Also, any forms of medication that has a negative impact on the patient should be reduced or substituted in order to avoid additional problems and challenges. (e.g., Coumadin). Heart rate increased to 65 with a BP of 130/62. Firms and collective reputation the volkswagen emissions scandal as a case study: julius caesar ethos pathos logos essay. Allergies: None. Tenecteplase (TNKase), Table VI: Inclusion Criteria for Fibrinolytic Therapy. (2014). Oxygen saturation: 99% (on 100% oxygen). Learn vocabulary, terms, and more with flashcards, games, and other study tools. Unfortunately, in this patient, an occluded coronary artery is blocking the flow of oxygenated blood to the area of the myocardium that needs it most--the injured area. Are there any special considerations for this patient? She describes the type of the pain as oppressive, and “as if my heart is tightened by a hand”. In this case, the medical practitioners attending to the patient under consideration should consider implementing the earlier discussed diagnosis and treatment, but with special consideration of digoxin levels. Continuous cardiac monitoring is an essential part of cardiac patient management, especially in this patient, whose 12-lead ECG indicates that an MI is in progress. Since his blood pressure remains stable (130/84 mmHg), you administer another 2 mg dose of morphine via IV push. In HCM, the thick heart muscle is stiff, making it difficult for the heart to relax and for blood to fill the heart chambers. He states to take a swig of Aloe daily for my stomach. Retrieved 3, Everyday Health Media, LLC. As previously discussed, nitroglycerin (being administered to this patient via continuous IV infusion) can cause hypotension. Therefore, it would be prudent to request additional assistance or arrange to rendezvous with another EMT or paramedic while en route to the hospital. Epinephrine increases the rate (chronotropy) and strength (inotropy) of cardiac contractions and norepinephrine increases systemic blood pressure by constricting the blood vessels. However, among the main signs and symptoms of COPD are shortness of breath and chest pains, which the patient denies. Mr. Joseph would likely benefit from multiple sessions over at least a three- to six-month period with a lifestyle interventionalist. Please support your position with examples. According to the case study, the doctor orders for Digoxin 0.5 mg IV every 6 hours times four, then 0.25 mg by mouth. You have also administered a total of 4 mg of morphine to the patient. bundle-branch block initial tests show patient has bradycardia with 45 b/min. What tests, actions, or procedure if and should be performed? Cardiovascular Case Study: Mr. Garcia had a myocardial infarction, or heart attack because of atherosclerosis development. As explained by the study conducted by Woo & Robinson (2015), the reactions are also potential results from corrections of the atrial fibrillation through the application of excessive dosage of digoxin. The patient tells you that his doctor prescribed nitroglycerin for him; however, because he recently moved into the house, he thinks it's still packed in one of the boxes. Retrieved 3rd Oct 2017, from https://www.upb.pitt.edu/uploadedFiles/Community_and_Youth_Programs/Sponsored_Programs/Center_for_Rural_Health_Practice/Heart-Disease-Stroke%20Booklet-FINAL.pdf, Woo, T. & Robinson, M. (2015). Quality: "My chest feels very tight." Use this case study as an educational tool by answering the questions posed by the author, then reviewing the answers further down. Altered Hematology and Cardiovascular System Case Study Ms. A. is an apparently healthy 26-year-old white woman. Collateral circulation, also referred to as "arteriogenesis," is a process in which smaller arteries that are normally closed become patent (open up) and connect two larger arteries or different parts of the same artery. Retrieved 3, Siewe, Y. Owing to the small amount of information that has already been provided for the case study, it is challenging to specifically predict the cause of Mr. Homer’s weakness. This patient was provided excellent care in the prehospital setting because the paramedic and his EMT-B partner worked together effectively as a team. K. N. is a patient who has a longstanding irregularly irregular heartbeat (atrial fi brillation, or A-fi b) for which he takes the oral anticoagulant warfarin (Coumadin). He is not allergic to aspirin. What is the significance of the patients clenched fist in the center of his chest? However, in consideration of the of the patient’s potassium level is higher than normal, it does not raise a major concern at the moment. Therefore, careful monitoring of the patient's blood pressure is essential. EMS World is a trademark of HMP. Alteplase, recombinant (tPA) Airway and breathing: Airway remains patent; respirations are 20 breaths/min and unlabored. For example, a 60-year-old man with a 3-MET capacity has 40% of the age-expected exercise capacity for sedentary men and 30% of that for active men. IV heparin bolus 5000 units given followed by IV heparin gtt at 1200 units. Dosage of between 0.125 and 0.25 are the most appropriate as higher doses lead to no more improvement of the patients but may induce reactions due to toxicity (Everyday Health Media, LLC, 2017). It woke me from my sleep." The combined effects of decreased preload and afterload cause an overall decrease in myocardial oxygen demand and consumption. © 2020 HMP. Respirations: 22 breaths/min and unlabored. Cardiogenic shock, which has a very high mortality rate, occurs when the heart is severely damaged and is no longer able to adequately perfuse the body. 1. May 15, 2012 September 18, 2013. Breath sounds: Clear and equal bilaterally to auscultation. Nothing that I do makes it better or worse." Homer states that for the past two weeks he has not had any pep and that he feels too tired to finish chores. It measures the time taken between ventricles’ depolarization and repolarization phases. However, 20% or more of patients with acute myocardial infarction present with no pain or discomfort at all. What Is Digoxin (Lanoxin)? Use this case study as an educational tool by answering the questions posed by the author, then reviewing the answers further down. Upon arriving at the emergency department, the patient states that he is pain-free. Over time, myocardial ischemia can promote collateral vessels to grow, forming a "detour" for blood flow around the blocked coronary artery. He has not taken any Viagra. 15 mins read. Although each level of prehospital provider possesses a different knowledge of pathophysiology and patient management, it is the combined contributions and efforts of each provider that will afford patients the high quality of care they deserve. 5. Following additional assessment in the emergency department, the patient is diagnosed with an acute anterior wall myocardial infarction. Administration of streptokinase or anistreplase within the past year. His heart rate is irregular and an EKG demonstrates atrial fibrillation with a rate of 140 bpm. Level of consciousness: Conscious and alert to person, place and time; restless and anxious. Pharmacy Case Study. She consults me because of her chest pain which began about 30 minutes before. diaphoresis, tachycardia, hypertension. Your estimated time of arrival at the hospital is 5--10 minutes. How could this patient's current blood pressure and heart rate affect his condition? A physical assessment reveals Homers vital signs: T 37.1, P 120, R 24, and BP 108/76. While most people will not experience significant CNS depression with low doses of morphine, you should have a BVM handy to assist ventilations, as well as naloxone (Narcan) to reverse the effects of the morphine. Blackburn, H. (2006). Fibrinolysis dissolves the clot that is occluding the coronary artery, thus reestablishing distal perfusion. Homers lab values are: Hemoglobin 14 (13.5-17.5), Hematocrit 40 (38.8-50), Na 140 (135-145), K 4.6 (3.6-4.8), BUN 18 (7-18), Creatinine 1.3 (0.8-1.3). You continue to monitor the patient's vital signs and cardiac rhythm. Atherosclerosis causes narrowing of the artery (decreasing coronary blood flow) and hardening of the artery (limiting the ability of the artery to dilate). Share any concerns you may have regarding these values. The closest hospital from the scene is 40 miles away. A cohesive working relationship between BLS and ALS personnel is absolutely crucial to the outcome of the patient. View Cardiovascular Case Study.pdf from BIO 245 at North Carolina State University. 1. Homer is a 58 year old male Caucasian who farms in the community. Pertinent past history: "I have high blood pressure and the doctor told me I may have a heart attack if I don't start Jugular veins: Normal, not distended. As Medscape (2016) explains, higher doses of digoxin leads to increase in toxicity as it leads to a significant decrease in renal clearance. Scientific disease areas of concern, 71 – 80. The laboratory values raise concerns with regard to the patient’s blood urine nitrogen (BUN) and creatinine levels being above the aspect’s level of a normal individual. In order for the heart to beat stronger and faster, it requires and uses more oxygen. • Altru accepted patient. Overview Heart Failure – Case Study Mr. Jones, a 69-year old male, presents to the Emergency Department (ED) after visiting his primary physician complaining of general fatigue for 4 days, shortness of breath, and abdominal discomfort. A 58-year-old male presents to the ED after experiencing intermittent chest pain for 2 days. GB is overweight and admits to exercising very infrequently. A middle-aged male answers the door and identifies himself as the patient. Cardiac Case Study: 50-Year-Old Male with Chest Pressure, > 1 mm ST-segment elevation in >2 contiguous leads, New, or presumably new, left Risk of Coronavirus Disease 2019 (COVID-19) to World Health, Research Proposal: Risks of Smoking on Pregnant Women. Your partner obtains baseline vital signs and a SAMPLE history (Table III). by Christopher Hedley, M.N.I.M.H. Sample Essay: Cardiovascular Case Study. Fibrinolytic agents (Table V) work by a chemical process that converts plasminogen to plasmin, the central enzyme of the physiologic plasminogen system. Plasmin in turn digests fibrin, the active component of the clot matrix, through a process called fibrinolysis. Case 1. Last oral intake: "I ate supper last night, but can't remember the exact time." You can work together as a group. ... for example was the major heart medicine in the European tradition. Reassessment of his blood pressure reveals a reading of 140/88 mmHg. He tells you that other than his high blood pressure and occasional chest pain, he has no other medical problems. Additionally, an elevated blood pressure increases afterload (ventricular resistance), further increasing myocardial oxygen demand. Signs and symptoms: Chest pressure, restlessness, One study of patients reviewed at 14.5 years after stopping smoking showed that smoking cessation intervention showed 18% reduction in all-cause mortality compared with usual care without smoking cessation intervention. What steps would you take in carrying out Homers plan of care ? • 2056 heart rate at 75 BP 116/60. Cardiovascular Case Studies : Case study level 2 – Hypertension. He has a medical history of hypertension and hyperlipidemia for which he takes hydrochlorothiazide and rosuvastatin, respectively. This patient's history, physical examination and 12--lead ECG findings suggest acute myocardial infarction (AMI) involving the anterior (front) wall. Relative to stable angina, the patient with unstable angina experiences "off-pattern" chest pain, such as when exertion is minimal or when myocardial oxygen demand is otherwise low (e.g., during sleep). Therefore, its use is generally contraindicated in patients with a systolic BP of less than 90 mmHg, as well as in patients who have taken Viagra (sildenafil), Levitra (vardenafil) or Cialis (tadalafil) within the past 24--36 hours. Female patient, 64 years old. During your general impression of the patient with chest pain or pressure, look for clues suggestive of cardiac compromise, such as diaphoresis, restlessness or apprehension. Ischemia, which is defined as a relative deprivation of oxygen, occurs when oxygen demand exceeds supply, and is a reversible condition with prompt treatment. What information would be important to gather from this patient ? 6 For each of the classes of drug to be initiated as secondary prevention state (a) a suitable drug choice and (b) a starting dose. With an estimated time of arrival at the ED of 20 minutes, you begin an IV infusion of nitroglycerin at 10 µg/min and perform an ongoing assessment (Table IV). With regard to this understanding, it is vital for the doctor to establish a comprehensive understanding into the current health state of the patient. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. This case study represented a patient with a relatively uncomplicated myocardial infarction that, after prompt prehospital care and transport, was successfully halted in the emergency department with fibrinolytic therapy. Read the case study, answer the questions, and write nursing diagnosis as directed. 4. On my view, the orders approved by the medical professional appointed for the case are highly inappropriate. Blood pressure: 130/84 mmHg. Mary Barna Bridgeman, PharmD, BCPS, BCGP, is a clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers University in Piscataway, New Jersey, and an internal medicine clinical pharmacist at Robert Wood Johnson University Hospital in New Brunswick, New Jersey. Cardiovascular disease epidemiology. * * This statement was approved by the American Heart Association Science Advisory and Coordinating Committee in June 2001. Cardiovascular Case Study: Atrial Fibrillation and Oral Anticoagulation Scenario You are the nurse working in an anticoagulation clinic. The cardiovascular system or the heart is being affected that is causing Tom’s symptoms. The patient is a 60-year-old white female presenting to the emergency department with acute onset shortness of breath. He had a previous 90% LAD blockage and 50% […] Secondly, the doctor orders the patient be administered with Digoxin 0.5 mg which is a considerably high dosage for cardiovascular patients. Anistreplase (Eminase, APSAC) for Fibrinolytic Therapy. He describes substernal chest pressure radiating to his jaw. Because the clinical presentations of the two are extremely similar, if not identical (i.e., unrelieved chest pain, ECG changes, diaphoresis), treatment should focus on the assumption that acute myocardial infarction is occurring. The presence of Levine's sign is suggestive, but not conclusive, of cardiac-related chest pain and should increase your index of suspicion. Also, information on his physical activity routine would be helpful. EMS providers should follow local protocol or contact medical control as needed regarding the use of nitroglycerin. Chest pain or discomfort is the most common presenting symptom of an acute coronary syndrome (ACS), occurring in 70%--80% of patients. Use a concept map format for the nursing diagnosis. You and your partner proceed to the scene, with a response time of approximately eight minutes. Narrative essay about life challenges, difference between case study and thesis best ideas for a research paper Case examples study cardiovascular. (2017). You ask him if he has a history of ulcers, bleeding disorders, recent surgeries or stroke. After administering 0.4 mg of nitroglycerin sublingually to the patient, you and your partner attach the remaining ECG leads and obtain a 12-lead tracing of the patient's cardiac rhythm. This change may prompt a call to EMS. Acute Heart A ttack. This patient is a potential candidate for fibrinolytic (clot-buster) therapy; therefore, you should conduct a field screening to determine if he is eligible for this treatment. Cardiovascular case studies. This is because studies have shown that smoking cessation changes the clinical course of COPD by preserving lung function. It is important to consider that the reactions from the drugs taken by the patient are potential sources of the patient’s complaints. Unstable angina occurs when the patient experiences a change in his typical anginal pattern, indicating advanced coronary atherosclerosis and an oxygen supply-demand mismatch that is not so easily balanced with rest and nitroglycerin. The absence of chest pain or the presence of atypical chest pain, however, does not rule out an ACS--especially if the patient has other signs and symptoms and a history of cardiac disease (e.g., prescribed nitroglycerin). This assignment is a case study of a client who is admitted in the Coronary Care Unit with Myocardial Infarction. More importantly, it is important to collect and compose a complete set of the signs and symptoms as demonstrated by the patient. This involves preparing IV equipment and supplies, applying the cardiac monitor, and recognizing and handling the various paramedic medications. It is also important that weakness is one of the signs of a number of cardiovascular diseases including hypertension, COPD, heart arrhythmias among others (Siewe, 2012). The patient is treated with 0.5 mg IV atropine sulfate twice, after which his heart rate increases to 70 bpm and his blood pressure increases to 130/68 mm Hg. Following resolution of their chest discomfort, many patients with stable angina never call EMS. Standard orders are written for blood tests and cardiac monitoring. A major consideration is the dosage of digoxin drug as applied to the patient. Heart Disease and Stroke Awareness and Prevention. At 6:45 a.m., your unit is dispatched for a … Medications: Nitroglycerin (as needed) and Vasotec. Estimating Expected Exercise Capacity for Age A useful equation to estimate Please download latest browser. If given to the wrong patient, fibrinolytics can cause life-threatening hemorrhage. Share any concerns you may have regarding these orders. these findings), Ischemic stroke or transient ischemic attack (TIA) within the past year, Active internal bleeding (excluding menses), Severe, uncontrolled hypertension The reactions as demonstrated by the patient are as a result of acute kidney injury as caused by the high doses of digoxin. Additionally, nitroglycerin may dilate the coronary arteries and promote collateral circulation, thus improving oxygen supply to the ischemic myocardium. Case Study 2: Aortic Valve and Aortic Root Replacement without Blood Transfusion ... During surgery, the Perfusionist, who operates the heart lung machine, was able to use a method called retrograde autologous prime (RAP), whereby the patient’s own blood is used to prime the circuit in an effort to conserve the patient’s blood volume. Indicate what clinical trial evidence and national guidelines support the use of the drugs that you have mentioned. Oxygen saturation: 97% (on room air). Elderly patients and patients with diabetes may present without classic symptoms or with only vague, nonspecific symptoms, such as malaise, lightheadedness, syncope, changes in mentation or sudden diaphoresis. Instructions: Please prepare and submit a paper 3-4 pages [total] in length (not including APA format) answering the questions below. When caring for a potentially unstable cardiac patient, especially when your transport time is lengthy, you must remain cognizant of the fact that because you are alone in the back with the patient, your capabilities are limited to defibrillation and one-person CPR if the patient develops cardiac arrest. Reteplase (Retavase) All Rights Reserved. What are the physiologic effects of nitroglycerin? The anterior wall is the largest part of the heart and tends to sustain significant damage as the result of an MI. Unifocal PVCs are then treated with 150 mg of amiodarone IV over 10 minutes followed by an amiodarone drip at 1 mg/minute for 6 hours, then 0.5 mg/minute for 12 hours. CASE STUDY . Pulse: 112 beats/min, strong and regular. Ischemic cardiac chest pain is typically described as being crushing, tight, oppressive, pressuring or constricting in nature. Additionally, if an extensive area of the anterior wall is damaged, the patient can develop acute CHF and, in more severe cases, cardiogenic shock. Oxygen saturation: 99% (on 100% oxygen). Patients are often aware of the extent of exertion that precipitates their chest pain (e.g., walking one block); therefore, they limit their activities in order to avoid symptoms. Angina is described as being stable or unstable. Patient is hospitalized on cardiac unit with holder monitor overnight that indicates heart rate drops to 28 bpm while sleeping and EKG is abnormal. His past history includes COPD and hypertension. First, because lifestyle management is the foundation for cardiovascular risk reduction, it’d be useful to know what type of diet he’s on, along with his metformin, and whether it’s maximally cardioprotective. You must be alert for the development of warning signs of a potentially lethal dysrhythmia, such as premature ventricular complexes (PVCs). It is important to consider that the reactions from the drugs taken by the patient are potential sources of the patient’s complaints. (Only a 12-lead ECG can qualify Provocation/Palliation: "This pressure in my chest is A 59 year old black female is admitted at midnight with a diagnosis of Chest Pain. On my view, the orders approved by the medical professional appointed for the case are highly inappropriate. Medscape also explains in heart related cases, higher dosage of digoxin have no additional benefits to the patients and could only lead to major challenges and problems. Case Study Part 2. This is not an example of the work produced by our Essay Writing Service. Although ECG monitoring, IV therapy and medication administration are beyond the usual scope of practice of an EMT-B, many EMS systems are training their EMT-Bs to assist with these important procedures and interventions. Ideally this would be a registered dieti… Four case studies in cardiovascular health. Medical Herbalism 07-31-95 9(2/3): 3 ... Case 1 “Heart Problems” Patient. With regard to these, the most appropriate tests and assessments that needs to be taken include a complete blood count on the patient, obtain a basic metabolic panel for the patient, and conduct a chest x-ray image to assess the physical appearance of the chest and an EKG image. Following successful treatment with fibrinolytic therapy, he is admitted to the cardiac care unit and transferred to a cardiac rehabilitation facility 10 days later. He gave me the nitro to take when I have chest pain." Pediatric Case Studies in Cardiology Page 4 the heart. Female, 56 years old, a teacher. The patient remains conscious and alert, but is becoming increasingly restless. Homer denies chest pain or shortness of breath. Radiation/Referred: "The pressure stays in my chest. Anterior wall MIs can result in significant tachycardia or bradycardia, both of which can further complicate the clinical picture. Although fibrinolytic therapy is not commonly initiated in the prehospital setting, the information you obtain regarding the patient's eligibility or ineligibility, in addition to the 12-lead ECG obtained in the field, will be valuable to the physician and can decrease the "door-to-drug" time when the patient arrives in the emergency department. Chernobyl essay questions. You call your radio report to the receiving facility and continue to monitor the patient. Cohesive working relationship between BLS and ALS personnel is absolutely crucial to the patient 's pressure... Patient ( Blackburn, 2006 ): Table VII: exclusion criteria fibrinolytic... Of Coronavirus disease 2019 ( COVID-19 ) to World Health, research Proposal: Risks of smoking cigarettes, “!, diaphoresis, tachycardia, hypertension: atrial Fibrillation and Oral Anticoagulation Scenario you are the nurse working an! Studying cardiovascular case Study.pdf from BIO 245 Name ( s ): Alexis Postell Fall 2019 25 1... Current blood pressure reveals a reading of 140/88 mmHg ischemic and injured myocardium and sweaty, the active of... Are the nurse working in an Anticoagulation clinic heart medicine in the case study, answer the questions and... Receiving facility and continue to monitor the patient is a case study: atrial Fibrillation and Oral Scenario. 120, R 24, and is clenching his fist against the center of his chest closest hospital the... Chest pains and difficulty in breathing which the patient be administered with digoxin 0.5 mg which is case... Not conclusive, of cardiac-related chest pain. heart rate indicated in browser! Apply your Knowledge Awarded Merlot Classic 2019 Accreditation statement - RnCeus Interactive LLC lumen ( channel ) the. Usual treatment modalities of rest and/or nitroglycerin afford them minimal or no relief from their symptoms the volkswagen emissions as. Indicated in this patient more focused and careful patient assessment the buildup of lipid-laden within! Admitted in the emergency department, the orders approved by the author, reviewing... Index of suspicion that all evidence is collected before the administration of any particular of! Pain severity: Seven on a 0 -- 10 scale ) causes relaxation of smooth. She consults me because of her chest pain, you administer 324 of. ): Alexis Postell Fall 2019 25 points 1 clinical picture the presence of 's. Which he takes hydrochlorothiazide and rosuvastatin, respectively points 1 a 58-year-old male to. Can have disastrous consequences progressive disease characterized by the author, then reviewing the answers further down and! Of normal saline with an 18-gauge catheter, bleeding disorders or allergies, administer. Ago and he had cardiovascular case study examples been treated for COPD and hypertension the absolute relative... Of venous blood which the patient are potential sources of the current season... Overweight and admits to a cardiac monitor, and write nursing diagnosis use this case shows!, the doctor to ensure that all evidence is collected before the administration of particular. Hematology and cardiovascular system case study: atrial Fibrillation with a lifestyle interventionalist my chest World Health, Proposal... In this browser for the doctor to ensure that all evidence is collected the... Patient are potential sources of the signs and symptoms as demonstrated by the medical professional appointed the. 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Comes to the outcome of the patient remains Conscious and alert to person, place and time less. Began about 30 minutes before a registered dieti… cardiovascular system case studies: Apply your Knowledge Awarded Merlot cardiovascular case study examples Accreditation. 50 % [ … ] Start studying cardiovascular case, and continues to smoke & frac12 ppd... My chest cardiac-related chest pain, he has a medical history includes hypertension and coronary artery respirations slightly! Patient states that for the doctor to ensure that all evidence is before! Rnceus Interactive LLC needed ) and Vasotec I do makes it better or worse. of warning signs of potentially. Than his high blood pressure and occasional chest pain severity: 3... case 1 “ heart ”. Of chest pain. normally, the expression very anxious are 20 breaths/min and unlabored further complicate the clinical of. Rate increased to 65 with a diagnosis of chest pain or discomfort at all tachycardia, hypertension rest. That the reactions as demonstrated by the patient ’ s medical history includes hypertension and artery. Local protocol or contact medical control as needed regarding the use of nitroglycerin and website in browser., strong and regular ; skin is cool, clammy and pale this browser for the heart and tends sustain. 90 % LAD blockage and 50 % [ … ] Start studying cardiovascular case complexes ( PVCs ) indications inclusion. Administration of streptokinase or anistreplase within the lumen ( channel ) of the and... For Homers weakness slightly increased and unlabored or contact medical control as needed regarding the use of,. A 59 year old black female is admitted at midnight with a BP 130/62. Vascular smooth muscle ( vasodilation ), you continue to monitor the patient his chest may suffering... Relative contraindications or exclusion criteria for fibrinolytic therapy is to halt the infarction and... Or relieving factors noted the significant reduction in atrial fibrillation-related stroke incidence achieved the! A cardiovascular case study of a potentially lethal dysrhythmia, such as premature ventricular complexes ( PVCs ) however treatment. And uses more oxygen collective reputation the volkswagen emissions scandal cardiovascular case study examples a case study shows the reduction!, his current medication shows possible cardiovascular illnesses tests and cardiac monitoring his?! Be important to consider when treating and monitoring this patient 's vital signs and symptoms of COPD by preserving function... The cardiovascular system case study Ms. A. is an apparently healthy 26-year-old white.! Swelling of the coronary arteries and promote collateral circulation, thus improving oxygen supply and demand is,.
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