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Occupational Medicine 2006;56:39–45
Published online 11 November 2005 doi:10.1093/occmed/kqi193
Searching bibliographic databases for literature on
chronic disease and work participation
Joke Haafkens
1
, Clara Moerma n
2
, Merel Schuring
1
and Frank van Dijk
1
Background The work participation of people with chronic diseases is a growing concern within the field of
occupational medicine. Information on this topic is dispersed across a variety of data sources, making
it difficult for health professionals to find relevant studies for literature reviews and guidelines.
Aim The goal of this project was to identify bibliographic databases and search terms that could be most
useful for retrieving relevant studies on this topic.
Methods Five broad questions regarding work participation and chronic disease were formulated, focusing on
angina pectoris, depression, diabetes mellitus, hearing impairment and rheumatoid arthritis. A
search strategy for retrieving information on these questions was developed and run in five biblio-
graphic databases: Medline, EMBASE, PsycINFO, Cinahl and OSHROM. Relevant publications
were selected from the search results. The utility of the selected databases and search terms was
evaluated by analysing the number of relevant publications that were retrieved.
Results The number of relevant publications retrieved from each database varied. Most (84%) of the relevant
publications that were retrieved from each database were unique to that source. For each database,
specific search terms for the concept of ‘work’ were useful for retrieving relevant publications.
Conclusion Medline, EMBASE and PsycINFO are useful databases for quick searches. Useful search terms for
the concept of ‘work’ are work capacity, work disability, vocational rehabilitation, occupational
health, sick leave, absenteeism, return to work, retirement, employment status and work status.
For comprehensive searches, we recommend additional searches in Cinahl and OSHROM, adapting
the search terms to specific databases.
Key words Bibliographic databases; chronic disease; occupational health; search strategies; search terms; work
disability.
Introduction
Advances in medical technology have decreased the rates
of mortality and incapacitating morbidity from chronic
diseases. Although one consequence of this development
is that more individuals with chronic diseases are able to
work, the labour participation of this group still lags be-
hind that of the general population [1,2]. In recent years,
a number of Western countries have adopted policies for
improving employment opportunities for people with
chronic diseases [3–5]. Such policies require the active
support of both employers and health care providers
[6,7]. Occupational health care for patients with chronic
diseases is therefore a growing concern in medicine.
In the past, occupational medicine focused primarily
on occupational diseases, clinical medicine focused on
the clinical aspects of chronic diseases and rehabilitation
medicine concentrated on enabling patients to be inde-
pendent at home rather than at work [8]. Occupational
physicians and other health care professionals have only
recently begun to develop specific programmes and prac-
tice guidelines for managing the work-related problems of
patients with chronic diseases [9,10]. Systematic reviews
of the professional literature are necessary to support
their efforts.
Although this literature can now be retrieved electron-
ically from bibliographic databases, searching these data-
bases is not always easy. Search strategies for retrieving
information on ‘clinical’ questions in biomedical data-
bases are already widely available [11–13]. Questions on
‘occupational health’ issues, however, often have a wider
1
Academic Medical Centre, Coronel Institute, Amsterdam, The Netherlands.
2
Department of General Practice, Academic Medical Centre, Amsterdam,
The Netherlands.
Correspondence to: Joke Haafkens, Coronel Institute, Academic Medical Centre,
Meibergdreef 15, Amsterdam 1105AZ, The Netherlands.
Tel: 10031205667291; e-mail: j.a.haafkens@amc.uva.nl
The Author 2005. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
by guest on June 2, 2013http://occmed.oxfordjournals.org/Downloaded from
scope and are of an interdisciplinary nature. Retrieving
information on such questions from on line bibliographic
databases has proved particularly complex and time con-
suming, even for experienced researchers [14,15].
The aim of this study was to identify bibliographic
databases and search terms that could be particularly use-
ful for locating literature on questions that are related to
chronic disease and work participation. We hope that the
results will facilitate the work of professionals who seek
information on occupational health care for people with
chronic diseases, including occupational health professio-
nals who are involved in the development of programmes
and practice guidelines, occupational health practitioners
and the librarians or information specialists who sup-
port them.
Materials and methods
The study was conducted between June 2001 and August
2002 by M.S., C.M., J.H. and F.vD., all of whom are
experienced IT users. Our goal was to develop a search
strategy that would facilitate the retrieval of good-quality
general background information on chronic disease
and work participation. To this end, we formulated five
broad questions regarding the relationship between these
two concepts that might be of interest to health care
providers:
• How does chronic disease affect work ability?
• How does working affect chronic disease?
• Which diagnostic and prognostic instruments have
been developed and evaluated to assess the work ability
of individuals with chronic diseases?
• How do clinical interventions affect the work ability of
individuals with chronic diseases?
• How do work-related interventions affect the work
ability of individuals with chronic diseases?
We limited the study to five chronic conditions: angina
pectoris, depression, diabetes mellitus, hearing impair-
ment and rheumatoid arthritis. These conditions have rel-
atively high prevalence and are likely to affect the work
ability of patients [16]. To select bibliographic databases
for our search, we scrutinized the contents of a list of 15
potentially relevant databases on occupational health and
occupational injuries, as recommended by Beahler et al.
[15]. From this list, we selected the biomedical databases
Medline, EMBASE and Cinahl, the occupational health
database OSHROM and the social science database Psyc-
INFO. These databases offer more general information
on chronic disease and work participation than do other
databases that are more specialized, and they are more
easily accessible to the general user (Table 1).
The selected databases can be accessed through vari-
ous search engines. Our department uses Ovid as a search
engine for accessing Medline, EMBASE and Cinahl, and
it uses WebSPIRS (Silverplatter) for accessing PsycINFO
and OSHROM. We therefore used Ovid and WebSPIRS
to develop our search strategies.
All five databases allow the use of ‘free-text words’ to
trace articles. Combined with the ability to search in ’all
fields’, free-text words can be used to locate any word or
combination of words used in the title, abstract, author’s
name, research institution or keyword lists. To facilitate
searching, articles in Medline, EMBASE, Cinahl and
PsycINFO are indexed in a thesaurus of terms or subject
headings (in Medline, they are known as ‘Medical Sub-
ject Headings’ or MeSH terms). With the exception of
PsycINFO, the thesauri of these databases have a hierar-
chical tree structure, ordered from general to specific.
All articles are indexed using the most specific subject
heading available. In addition, the thesauri of Medline,
EMBASE and Cinahl contain subheadings that classify
articles under particular subject headings (e.g. diabetes
mellitus) into more specific medical categories (e.g. aeti-
ology, diagnosis).
Search terms for the ‘five chronic diseases’, were de-
rived from the subject headings in the thesauri of Med-
line, EMBASE and Cinahl. Because these databases are
of biomedical origin, we assumed that chronic diseases
would be appropriately defined by those subject headings.
Search terms related to the concept of work participa-
tion were selected by exploring subject headings from
thesauri and keywords found in the abstracts of relevant
publications, as well as through consultation with experts
in the field. For a number of reasons, we did not limit the
selection to subject headings that are indexed in the
thesauri of the databases. First, the only specialized
database on occupational health issues, OSHROM, does
Ta ble 1 . Bibliographic databases selected for literature searches
on chronic disease illness and work participation
a
1. Medline: contains biomedical literature from 1966
(http://www.ncbi.nlm.nih.gov/PubMed, http://www.ovid.com)
2. EMBASE: contains biomedical and pharmaceutical literature
from 1980 (http://www.elsevier.nl, http://www.ovid.com)
3. PsycINFO, contains psychological literature from 1887
(http://www.apa.org, http://silverplatter.com)
4. Cinahl: contains literature on nursing and other paramedical
professions from 1983 (http://www.cinahl.com, http://
www.ovid.com)
5. OSHROM: contains literature on occupational safety and
health, comprising the databases Rilosh from 1970, Hseline
from 1921, Cisdoc from 1921 and NIOSHTIC from 1971
(http://www.apa.org, http://silverplatter.com)
a
Not selected: ‘Occupational health database’: Transportation Research
Information Services (TRIS). ‘Business database’: ABI Inform. ‘Criminal
justice and social science databases’: Criminal Justice Periodicals Index (CJPI),
Sociofile, Educational Resources Information Centre (ERIC). ‘Agricultural
database’: Agris International, Agricola. ‘US Government databases’: National
Technical Information Services (NTIS), Public Affairs Information Service
(PAIS). ‘General databases’: Books in Print, Dissertation Abstracts, Expanded
Academic Index.
40 OCCUPATIONAL MEDICINE
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not provide a thesaurus. Second, we discovered that sub-
ject headings related to the concept of ‘work’ are not
always consistently defined and classified in the thesauri
of the other databases. For example, the Medline thesau-
rus defines the subject heading ‘work’ as ‘purposeful ac-
tivity (differentiate from employment for pay)’ and it has
one lower order subject heading: ‘work schedule toler-
ance’. In contrast, the EMBASE thesaurus defines the
subject heading ‘work’ as ‘job; job description; protected
work; work physiology’, and it has nineteen lower order
subject headings, including ‘absenteeism’, ‘job perfor-
mance’, ‘job satisfaction’ or ‘work schedule’.
Our initial selection of search terms for work partici-
pation consisted of 49 items (on request available from
the authors). To reduce this list, M.S. conducted test
searches in Medline (1966 to May 2001), EMBASE
(1988 to April 2001), Cinahl (1982 to April 2001),
PsycINFO (1966 to July 2001) and OSHROM (Rilosh,
Hseline and Cisdoc:1985–2001, NIOSHTIC:1985–
1998), using a combination of the search terms for ‘work’
and the search terms for the five chronic conditions. In
these searches, the search terms were used as both free-
text words (using all fields) and subject headings. To in-
crease the sensitivity of the searches (the probability of
retrieving all relevant publications), the facility to ‘ex-
plode’ subject headings was used for a number of search
terms related to work participation. To increase the spec-
ificity of the searches (the probability of retrieving only
information on specific topics), search terms for chronic
diseases were restricted to a selection of subheadings
(e.g. diagnosis or therapy) [17].
Based on the number of publications (hits) found by
the searches, as well as on discussions among the mem-
bers of the project team, we selected 22 search terms re-
lated to work participation that were likely to yield good
results. Terms that yielded more than 650 hits in more
than one database were excluded, as they were too broad
and insufficiently precise. The term ‘work’ is one exam-
ple. Used as both a subject heading and a free-text word,
it yielded 9373 hits in Medline, 5896 in EMBASE, 637
in Cinahl, 4405 in PsycINFO and 638 in OSHROM.
‘Employment’, ‘occupation’ and similar terms were ex-
cluded for the same reason. We also excluded terms that
yielded fewer than 10 hits in four databases (e.g. occupa-
tional nurse, occupational questionnaire, safety hazard).
Upon closer examination, these terms appeared to be
either insufficiently formulated or related to other areas
of interest in occupational medicine. Finally, specific
terms (e.g. work capacity evaluation) were excluded if
more general terms (e.g. work capacity) were included
that were likely to yield the same information. The use-
fulness of the five selected databases and the 22 search
terms was evaluated as follows.
First, M.S. searched all five databases using the se-
lected search terms for the five chronic conditions and
the 22 selected search terms for work. Searches were con-
ducted in Medline (1985 to May 2001) EMBASE (1988
to May 2001), Cinahl (1985 to May 2001), PsycINFO
(1988 to May 2001), OSHROM (1985 to April 2001)
and NIOSHTIC (1985 to September 1998). The
searches were restricted to human studies. Second, we
used the Reference Manager software to create a sepa-
rate file for each publication that was retrieved. Each file
contains the title and abstract of the publication, its key-
word lists and the database(s) in which it was found.
The third step in the evaluation involved the selection
of relevant publications. Two researchers (M.S. and
C.M.) screened the abstracts and titles of the publica-
tions that were retrieved and determined independently
whether they provided relevant information on any of the
five initial research questions. To be considered relevant,
a publication had to contain data from one or more orig-
inal studies and meet the following inclusion criteria:
• Study participants: people between the ages of 18 and
64 who had been diagnosed with any of the selected
chronic diseases and who had no other important co-
morbidity.
• Interventions (if applicable): any intervention that was
targeted at the health situations of working people or
the employment situations of people with the selected
chronic diseases.
• Outcome measures: outcome measures had to include
either work-related or disease-related aspects (e.g.
work performance, experienced quality of work, sick-
ness absence or change in health status).
Publications were rejected if both reviewers considered
that they did not meet the inclusion criteria. If the
reviewers did not agree or if one of them was uncertain,
a third assessor (J.H. or F.vD.) was consulted. Differ-
ences of opinion were settled by consensus.
Fourth, to identify the databases that were the most
useful, we assessed the percentage of relevant publica-
tions that were retrieved from each database. Because
different databases may refer to the same publication,
we also assessed the proportion of relevant publications
that were unique to individual databases. To this end, we
analysed data from the Reference Manager files to deter-
mine the number of relevant publications that had been
obtained from each database and the number of rele-
vant publications that had been identified in one data-
base, but not in the others.
Fifth, to identify the search terms for ‘work’ that had
been most useful for the search, for each database, we
computed the number of relevant publications containing
one or more of the 22 selected search terms. Because
these terms had been combined in our search strategy,
we could not know which specific search terms had led to
retrieval of a given publication. To solve this problem,
C.M. and J.H. attempted to locate them by screening
the titles, abstracts or keyword lists of the relevant pub-
lications, using information from the Reference Manager
J. HAAFKENS ET AL.: SEARCHING DATABASES FOR LITERATURE ON CHRONIC DISEASE AND WORK PARTICIPATION 41
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files. After discussion, the research team decided to
regard a search term as particularly useful if it had
occurred in at least 5% of the relevant publications that
had been retrieved from a particular database.
To avoid bias, the evaluations of databases and search
terms in the fourth and fifth steps were based on the
relevant publications that had been published within
the same time frame: between 1988 and the beginning
of 2001.
Results
Searches conducted using the 22 selected search terms for
work participation and those for the five chronic con-
ditions yielded 3063 publications from the five data-
bases (Table 2). The most publications for diabetes
mellitus and angina pectoris were found in Medline;
EMBASE contained the most publications for rheuma-
toid arthritis and hearing impairment and, not surprisingly,
PsycINFO proved to be the best source for publications
on depression. In many instances, more than one data-
base referred to the same publication. After controlling
for double entries, the searches yielded 2467 unique pub-
lications, varying from 1212 for depression to 142 for
angina pectoris. After screening, only 436 publications
appeared to contain information that was relevant to the
research questions.
Table 3 provides information on the relevant publica-
tions that had been published between 1988 and 2001
(Table 3). Column 1 shows the percentage of relevant
publications that would have been retrieved if we had
searched ‘only one’ of the five databases. In this case,
Medline, EMBASE or PsycINFO would have yielded
36, 40 or 23%, respectively, of the relevant publications.
OSHROM and Cinahl would have provided lower per-
centages. Column 2 shows the proportion of the relevant
publications that were found in ‘one’ particular database,
and ‘not’ in others. Surprisingly, most of the relevant
publications (84%) were found in ‘only one’ of the data-
bases: 24% in Medline, 22% in EMBASE, 19% in
PsycINFO, 13% in OSHROM and 6% in Cinahl. Each
database thus offered specific information that was rele-
vant to our research questions and that could not be
found in the other databases.
Many of the search terms could be traced back in the
titles, abstracts and keyword listings of the relevant
publications of the five databases (Table 4). We con-
sidered a search term useful for a database if it occurred
in at least 5% of the relevant articles that were found in
that database. For each database, we found specific
search terms that met this criterion: Medline (10 search
terms), EMBASE (11), PsycINFO (9), Cinahl (10) and
OSHROM (9). A different selection of search terms may
therefore be appropriate for specific databases. With few
exceptions, however, almost all the terms that yielded at
least 5% of the relevant publications in Medline were
also relevant for the other databases. We therefore recom-
mend the first 10 terms from Table 4 for a quick search
of literature on chronic illness and work participation.
Discussion
Searching literature for literature reviews in the field of
chronic illness and work is not an easy task. Potentially
relevant literature may be found in a large number of
databases, and a great variety of search terms for work
Table 2. Summary of the results of a literature search in five databases
a,b
Rheumatoid
arthritis
Depression Diabetes
mellitus
Hearing
impairment
Angina
pectoris
Total
Number of references
Medline 119 228 171 90 83 691
EMBASE 169 295 124 263 79 930
PsycINFO 16 578 7 56 2 659
Cinahl 28 61 10 40 2 141
OSHROM 133 331 82 88 8 642
Total 465 1493 394 537 174 3063
Number of references after excluding
double references
262 1212 350 501 142 2467
Number of references selected as relevant 108 145 110 44 29 436
a
The search combined 22 search terms for work participation with search terms for five chronic conditions. The 22 selected search terms for work participation are: work
disability, sick leave, employment status, work capacity, vocational rehabilitation, occupational health, return to work, work status, sick absence, job satisfaction, disability
pension, work ability, occupational rehabilitation, occupational physician, employment record, occupational stress, occupational health service, retirement, absenteeism,
occupational medicine, vocational guidance, job performance. Search terms also used as subject headings in Medline, EMBASE, Cinahl and PsycINFO: occupational
health service, retirement, absenteeism, occupational medicine, vocational guidance, job performance.
b
The search was conducted in Medline (1985 to May 2001), EMBASE (1988 to May 2001), Cinahl (1985 to May 2001), PsycINFO (1988 to May 2001), OSHROM
(1985 to April 2001) and NIOSHTIC (1985 to September 1998).
42 OCCUPATIONAL MEDICINE
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participation may be used to retrieve publications. In this
study, we developed and evaluated a search strategy that
could facilitate this task. We found that certain biblio-
graphic databases and certain search terms were more
useful than others. A number of caveats are nonetheless
in order.
First, we found that a limited number of the 22 search
terms for work participation (Table 4) yielded the best
results. We excluded such obvious terms as ‘employ-
ment’, ‘occupation’ and ‘work’ from this selection, as
they were defined differently in the thesauri of the various
databases and because they provided too many hits in our
test searches. Although their exclusion increased the effi-
ciency of our search strategy, including them may have
enabled us to find additional relevant studies. This issue
requires further investigation.
Second, we chose to restrict our searches to 5 of the 15
potentially relevant databases for occupational health
that were recommended by Beahler et al. [15]: Medline,
EMBASE, Cinahl, PsycINFO and OSHROM. Surpris-
ingly, we found little overlap among these databases re-
garding the retrieval of relevant publications. In each
database, we found a considerable number of unique
publications on chronic disease and work participation
that could not be found in the other databases. Studies on
the retrieval of information on other health-care-related
topics (e.g. rehabilitation of people with severe mental
Table 4. Relevant publications per database, by search terms related to work (presented as percentages of all relevant publications found in
that database)
a,b,c
Relevant publications (N 5 480) Database
Medline
(n 5 142)
EMBASE
(n 5 155)
PsycINFO
(n 5 89)
Cinahl
(n 5 31)
OSHROM
(n 5 63)
Search term present in titles, abstracts
or key word listings
%%% %%
Absenteeism 25 23 7 3 14
Work disability 22 23 7 16 8
Sick leave 17 8 6 6 0
Employment status 13 8 31 13 0
Work capacity 11 20 33 6 13
Rehabilitation, vocational 11 5 15 10 0
Occupational health 12 10 0 32 38
Return to work 65105
Retirement 10 7 2 13 5
Work status 753 10 5
Occupational medicine 4 2 0 0 19
Job satisfaction 2 4 1 3 0
Work ability 2 1 5 00
Job performance 1 88 0 3
Occupational stress 0 0 8100
Occupational health service 0 0 0 10 6
a
These data are based on the results from searches conducted in Medline (1988 to May 2001), EMBASE (1988 to May 2001), Cinahl (1988 to May 2001), PsycINFO
(1988 to May 2001), OSHROM (1988 to April 2001) and NIOSHTIC (1988 to September 1998).
b
The table mentions only search terms that were present $5% of the relevant publications found in at least one database. Search terms that were present in ,5% of the
relevant publications in each database are as follows: sick absence, vocational guidance, disability pension, occupational rehabilitation, occupational physician and
employment record.
c
Italic numbers refer to recommended search terms for each database.
Table 3. Percentage of relevant references, by database
a
Database % of all relevant
references found
in this database
(N 5 390)
b
% of all relevant
references found
‘only’ in this
database (N 5 390)
b
Medline 36 24
EMBASE 40 22
PsycINFO 23 19
Cinahl 8 6
OSHROM 16 13
Total 123
c
84
a
These data are based on the results from searches conducted in Medline (1988 to
May 2001), EMBASE (1988 to May 2001), Cinahl (1988 to May 2001),
PsycINFO (1988 to May 2001), OSHROM (1988 to April 2001) and
NIOSHTIC (1988 to September 1998).
b
For four publications, accurate information about the databases from which they
were retrieved was missing.
c
Total .100%, as one reference may be present in more than one database.
J. HAAFKENS ET AL.: SEARCHING DATABASES FOR LITERATURE ON CHRONIC DISEASE AND WORK PARTICIPATION 43
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illness and toxicology) have arrived at similar results
[18,19]. It therefore seems constructive to examine
whether the databases that were not tested in this study
could also yield relevant publications that are unique to
those sources. At the same time, it should be acknowl-
edged that we may have found more overlap among
the databases had we included such search terms as
‘employment’, ‘occupation’ and ‘work’, which yielded
many hits in our exploratory search. This issue also calls
for further investigation.
Third, the goal of this study was to identify databases
and search terms that could be useful for retrieving a com-
prehensive set of studies on broad questions concerning
chronic disease and work participation. Because the
study was an initial attempt at retrieving such informa-
tion, we feel that any attempt to define the relevant stud-
ies we found as the gold standard of evidence in the area
to be premature. For that reason, we made no attempt to
evaluate the usefulness of the search strategy by calculat-
ing the sensitivity and specificity of particular databases
and search terms with reference to a gold-standard
search. We intend to use this method in future research
on optimal search strategies for retrieving information for
systematic reviews in the field of occupational health.
Fourth, bibliographic databases are occasionally
reconfigured, and subject headings may be added, deleted
or defined differently. Conventions in the terminology
used by researchers may also change over time. The val-
idity of the relevant search terms we found in our study is
therefore debatable. In our opinion, these search terms
are quite robust, as many appeared to be relevant for all
five databases. Moreover, these search terms could always
be used as free-text words, even if the subject headings in
the thesauri of the databases were to be reconfigured.
Nevertheless, regular re-evaluation of the search terms
is advisable.
This study was an initial attempt to facilitate the work of
occupational health professionals and others who may seek
information on work participation and chronic disease.
Despite its limitations and the further work that is needed,
the results suggest a number of recommendations:
• For limited searches, at least three databases should be
searched: Medline, EMBASE and PsycINFO. Com-
prehensive searches should make use of OSHROM
and Cinahl as well.
• For quick searches covering all databases, the following
search terms related to work participation are most
useful: work capacity, work disability, vocational re-
habilitation, occupational health, sick leave, absentee-
ism, return to work, retirement, employment status
and work status. They can be used as a string of
terms, connected with the term OR.
• For searches in specific databases, specific combina-
tions of search terms for work participation may be
most useful (Table 4).
• When the results of a search are poor, more general
terms (e.g. ‘employment’, ‘work’ or ‘occupation’)
may be included.
• The search terms for work participation can be used
as free-text words, as subject headings or (preferably)
in both ways, according to the characteristics of the
database searched.
• In general, subject headings (MeSH terms) that are
available in the thesauri of the biomedical databases
(Medline and EMBASE) can be recommended as
search terms for chronic diseases. These terms may
need to be adapted for searches in other databases.
Finally, it should be acknowledged that the use of the
recommended databases and search terms does not au-
tomatically produce good search results. Each enquirer
who carries out a search has specific questions and in-
formational needs. The choice of search terms ultimately
depends chiefly on those specific informational needs.
Acknowledgements
This study was part of a larger project on ‘chronic disease and
work’, funded by the Dutch Board of Health Insurances. We
would like to thank the Board for the financial support, as well
as the programme ‘Fatigue and Work’ of the Dutch Organiza-
tion of Scientific Research. We would also like to acknowledge
the librarians of the Library of the Academic Medical Centre in
Amsterdam for their support and Jos Verbeek for his useful
comments on an earlier version of this paper.
Conflicts of interest
None declared.
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