Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

This paper involves a case-study of an 8-year-old boy who reported to the ER, in the company of his mother. According to the mother, the client had symptoms such as reduced interactions with his peers, reduced appetite, being irritable, and sadness. The client was assessed and the findings showed that the client had achieved all the required milestones for his age, while the physical assessment indicated that the client did not have any abnormality. The MSE also showed that he was alert and properly oriented. The client reported that his mood was sad. He denied any hallucinations. The client did not have any paranoia or delusional thought process. The findings further showed that his insight and judgment were satisfactory. During the interview, he denied having suicidal thoughts but stated that he would often have thoughts about death. The client was administered the Children’s Depression Rating Scale and he scored 30, which showed that he was having severe depression. The client was thus diagnosed with depression. Depression is characterized by symptoms such as sadness, irritability, social withdrawal, sleep problems, appetite loss, among other symptoms (Park & Jung, 2019). This paper will analyze three decisions regarding the client’s treatment plan and because he is a minor, it will be important to select medications with few side effects. Moreover, the paper will analyze the ethical issues that will impact each treatment decision for this client.

Decision Point One

The client should start Zoloft 25 mg. Zoloft is effective and used widely in treating depression. The medication is also approved to treat depression in the pediatric population. Zoloft increases serotonin within the brain, a chemical that improves mood. (Dwyer & Bloch, 2019). Paxil and Wellbutrin were not selected because the medications have many side effects and hence not appropriate for the pediatric population.

Choosing Zoloft hoped that the client would manifest symptom improvement through improved mood, improved appetite, and increased interactions with peers. This is because Zoloft’s efficacy in treating depression has been demonstrated in many studies. Moreover, the medication is well-tolerated since it has few side effects (Dwyer & Bloch, 2019).

Nevertheless, the client did not respond to Zoloft 25 mg as he did not manifest any symptom improvement. This can be due to the low start dose of Zoloft which was not effective in improving the depressive symptoms for the client. Evidence shows that the efficacy of SSRIs depends on the level of dose, and therefore higher doses are more effective (Sanchez et al., 2016).

The ethical considerations include that PMHNP should seek consent from the parents of the client before administering any medication. This means the PMHNP needs to educate the parents regarding the three treatment choices, including their side effects to ensure that they make an informed decision. It will also be important for the PMHNP to respect the autonomy of the client’s parents and therefore if the parents choose to accept or reject the treatment, their decision should be respected (Bester et al., 2016).

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Decision Point Two

Since the client did not show any symptom improvement, the second decision should be to increase the Zoloft dose to 50 mg. It is important to evaluate the efficacy of the maximum dose of the first-line treatment before changing the medication. Therefore, a higher dose of Zoloft is anticipated to be more effective (Hieronymus et al., 2016). Changing to Paxil was not considered due to the medication’s side effects while increasing the Zoloft dose to 37.5 mg was not considered because the titration of Zoloft should start from 25 mg and then to 50 mg.

The decision of increasing the dose to 50 mg expects that the client would ultimately start responding, and exhibit notable symptom improvement. This is because the higher Zoloft dose should have increased efficacy, and thus result in symptom improvement (Cipriani et al., 2018). Another expectation is that the client would not have any adverse effects on the increased dose. The client manifested a 50% symptom reduction with the higher Zoloft dose (50 mg). This improvement is because the client started responding to a higher dose of Zoloft since higher doses are more effective. Moreover, he did not have any side effects, indicating that he tolerated the increased Zoloft dose.

The dose increment could lead to side effects. Therefore, the nurse practitioner needs to explain to the parents of the client about the possible effects of an increased dose, including the client experiencing side effects. This will enable the parents to make an informed choice when agreeing to accept the choice of increased dose (Yip et al., 2016).

Decision Point Three

The client is responding to the Zoloft 50 mg. Moreover, he did not have any side effects with this dose. Therefore, the third decision is to have the 50 mg dose maintained. This is because evidence recommends the use of the minimum effective dose to avoid any possible side effects with a higher dose. The drug was not changed to an SNRI since the client is already showing a satisfactory response with the first-line treatment option. Moreover, the decision of increased the Zoloft dose to 75 mg was not considered to avoid any possible side effects with a higher dose (Carvalho et al., 2016).

With this decision (maintain Zoloft 50 mg), the expectations are that the client will show further symptom improvement, and eventually attain complete symptom remission. Secondly, it is hoped that the client will continue tolerating the medication and the dose. This is due to the efficacy of Zoloft in the treatment of depression and the medication’s good safety profile and tolerability (Solmi et al., 2020).

The relevant ethical consideration for this decision includes beneficence. This means that the PMHNP should make decisions according to the client’s best interest. This involves making sure that the prescribed medication and dose, is not only effective but also does not result in unwanted side effects. It is also important to maintain the confidentiality of the client’s information. To achieve this, the PMHNP should make sure that the client’s diagnosis and treatment plan are not disclosed to an unauthorized party (Yip et al., 2016). Only authorized parties such as the parents and the healthcare providers should access the client’s health information.

Conclusion

The initial decision was to have the client begin Zoloft 25 mg. This choice was selected due to Zoloft’s efficacy and tolerability in the treatment of depressive symptoms. Zoloft is also recommended in the treatment of children with depression. Paxil and Wellbutrin were not considered due to the numerous side effects associated with these medications. The client did not respond to Zoloft 25 mg and thus the second decision involved increasing the dose to 50 mg in order to increase the medication’s efficacy. After the Zoloft dose was elevated to 50 mg, the symptoms adequately improved as demonstrated by the 50% symptom reduction after four weeks. Changing to Paxil was not considered due to many side effects of Paxil, while the choice to increase the dose to 37. 5 mg was not considered because titration of Zoloft should start from 25 mg to 50 mg, to 75 mg, in that order. Because the client tolerated the Zoloft 50 mg and showed an adequate response, the third decision involved maintaining Zoloft 50 mg dose. The choice to change to an SNRI was not considered because there is no clinical reason to change from the first-line treatment while the decision to increase the Zoloft dose to 75 mg was not considered to avoid any possible side effects with the further dose increase. It is important to ensure that informed consent is obtained from the client’s parents before making any treatment decision, protect the confidentiality of the client’s information, and ensure that the nurse practitioner acts in the client’s best interests.

References

Bester, J., Cole, C. M., & Kodish, E. (2016). The limits of informed consent for an overwhelmed patient: clinicians’ role in protecting patients and preventing overwhelm. AMA Journal of Ethics, 18(9), 869-886.

Carvalho A, Sharma M, Brunoni A, Vieta E & Fava G. (2016). The Safety, Tolerability, and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. Psychother Psychosom, 2016(85), 270–288.

Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., … & Egger, M. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Focus, 16(4), 420-429.

Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for Pediatric Patients. Current Psychiatry, 18(9), 26–42F.

Hieronymus F, Nilsson S & Eriksson E. (2016). A meta-analysis of fixed-dose trials reveals dose-dependency and rapid onset of action for the antidepressant effect of three selective serotonin reuptake inhibitors. Transl Psychiatry, 6(6), e834.

Park, E. H., & Jung, M. H. (2019). The impact of the major depressive disorder on adaptive function: A retrospective observational study. Medicine, 98(52).

Sanchez, C., Reines, E. H., & Montgomery, S. A. (2016). A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike? International clinical psychopharmacology, 29(4), 185–196. https://doi.org/10.1097/YIC.0000000000000023

Solmi, M., Miola, A., Croatto, G., Pigato, G., Favaro, A., Fornaro, M., … & Correll, C. U. (2020). How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations. Brazilian Journal of Psychiatry, (AHEAD).

Yip, C., Han, N. R., & Sng, B. L. (2016). Legal and ethical issues in research. Indian journal of anesthesia, 60(9), 684–688. https://doi.org/10.4103/0019-5049.190627

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When pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.

To prepare for this Assignment:

  • Review this week’s Learning Resources, including the Medication Resources indicated for this week.
  • Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.

The Assignment: 5 pages

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this patient (https://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_02/index.html ) . Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

  • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

  • Which decision did you select?
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632).All papers submitted must use this formatting.

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6630_Week4_Assignment_Rubric

  Excellent

Point range: 90–100

Good

Point range: 80–89

Fair

Point range: 70–79

Poor

Point range: 0–69

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

9 (9%) – 10 (10%)

The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.

8 (8%) – 8 (8%)

The response accurately summarizes the case for the Assignment.

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.

7 (7%) – 7 (7%)

The response inaccurately or vaguely summarizes the case for the Assignment.

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

0 (0%) – 6 (6%)

The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

Decision #1 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

18 (18%) – 20 (20%)

The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.

16 (16%) – 17 (17%)

The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.

14 (14%) – 15 (15%)

The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.

0 (0%) – 13 (13%)

The response inaccurately and vaguely explains the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.

Decision #2 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

18 (18%) – 20 (20%)

The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.

16 (16%) – 17 (17%)

The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.

14 (14%) – 15 (15%)

The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.

0 (0%) – 13 (13%)

The response inaccurately and vaguely explains in detail the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.

Decision #3 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

18 (18%) – 20 (20%)

The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.

16 (16%) – 17 (17%)

The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.

14 (14%) – 15 (15%)

The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.

0 (0%) – 13 (13%)

The response inaccurately and vaguely explains in detail the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

14 (14%) – 15 (15%)

The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.

The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.

12 (12%) – 13 (13%)

The response accurately summarizes the recommendations on the treatment options selected for this patient.

The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided.

11 (11%) – 11 (11%)

The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient.

The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided.

0 (0%) – 10 (10%)

The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.

The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

0 (0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

4 (4%) – 4 (4%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.5 (3.5%) – 3.5 (3.5%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 (0%) – 3 (3%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

3.5 (3.5%) – 3.5 (3.5%)

Contains several (3 or 4) APA format errors.

0 (0%) – 3 (3%)

Contains many (≥ 5) APA format errors.

 

Total Points: 100

 

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