women with primary school or less, the probability of accessing CC screening services increases with increasing income (
    Conclusion: These results show that CC screening programs in resource-constrained settings need approaches tailored to different segments of women with respect to education and income to achieve equitable improvement in the levels of screening uptake.
    Language English
    Publishing date 2018-08-16
    Publishing country India
    Document type Journal Article
    ZDB-ID 2545454-7
    ISSN 0974-8245 ; 0974-777X
    ISSN (online) 0974-8245
    ISSN 0974-777X
    DOI 10.4103/jgid.jgid_165_17
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  10. Article ; Online: Characterizing multidimensional poverty in Migori County, Kenya and its association with depression.

    Starnes, Joseph R / Di Gravio, Chiara / Irlmeier, Rebecca / Moore, Ryan / Okoth, Vincent / Rogers, Ash / Ressler, Daniele J / Moon, Troy D

    PloS one

    2021  Volume 16, Issue 11, Page(s) e0259848

    Abstract: Introduction: Narrow, unidimensional measures of poverty often fail to measure true poverty and inadequately capture its drivers. Multidimensional indices of poverty more accurately capture the diversity of poverty. There is little research regarding ... ...

    Abstract Introduction: Narrow, unidimensional measures of poverty often fail to measure true poverty and inadequately capture its drivers. Multidimensional indices of poverty more accurately capture the diversity of poverty. There is little research regarding the association between multidimensional poverty and depression.
    Methods: A cross-sectional survey was administered in five sub-locations in Migori County, Kenya. A total of 4,765 heads of household were surveyed. Multidimensional poverty indices were used to determine the association of poverty with depression using the Patient Health Questionnaire (PHQ-8) depression screening tool.
    Results: Across the geographic areas surveyed, the overall prevalence of household poverty (deprivation headcount) was 19.4%, ranging from a low of 13.6% in Central Kamagambo to a high of 24.6% in North Kamagambo. Overall multidimensional poverty index varied from 0.053 in Central Kamagambo to 0.098 in North Kamagambo. Of the 3,939 participants with depression data available, 481 (12.2%) met the criteria for depression based on a PHQ-8 depression score ≥10. Poverty showed a dose-response association with depression.
    Conclusions: Multidimensional poverty indices can be used to accurately capture poverty in rural Kenya and to characterize differences in poverty across areas. There is a clear association between multidimensional poverty and depressive symptoms, including a dose effect with increasing poverty intensity. This supports the importance of multifaceted poverty policies and interventions to improve wellbeing and reduce depression.
    MeSH term(s) Adult ; Cross-Sectional Studies ; Depression/epidemiology ; Female ; Humans ; Kenya ; Male ; Poverty/statistics & numerical data ; Prevalence
    Language English
    Publishing date 2021-11-16
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0259848
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