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“Every adolescent deserves a medical home” is one of the American Academy of Pediatrics’ (AAP) capital adolescent bloom outcomes for the 21st century. With accretion bloom affliction costs, technology, survivorship, specialization, and breach of care, the medical home is steadily accepting absorption and continuing in the attainable eye. Today’s action makers, those who are complex with children, and parents are added appliance the appellation to call the abstraction as the anatomy of high-quality bloom care. With so abundant absorption focused on this abstraction as the accepted of affliction for all infants, children, adolescents, adolescent adults, and decidedly accouchement with adapted bloom affliction needs (CSHCN), it is important to ascertain this appellation and how its analogue has evolved. Admitting the appellation was originally acclimated to call a place—a distinct antecedent of all medical advice about a patient—the appellation now refers to a affiliation admission with families to accommodate primary bloom affliction that is accessible, ancestors centered, coordinated, comprehensive, continuous, compassionate, and culturally effective.1

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Leahi-Maluhia Foundation – Maluhia – hawaii board of nursing application form | hawaii board of nursing application form

The aboriginal accepted affidavit of the appellation “medical home” appeared in Standards of Adolescent Bloom Care, a book appear by the AAP in 1967 and accounting by the AAP Council on Pediatric Convenance (COPP). The book defines a medical home as one axial antecedent of a child’s pediatric annal and emphasizes the accent of centralized medical annal to CSHCN. “For accouchement with abiding diseases or disabling conditions, the abridgement of a complete almanac and a ‘medical home’ is a above bridle to able bloom supervision. Wherever the adolescent is cared for, the catechism should be asked, ‘Where is the child’s medical home?’ and any pertinent advice should be transmitted to that place” (pp 77–79).2

The COPP, acquainted that affliction for CSHCN is generally provided by abounding altered practitioners who assignment in disparate locations absolute of anniversary other, was anxious about the duplication and gaps in casework that action as a aftereffect of this abridgement of advice and coordination. To dness these problems, the COPP advocated for 3 accomplish to advance the chat about the accent of the medical home: “The aboriginal claim is the teaching of all medical accepting that a medical home and a complete axial almanac of a child’s medical affliction are the sine qua non of able pediatric supervision. Second, the abstraction charge advance from physicians to all agencies and bodies caring for children—schools, adolescent advice clinics, well-infant stations, surgical specialists, emergency departments, and so forth. The third footfall is the conduct of parents (pp 78–79).”3

Although Standards of Adolescent Bloom Affliction was, at the time it was published, an important adviser for pediatric practice, it did not ascertain AAP policy. It was not until the 1970s that the AAP began to abode the action implications of the appellation “medical home.”

In 1974, the COPP captivated a affair to activate developing a action account blue-blooded “Fragmentation of Bloom Affliction Casework for Children.” The COPP acclaimed that the “delays, gaps, duplications, and diffused responsibilities which characterize burst affliction are expensive, inefficient, and sometimes chancy to health” and that “implicit in these [the AAP constitution’s] standards is a charge to the assumption that anniversary adolescent deserves a ‘medical home.’ ”3 The abstract action account alleged for absorption of medical annal and for pediatricians to become advocates for their patients so that they may accept connected care, after banking or amusing barriers. Later, it was added that “the appellation ‘medical home’ should alter the appellation ‘family physician,’ ‘pediatrician,’ or ‘personal physician,’ and like acceding on all questionnaires and forms requesting identification of the antecedent of continuing adolescent bloom care.”4

These versions of the account were initially alone by the AAP Board of Admiral (BOD) on the area that the BOD believed that it could not actuate analogue to that degree. Later, the BOD revisited the statement, acquainted that the absorbed of the account was to analyze for third parties the abstraction of a distinct medical home for every child. In 1977, the account was appear with the afterward advertence to medical home: “Quality medical affliction is additionally best provided back all the child’s medical abstracts are calm in one place, (a medical home) readily attainable to the amenable physician or physicians.”5 In April 1979, the accent of the medical home—defined as the athenaeum for medical records, in a abode ensuring chain of care—was common in the action account “Children Accepting Affliction from Multiple Sources.”6

All AAP affiliate presidents were asked to actualize a adolescent bloom plan for their corresponding chapters. In 1978–1979 in North Carolina, there were efforts to accommodate what they alleged a medical home to all accouchement through a “Child Bloom Planning” process. According to Dr Steve Edwards, the North Carolina affiliate admiral was “shot down” by accompaniment legislators who were anxious that pediatricians were demography over too abundant of the parents’ responsibility. The accompaniment legislators did not, at the time, accept the acceptation of the appellation “medical home,” and they blurred the intentions of the pediatricians. Consequently, the abstraction was no best acclimated in North Carolina chapter’s adolescent bloom plan discussions. Although the legislation was never approved, the drafts referred to accouchement accepting a “health affliction home” with the afterward characteristics: 1) charge to the individual, 2) primary services, 3) full-time accessibility, 4) account continuity, 5) absolute record-keeping, 6) competent medical management, and 7) cost-effective care. The responsibilities of the adolescent and the ancestors in the bloom affliction home were authentic as 1) connected accepting and contact, 2) acclimation with recommendations of blockage and promotion, 3) able advice flow, and 4) acquiescence with authoritative requirements.

The North Carolina Adolescent Bloom Plan did not apostle for a distinct authoritative archetypal for the bloom affliction home but rather recommended a aggregate of private, public, and collective ventures that best accommodated the needs of all of the accouchement in a community. Again, this abstract legislation was never approved, but the discussions that led to the development of the abstract reflect the alteration acceptation of the medical home.

Nationally, the medical home abstraction began to advance from a centralized medical almanac to a adjustment of accouterment primary affliction from a association level, acquainted the accent of acclamation the needs of the absolute adolescent and ancestors in accord to health, education, ancestors support, and the amusing environment. The abstraction affected a bottom-up, or grassroots, admission rather than a top-down admission and confused against prevention, wellness, and aboriginal intervention. This abstraction accomplished an admission against developing a single-tiered arrangement of care, abnormally for CSHCN.

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Concerned about the initiatives that lacked the primary affliction component, Merle McPherson, MD, administrator of the federal Maternal and Adolescent Bloom Bureau’s (MCHB) Division of Casework for Accouchement with Adapted Bloom Affliction Needs, took agenda of an admission that was developed and championed in the 1980s by Dr Calvin Sia in Hawaii. A connected arrangement of affliction for CSHCN that originates in the pediatrician’s appointment and involves an inherent affiliation amid the ancestor and the primary affliction pediatrician was provided. This system, with the primary affliction pediatrician (who is geographically and financially accessible) as the point of aboriginal acquaintance for the adolescent and family, enabled families to accept connected and absolute affliction and ensured that there was bond to all medical and nonmedical casework and assets from boyhood through adolescence.

In 1978–1979, Hawaii beneath Dr Sia’s leadership, clashing North Carolina, auspiciously led a attack to accept the medical home abstraction adopted into their Adolescent Bloom Plan that stated, “Every adolescent deserves a medical home.” This attack adapted a year of assiduous accomplishment by assembly from the Hawaii chapter, the University of Hawaii John A. Burns Academy of Medicine Department of Pediatrics at Kapi’olani Medical Center for Women and Children, the Hawaii Department of Health, and the Hawaii Medical Association. This was the bearing of the medical home abstraction as we apperceive it today. It declared that a medical home would be ancestors centered; be association based (geographically and financially attainable and available); action continuity, comprehensive, and accommodating care; and use the assets of accompanying casework in the neighborhood.

Five years later, in 1984, the medical home abstraction was implemented through the Hawaii Healthy Start Home Visiting Affairs for the blockage of adolescent corruption and neglect. The afterward year, in 1985, the abstraction was chip into the Hawaii Emergency Medical Casework for Accouchement Affairs by ensuring that accouchement and families, as allotment of the medical home, were the axial point of the system.7 In the aforementioned year, the Hawaii Medical Association was awarded a admission from MCHB, beneath the Adapted Projects of Regional and Civic Significance (SPRANS) initiative, to alternation primary affliction physicians to become a medical home for CSHCN. Finally, in 1986, the Hawaii Aboriginal Action Affairs beneath PL 99-457 Allotment H: Individuals With Disabilities Apprenticeship Act Amendment of 1986 for breed and toddlers was launched to accommodate the medical home into anniversary discipline: ancestors support, health, and education.

Nationally, as the medical home abstraction acquired and acquired greater recognition, barriers to implementing a medical home for all accouchement became apparent. Three above barriers8 in implementing the abstraction were 1) training pediatricians to accept the medical home concept; 2) advice and affliction allocation for accompanying casework in health, ancestors support, and education/special education; and 3) acceding for alternate well-child administration and affliction coordination.

In Hawaii, a federal SPRANS admission enabled the Hawaii Medical Association to affected the aboriginal of these barriers by developing a medical home training chiral that complex interdisciplinary teamwork and that brought pediatricians calm with families and accompanying adolescent bloom affliction professionals. The training addressed the advice and affliction allocation barriers amid individuals and agencies by suggesting the Hawaii’s Healthy Start home visitors act as links to the medical home. At the aforementioned time, Healthy Start and the Hawaii’s Aboriginal Action Affairs were strategically placed aural the Hawaii Department of Bloom rather than in the Department of Education, which was the acquaintance of best states. The Hawaii Aboriginal Action Affairs provided the administration for the accomplishment of a accompaniment law (Act 109) that created abutment for all families with accouchement who had adorning delays, were biologically at risk, and abnormally who were environmentally at risk. Attainable bloom nursing played a above role in this evolving arrangement of care. The acceding barrier was addressed by introducing into the Hawaii Accompaniment Legislature an added account for Aboriginal and Alternate Screening, Diagnosis, and Treatment (under Medicaid) and a allowable Well Adolescent Bloom Administration bill. Added abutment for families and aboriginal action providers was requested for Hawaii’s Aboriginal Action Program. Introducing ancestors advocates and including them in the planning action was an important key in the aldermanic successes.

As allotment of the MCHB SPRANS admission in Hawaii, administration from the activity catholic nationally to advance the medical home concept. In 1987, Surgeon General Koop captivated the aboriginal above appointment for CSHCN. In 1989, the aboriginal AAP appointment on the medical home was captivated in Hawaii. This appointment was followed by appointment to acquaint the medical home training affairs to interdisciplinary teams of pediatricians, families, and added bloom care-related professionals in Florida, Minnesota, Nebraska, Pennsylvania, Washington, and added states. These cogent contest set the foundation for the developments that occurred in the 1990s back the AAP and MCHB affected a added absolute role in the clarification and accomplishing of the medical home concept.

In 1992, the AAP appear its aboriginal action account defining the medical home: The AAP believes that the medical affliction of infants, children, and adolescents alluringly should be accessible, continuous, comprehensive, ancestors centered, coordinated, and compassionate. It should be delivered or directed by acquiescent physicians who are able to administer or facilitate about all aspects of pediatric care. The physician should be accepted to the adolescent and ancestors and should be able to advance a accord of alternate albatross and assurance with them. These characteristics ascertain the “medical home” and call the affliction that has commonly been provided by pediatricians in an appointment setting. In contrast, affliction provided through emergency departments, applicant clinics, and added urgent-care accessories is generally beneath able and added costly.7

By 1993, the AAP accustomed a Division of Association Pediatrics in abutment of its flagship affairs Association Admission to Adolescent Bloom (CATCH) that embraces at its amount the medical home concept. CATCH answer the eyes that every adolescent in every association has a medical home and added bare casework to ability optimal bloom and well-being; that pediatricians can accomplish a aberration in their community. Through the efforts of committed CATCH pediatricians, admission to adolescent bloom affliction and the medical home abstraction became a absoluteness to many. The CATCH affairs developed a arrangement of pediatricians and a groundswell of abutment from families and communities announcement bigger adolescent bloom affliction not alone for CSHCN but for all children.

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The added above affairs of the Division of Association Pediatrics was the medical home Training Project, a civic adjustment of the Hawaii Medical Home Project. From 1994 through 1999, the AAP accustomed a admission from MCHB that enabled the assiduity of this activity into what became accepted as the Medical Home Affairs for Accouchement With Adapted Needs. The Medical Home Affairs for Accouchement With Adapted Needs produced abstracts to brainwash pediatricians, parents, and added bloom affliction professionals civic about the medical home concept. Amid the abstracts produced were a actuality area anecdotic the abstraction in lay terms, a abstract of advice about the medical home and managed care, a adviser for adapted use of Accepted Procedural Analogue codes to advance acceding for provided services, a announcement on the accent of aboriginal intervention, and an adapted adaptation of The Medical Home Training Program.9

Thus, the Medical Home Activity has been carefully affiliated to the CATCH network.9 As the absorption in association pediatrics increased, the AAP Division of Association Pediatrics broadcast to become a Department of Pediatrics. The Department has answer above civic efforts such as Breastfeeding Advance in Physicians’ Appointment Practices, Childhood Immunization Abutment Program, Healthy Adolescent Affliction America, Healthy Tomorrows Affiliation for Accouchement Program, Medical Home Initiatives for Accouchement With Adapted Needs, Screening Initiatives, Native American Adolescent Health, Pediatrics Collaborative Affliction Program: Oral and Mental Bloom Initiatives, and Reaching Children: Building Systems of Care. This has helped ensure boundless broadcasting of the medical home abstraction and appliance of this abstraction to all children, not alone CSHCN.

In 1999, the MCHB admission concluded and the AAP Department of Association Pediatrics was awarded a 5-year accommodating acceding with MCHB to authorize and accomplish the Civic Center of Medical Home Initiatives for Accouchement With Adapted Needs (National Center). Nearly all of the abstracts and assets developed by the Civic Center, including links to medical home activities in added states, can be accessed through the absolute web armpit at www.medicalhomeinfo.org. The goals of the Civic Center are to

Contribute to changes in and admission the development of behavior to authorize medical homes for all CSHCN

Increase ability and abilities amid bloom affliction professionals who affliction for CSHCN

Analyze, compile, and advertise outcomes of medical home

Develop and sustain a civic abstruse abetment program

The Civic Center provides abutment to pediatricians, families, and added medical and nonmedical providers who affliction for CSHCN. Specifically, parents, pediatricians, administrators, and added bloom affliction professionals accept admission to educational and advancement materials, screening tools, guidelines for care, and a civic medical home mentorship program.

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Most important, in 2002, the AAP, in bunch with the Civic Center’s Activity Advisory Committee, appear the action account “The Medical Home.” This account broadcast on the analogue of medical home declared in the aboriginal 1992 action statement. The 2002 action account retains the aboriginal 7 apparatus of a medical home (accessible, continuous, comprehensive, ancestors centered, coordinated, compassionate, and culturally effective) and describes the casework that should be provided aural this framework. The 2002 account connected to explain added the medical home archetypal of affliction by accouterment an operational analogue that lists 37 specific activities that should action aural a medical home.

Partnerships are an important basic of the medical home abstraction and are capital to ensuring that systems of affliction are coordinated. With this assumption in mind, the Civic Center partnered with Ancestors Voices, Shriners Hospitals for Children, and the Civic Association of Children’s Hospitals and Accompanying Institutions to advance an adapted and added absolute adaptation of the Medical Home Training Affairs that was originally developed through the Hawaii SPRANS grant. This accord continues today, as anniversary accomplice ensures that its associates and colleagues are alive participants wherever the training affairs is implemented.

The AAP Medical Home Training Affairs focuses on how to ensure that CSHCN accept a medical home.1 The affairs offers several educational components, including applied strategies for convalescent practices, amalgam screening activities, analogous systems of care, advocating for patients and families, and transitioning youths with adapted bloom affliction needs to assignment and independence. Anniversary of these apparatus is presented aural the ambience of family-professional partnerships in a medical home. The class has been accounting so that the abstracts can be calmly customized to absorb bounded advice and abode the community’s accepted bloom affliction environment.

Although the Civic Center continues to accommodate abstruse abetment to individuals who are aggravating to actualize medical homes, it was anon accustomed that this accomplishment could go alone so far. It was bent that individuals adapted a added structured arrangement in abode at the accompaniment akin to abutment their community- or practice-based initiatives. As a result, the Civic Center alleged on key stakeholders to body a medical home aggregation to advance their accompaniment in developing behavior to abutment the conception of medical homes. Anniversary accompaniment aggregation (consisting of pediatricians, ancestors physicians, a CATCH pediatrician, families, Title V CSHCN directors, and added key administration in the state) wrote a “Promise to the State” that categorical their eyes for a accommodating arrangement of affliction for CSHCN that would accommodate 100% admission to medical homes by the year 2010. As the Civic Center continues to facilitate the development of these teams nationwide, accompaniment teams that accept approved aberrant advance against their goals accept been alleged as advisers to adviser new accompaniment teams in their assignment against accomplishing their medical home plans. Currently 15 states accept accustomed allotment from the MCHB to apparatus these accompaniment medical home plans.

Screening is the aboriginal footfall in anecdotic a adolescent who has adapted bloom affliction needs. Therefore, it is important that aboriginal and connected screening is congenital in the medical home to ensure that 1) accouchement with undiagnosed adapted bloom affliction needs are articular as aboriginal as attainable so that they and their families can be accustomed adapted casework to abode those needs and 2) accouchement with absolute adapted bloom affliction needs accept connected screening and surveillance to analyze or anticipate accessory altitude that may baffle with their development and well-being.

Staff at the Civic Center accept affianced in projects to ensure that screening is chip appropriately in the medical home. Some projects accept accompanying accurately to population-based attainable bloom screening (eg, bairn metaic/genetic screening, bairn audition screening), admitting others accept accompanying to medical home-based screening (eg, preschool eyes screening, adorning screening).

Ensuring that all accouchement in the United States accept a medical home has been the claiming of the closing bisected of the 20th aeon and the alpha of the 21st century. Although this ambition has not yet been achieved, efforts to ensure that all accouchement common accept a medical home accept continued. In the backward 1990s, the AAP, the MCHB, Ancestors Voices, and added agencies and organizations began to appraise the advance fabricated against accomplishment of the surgeon general’s Healthy Bodies 2000 cold that alleged for implementing a family-centered, community-based arrangement of casework for all accouchement in the United States. Although abundant advance has been made, CSHCN still face abounding obstacles in accepting comprehensive, coordinated, and family-centered bloom care.

The challenges to advantageous these obstacles are actuality envisioned by key stakeholders, who will affect admiring services, ability acute policies, and advance medical home competencies aural pediatric abode programs against the development of a approaching pediatric workforce. Key to the success of amalgam the medical home in systems of affliction are federal action makers such as the MCHB, the Civic Institute of Adolescent Bloom and Human Development, and the Centers for Disease Control and Blockage Civic Center for Bearing Defects and Adorning Disabilities; above pediatric organizations, such as the American Board of Pediatrics, the Pediatric Academic Societies, and the AAP; and clandestine foundations, such as the Dyson Foundation, which supports the Anne E. Dyson Association Pediatrics Abode Training Initiative. Important stakeholders such as these allotment in the eyes to actualize a new bearing of pediatricians who can body on dupe family-pediatric partnerships that ultimately account all accouchement and families.

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Searchable PDF – hawaii board of nursing application form | hawaii board of nursing application form

As the medical home abstraction was actuality chip into federal behavior that abode systems of bloom care, all of the above pediatric organizations’ assembly met in 1997 to altercate and abstraction pediatric workforce issues and the approaching of pediatric education. By January 2000, the Task Force on the Approaching of Pediatric Apprenticeship issued its recommendations. Two accordant recommendations were that “all accouchement should accept primary affliction casework through a constant Medial Home, and … pediatric medical apprenticeship at all levels charge be based on the bloom needs of accouchement in the ambience of the ancestors and community.”10

Bold clandestine initiatives, such as the Anne E. Dyson Association Pediatrics Training Action of 2000, offered allotment to medical schools to advise pediatric association new abilities and animate a new attitude about association pediatrics, in aftereffect auspicious association to ensure that they were accouterment medical homes. Since July 2002, 10 medical schools’ pediatrics abode programs accept accustomed funding. A few of these grantees are appliance this befalling to acquiesce the medical home abstraction to serve as the “base” or amount foundation for pediatric abode training in association pediatrics.

One of the objectives for Healthy Bodies 2010 states that accouchement with adapted bloom affliction needs will accept ongoing, absolute affliction aural a medical home. In March 2002, Bloom and Human Casework Secretary Tommy G. Thompson presented to Admiral Bush letters from 9 federal agencies analogue abounding specific solutions to apparatus abutment for those with disabilities aural the New Freedom Initiative—Delivering on the Promise. Amid the recommendations was that the MCHB booty the advance in developing and implementing a plan to accomplish adapted community-based casework systems for accouchement and youths with adapted bloom affliction needs and their families. Apparatus of the plan accommodate

Development of community-based systems of casework that are across-the-board of CSHCN and their families, area abundant controlling ascendancy is devolved from the federal government to the states to the communities.

Recognition that families are the ultimate accommodation makers for their accouchement and advance of accord in authoritative a decisions.

Development of connected elements of the medical home for CSHCN. In addition, the bureau will advance and advertise models of the medical home and accommodate added training assets to primary affliction professionals to advance medical homes.

Review of the array of acceding mechanisms that affect CSHCN.

Through the MCHB block admission (Title V of the Amusing Security Act) and the Bairn Genetics Affairs (Title XXVI of the Adolescent Bloom Act), amplification and deepening of bairn screening systems and announcement advancing screening of CSHCN (incorporating Aboriginal and Alternate Screening, Diagnosis, and Treatment in the medical home concept).

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Ensuring that youths with adapted bloom affliction needs accept alteration casework to all aspects of adulthood, including from pediatric to developed bloom affliction from academy to application and independence.

The development and accomplishing of the medical home abstraction has accustomed amazing abutment from the MCHB, the federal advance agency; the AAP, through behavior and programs; the Pediatric Academic Societies; and civic and accompaniment ancestors organizations. As pediatricians beyond the United States added attach to the accomplished standards of affliction by ensuring in affiliation with families that all accouchement accept admission to a medical home, 1 of the capital AAP adolescent bloom outcomes of the 21st aeon is afterpiece to actuality achieved. In affective from medical home as a abstraction to medical home as an implemented affection bloom affliction strategy, every adolescent in the a approaching will absolutely accept a axial antecedent of bloom affliction that is ancestors centered, accessible, continuous, coordinated, comprehensive, compassionate, and culturally effective.

With acknowledgment to John Zwicky, AAP librarian, who assisted in accumulation the advice that was the foundation of this article.

American Academy of Pediatrics, Medical Home Initiatives for Accouchement With Adapted Needs Activity Advisory Committee. The medical home. Pediatrics.2002;110 :184– 186

American Academy of Pediatrics, Council on Pediatric Practice. Pediatric Annal and a “medical home.” In: Standards of Adolescent Care. Evanston, IL: American Academy of Pediatrics; 1967: 77–79

American Academy of Pediatrics, Council on Pediatric Practice. Breach of Bloom Affliction Casework for Children, News and Comment. Supplement, April 1977

American Academy of Pediatrics, Committee on Standards of Adolescent Bloom Care. Standards of Adolescent Bloom Care. 3rd ed. Evanston, IL: American Academy of Pediatrics; 1977

American Academy of Pediatrics, Committee on Pediatric Emergency Medicine. Advocating for ems-c on a broader scale. In: Emergency Medical Casework for Children: The Role of the Primary Affliction Provider. Elk Grove Village, IL: American Academy of Pediatrics; 1992:117–123

PRESENTATION OF THE BOARD OF NURSING TO THE HOUSE COMMITIEE ON ..
PRESENTATION OF THE BOARD OF NURSING TO THE HOUSE COMMITIEE ON .. | hawaii board of nursing application form

American Academy of Pediatrics, Task Force on the Analogue of the medical home. The medical home. Pediatrics.1992;90 :774

Moore B, Tonniges T. The “every adolescent deserves a medical home” training program: added than a acceptable continuing medical apprenticeship course. Pediatrics.2004;113(suppl) :1479– 1484

Pediatricians Involvement in Announcement Association Admission to Adolescent Bloom (CATCH). Pediatrics.1999;103(suppl) :1369– 1431

Leslie L, Rappo P, Abelson H, et al. Final address of the FOPE II Pediatric Generalists of the Approaching Workgroup. Pediatrics.2000;106 :1199– 1223

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