Between January 29 and February 11, 2019, the Townsville region in Australia experienced a major flooding event. This study explored impacts on affected community pharmacies. Semi-structured phone interviews were conducted with six pharmacists who worked in affected Townsville community pharmacies during this flood. De-identified transcript data were analyzed using reflexive thematic analysis. The thematic analysis yielded six themes - "financial impact on pharmacy owners," "engagement with Local Disaster Coordination Center (LDCC) important," "workload pressures," "preparedness," "medication supply impacts," and "communication and collaboration." Financial impacts to owners included loss of property (two pharmacies were completely flooded), purchase or hire costs of generators when power was lost, and loss of revenue from complete or early closure of pharmacies and when patients could not pay or did not have a prescription and did not return to the pharmacy after the event. Engagement with the LDCC assisted pharmacy responsiveness. Medication supply issues were experienced by patients whose houses had flooded, or who had left their prescriptions with pharmacies that had flooded. Opioid Replacement Therapy (ORT) program patients were also impacted due to communication difficulties between them, their clinics, and their pharmacies. Increased customer numbers by those whose regular pharmacy was closed, reduced staff numbers, and austere working conditions increased workload pressures. Pharmacists collaborated to consolidate resources with those whose pharmacy had closed, working in pharmacies that were open. This research highlights a critical need for improved flood preparedness among Townsville pharmacists. Regardless, they collaborated to ensure there were minimal critical medication delays.

Background Healthcare waste is growing annually at a rate of 2–3% globally with negative implications for environmental and population health. Improving recycling of non-contaminated healthcare waste can reduce carbon emissions and landfill use with consequent financial and health co-benefits. This paper reports the development of a co-designed behavioural change recycling intervention in a small, rural hospital in Queensland, Australia. The aim was to reduce the amount of potentially recyclable or reusable non-contaminated waste currently ending up in landfill. Methods This study utilised co-design to develop a behavioural change intervention informed by an evidence-based, theoretical framework – the integrated Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). This study was undertaken in a 20-bed rural Queensland Health hospital and included hospital staff in the co-design of a recycling intervention. The waste streams chosen were commingled recycling stream and waste accepted by the Containers-for-Change recycling scheme. Two co-design workshops were held onsite at the hospital on 2nd June (n = 8) and 3rd August 2023 (n = 6) followed by a visit to the hospital on 31st August 2023 to implement the recycling intervention. Final data collection was undertaken at the end of November 2023. Results The co-designed intervention comprised placing commingled bins (grey with yellow lids) and CFC bins (grey with white lids) at points of recyclable waste generation with signage and ‘train-the-trainer’ education sessions with the green champions. Over the 3-month post-intervention data collection period there was a reduction of 1.25t for the general waste stream, 0.1042t of recyclable waste was recycled through the newly introduced CFC scheme, and an increase of 0.07t of commingled recyclable waste after the intervention. In summary, across a three-month period, this co-designed recycling intervention reduced CO2e by 2t. This equates to a reduction of 13,652 km of car travel in an Australian sedan or light SUV. Importantly, it also diverted approximately 3,000 plastic bottles and 866 aluminium cans from landfill. Conclusions Despite the small number of participants in the two co-design workshops, combining co-design with an evidence-based theoretical framework (BCW + TDF) produced a robust, fit-for-purpose, recycling intervention that led to behaviour change (recycling).

Introduction Pharmaceuticals are used widely in radiography practice but pose an environmental risk. This study explored Australian radiographers’ environmental attitude, pharmaceutical waste disposal practices, and knowledge and concern regarding the environmental impact of these pharmaceuticals. Methods This study utilised an anonymous, online questionnaire developed from two validated questionnaires. Participants (n = 150) held current registration with the Medical Radiation Practice Board of Australia and were working eight or more hours per week in a medical imaging practice (public or private). Results Participants did not answer all questions, hence percentages reported reflect the number of counts for each question. Most participants (71.4%; 105/147) disposed of contaminated pharmaceutical waste in clinical waste bins with 17.1% (15/146) disposing of it down drains. More hospital radiographers 13.54% (13/96) reported this disposal compared with 2.08% (1/48) of community-based radiographers (Fisher's Exact Test, p = 0.035). There was no difference in disposal of non-contaminated waste between practice settings - general waste bin (68.5%; 100/150), recycling bin (28.8%; 42/146), and clinical waste bin (41.8%; 61/146). Participants lacked knowledge of impacts on the food chain and the health of humans and wildlife. Only 34.7% (48/138) of participants expressed concern regarding the impacts of human excreted pharmaceuticals on the environment compared with 65.8% (98/149) regarding impacts from incorrect disposal. Many (18.4%; 25/136) reported having received no information on correct disposal of pharmaceutical waste. Conclusion This study highlighted participants’ lack of knowledge on how pharmaceuticals enter the natural environment and the subsequent impacts on the environment and on the health of humans, and flora and fauna. They lacked knowledge of correct pharmaceutical waste disposal methods, but most agreed it was their professional responsibility to dispose of waste correctly. Implications for practice Improving radiographers’ pharmaceutical waste disposal practices through education and professional support will reduce environmental impacts and also provide financial co-benefits if non-contaminated waste is recycled where possible and not incinerated.

This case study investigated waste management in a small, rural, Queensland hospital identifying areas where staff could reduce CO2e within the context of what is logistically possible. Phase I captured waste streams and disposal data for 1 May 2022-31 May 23 in a 20-bed Queensland Health hospital and included three audits of the hospital's pharmaceutical waste bin. Phase II comprised semi-structured interviews with seven staff. Most potentially recyclable waste was being disposed of in the clinical, pharmaceutical, and general waste streams. All participants were interested in recycling more if appropriate bins were accessible in their work and lunch areas and recycling education was provided. Between 1 May 2022 and 31 May 2023, the CO2e were 44.53t, which equates to approximately 48,327 car km. This study identified opportunities for hospital-wide recycling which would reduce CO2e, waste collection fees, and landfill volume. A limitation was the small number of interviewees due to rural workforce shortages and a COVID-19 outbreak.

Human health and well-being are inextricably linked to the environment, but human development in Western countries has been at the expense of the natural environment, largely through our reliance on fossil fuels. As we may have already reached "tipping points" in terms of some global environmental changes (e.g., climate change, biodiversity loss, air pollution), threatening human health and well-being, health professionals must respond urgently through mitigation, adaptation, and advocacy. Many are, however, not sufficiently informed to feel confident to do so. There is thus an imperative to upskill and educate practicing health professionals and current health professional students to practice environmentally sustainable health care and to take action to protect the environment to ensure human health. This chapter sets the scene in terms of the importance of the environmental determinants of health for individuals and for populations. It also provides health professionals and health professions educators with a resource list and case studies to guide the integration of planetary health and sustainable health care into the curriculum.

OBJECTIVE:To explore community pharmacy consumers' knowledge and attitudes of mental illness, support services, and community pharmacists' role in supporting people living with mental illness (PLMI).METHODS:This survey was conducted in 15 community pharmacies between June and September 2019. Participants were aged 18 years or older without prior or ongoing history of mental illness and/or with close family members with mental illness. Open-ended responses to the anonymous questionnaire were analysed using content analysis.KEY FINDINGS:Majority of the 380 participants were female (57.4%) with a mean age 52.9 years and 33.7% having completed university. Most (70.3%) believed that people with mental illness had a negative image due to poor health literacy providing possible solutions of 'awareness campaigns', 'education and training', and 'increased government funding for mental health (MH) support services'. Only 33.7% and 63.7% of participants were aware of Mental Health Week and the R U OK? Campaign, respectively. Whilst 12.4% of participants had participated in MH campaigns, only 3.4% were aware of community pharmacists-led MH educational activities. There were significant differences between adults (<65 years) and older adults (≥65 years old) with the latter reporting a more negative image for mental illness (P < 0.05) and having less exposure and engagement with MH resources (P < 0.001) and campaigns (P < 0.01).CONCLUSION:Despite awareness, participants reported low engagement with MH campaigns. Additionally, older adults had lower MH literacy and exposure to resources and campaigns. This study highlighted that the community lacked awareness of what pharmacists can offer to support PLMIs.

Accepted abstracts under the theme: Social and Administrative Pharmacy (n=125)

Background: In Queensland, each hospital and health service (local hospital network) has its own waste reduction and recycling plan to comply with the Queensland Government's Waste Reduction and Recycling Act 2011 (Qld). The aim is to reduce both the hospital's carbon footprint and waste handling costs. Hospital environmental waste services staff do not audit pharmaceutical waste bins as this requires the presence of a registered pharmacist.Aim: Since previous published studies of healthcare waste disposal practices have not included pharmacy waste bin audits, this study aimed to investigate waste disposal behaviours in a hospital pharmacy department.Method: This sequential, two-phase mixed methods study was conducted in a metropolitan, tertiary public hospital's pharmacy department in Queensland. Phase I involved semi-structured interviews of hospital pharmacists and pharmacy technicians while Phase II comprised bin audits of the pharmacy department's waste streams. Results: The bin audits revealed 36.1%, 23.8%, and 4.9% of recyclable waste in the clinical waste stream for each of the three bin audits respectively. In the general waste stream, the two bin audits of this stream revealed 14.3% and 44.4%, respectively. The rea-sons were identified in the interviews: there were no recycling bins in the main dispensing areas and there was confusion surrounding correct disposal of original containers and non-contaminated packaging waste. Non-paper waste was found in the confidential (shredded) waste stream in the two bin audits of this stream (10.1% and 16.7%, respectively).Conclusion: Provision of commingled recycling bins and clean office paper waste bins in dispensing areas and education of staff on correct waste segregation processes will improve waste segregation in hospital pharmacy departments with both financial and envir-onmental benefits for the hospital and the general population.

Nature-based social prescribing such as "blue prescription" promotes public health and health improvement of individuals with long-term health conditions. However, there is limited evidence explaining the relationship of contexts, mechanisms, and outcomes of implementing blue prescription programmes (BPPs) in health and social care settings that could inform policy and practice. We conducted a systematic realist review by searching PubMed, Web of Science, PsycInfo, Scopus, MEDLINE, and CINAHL for articles published in English between January 2000 and June 2022 about health and social care professionals providing referral to or prescription of blue space activities (e.g., swimming, fishing, surfing, etc.) with health-related outcomes. Components and descriptions of BPP implementation were extracted and used to develop themes of contextual factors used to develop programme theories and a logic model demonstrating the mechanisms of BPP implementation. Sixteen studies with adequate to strong quality were included from 8,619 records. After participating in BPPs referred to or prescribed by health and social care professionals, service users had improvements in their physical, cognitive (mental), social health, and proenvironmental knowledge. Service user-related contextual factors were referral information, free equipment, transportation, social support, blue space environments, and skills of service providers. Programme-related contextual factors were communication, multistakeholder collaboration, financing, and adequate service providers. Programme theories on service user enrolment, engagement, adherence, communication protocols, and programme sustainability explain the mechanisms of BPP implementation. BPPs could promote health and wellbeing if contextual factors and programme theories associated with service users' characteristics and programme delivery are considered in the design, delivery, and evaluation of BPPs. Our study was registered with PROSPERO (CRD42020170660).

Background: Given the negative environmental impacts of pharmaceuticals, including their contribution to healthcare's carbon footprint, pharmacists have a role in responding to the climate and biodiversity crises. Knowledge and education are required to support transitions to environmentally sustainable pharmacy practice (ESPP). The aim of this study was to explore Australian undergraduate pharmacy students' knowledge and attitudes towards environmental sustainability and ESPP curriculum content. Methods: Participants were surveyed using an anonymous online questionnaire deployed using Qualtrics. The questionnaire comprised of two main sections: the 15-item New Ecological Paradigm (NEP) scale to determine participants' environmental attitude score, and section on students' perceptions and curricular experience of environmentally sustainable practice which was adapted from previously published surveys. The invitation with survey link was disseminated via social media, Australian pharmacy student organisations, and direct approach. Quantitative data were reported descriptively. Qualitative data from responses to open-ended questions were analysed thematically using a reflexive, recursive approach. Incomplete survey responses were excluded from the analysis. Results: Of the 164 complete responses, 99% had previously received information on environmental sustainability. However, only 10% were knowledgeable about ESPP and only 8.5% were aware of ESPP content in their pharmacy school curriculum. Importantly, 70% of respondents saw ESPP as relevant to their future pharmacy practice, and 94% believed the pharmacy profession has a responsibility to undertake sustainability initiatives in the delivery of pharmaceutical care. Conclusions: Australian pharmacy students lacked knowledge of ESPP and few reported having curricular exposure to ESPP content in their pharmacy degrees. Therefore, ESPP content is an important area for development in pharmacy curricula.

Scottish Government Hydro Nation Scholars Programme.

Objectives NHS England has set itself a target of net zero emissions by 2050. Therefore, to address this gap in the literature, this study aimed to explore engagement with NHS policy on carbon reduction (including awareness of the Sustainable Development Unit [SDU] and the Coalition for Sustainable Pharmaceuticals and Medical Devices [CSPM]) in NHS hospital pharmacists in England. Methods Semi-structured interviews were conducted with 23 pharmacists working in six NHS England hospitals across all hierarchical levels. Four interview questions elicited Yes/No responses and one generated qualitative data which were analysed by two methods - Leximancer and manual coding. Key Findings Only five (5/23; 21.74%) had heard of the SDU and none knew its purpose. Those who did not wish to learn more about the SDU could not see its relevance to their clinical practice. Barriers identified to the inclusion of sustainability considerations in clinical decision-making were lack of knowledge of the environmental risk profiles for treatment options, lack of quality environmental evidence incorporated into clinical guidelines and lack of time to research for themselves. Many participants did not believe that environmental considerations were part of their job. Conclusions For NHS England to successfully deliver on its target of net zero emissions by 2050, immediate action is required from all hospital staff, clinicians included. The challenge for the NHS will be engaging pharmacists and other clinicians with sustainable clinical practice and working with clinicians to reduce identified barriers. As these data were collected in 2016, further research is warranted to determine if pharmacists' attitudes towards sustainable practice are changing.

Pharmaceuticals and their packaging have a significant negative impact on the environment providing a very strong argument for action on the part of pharmacists and pharmacy technicians to engage with pro-environmental behaviours (PEBs) in their workplaces. The aims of this research were therefore to investigate in hospital pharmacists and pharmacy technicians, 1) factors affecting engagement with workplace PEBs, and 2) determine if legislated carbon reduction targets in the UK influenced workplace PEBs in the UK compared with Australia which does not have legislated carbon reduction targets. The environmentally responsible disposal of pharmaceutical waste was the PEB of interest in this study. A mixed methods research design was utilised and a conceptual model (key variables: environmental attitude, concern, and knowledge, and organisational factors) was developed to identify factors influencing workplace PEBs. Participants were from five hospitals in Queensland, Australia and five NHS hospitals in England, UK. There was no statistically significant difference in environmental attitude or concern between the two groups-most had a mid-environmental attitude score and low levels of environmental concern. Participants lacked knowledge of the issue and the link between the environment and public health. Both Australian and UK participants reported recycling packaging waste was not a priority in the hospital pharmacy workplace (even in hospitals with recycling capability) as hospitals focused on compliance with clinical (contaminated) and confidential waste streams. Environmental attitude, knowledge, and concern therefore appeared to be weak influences on intention to perform workplace PEBs with workplace social norms (compliance due to audits) appearing to be a significant mediator of action. The key difference between the cohorts was that UK pharmacists felt waste was not in the scope of their role, and therefore not their responsibility. This study identified that legislated carbon reduction targets did not influence hospital pharmacy workplace PEBs-neither cohort reported engaging significantly in workplace PEBs. UK Government and NHS sustainability policy did not appear to have disseminated to pharmacy department level of UK public hospitals to any great extent.

Group assessment is an important collaborative learning structure for development of graduate teamwork competencies. However, group assessments are often associated with poorer learning outcomes due to highly negative student experiences involving tension and conflict. In this study, an online tool incorporating four strategic ‘GATES’ (Team structure, Communication, Leadership, and Situation monitoring/Mutual support) was designed to support the social processes required for team cohesion. The ‘GATES’ tool was evaluated using mixed methods in an observational, correlational (cross-sectional) study of 693 undergraduate and post-graduate university students and five academics in five Allied Health university courses with a group assessment task. Participants completed two anonymous questionnaires (previous experiences and current experiences) that generated both quantitative and qualitative data. In the first, 95.19% (178/187) of respondents reported a previous group assessment experience, and the experience was negative for 19.1% (34/178) of these students, with 85.3% (29/34) attributing this to group member behaviour. All academics reported issues with previous group assessments they had delivered. Of the students who used the tool (n = 52), there was no statistically significant association between gender, CALD status, or age with group assessment experience. However, 56.9% (29/52) of students and all five academics found the tool useful for getting the group started early, and for managing team issues. The tool appeared most helpful with organisation and planning than in managing team issues, potentially due to the tool negating issues before they arose. Overall, our study’s findings indicate that ‘GATES’ keeps students on track and provides timely support during the team management process.

Abstract The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to ‘rapid, far-reaching and unprecedented changes’ to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet. The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals. This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. ‘Consensus’ implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE). To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as ‘the system comprising structures, curricula, faculty and activities contributing to a learning process’. This Statement is relevant to the full continuum of training – from undergraduate to postgraduate and continuing professional development.

AbstractBackgroundNature-based social prescribing programmes such as ‘bluespace prescription’ may promote public health and health improvement of individuals with long-term conditions. However, there is limited systematically synthesised evidence that investigates the contexts and mechanisms of Bluespace Prescription Programmes (BPPs) that could inform programme theories for policy and practice.MethodsWe conducted a realist review by searching six databases for articles published between January 2000 and February 2020, in English, about health and social care professionals providing referral to or prescription of blue space activities with health-related outcomes. We developed themes of contextual factors by analysing the contexts of BPPs. We used these contextual factors to develop programme theories describing the mechanisms of BPP implementation. Our study was registered with PROSPERO (CRD42020170660).ResultsFifteen studies with adequate to strong quality were included from 6,736 records. Service users had improvements on their physical, mental, social health, and environmental knowledge after participating in BPPs referred to or prescribed by health and social care professionals. Patient-related contextual factors were referral information, free equipment and transportation, social support, blue space environments, and skills of service providers. Programme-related contextual factors were communication, multi-stakeholder collaboration, financing, and adequate service providers. Programme theories on patient enrolment, engagement, adherence, communication protocols, and long-term programme sustainability described the mechanisms of BPP implementation.ConclusionBPPs could support health and social care services if contextual factors and mechanisms of programme theories associated with patients and programme delivery are considered for implementation. Our findings have implications in planning, development, and implementation of similar nature-based social prescribing programmes in health and social care settings.

Background Disasters affect health services, health professionals and the health of individuals. During disasters, pharmacists are essential in maintaining the health of their communities. Despite the important roles pharmacists undertake in disasters, little is known about their preparedness to respond to disasters that may affect their communities. Aim To qualitatively explore the factors that affect Australian pharmacists' preparedness for disasters. Methods Semistructured interviews aimed at exploring disaster preparedness were conducted with 13 pharmacists in Australia. Participants were recruited using purposive, snowball, and convenience sampling methods. Interviews were audio recorded and transcribed verbatim. Open and axial coding methods were used to determine the factors associated with preparedness. Ethical approval was obtained from Queensland University of Technology (no. 1700000626). Results Almost half of the participants (46%) did not feel that they were prepared for a disaster likely to affect their primary place of practice. Two overarching themes contributing to participants' preparedness were identified: 'individual factors' and 'external factors'. Pharmacists believed that their preparedness was affected by the individual factors of experience, soft skills, knowledge and training. They also noted that external factors such as available resources, administrative support, multisector support and actions by supports were required for them to be prepared. Conclusion This research is the first of its kind to explore the factors affecting pharmacists' disaster preparedness. The results indicate that Australian pharmacists feel underprepared for disasters; however, improving this preparedness is complex and will require more than a single intervention. Interventions for improving preparedness need to target individual and environmental factors and involve the whole healthcare team.

Background: The importance of mental health is increasingly recognised, but mental health services are under strain to meet demand, and this is compounded by the impact of COVID-19. Evidence suggests how blue spaces improve health and wellbeing. Acknowledging the growing interest in nature-based social prescribing, we investigated how blue prescriptions are implemented in health and social care settings, developed determinant frameworks, and extrapolated these to current and post COVID-19 blue space management measures to support mental health.Methods: We conducted a systematic review by searching six databases for original research, published between January 2000 and February 2020, in English, on blue prescriptions by health or social care workers with the outcome of improved health or wellbeing. We excluded studies where participants were recruited by non-health professionals. We also added articles cited in relevant literature. We employed thematic analysis and realist synthesis to describe beneficiaries, mechanisms, outcomes, and contexts where blue prescriptions work. Our study was registered with PROSPERO, CRD42020170660.Findings: We identified 5447 records, of which after screening, 15 studies with adequate to strong quality based on QualSyst tool were included. Health, social care workers, or health-trained professionals referred or prescribed blue space activities to individuals with physical, mental, and social health conditions. Patient- (enrolment, engagement, adherence) and programme-related (communication protocol and long-term programme sustainability) implementation principles described successful blue prescription programmes. Patient-related determinants were clear referral information reinforcing patient belief;free blue space activities and logistics;social support;natural environment and biodiversity;skills and values of service providers. Effective communication channels, multi-stakeholder collaboration, financing, and trained link workers sustained implementation of blue prescription programmes.Interpretation: Findings underscore critical determinant frameworks generating outcomes of successful blue prescription programmes in health, social care, and educational facilities that could be adopted during and post-pandemic.Funding: Scottish Government Hydro Nation Scholars ProgrammeDeclaration of Interests: We declare no competing interests.

INTRODUCTION:In a disaster aftermath, pharmacists have the potential to provide essential health services and contribute to the maintenance of the health and well-being of their community. Despite their importance in the health care system, little is known about the factors that affect pharmacists' disaster preparedness and associated behaviors.STUDY OBJECTIVE:The goal of this study was to determine the factors that influence disaster preparedness behaviors and disaster preparedness of Australian pharmacists.METHODS:A 70-question survey was developed from previous research findings. This survey was released online and registered Australian pharmacists were invited to participate. Multiple linear regression was used to determine the factors that influenced preparedness and preparedness behaviors among pharmacists.RESULTS:The final model of disaster preparedness indicated that 86.0% of variation in preparedness was explained by disaster experience, perceived knowledge and skills, colleague preparedness, perceived self-efficacy, previous preparedness behaviors, perceived potential disaster severity, and trust of external information sources. The final model of preparedness behaviors indicated that 71.1% of variation in previous preparedness behaviors can be explained by disaster experience, perceived institution responsibility, colleague preparedness, perceived likelihood of disaster, perceived professional responsibility, and years of practice as a pharmacist.CONCLUSION:This research is the first to explore the significant factors affecting preparedness behaviors and preparedness of Australian pharmacists for disasters. It begins to provide insight into potential critical gaps in current disaster preparedness behaviors and preparedness among pharmacists.

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