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									    RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
                  BANGALORE, KARNATAKA

                            ANNEXURE-I


SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION


1   NAME OF THE                 MRS. SUVARNA D. HONNALLI.
    CANDIDATE AND               KLES INSTITUTE OF NURSING SCIENCES,
    ADDRESS                     VIDYANAGAR,
                                HUBLI-580031.


2   NAME OF THE INSTITUTE       KLES INSTITUTE OF NURSING SCIENCES,
                                VIDYANAGAR,
                                HUBLI – 580031.



3   COURSE OF STUDY AND         M.Sc NURSING – 1ST YEAR
    SUBJECT                     MEDICAL SURGICAL NURSING.




4   DATE OF ADMISSION TO        15TH JUNE 2009.
    THE COURSE


5   TITLE OF THE TOPIC          “EFFECTIVENESS       OF     PLANNED
                                TEACHING          PROGRAMME      ON
                                KNOWLEDGE          AND    PRACTICES
                                REGARDING PREVENTION OF ANEMIA
                                AMONG ADOLESCENT GIRLS.”




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6   BRIEF RESUME OF THE INTENDED WORK
     6.1 NEED FOR THE STUDY


         “Adolescence is a phase of life that begins in biology and ends with society.”
                                                                                -Sharma
            Adolescence is a time of major physical, cognitive and psychological growth and
    development. The blossoming of adolescence in each generation is a fascinating sight,
    predictable and repetitive yet none more the less enchanting. The hallmark of adolescent
    years is change. There exists a general feeling in the society that adolescent years are
    normally free from major health problems. On the contrary it is a crucial period because an
    adolescent girl is still a developing child.¹
            As per the last census in 2001, India is the second most populous country in the
    world with total population of over 1081 million. Adolescent (10-19years) form a large
    section of population about 22.5% that is about 225 million. They are living in diverse
    circumstances and have diverse health needs. ²
          The problems of adolescence are multidimensional in nature and require holistic
    approach. Some of the problems faced by adolescents are anorexia nervosa, obesity, over
    weight, micronutrient deficiency, emotional problems, behavioural problems, substance
    abuse, sexually transmitted diseases, identity and study problems.³
            Inspite of impressive gains in the field of health and nutrition, significant
    proportion of young people in developing countries suffer from nutritional anemia. The
    effect of earlier nutritional insult is visible in the adolescent age particularly in girls.
    Usually menstruation is a major cause of anemia among teenage girls, and this tends to
    continue into adulthood. ¹
          Anemia is decrease in normal number of red blood cells or less than the normal
    quantity of hemoglobin in the blood. The hemoglobin threshold for adolescents is
    12gm/dl. The most common type of anemia which occurs more commonly among
    adolescents is iron deficiency anemia and the cause for this is insufficient intake of iron
    containing diet, menstruation in girls, parasitic infections like malaria. The common signs
    and symptoms are feeling of weakness, fatigue, general malaise and sometimes poor
    concentration, dyspnoea, on exertion, pallor etc. Anemia can be best prevented by intake
    of iron in their diet such as cereals, pastas , bread, legumes such as peas, baked beans and
    leafy vegetables such as spinach and coriander leaves, canned asparagus, baked potato,
    dried fruits, raisins and apricots etc.4




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     The World Health Organization calls iron deficiency the most common anemia as it is
estimated to affect approximately 2 billion people world wide. In developing countries this
rate has been related to insufficient iron intake, exacerbated by chronic intestinal blood
loss due to parasitic and malarial infections. In developed countries it is more commonly
due to insufficient iron intake.5
    India has highest prevalence of iron deficiency anemia among women in the world
including adolescents 60-70% of Indian adolescent girls are anemic (Hemoglobin (hb<12
gm/dl).6 Adolescence in India goes hand in hand with iron deficiency anemia, says the
latest National Family Health Survey (NFHS). The NFHS-3, conducted in 2005, 2006,
presents statistics that mark a growth in cases pertaining to anemia.7
      India was among the fastest developing countries to have taken up the National
Anemia Prophylaxis Programme (NAPP) in 1970 to prevent anemia among women and
children through distribution of iron and folate tablets. However due to various reason like
irregular supply chain and poor compliance, the programme has not made an appreciable
dent in prevention of anemia. Hence it prompts us to take other alternatives.¹
         Dr. R.S.Chatterjee Sr.Consultant of Rockland Hospital, New Delhi, says although
well known to all, anemia rarely features our regular list “Normally women are not aware
of their tendency of being anemic. They don’t have any complaint otherwise. It is only
when they come for blood test for some disease, we find that they are anemic”.7
     Dr. Anant Mohan of All India Institute of Medical Sciences (AIIMS), New Delhi
admits that lack of consciousness especially regarding the cause of the disease is one of the
main reason of preponderance anemia.7
     Personal experience of the investigator and review of literature revealed that
adolescent girls are prone to be anemic and have lack of knowledge regarding prevention
of anemia. But they are full of energy, have significant drive and new ideas. They are a
positive force for a nation and are responsible for its future productivity provided they
develop in a healthy manner. We the Nurses being part of the health team have
responsibility to educate the adolescent girls and show the correct pathway to prevent
anemia. Hence, the above mentioned factors motivated the investigator to undertake the
study.




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6.2    REVIEW OF LITERATURE

       A cross sectional study was conducted on prevalence of anemia among school going
adolescent girls from August 2002 to November 2002 in urban and rural areas of
Chandigarh. A total of 1180 students from thirteen schools between the age group of 12 to
18 years participated in the study. The total population comprised of 911 students from
urban and 209 from rural areas. There were 590 girls and 530 boys. The results show that
prevalence of anemia among adolescents was 16.25% (182/1120). The hemoglobin values
ranged from 6.5 to 18.2. Prevalence of anemia was significantly higher (p<0.01) among
girls (23.9%, 41/590) as compared to the boys (7.7%, 41/530). The study concluded that
anemia was significantly less among the urban school going children as compared to rural
school going ones (14.16% vs. 25.4%; p<0.01). Both, girls 34.23% and boys 15.3% of
rural groups were significantly more anemic than girls 21.5% and boys 6% from urban
group (p<0.05 and <0.01 respectively).8
      A study was conducted to evaluate the effectiveness of two school based weekly iron
and folic acid (IFA) supplementation regimen (5 months supplementation vs. 8 months
supplementation regimen) in girls 10 to 18 years old attending school in Manica Province.
Twelve schools were included in the study. Schools were ordered by descending mean
hemoglobin concentration, and assigned alternatively to study group 5 (six school 5-
month supplementation) and study group 8 (six schools; 8- month supplementation). In
both study groups, the weekly supplement contained 60mg of elemental iron and 400
microg of folic acid. All girls received a single dose of mebendazol (500mg) twice-once at
the beginning of the study (T0) and once six months later (T6). Between T0 and T3, girls in
the study group 8 received IFA supplement weekly where as girls in study group 5 did not.
Between T3 and T8, all girls in both group received weekly IFA supplements. The results
of the study was at T0, mean hemoglobin concentration and anemia prevalence were
comparable in the study groups 8 and 5 (125.3 12.6g/L vs. 123.8 12.8g/L; 28%vs. 29%,
respectively). At T3, the mean hemoglobin concentration in the study group 8 was
significantly higher (126.3 14.3g/L vs. 121.5 11.9g/L, p<0.001) and the prevalence of
anemia was lower (28% vs. 35%, p=0.076) than in study group 5. At T8, after an additional
5- month supplementation period in both study groups, mean hemoglobin concentration
and anemia prevalence in study group 8 and 5 were not significantly different (126.5
12.6g/L vs. 124.9 12.3 g/L; 23% vs. 27%, respectively) .The study concluded that IFA
supplementation is feasible and effective intervention to prevent seasonal drop in


                                          4
hemoglobin concentration and increases in anemia prevalence. 9
       A cross sectional study was carried out to study epidemiological co-relates of
nutritional anemia among 630 adolescent girls in four villages namely Anji, Borgan,
Pawnoor, Chaka-Majier of Kasturba, Rural Health Training Centre. A pre -tested and pre-
designed performa was used to collect the information of socio-demographic
characteristics, hemoglobin estimation was done, anthropometric measurements taken and
univariate and multivariate analysis were carried out. The results showed the prevalence of
anemia was 59.8%. In univariate analysis low socio economical status, low iron intake,
vegetarian diet, history of worm infestation and history of excessive menstrual bleeding
showed association with anemia and with multivariate logistic regression analysis
suggested that strongest predictors of anemia was vegetarian diet followed by history of
excessive menstrual bleeding, low iron intake and worm infestation . The study concluded
to initiate the anemic prophylaxis measures for adolescent girls in India. 10
       A cross sectional study was conducted to determine the prevalence of iron
deficiency among 385 adolescent school girls aged 14-20 years, from 20 different high
schools located in three educational areas of Kermanshah, the capital of Kermanshah
provinces in western Iran. The results of studies shown that the prevalence of anemia
among adolescent school girls was 21.4%. Iron deficiency using a ferritin level <12 micro
g/l was found 23.7% of studied girls. There were 47 girls (12.2%) with iron deficiency
anemia (hb<12g/l and ferritin <20 microg/l). Around 57.3% of anemic girls were iron
deficient. The study concluded that there was no significant difference between the
presence of anemia and the level of education of parents.¹¹
     A quasi experimental study was conducted to evaluate the impact of an intensive
dietary program for the treatment of iron deficiency anemia in 34 intervention and 34
control boarding–school girls aged 12 to 17 years from Benin. The study was of 4 weeks
of nutrition education combined with an increase in the content and bioavailability of
dietary iron for 22 weeks was implemented in the intervention school, but not in the
control school. Data were obtained from both groups from a nutrition knowledge
questionnaire, 24- hour dietary recalls, anthropometric measurements, of iron status
indices, and screening for malarial and intestinal parasitic infections. The study resulted
that the nutrition scores and mean intakes of nutrients, including dietary iron, absorbable
iron, and vitamin C, were significantly higher in the intervention group (p<0.05) than in
control group after 26 weeks. Mean hemoglobin and serum ferritin values were also



                                           5
significantly higher in the intervention group than in control group (122 vs.112g/L[p=0.4])
and (32 vs. 19microg/L [p=0.005]) and iron deficiency anemia (26% vs. 56% [p=0.04])
was significantly lower in intervention group than in the control group. The study
concluded that multidietary strategy aiming to improve available dietary iron can reduce
iron deficiency anemia in adolescent girls.¹²
     A cross-sectional survey was conducted to estimate the prevalence of anemia among
adolescent girls in an urban area under Urban Health Training Center, Nagpur, India. 296
adolescent girls were included in this study and house-to-house survey was carried and
information    about    the   socio-demographic     characteristics   was    recorded    and
anthropometric measurements taken and hemoglobin was estimated. The result of the
study showed that 35.1% were found to be anemic. Out of that 69.2% had mild anemia
[Hb 10 to<12 gm%] and 30.8% had moderate anemia [Hb 7 to <10 gm%].None of the
subjects had severe anemia. The study concluded that there was a need to develop
strategies for intensive adult education and to improve the socio-economic status of the
population through poverty alleviation programs. ¹³
        A study was conducted to assess the effect of nutrition education on hematologic
indices, iron status, nutritional knowledge, and nutritional practices of high school girls in
Iran. The sample size was 60 healthy girls aged between 16-18 years were randomly
selected from two high schools in the city of Ahvaz and divided into two equally matched
groups, one that received nutrition education, and one that did not. The education group
received instruction in face to face sessions, group discussion, and pamphlets for two
months. The control group did not receive any information during the study. Hematology
test, corpuscular indices, and serum ferritin levels were measured at baseline and after two
months. Food- frequency questionnaire were administered and histories taken, clinical
signs of nutritional deficiencies observed, anthropometric measurements taken, nutrition
knowledge tested, practices determined, and life style questionnaire administered to all
subjects. The result revealed that, there was no significant difference in baseline
characteristics between the two groups. Scores for nutrition knowledge and practices of
education group were significantly higher after two months compared with the baseline
(31.4±6 vs. 24.3±5.9 points, p<0.001, and 31.2±5 vs.              28.4±5.7 points p<0.05,
respectively).The scores in the control group showed no significant change in base line to
2 months. The study concluded that nutritional education can improve knowledge of
healthy nutrition and lifestyle choices.14


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6. 3 STATEMENT OF THE PROBLEM

        “A study to evaluate the effectiveness of planned teaching programme on
knowledge and practices regarding prevention of anemia among adolescent girls at
selected PU Colleges, Hubli, Karnataka.”

6.4 OBJECTIVES OF THE STUDY

1.   To assess the knowledge regarding prevention of anemia among adolescent girls in
     experimental and control group before and after administration of planned teaching
     programme.
2.   To assess the practices regarding prevention of anemia among adolescent girls in
     experimental and control group before and after administration of planned teaching
     programme.
3.   To determine the relationship between the pretest knowledge and practice scores of
     adolescent girls regarding prevention of anemia among experimental and control
     group.
4.   To evaluate the effectiveness of planned teaching programme regarding prevention
     of anemia in terms of gain in knowledge and practice scores of adolescent girls.
5.   To find out an association between pretest knowledge scores of adolescent girls and
     their selected demographic variables.
6.   To find out an association between pretest practice scores of adolescent girls and
     their selected demographic variables.


6.5 OPERATIONAL DEFINITIONS

1.   Evaluate: Refers to statistical analysis of knowledge and practice scores of
     adolescent girls towards prevention of anemia as included in structured
     questionnaire.
2.   Effectiveness: Refers to the extent to which the planned teaching programme has
     achieved the desired outcome as measured by gain in knowledge and practice scores.
3.   Planned teaching programme: Refers to the written/verbal materials on anemia,
     developed by the investigator and validated by the experts. This includes - Anatomy
     and Physiology of blood, definition, causes, clinical manifestation, types,
     pathophysiology, complication, management and prevention of anemia.




                                             7
4.   Knowledge: Refers to scores obtained by the adolescent girls on the knowledge
     items of the structured questionnaire regarding prevention of anemia.
5.   Practice: Refers to scores obtained by adolescent girls on practice items of
     structured questionnaire regarding prevention of anemia.
6.   Anemia: Refers to decrease in normal number of Red Blood Cells or less than the
     normal quantity of hemoglobin (hb) in the blood. Normal hemoglobin threshold for
     adolescent girls s 12 gm/dl.
7.   Adolescent girls: Refers to girls between age group of 16-19 years studying at
     selected PU Colleges of Hubli.
8.   Demographic variables: Refers to variables like age, age at menarche, religion,
     socio-economic status, parent education, dietary pattern, year of study, area of
     residence, source of information, type of family.

6.6 HYPOTHESIS

H1: The mean post test knowledge scores of the adolescent girls on prevention of anemia,
     who have undergone the planned teaching programme will be significantly higher
     than the mean pre test knowledge scores at 0.05 level of significance.
H2: The mean post test practice scores of the adolescent girls on prevention of anemia,
     who have undergone planned teaching programme, will be significantly higher than
     the mean pre test practice scores at 0.05 level of significance.
H3: There will be significant relationship between knowledge and practice scores of
     adolescent girls regarding prevention of anemia at 0.05 level of significance.
H4: The mean post test knowledge scores of adolescent girls on prevention of anemia
     who have undergone planned teaching programme will be significantly higher than
     the mean post knowledge scores of adolescent girls who are not undergone the
     planned teaching programme at 0.05 level of significance.
H5: The mean post test practice scores of adolescent girls on prevention of anemia, who
     have under gone the planned teaching programme will be significantly higher than
     the mean post test practice scores of adolescent girls who are not undergone the
     planned teaching programme at 0.05 level of significance.
H6: There will be statistical association between the mean pretest knowledge scores of
     adolescent girls regarding prevention of anemia and their selected demographic
     variables at 0.05 level of significance.



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    H7: There will be statistical association between the mean pretest practice scores of
        adolescent girls regarding prevention of anemia and their selected demographic
        variables at 0.05 level of significance.

    6.7 ASSUMPTIONS

       1. Adolescent girls have some knowledge about anemia.
       2. Adolescent girls are more prone to be anemic.
       3. Planned teaching programme is an effective method to improve knowledge and
           practice towards prevention of anemia among adolescent girls.

    6.8 DELIMITATION

           The study is delimited to adolescent PUC girls studying at selected PU colleges of
           Hubli & assessment of practices related to anemia is limited to eliciting their
           practices through practice questionnaire only.

    6.9 PROJECTED OUTCOME

       1. The study will help the adolescent girls to gain in knowledge regarding causes,
           signs and symptoms, and prevention of anemia.
       2. The study will help the adolescent girls to follow the healthy practices to prevent
           anemia.

7   MATERIAL AND METHODS

    7.1 SOURCES OF DATA

     Primary source: Adolescent girls studying in I and II year PUC.
     Secondary source: Records maintained in the colleges.
     Research approach: Evaluative.
     Research design: True experimental; pretest-post test control group.
     Research setting: Selected PU Colleges of Hubli.
     Population: Adolescent girls studying in I and II year of selected PU Colleges of Hubli.
     Sample size: 100 (Experimental group-50 & Control group-50)
    Inclusive criteria:
    1. Adolescent girls who can understand, comprehend and respond to English and
        Kannada.
    2. Adolescent girls who are present during data collection.



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3. Adolescent girls who are willing to participate in the study.
Exclusive criteria:
      Adolescent girls having any behavioural problems as reported by their teacher.

7.2 METHODS OF COLLECTION OF DATA

Sampling technique : Simple random sampling.
Instrument                 : Structured questionnaire.
      Section I        :    Demographic variables.
      Section II       :    Knowledge items on prevention of anemia.
      Section III      :    Practice items on prevention of anemia.
Steps of data collection:
      Step I       :   The investigator obtains permission from respective authority to
                       conduct the study.
      Step II      :   Selection of PU Colleges and subjects through randomization.
      Step III     :   Investigator introduces herself to the subjects and notifies about her
                       aims, objectives, steps of the study and takes written consent.
      Step IV      :   Pretest / assess the adolescent girls for knowledge and practices
                       regarding prevention of anemia in both experimental and control group
                       using a structured questionnaire.
      Step V       :   Administer planned teaching programme to experimental group.
      StepVI       :   Post test/ assess the gain in knowledge and practices regarding
                       prevention of anemia in both experimental and control group using
                       structured questionnaire.
      Step VII :       Data will be analyzed & interpreted by using descriptive and
                       inferential statistics.

7.3      Does the study require any interventions or investigation to be conducted on
patients or other humans or animals? If so describe briefly.
                                   Yes. [Planned Teaching Programme]

7.4      Has permission been obtained from your institution?
                                   Yes

7.5      Has ethical clearance been obtained from your institution?
                                   Yes.



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8   LIST OF REFERENCES

    1.   Marthur B, Bertin E. A comparative study of impact of leaf concentration and Iron
         and folic supplementation on the blood profile of anemic adolescent girls. An
         Analytical Review [online] Dec 2005 [cited 2009 Nov2]; Available from:
         URL: http://www.nutritionluzere.org/pdf
    2.   Adolescence health and development. Core Programme Clusters Family and
         Community Health WHO India [online]. May 2008 [cited 2009 Nov 2]; Available
         from: URL: http://www.whoindia.org/EN/Section6/Section 425.htm
    3.   Ghai OP, Gupta P, Paul VK. Ghai Essential Pediatrics.6th ed.New Delhi (India): Dr.
         O.P Ghai publication; 2005. p.66, 75-8.
    4.   Nabili ST, Hebert PC , Wells G, Blajchman, Bush RL, Pevec WC.et
         al.Anemia.Wikipedia [online] 2000 Sep [cited 2009 Nov 6] ; Available from: URL:
         http://en.wikipedia.org/wiki/anemia
    5.   Assess clinically focused product information on Medscape. Pediatric Nursing
         [online] 2003 [cited 2009Nov 2]; 29(2). Available from: URL:http: // www,
         medscape.com / view artcle/452690
    6.   Pachod. Reducing Iron Deficiency Anemia and changing Dietary Behaviors among
         adolescent girls in Maharastra, India. Institute for Health Management [online] 2004
         [cited2009Nov 6]; 2 Available from: URL: http: // www. popline.org /
         docs/1736/314764.html
    7.   Anemia is on rise in India, says NFHS report. Express India [online] 2008 Jul
         [cited2009 Oct29]; Available from: URL: http:// www. expressindia.co / latest new /
         Anemia-is-on-the-rise-in-india
    8.   Basu S, Hazarika R, Veena P. Prevalence of anemia among school going adolescents
         of Chandigarh. Indian pediatrics [online] 2005 Jan [cited2009Nov2]; 42. Available
         from: URL: http:// indianpediatrics. net/june2005/593.pdf
    9.   Horjus P, Aguyo VM, Roley JA, Pene MC, Merashoek SP. School based iron and
         folic acid supplementation for adolescent girls. Food Nutr Bull [online] Sep2005
         [cited 2009Nov 8]; 26(3):[281-6]. Available from:
         URL: http:// www.ncbi.nlm.nic.gov/pub med/162222919
    10. Kaur S, Deshmukh PR, Garg BS. Epidemiological Co-relates of Nutritional Anemia
         in Adolescent Girls of Rural Wardha.Indian Journal of Community Medicine



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    [online] 2006 Oct [cited 2009 Nov 13]; 31(4). Available from: URL: http:// www.
    indmedica.com / journals. php? journalid= 7 & issueid = 83 & articleid = 1106&
    action=article
11. Akramipour R, Lezari M, Rahimi Z. Prevalence of iron deficiency among adolescent
    school girls from Kermanshah, Western Iran. Hematology [online] 2008 Dec [cited
    2009 Nov 8]; 13(6):[352-5]. Available from:URL: http://www.ncbi.nlm.nic.gov/pub
    med/19055864
12. Alaofa H, Zee J, Dossa R, O Brem HT. Education of improved iron intake for
    treatment by mild iron deficiency anemia in adolescent girls in Southern Benin. Food
    Nutr Bull [online] Mar 2009 [cited 2009Nov 8]; 30(1):[24-36]. Available from:
    URL: http://www.ncbi.nlm.nic.gov/pub med/19445257
13. Choudhary SM, Dharge VR. A study of anemia among adolescent females in the
    urban area of Nagpur.Indian Journal of Community Medicine [online] Oct2008
    [cited 2009 Nov 13]; 33(4):[243].
    Available from:URL: http://medind.nic.in/iaj/t08/i4/iajt08i4p243.pdf
14. Amani R, Soflaei M. Nutrition education alone improves dietary practices but not
   hematologic indices of adolescent girls in Iran. Food Nutr Bull [online] 2006 Sep2006
   [cited     2009      Nov      11];     27(3):[260-4].      Available      from:URL:
   http://www.ncbi.nlm.nih.gov/pubmed/17542117




                                        12
9    SIGNATURE OF THE
     CANDIDATE

10   REMARKS OF GUIDE            The study is feasible and of genuine interest of
                                 the student.

11   11.1 NAME AND DESIGNATION Mr. SANJAY M. PEERAPUR M.Sc (N)
         OF GUIDE                Professor / Principal
                                 KLES Institute of Nursing Sciences,
                                 Vidyanagar, Hubli –580031.
     11.2 SIGNATURE



     11.3 CO-GUIDE (IF ANY)      Mr. SHIVAPPA. MARANABASARI M.Sc(N)
                                 Lecturer
                                 KLES Institute of Nursing Sciences,
                                 Vidyanagar, Hubli –580031.
     11.4 SIGNATURE


     11.5 HEAD OF THE            Mr. SANJAY M. PEERAPUR M.Sc (N)
         DEPARTMENT              Professor / Principal
                                 KLES Institute of Nursing Sciences,
                                 Vidyanagar, Hubli –580031.
     11.6 SIGNATURE


12   12.1 REMARKS OF THE         This topic was discussed with the members of
         PRINCIPAL               the research committee and finalized. She is
                                 permitted to conduct the study.

     12.2 SIGNATURE




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