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Karlsson, M., Garvare, R., Zingmark, K. & Nordström, B. (2019). Organizing for sustainable inter-organizational collaboration in health care processes. Journal of Interprofessional Care
Open this publication in new window or tab >>Organizing for sustainable inter-organizational collaboration in health care processes
2019 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567Article in journal (Refereed) Epub ahead of print
Abstract [en]

Integrating health care services has proven to be important from both the patient and organizational perspectives. This study explores what defines a perceived well-functioning collaboration in the inter-organizational process of providing assistive devices in Sweden. Two focus groups comprising participants with profound knowledge of collaboration were performed, and data were analyzed in five steps, resulting in a data structure. Results yield the identification of three interacting processes: coordinating efforts to patient needs, ensuring evidence-based practice, and planning for efficient use of resources. These processes affected one another, and, therefore, would likely not have been effectively managed separately. The study contributes to theories of process management and organization by specifically focusing on how to analyze and improve sustainable collaboration in health care processes at both the management and professional levels. Theoretical frameworks that show different ways of organizing collaboration, as well as the concepts of action nets and boundary objects, can support both analysis and planning of collaboration. The intention would be to develop integration in inter-organizational health care processes, resulting in more person-centered care.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Focus groups, interprofessional collaboration, integration, partnership, health and social care
National Category
Reliability and Maintenance Nursing Physiotherapy
Research subject
Quality technology and logistics; Nursing; Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-75581 (URN)10.1080/13561820.2019.1638760 (DOI)000477536400001 ()31329471 (PubMedID)
Available from: 2019-08-19 Created: 2019-08-19 Last updated: 2019-08-22
Nyström, M. E., Höög, E., Garvare, R., Andersson Bäck, M., Terris, D. D. & Hansson, J. (2018). Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region. BMC Health Services Research, 18(1), Article ID 376.
Open this publication in new window or tab >>Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region
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2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, no 1, article id 376Article in journal (Refereed) Published
Abstract [en]

Background

Eldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors’ approaches to COIL. The approach, named “Sustainable Improvement and Development through Strategic and Systematic Approaches” (SIDSSA), was applied through an action-research and action-learning intervention.

Methods

The SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge - all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses.

Results

The new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting.

Conclusions

An easily understood and generalizable model internalized by key organizational actors is an important step before more complex development models can be implemented. SIDSSA facilitated individual and group learning through action-learning and supported systems-level views and structured approaches across multiple organizational levels. Active involvement of diverse organizational functions and levels in the learning process was facilitated. However, the time frame was too short to fully test all aspects of the approach, specifically in reaching beyond the involved managers to front-line staff and patients.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Continuous quality improvement, Organizational learning, Change management, Organizational development, Health care, Social services
National Category
Reliability and Maintenance
Research subject
Quality Technology & Management
Identifiers
urn:nbn:se:ltu:diva-69052 (URN)10.1186/s12913-018-3129-3 (DOI)000433478900001 ()29793473 (PubMedID)2-s2.0-85047396081 (Scopus ID)
Note

Validerad;2018;Nivå 2;2018-06-01 (rokbeg)

Available from: 2018-06-01 Created: 2018-06-01 Last updated: 2019-03-27Bibliographically approved
Ranängen, H., Cöster, M., Isaksson, R. & Garvare, R. (2018). From global goals and planetary boundaries to public governance: A framework for prioritizing organizational sustainability activities. Sustainability, 10(8), Article ID 2741.
Open this publication in new window or tab >>From global goals and planetary boundaries to public governance: A framework for prioritizing organizational sustainability activities
2018 (English)In: Sustainability, ISSN 2071-1050, E-ISSN 2071-1050, Vol. 10, no 8, article id 2741Article in journal (Refereed) Published
Abstract [en]

Background: A particular challenge in the work to realize the global goals for sustainable development is to find ways for organizations to identify and prioritize organizational activities that address these goals. There are also several sustainability initiatives, guidelines and tools to consider when planning, working with and reporting on sustainable development. Although progress has been made, little has been written about how organizations rise to and manage the challenge. The paper explores how organizations address sustainable development, which sustainability aspects they prioritize and whether previous research can improve the priority process by using materiality analysis approach. Methods: A case study approach was chosen. Data was collected by interactive workshops and documentation. The participating organizations were two Swedish municipalities; Results: The municipalities have introduced a number of sustainability aspects into their organizational governance, especially in terms of society, human rights and the environment. A materiality analysis was conducted to determine the relevance and significance of sustainability aspects. The result shows that climate action, biodiversity and freshwater use are aspects that should be prioritized; Conclusion: The materiality analysis methodology chosen for prioritizing of sustainability aspects was useful and easy to work with. However, the sustainability aspect matrix and the risk assessment have to be updated regularly in order to form an effective base for the materiality analysis.

Place, publisher, year, edition, pages
MDPI, 2018
National Category
Economics and Business Reliability and Maintenance
Research subject
Quality Technology & Management
Identifiers
urn:nbn:se:ltu:diva-70337 (URN)10.3390/su10082741 (DOI)2-s2.0-85051056486 (Scopus ID)
Note

Validerad;2018;Nivå 2;2018-08-13 (andbra)

Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-08-15Bibliographically approved
Westerlund, A., Garvare, R., Nyström, M. E., Eurenius, E., Lindkvist, M. & Ivarsson, A. (2017). Managing the initiation and early implementation of health promotion interventions: A study of a parental support programme in primary care (ed.). Scandinavian Journal of Caring Sciences, 31(1), 128-138
Open this publication in new window or tab >>Managing the initiation and early implementation of health promotion interventions: A study of a parental support programme in primary care
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2017 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 128-138Article in journal (Refereed) Published
Abstract [en]

BackgroundMental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed.AimThis study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors’ views on factors likely to affect implementation and the strategies used to manage them.DesignA case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used.MethodsEighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors.FindingsInterviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices.ConclusionsImplementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these insights might help increase the rate of adoption and the use of such programmes and thereby increase their effectiveness.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Reliability and Maintenance
Research subject
Quality Technology & Management
Identifiers
urn:nbn:se:ltu:diva-15911 (URN)10.1111/scs.12329 (DOI)000394988700014 ()27246248 (PubMedID)2-s2.0-84973301057 (Scopus ID)f7c4f9b7-49dd-4959-af6b-abb5fbc79a12 (Local ID)f7c4f9b7-49dd-4959-af6b-abb5fbc79a12 (Archive number)f7c4f9b7-49dd-4959-af6b-abb5fbc79a12 (OAI)
Note

Validerad; 2017; Nivå 2; 2017-02-28 (rokbeg)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-09-14Bibliographically approved
Richter Sundberg, L., Garvare, R. & Nyström, M. E. (2017). Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare. BMC Health Services Research, 17(1), Article ID 334.
Open this publication in new window or tab >>Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare
2017 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 334Article in journal (Refereed) Published
Abstract [en]

Background

The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease.

Methods

A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data.

Results

The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: ‘clinical knowledge and experience’, ‘potential guideline consequences’ and ‘needs of vulnerable groups’. The frequency of the use of various criteria in discussions varied over time. Gender, professional status, and interpersonal skills were perceived to affect individuals’ relative influence on group discussions.

Conclusions

The study shows that guideline development groups make compromises between rigour and pragmatism. The formal guideline development model incorporated multiple aspects, but offered few details on how the different criteria should be handled. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from clarifying the role of the group-related factors and non-research evidence, such as clinical experience and ethical considerations, in decision-processes during guideline development.

Place, publisher, year, edition, pages
BioMed Central, 2017
National Category
Reliability and Maintenance
Research subject
Quality Technology and Management
Identifiers
urn:nbn:se:ltu:diva-63332 (URN)10.1186/s12913-017-2277-1 (DOI)000403096400001 ()28490325 (PubMedID)2-s2.0-85019080276 (Scopus ID)
Note

Validerad; 2017; Nivå 2; 2017-05-12 (andbra)

Available from: 2017-05-12 Created: 2017-05-12 Last updated: 2018-07-10Bibliographically approved
Karlsson, M., Garvare, R., Zingmark, K. & Nordström, B. (2016). Customer orientation in a Swedish county council (ed.). International Journal of Quality and Service Sciences, 8(1), 2-16
Open this publication in new window or tab >>Customer orientation in a Swedish county council
2016 (English)In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 8, no 1, p. 2-16Article in journal (Refereed) Published
Abstract [en]

PurposeThe use of the customer concept and ways of interacting with customers in support functions are relatively new areas of interest for public organizations. The aim of this study is to describe the development towards a stronger customer orientation in a support function in a Swedish county council from a management team perspective.Design/methodology/approachA revision of plans and annual reports and individual interviews with the members of a management team was done. The interviews were examined using qualitative content analysis.FindingsThe results are presented in one overarching theme: the double-edged customer concept, and three themes: meeting the customer’s needs, being the customer’s specialist, and developing in collaboration with the customer. The development of a customer orientation is illustrated as a spiral involving the concepts of understanding, wanting, and acting.Originality/valueThe paper contributes to new understanding of how customer orientation develops in the context of public organizations’ support functions.

National Category
Reliability and Maintenance
Research subject
Quality Technology and Management
Identifiers
urn:nbn:se:ltu:diva-5210 (URN)3412978d-34f8-4381-8a8a-b026642fdff7 (Local ID)3412978d-34f8-4381-8a8a-b026642fdff7 (Archive number)3412978d-34f8-4381-8a8a-b026642fdff7 (OAI)
Note

Validerad; 2016; Nivå 1; 20160212 (andbra)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-02-07Bibliographically approved
Eriksson, H., Gremyr, I., Bergquist, B., Garvare, R., Fundin, A., Wiklund, H., . . . Sörqvist, L. (2016). Exploring Quality Challenges and the Validity of Excellence Models (ed.). International Journal of Operations & Production Management, 36(10), 1201-1221
Open this publication in new window or tab >>Exploring Quality Challenges and the Validity of Excellence Models
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2016 (English)In: International Journal of Operations & Production Management, ISSN 0144-3577, E-ISSN 1758-6593, Vol. 36, no 10, p. 1201-1221Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose is to identify and explore important quality-related challenges facing organizations, and how current excellence models incorporate these challenges.Methodology: The article is based on a Delphi study in Swedish organizations, 49 challenges were generated and ranked according to importance. The top 10 ranked challenges were compared to the principles of four excellence models.Findings: The excellence models seem to still be relevant since their content matches many of the challenges identified. The MBNQA and the SIQ models were found to have the most comprehensive coverage, while the ISO model had limited coverage. Research Limitations/Implications: Three areas for further research were identified: 1) how QM can evolve in different contexts with varying needs in terms of adaptive and explorative capabilities, 2) the interfaces of QM and sustainability, and ways to understand how customers and stakeholders can be active contributors to improvements and 3) the roles of the owners and board of directors in QM, and how to organize and distribute responsibilities of the QM work.Practical and Social Implications: Three important challenges could be addressed in upcoming revisions of excellence models: 1) making QM a strategic issue for company owners; 2) involving customers in the improvement activities; and 3) developing processes that are robust, while still easily adaptable.Originality/Value: The Delphi study has identified upcoming challenges in the QM area based on input from 188 quality professionals.

Keywords
Business / Economics - Business studies, Ekonomi - Företagsekonomi
National Category
Reliability and Maintenance
Research subject
Quality Technology and Management; Effective innovation and organisation (AERI)
Identifiers
urn:nbn:se:ltu:diva-5988 (URN)10.1108/IJOPM-12-2014-0610 (DOI)000387084100005 ()2-s2.0-84989227524 (Scopus ID)42fcbc13-6e86-4078-bc5a-80a39821b32a (Local ID)42fcbc13-6e86-4078-bc5a-80a39821b32a (Archive number)42fcbc13-6e86-4078-bc5a-80a39821b32a (OAI)
Note

Validerad; 2016; Nivå 2; 2016-10-05 (andbra)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-07-10Bibliographically approved
Bröchner, J., Camén, C., Eriksson, H. & Garvare, R. (2016). Quality and legal aspects in public care procurement (ed.). The TQM Journal, 28(4), 648-663
Open this publication in new window or tab >>Quality and legal aspects in public care procurement
2016 (English)In: The TQM Journal, ISSN 1754-2731, E-ISSN 1754-274X, Vol. 28, no 4, p. 648-663Article in journal (Refereed) Published
Abstract [en]

Purpose– The purpose of this paper is to assess the applicability of care quality concepts as contract award criteria for public procurement of health and social care, using the case of Sweden. Design/methodology/approach– Based on a literature review, European and Swedish legal texts, government regulations as well as 26 Swedish court review cases concerning care procurement have been analysedFindings– Methods used for assessing care quality are seldom useful for predicting the quality to be delivered by a potential contractor. Legal principles of transparency and equal treatment of tenderers make it necessary to apply strict requirements for verification. Research limitations/implications– Results refer primarily to a Swedish context but could be applicable throughout the EU. Further studies of relations between award criteria and public/private collaborative practices for improving care quality during contractual periods are desirable. Practical implications– Local and regional procurement officials should benefit from a better understanding of how quality criteria should be designed and applied to the award procedures for care contracts. Care providers in the private sector would also be able to develop their quality strategies and present their abilities more efficiently when tendering for public contracts. Social implications– Issues of quality of health and social care are of obvious importance for social sustainability. Public awareness of care quality problems is evident and often a cause of media concern. Originality/value– This investigation pinpoints the difference between traditional care quality thinking and the legal principles underlying contract award in public procurement of care services.

National Category
Reliability and Maintenance
Research subject
Quality Technology and Management
Identifiers
urn:nbn:se:ltu:diva-15839 (URN)10.1108/TQM-09-2014-0075 (DOI)2-s2.0-84975735304 (Scopus ID)f6651e3d-3610-447c-92c6-67f55eb9692d (Local ID)f6651e3d-3610-447c-92c6-67f55eb9692d (Archive number)f6651e3d-3610-447c-92c6-67f55eb9692d (OAI)
Note

Validerad; 2016; Nivå 1; 20160601 (andbra)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-07-10Bibliographically approved
Höög, E., Lysholm, J., Garvare, R., Weinehall, L. & Nyström, M. E. (2016). Quality Improvement in large healthcare organizations: Searching for system-wide and coherent monitoring and follow-up strategies (ed.). Journal of Health Organisation & Management, 30(1), 133-153
Open this publication in new window or tab >>Quality Improvement in large healthcare organizations: Searching for system-wide and coherent monitoring and follow-up strategies
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2016 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 30, no 1, p. 133-153Article in journal (Refereed) Published
Abstract [en]

PurposeTo investigate the obstacles and challenges associated with organizational monitoring and follow-up processes related to health care quality improvement (QI) and development.Design/methodology/approachA longitudinal case study of a large healthcare organization during a system-wide QI intervention. Content analysis was conducted of repeated interviews with key actors and archival data collected over a period of four years.FindingsThe demand for improved monitoring and follow-up strategies, and what and how to monitor were described by the respondents. Obstacles and challenges for achieving monitoring and follow-up (M&F) strategies that enables system-wide and coherent development were found in three areas: monitoring, processing, feed-back and communication. Also overarching challenges were found. Practical implicationsA model of important aspects of M&F systems is presented that can be used for analysis and planning and contribute to shared cognition of such systems. Approaches for systematic analysis and follow-up of identified problems have to be developed and fully incorporated in the organization’s measurement systems. A systematic M&F needs analytic and process oriented competence, and this study highlights the potential in an organizational function with capacity and mandate for such tasks.Originality/valueMost health care systems are flooded with a vast amount of registers, records, and measurements. A key issue is how such data can be processed and refined to reflect the needs and the development process of the health care system and how rich data can be used for improvement purposes. This study presents key organizational actor’s view on important factors to consider when building a coherent organizational monitoring and follow-up strategy.

National Category
Reliability and Maintenance
Research subject
Quality Technology & Management
Identifiers
urn:nbn:se:ltu:diva-7160 (URN)10.1108/JHOM-10-2013-0209 (DOI)000374156600008 ()2-s2.0-84960332093 (Scopus ID)57c51b82-9427-4ba1-a059-7335bf92fe67 (Local ID)57c51b82-9427-4ba1-a059-7335bf92fe67 (Archive number)57c51b82-9427-4ba1-a059-7335bf92fe67 (OAI)
Note

Validerad; 2016; Nivå 2; 20140915 (rickg)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-08-16Bibliographically approved
Siva, V., Gremyr, I., Bergquist, B., Garvare, R., Zobel, T. & Isaksson, R. (2016). The Support of Quality Management for Sustainable Development: A Literature Review (ed.). Journal of Cleaner Production, 138(2), 148-157
Open this publication in new window or tab >>The Support of Quality Management for Sustainable Development: A Literature Review
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2016 (English)In: Journal of Cleaner Production, ISSN 0959-6526, E-ISSN 1879-1786, Vol. 138, no 2, p. 148-157Article in journal (Refereed) Published
Abstract [en]

Quality Management is considered to be suitable as support forthe integration of sustainability considerations in areas such as productdevelopment. The purpose of this paper is to review research in whichQuality Management methods, tools or practices have been used inconjunction with sustainable development initiatives. We have identifiedfour themes that synthesize the research on Quality Management and itssupport to approaches for sustainable development: (1) supportingsustainability through integration of management systems, (2) QualityManagement as support to the implementation of Environmental ManagementSystems and to the management of sustainability, (3) supportingintegration of sustainability considerations in daily work, and (4)supporting stakeholder management and customer focus. By far the mostresearch has been conducted within the first two themes. This paper alsocontributes with proposals for future research, such as the need to movebeyond existing standards and management systems to enable more radicalimprovements, and the need for empirical evidence of the effect ofintegrated management systems on environmental performance. We alsohighlight the point that Quality Management practices and tools must bedeveloped and adapted in order to support sustainability considerations.

Keywords
Other technology - Environmental engineering, Industrial engineering and economy - Industrial organisation, administration and economics, Övriga teknikvetenskaper - Miljöteknik, Industriell teknik och ekonomi - Industriell organisation, administration och ekonomi
National Category
Reliability and Maintenance Environmental Management
Research subject
Quality Technology and Management; Environmental Management; Effective innovation and organisation (AERI)
Identifiers
urn:nbn:se:ltu:diva-13530 (URN)10.1016/j.jclepro.2016.01.020 (DOI)000386739000002 ()2-s2.0-84957927270 (Scopus ID)cc04ebf5-0ad9-484c-a4b7-7a0e9fd48976 (Local ID)cc04ebf5-0ad9-484c-a4b7-7a0e9fd48976 (Archive number)cc04ebf5-0ad9-484c-a4b7-7a0e9fd48976 (OAI)
Note

Validerad; 2016; Nivå 2; 2016-11-17 (rokbeg)

Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-07-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7106-9644

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