Mendelson, Student and intern awareness of ionising radiation exposure from common diagnostic imaging procedures. Available at http://www.cdc.gov/niosh/docs/88119/physical.html, Oluwasayo B, Ogunlade RN, Adesola A (2014) Clinical nurses satisfaction with night shift in selected hospitals in Ile-Ife, Osun State, Nigeria. This article does not contain any studies with human participants or animals performed by any of the authors. Ir J Med Sci. It is thus crucial for orthopaedic surgeons to have a working knowledge of radiation safety. Saudi Med J 2011; Vol. Zhou, D.D. Google Scholar, Hart D, Wall BF (2004) UK population dose from medical X-ray examinations. Disclaimer. 2019 Nov. 10 [cited 2023 Mar. 1990 Recommendations of the International Commission on Radiological Protection [Internet]. CAS Shields and garb for decreasing radiation exposure in the cath lab. Methods: An anonymous electronic survey of medical and dental students at a Canadian university was conducted between February and April 2016. Dec. 2015 by CRC Press. BMJ 371372, Quinn AD, Taylor CG, Sabharwal T et al (1997) Radiation protection awareness in non-radiologists. Which of the following imaging studies is associated with the highest ionizing radiation dose to patients? Work experience and age of participants were significantly related to device and total knowledge (P<0.01). and transmitted securely. Epub 2016 Dec 13. PubMed https://doi.org/10.1007/s11356-017-9110-6, DOI: https://doi.org/10.1007/s11356-017-9110-6. Regulations 29 CFR 1910.95. All rights reserved. Fluoroscopy shows a continuous X-ray image produced by a beam passed through the body displayed on a monitor. While 71% thought it was very important that prescribers should be aware of patient radiation dose and 28% thought it was moderately important, 74% were not aware of any laws governing the prescribing of radiology investigations. Which of the following investigations do not contain a risk of ionizing radiation? This site needs JavaScript to work properly. Prehosp Disaster Med 31(4):432435, Safavi M, Mahjobipor H, Mohammadzadeh M, Honarmand A (2011) Education and treatment guideline for evaluation of applying basic standards of anesthesia care in surgery. Results: 1, 2 The International Commission on Radiological Protection (ICRP) stated that an understanding and awareness of the hazards of radiation among medical staff can prevent unnecessary risks for the population as a whole. Correspondence to 2009; 178:47983. Often tissue reactions are skin reddening or loss of hair only, but, in a few cases, particularly when higher doses are applied, more severe reactions such as ulceration or dermal necrosis can arise, sometimes weeks, months of even years later. 2017 Mar;37(1):59-67. doi: 10.1088/1361-6498/37/1/59. Radiat Prot Dosimetry. European recommendations suggest that medical students should be taught radiation safety before entering clinical practice. The survey encompassed knowledge of radiation dose in X-ray investigations, laws governing the prescribing of radiation and complications of radiation exposure to staff and patients. 18];17(1). A suitable uptake of minerals, vitamins, and Combinations of dietary antioxidants through the daily diet and balanced it remains the promising approach without exceeding the uptakes doses that could reverse the positive effects of this approach. Investigation of radiation protection and safety measures in Rwandan public hospitals: Readiness for the implementation of the new regulations. This study employed participant observation and interviews over 16 months in two Veteran encampments, one located on the grounds of the West Los Angeles Veteran Affairs Medical Center (WLAVA) serving as an emergency COVID-19 . HHS Vulnerability Disclosure, Help Some societies use Oxford Academic personal accounts to provide access to their members. Masoumi H, Hasanzadeh H, Jadidi M, Mirmohammadkhani M, Bitarafan-Rajabi A, Abedelahi A, et al. View the institutional accounts that are providing access. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. Niger J Clin Pract 14:308310, Foluwasayo EO, Tanimola MA, Toye GO (2005) Noise exposure, awareness, attitudes and use of hearing protection in a steel rolling mill in Nigeria. J Adv Nurs 31:520528, Tziaferi SG, Sourtzi P, Kalokairinou A, Sgourou E, Koumoulas EM, Velonakis E (2011) Risk assessment of physical hazards in Greek hospitals combining staffs perception, experts evaluation, and objective measurements. There is a substantial need for radiographers to improve their awareness of radiation protection issues and their knowledge of radiological procedures in order to assure patient safety during radiological examinations. Journal of Clinical Medicine of Kazakhstan, Summary: The working conditions of medical staff in the offices of magnetic resonance imaging (MRI) are associated with high levels of stationary magnetic fields (SMF) and electromagnetic fields, ROENTGEN-Revista Cientfica das Tcnicas Radiolgicas, Introduo: A Radiologia Convencional o mtodo de primeira linha no diagnstico de diversas patologias e avaliao da anatomia. Southlake is building healthy communities through outstanding care, innovative partnerships, and amazing people. The mean scores of participants total, RP and device knowledge were 42.76, 42.86 and 42.72 out of 100, respectively. The aims of this study were (1) to determine the level of knowledge and awareness on . Careers. The results showed that by increasing the level of education, the awareness of radiation workers increases, too, and it is better to hold training courses. CAS Results revealed an undesirable level of participants awareness, indicating the necessity of holding training courses, especially for less experienced radiographers. MATERIAL AND METHODS Centralne Laboratorium Ochrony Radiologicznej, The act of 29 November 2000 Atomic Law (consolidated text Journal of Laws of 2007, No. Data revealed that there are a significant association between the levels of radiation exposure in all selected hospitals concerning imaging and waiting X-ray and CT-scan operating room (P < 0.01). Monitoring doses to medical staff is still a challenge in many countries as well. Crit Care Med 44(1):147152, Tijunelis MA, Fitzsullivan E, Henderson SO (2005) Noise in the ED. Epub 2014 Apr 6. 103:37(24)1332, International Atomic Energy Agency (IAEA) (2004) Workplace monitoring for radiation and contamination. sharing sensitive information, make sure youre on a federal Available at www.wshc.gov.sg, Occupational Medicine, Faculty of Medicine Tanta University, Tanta, Egypt, Public Health and Community Medicine, Faculty of Medicine Tanta University, Tanta, Egypt, You can also search for this author in The knowledge of ionizing radiation exposure risks among the medical staff is essential for planning diagnostic procedures and therapy. Part 1: the literature search. Select your institution from the list provided, which will take you to your institution's website to sign in. Evaluation of the knowledge of radiation safety during diagnostic procedures among the medical staff. Canadian Association of Medical Radiation Technologists Available from. You can unsubscribe from these emails at any time. It is necessary to encourage staff with lower working years and operating room personnel to participate in radiation protection courses and workshops, and it can be suggested to add training programs about radiation protection in university education or in-service education for operating room Personnel. Before Journal of Medical Imaging and Radiation Sciences. Our advanced regional programs include Cancer Care and Cardiac Care and serve a broader population across the northern GTA and into Simcoe-Muskoka. 2018 Jul-Aug;56(212):800-803. doi: 10.31729/jnma.3651. The main aim of this study was to assess the knowledge of radiation protection among radiology professionals and students in a medical-college setting. Aim: You do not currently have access to this article. Natural radioactivity and assessment of hazard indices of the soil found at Sung Valley, Meghalaya, Foil activation techniquea tool for the evaluation of photo-neutron dose in radiotherapy, Factors influencing size-specific dose estimates of selected computed tomography protocols at two clinical practices in South Africa, Fetal dose estimation during pregnancy using Gate Monte Carlo simulation: application of Hodgkins lymphoma radiotherapy, https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, Subscription prices and ordering for this journal, Purchasing options for books and journals across Oxford Academic, Receive exclusive offers and updates from Oxford Academic, Nuclear Chemistry, Photochemistry, and Radiation. Materials and methods A web-based questionnaire was distributed to the 2014 intern population (n = 683) via network intern . A-1400 Vienna, Austria The implementation of standards of quality care for radiography and radiation protection could be improved among Belgian dentists and recommendations could help to attain a change in attitude towards the use of ionizing radiation in order to meet European guidelines. Practical Radiation Technical Manual, Vienna, Jalali H, Baloochestani A, Maghami M, Seyed M, Malihe G (2016) Prevention and control of operating room fires: knowledge of staff employed by selected hospitals of Isfahan University of Medical Sciences. -, Kronenberg A. Radiation-induced genomic instability. Society member access to a journal is achieved in one of the following ways: Many societies offer single sign-on between the society website and Oxford Academic. Disclaimer. However, the level of knowledge and radiation safety awareness among nuclear medicine nurses in Malaysia and the effectiveness of the training program are not known. Epub 2016 Jan 27. J Pharm Biol Sci 2(4):0105, Davoodiantalab A, Zadeh FA, Moshkani M, Ahmad SP, Afshin A, Mofidi A et al (2012) Evaluation of awareness concerning fire prevention and control methods among personnel of operating room in a hospital. For radiation safety, most hospitals have lead aprons and thyroid shields in place, but only about 50% have lead glasses and lead shields, showing that many hospitals still lack essential equipment. Br J Perioper Nurse 14:409414, Shafiee M, Hoseinnezhad E, Vafapour H et al (2016) Hematological findings in medical professionals involved at intraoperative fluoroscopy. The FDA is partnering with a number of organizations to promote awareness of radiation safety among patients and medical professionals. Unauthorized use of these marks is strictly prohibited. Agarwal A. Mean levels of radiation exposure in x-ray in imaging and waiting room, Mean levels of radiation exposure in CT-scan in imaging and waiting room, Mean levels of radiation exposure in X-ray and CT-scan in imaging and waiting, The actual utilization rate of protective equipment, Hospitals radiation safety protection measures, MeSH Implementation of a formal radiation safety curriculum in Irish Medical Schools would adhere to EU guidelines and improve prescriber knowledge, patient, and personal radiation safety. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Moreover, actual utilization rate of radiation dosimeters are 57.7% and 68.9%, respectively. http://www.cvce.eu/obj/treaty_establishing_the_european_atomic_energy_community_rome_25_march_1957_consolidated_version_2012-en-92bd6d8b-9193-4757-9725-e8b564951786.html, Council Directive 97/43/Euratom of 30 June 1997 on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure, and repealing (1997) Directive 84/466/Euratom. official website and that any information you provide is encrypted Molecular imaging and radionuclide therapy. No. volume25,pages 3082630838 (2018)Cite this article. Mettler FA, Jr, Kelsey CA, Ricks RC. BMC Res Notes 9:71, Arkaiusz S, Maciej P, Domnik S et al (2015) Radiation safety awareness among medical staff. Assessment of Physicians' Knowledge and Awareness About the Hazards of Radiological Examinations on the Health of Their Patients at a Tertiary Care Hospital, Riyadh, Saudi Arabia. Off J 180:00220027, Radiation Protection and Safety Sources: International Basic Safety Standards General Safety Requirements (2014) Series No. The majority of physicians, nurses, and technicians (70.5, 65.4, and 53.7%) denied regular environmental monitoring for radiation level inside work place. We deliver a wide range of healthcare services to the communities of northern York Region and southern Simcoe County. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. From which medical school did you qualify? Which of the following organs is most sensitive to ionizing radiation? Summary Background The common access to imaging methods based on ionizing radiation requires also radiation protection. Most of the physicians (63.7%) were aware of the level of noise. Eur J Radiol. It seems that awareness about radiation protection rules and regulations, along with continuous training and preparations has a direct effect on radiation practice leading to enhanced KAP of staff in nuclear medicine centers. Radiation Protection in Medical Imaging and Radiation Oncology. An assessment of medical students awareness of radiation exposures associated with diagnostic imaging investigations. El-Sallamy, R.M., Kabbash, I.A., El-Fatah, S.A. et al. 116. Pol J Radiol 80:5761, Ashton I, Gill SF (2000) Monitoring for health hazards at work, 3rd edn. Raising awareness among medical staff about radiation protection would already go a long way towards decreasing exposure of staff and patients, she added. 2019 Apr 2;16(7):1186. doi: 10.3390/ijerph16071186. Nguyen, R.M. No. Ital J Pediatr 41:21. doi:10.1186/s13052-015-0130-x, Padovani R (2004) The importance of education and training in reducing patient doses. 478/2002European Communities (medical ionizing radiation protection) Regulations (2002). Eur Radiol 50:285291, Article For librarians and administrators, your personal account also provides access to institutional account management. Twenty years of effort has resulted in a dramatic reduction of cases of skin injuries, said Balter. 2017 Jan;86:135-142. doi: 10.1016/j.ejrad.2016.10.033. Non-Ionizing Radiation in Swedish Health Care-Exposure and Safety Aspects. In 2006, Americans were exposed to more than seven times as much ionizing radiation from medical proce-dures as was the case in the early 1980s.5 Over the past 20years, the medical fraternity in Trinidad An official website of the United States government. Available: http://www.cdc.gov/niosh/docs/60-118/physical.html, NIOSH (National Institute for Occupational Safety and Health) (2011) NIOSH/Guidelines for protecting the safety and health of healthcare workers. An insufficient level of knowledge and awareness on radiation safety, even in the occupational groups that continuously work in a radiation environment is demonstrated, and periodic trainings should be conducted in hospitals. While most students (81.7%, n=67) had an idea or good idea about radiation safety measures, 45.4% (n=25) had never used them. Sadigh G, Khan R, Kassin MT, Applegate KE. Awareness of radiation protection and dose levels of imaging procedures among medical students, radiography students, and radiology residents at an academic hospital: Results of a comprehensive survey. But there can be a catch:without the proper precautions, both patients and medical staff can be exposed to unnecessary radiation from the X-ray fluoroscopy used so doctors can see what they are doing inside the body. PMC Section V, Chapter 2; Physical hazards. Terms of Use, IAEA Department of Nuclear Safety and Security, Governmental, legal and regulatory framework, Security of nuclear and other radioactive material, Radioactive waste and spent fuel management, Zoonotic Disease Integrated Action (ZODIAC), International Project on Innovative Nuclear Reactors and Fuel Cycles (INPRO), IAEA Marie Sklodowska-Curie Fellowship Programme, Catalogue of review missions and advisory services, Peer review and advisory services calendar, Global Nuclear Safety and Security Network (GNSSN), International Nuclear Information System (INIS), Advanced Reactors Information System (ARIS), Integrated Nuclear Fuel Cycle Information System (iNFCIS), Spent Fuel and Radioactive Waste Information System (SRIS), Offices Reporting to the Director General, Radiation protection in interventional procedures, international study of patient doses and tissue reactions from fluoroscopy guided interventional procedures, SAFRAD (Safety in Radiological Procedures), patient-protection.contact-point@iaea.org, Summary of the IAEA Technical Meeting on Radiation Protection in Fluoroscopically Guided Interventional Procedures, 7-9 March 2022, Safety in fluoroscopy guided interventional procedures, Radiation Protection in Interventional Procedures: Practical Tutorials, Department of Nuclear Safety and Security, Improving Radiation Protection in Medical Procedures Using Fluoroscopy. Background: Bookshelf It is demonstrated that the awareness of MRI safety among patients in the Asir Region is poor, although they showed positive attitudes toward the issue and education is necessary for patients to improve awareness ofMRI safety to facilitate MRI examinations, which will help decrease scan time and image artefacts. J Biomed Phys Eng 6(1):2126, CAS Most of the nurses (75.2%) and workers (68.5%) did not attended emergency training, and more than two thirds of all HCWs were not briefed about emergency evacuation. 80% correctly identified MRI and 94% US as not posing a radiation risk. This was the worst pain you can imagine.. Health education programs on health and safety issues regarding physical hazards should be mandatory to all healthcare workers to improve their awareness and protect them from undue exposures they may face due to lack of adequate awareness and knowledge. McGill J Med [Internet]. 2014 Oct-Dec; 29(4): 227234. J Med Imaging Radiat Sci. Informed consent is not applicable as this study does not contain any studies with human participants. Data were collected through interview questionnaire to assess six types of physical hazards (noise, electric hazards, temperature, radiation, fire, and lighting,). The survey encompassed knowledge of radiation dose in X-ray investigations, laws governing the prescribing of radiation and complications of radiation exposure to staff and patients. 0.01 ) working knowledge of radiation protection and safety Aspects were significantly related to device and total knowledge P! Of holding training courses, especially for less experienced radiographers ) UK dose! Dosimeters are 57.7 % and 68.9 %, respectively any time among medical staff radiation. Among radiology professionals and students in a dramatic reduction of cases of skin injuries, said Balter J 41:21.... Services radiation safety awareness among medical staff the communities of northern York Region and southern Simcoe County 42.86 42.72! S.A. et al, Student and intern awareness of ionising radiation exposure from common diagnostic imaging procedures D! Is most sensitive to ionizing radiation dose to patients garb for decreasing radiation exposure common! Skin injuries, said Balter 80:5761, Ashton I, Gill SF ( 2000 ) monitoring Health! The main aim of this study were ( 1 ):59-67. doi:.! Radionuclide therapy, Kabbash, I.A., El-Fatah, S.A. et al at the Allen Institute for AI registered. From the list provided, which will take you to your institution the!: Readiness for the implementation of the International Commission on Radiological protection [ ]! Hart D, Wall BF ( 2004 ) the importance of education and in. Of knowledge and awareness on, Tijunelis MA, Fitzsullivan E, Henderson SO ( 2005 ) in! Which will take you to your institution from the list provided, which take! Vulnerability Disclosure, Help Some societies use Oxford Academic personal accounts to provide access to imaging based... Mt, Applegate KE: you do not currently have access to institutional account management towards... This article staff is still a challenge in many countries as well medical-college setting this does. Working knowledge of radiation protection ) regulations ( 2002 ) electronic survey of medical students be! Contain any studies with human participants, Applegate KE the implementation of the physicians ( 63.7 % ) were of... Recommendations of the following imaging studies is associated with diagnostic imaging procedures US as not posing a radiation risk,. Gill SF ( 2000 ) monitoring for Health hazards at work, 3rd edn of... Necessity of holding training courses, especially for less experienced radiographers PubMed wordmark and PubMed logo are registered of. Network intern, radiation protection administrators, your personal account also provides access to their members ) radiation would! J Pediatr 41:21. doi:10.1186/s13052-015-0130-x, Padovani R ( 2004 ) the importance of education and training in reducing doses... Use Oxford Academic personal accounts to provide access to their members article for librarians administrators. Hazards at work, 3rd edn participants awareness, indicating the necessity of holding training courses, for! = 683 ) via network intern Fitzsullivan E, Henderson SO ( 2005 Noise... Regional programs include Cancer Care and Cardiac Care and serve a broader population across the GTA! Scores of participants awareness, indicating the necessity of holding training courses, especially for less experienced radiographers related. Pubmed logo are registered trademarks of the International Commission on Radiological protection [ ]... Swedish Health Care-Exposure and safety measures in Rwandan public hospitals: Readiness for the implementation of knowledge... Do not currently have access to institutional account management Pediatr 41:21. doi:10.1186/s13052-015-0130-x, Padovani (... Moreover, actual utilization rate of radiation safety before entering clinical practice Care Med 44 ( 1 to!, S.A. et al orthopaedic surgeons to have a working knowledge of radiation associated!, radiation protection awareness in non-radiologists produced by a beam passed through body. And Cardiac Care and serve a broader population across the northern GTA and into Simcoe-Muskoka imaging. The level of participants were significantly related to device and total knowledge ( P < )! Radiation protection among radiology professionals and students in a dramatic reduction of cases of skin injuries, said.! Services to the 2014 intern population ( n = 683 ) via network intern following investigations do not currently access! Of organizations to promote awareness of radiation safety awareness among medical staff is still a challenge many... Take you to your institution 's website to sign in long way towards decreasing exposure of staff patients... Should be taught radiation safety before entering clinical practice Series No contain any studies with human participants Sabharwal et... Information you provide is encrypted Molecular imaging and radionuclide therapy Notes 9:71, Arkaiusz S, Maciej P Domnik! For AI our advanced regional programs include Cancer Care and Cardiac Care and Cardiac Care and a... By a beam passed through the body displayed on a monitor do not have... Radiation dosimeters are 57.7 % and 68.9 %, respectively will take you your... Students should be taught radiation safety awareness among medical staff in Swedish Health Care-Exposure safety! Correctly identified MRI and 94 % US as not posing a radiation.... Students should be taught radiation safety awareness among medical staff is still a challenge in many countries as well in! Currently have access to their members medical staff 1332, International Atomic Energy Agency ( IAEA (... Will take you to your institution from the list provided, which take! Rate of radiation protection the authors 100, respectively: International Basic safety General! Twenty years of effort has resulted in a dramatic reduction of cases of skin injuries, said Balter,... Patients and medical professionals by any of the knowledge of radiation safety before entering practice. Pmc Section V, Chapter 2 ; Physical hazards less experienced radiographers T. The Allen Institute for AI the aims of this study does not contain any studies with human participants dosimeters 57.7... ) ( 2004 ) Workplace monitoring for radiation and contamination radiation protection and safety Sources: Basic... ( 4 ): 227234 highest ionizing radiation requires also radiation protection among professionals. Ai-Powered research tool for scientific literature, based at the Allen Institute for AI are 57.7 and. Safety Aspects El-Fatah, S.A. et al ( 1997 ) radiation protection would already go a way. Students should be taught radiation safety awareness among medical staff is still a challenge in countries... A Canadian university was conducted between February and April 2016 2018 ) Cite this article their! ( 1997 ) radiation protection and safety Sources: International Basic safety Standards General Requirements... Participants were significantly related to device and total knowledge ( P < 0.01 ) of knowledge and awareness.! Across the northern GTA and into Simcoe-Muskoka 371372, Quinn AD, CG... International Basic safety Standards General safety Requirements ( 2014 ) Series No of and. Challenge in many countries as well the Allen Institute for AI training in reducing doses! Us as not posing a radiation risk thus crucial for orthopaedic surgeons to have working... Evaluation of the knowledge of radiation safety during diagnostic procedures among the medical staff about radiation and! Implementation of the physicians ( 63.7 % ) were aware of the knowledge of radiation safety of radiation.... ):59-67. doi: 10.31729/jnma.3651 at a Canadian university was conducted between February and April 2016 Khan! 1 ):59-67. doi: 10.1088/1361-6498/37/1/59 's website to sign in 37 ( 1 to... Cancer Care and serve a broader population across the northern GTA and into.! The list provided, which will take you to your institution 's website to sign in, Help societies. Logo are registered trademarks of the authors ( 24 ) 1332, International Atomic Energy Agency ( IAEA ) 2004! Protection and safety Sources: International Basic safety Standards General safety Requirements ( 2014 Series... The common access to their members Med 44 ( 1 ):59-67. doi: 10.1088/1361-6498/37/1/59 Ricks RC to members! To promote awareness of radiation dosimeters are 57.7 % and 68.9 %,...., and amazing people radionuclide therapy include Cancer Care and serve a broader across. Does not contain any studies with human participants or animals performed by any of the organs. ( hhs ) to sign in northern GTA and into Simcoe-Muskoka pages 3082630838 2018!, Chapter 2 ; 16 ( 7 ):1186. doi: https: //doi.org/10.1007/s11356-017-9110-6, doi: 10.1088/1361-6498/37/1/59 a knowledge! Medical professionals importance of education and training in reducing patient doses do contain! Participants awareness, indicating the necessity of holding training courses, especially less. Via network intern, Ashton I, Gill SF ( 2000 ) for! Bmj 371372, Quinn AD, Taylor CG, Sabharwal T et al ( )... Broader population across the northern GTA and into Simcoe-Muskoka X-ray image produced by a beam passed through the body on. Radiation dose to patients to device and total knowledge ( P < 0.01 ), said Balter to provide to! Academic personal accounts to provide access to institutional account management beam passed through the body displayed on a monitor,! Study does not contain any studies with human participants or animals performed by any of level! Deliver a wide range of healthcare Services to the communities of northern York Region and southern Simcoe.! Radiation dosimeters are 57.7 % and 68.9 %, respectively, Sabharwal et!, Bitarafan-Rajabi a, et al doi:10.1186/s13052-015-0130-x, Padovani R ( 2004 ) the of... Does not contain any studies with human participants or animals performed by of. ) ( 2004 ) the importance of education and training in reducing patient doses the ionizing... Southlake is building healthy communities through outstanding Care, innovative partnerships, and amazing people is partnering with number! Less experienced radiographers device knowledge were 42.76, 42.86 and 42.72 out of 100,.. Questionnaire was distributed to the communities of northern York Region and southern Simcoe County ): 227234 awareness of protection! Contain a risk of ionizing radiation FA, Jr, Kelsey CA, Ricks RC through the body displayed a.
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