Modeling and Role-Modeling

Modeling and Role-Modeling 

Margaret E. Erickson


Helen C. Erickson

Helen C. Erickson received a diploma from Saginaw General Hospital, Saginaw, Michigan, in 1957. Her degrees include a baccalaureate in nursing in 1974, dual master’s degrees in psychiatric nursing and medical-surgical nursing in 1976, and a doctor of educational psychology in 1984, all from the University of Michigan.

Erickson’s professional experience began in the emergency room of the Midland Community Hospital in Midland, Texas, where she was Head Nurse for 2 years. She then worked in Mount Pleasant, Michigan, as Night Supervisor of Nursing in the Michigan State Home for the Mentally Impaired and Handicapped. In 1960, she moved to Puerto Rico with her husband and assumed the position of Director of Health Services at the Inter-American University in San German, Puerto Rico, until 1964. On her return to the United States, she worked as a staff nurse at both St. Joseph’s Hospital and University Hospital in Ann Arbor, Michigan. Erickson later served as a psychiatric nurse consultant to the Pediatric Nurse Practitioner Program at the University of Michigan and the University of Michigan Hospitals–Adult Care.

Her academic career began as an assistant instructor in the RN Studies Program at the University of Michigan School of Nursing, where she later served as Chairperson of the Undergraduate Program and Dean for Undergraduate Studies. Erickson was Assistant Professor of Nursing at the University of Michigan from 1978 to 1986. In 1986, she left Michigan to go to the University of South Carolina College of Nursing. Initially, she served as Associate Professor and Assistant Dean for Academic Programs; later, she held the position of Associate Dean for Academic Affairs. In 1988, she moved to Austin, Texas, and served as Professor of Nursing and Chair of Adult Health at the University of Texas at Austin School of Nursing. In addition, she served as Special Assistant to the Dean, Graduate Programs. Since 1997, she has been an Emeritus Professor at the University of Texas at Austin. Erickson has maintained an independent nursing practice since 1976.

Erickson is a member of the American Nurses Association, American Nurses Foundation, the Charter Club, American Holistic Nurses Association, Texas Nurses Association, Sigma Theta Tau, and the Institute for the Advancement of Health. In addition, she served as President of the Society for the Advancement of Modeling and Role-Modeling from 1986 to 1990. She was the Chairperson of the First National Symposium on Modeling and Role-Modeling in 1986 and served on the planning committee for the second, third, fourth, fifth, sixth, seventh, eighth, ninth, and tenth national conferences in 1988, 1990, 1992, 1994, 1996, 1998, 2000, 2002, 2004, and 2006, respectively.

Erickson has been listed in Who’s Who Among University Students and is a member of Phi Kappa Phi. She received the Sigma Theta Tau Rho Chapter Award of Excellence in Nursing in 1980 and the Amoco Foundation Good Teaching Award in 1982, and was accepted into ADARA (a University of Michigan honor society for women in leadership) in 1982. In 1990, she received the Faculty Teaching Award, University of Texas at Austin, School of Nursing. She received a founders award from the Sigma Theta Tau International Honor Society in Nursing, Excellence in Education Award by the Epsilon Theta Chapter in 1993; she received the Graduate Faculty Teaching Award, University of Texas at Austin School of Nursing in 1995; and she was inducted as a Fellow into the American Academy of Nursing in 1996. The Helen Erickson Endowed Lectureship in Holistic Health Nursing was established in her honor in 1997 at the University of Texas at Austin. She received the Distinguished Faculty citation from Humboldt State University in California in 2001.

Erickson continues to research actively the Modeling and Role-Modeling Theory and has presented numerous seminars, conferences, and papers on various aspects of the theory, both nationally and internationally. She has served as a consultant in the implementation of the theory in clinical practice at the University of Michigan Medical Center in the surgical area, at Brigham and Women’s Hospital in Boston, at the Oregon Health Science University Hospital in Portland, and at the University of Pittsburgh hospitals. She has consulted with faculty members who have adopted the theory into their curricula and practice in various schools of nursing and service agencies. Humboldt University School of Nursing in Arcata, California, was the first school to use the Modeling and Role-Modeling Theory as its conceptual base. Metropolitan State University at St. Paul, Minnesota, has adopted the Modeling and Role-Modeling Theory for its RN and baccalaureate and master’s in nursing programs. St. Catherine’s College, St. Paul, Minnesota, has also adopted it for the associate degree in nursing program. The University of Texas at Austin has adopted concepts as a foundation for the alternative entry program, and the University of Texas at Galveston has adopted core concepts for the academic and service model at the University of Texas Medical Branch in Galveston (H. Erickson, personal correspondence, July 1992).

Erickson has been an invited speaker at many national and international conferences. She has participated in numerous workshops, including several congresses on Ericksonian approaches to hypnosis sponsored by the Erickson Foundation and several conferences sponsored by the National Institute for the Clinical Application of Behavioral Medicine. She has also been involved in activities sponsored by the American Holistic Nurses’ Association. She served as a content expert for certification curricula and was included in a book featuring nurse healers (H. Erickson, personal correspondence, July 1992). Although retired from the University of Texas at Austin, Erickson continues to be actively involved in the promotion of holistic nursing. She became Chairman for the board of directors of the American Holistic Nurses’ Certification Corporation in 2002, provides consultation and educational programs, and is actively involved in the Society for the Advancement of Modeling and Role-Modeling (H. Erickson, personal correspondence, June 10, 2000).

Evelyn M. Tomlin

Evelyn M. Tomlin’s nursing education began in Southern California. She attended Pasadena City College, Los Angeles County General Hospital School of Nursing, and the University of Southern California, where she received her bachelor of science in nursing. She received a master of science in psychiatric nursing from the University of Michigan in 1976.

Tomlin’s professional experiences are varied. She began as a clinical instructor at Los Angeles County General Hospital School of Nursing in surgical nursing and maternal and premature infant nursing. She later lived in Kabul, Afghanistan, where she taught English at the Afghan Institute of Technology. She then served as a school nurse and practiced family nursing in the overseas American and European communities where she lived, a role that included participating in more than 46 home deliveries with a certified nurse-midwife. After the establishment of medical services at the United States Embassy Hospital, she functioned as a relief staff nurse. Upon returning to the United States, she was employed by the Visiting Nurse Association (VNA) as a staff nurse in Ann Arbor, Michigan. At the VNA, she acted as the coordinator and clinical instructor for student practical nurses. In addition, she was a staff nurse in a coronary care unit for 5 years, worked in the respiratory intensive care unit, and was Head Nurse of the emergency department at St. Joseph’s Mercy Hospital in Ann Arbor. For the next 8 years, she taught the fundamentals of nursing as Assistant Professor of Nursing in the RN Studies Program at the University of Michigan School of Nursing. During that time, she also served as mental health consultant to the pediatric nurse practitioner program at the University of Michigan.

Tomlin was among the first 16 nurses in the United States to be certified by the American Association of Critical Care Nurses. With several colleagues, she opened one of the first offices for independent nursing practice in Michigan. She continued her independent practice until 1993.

She is a member of Sigma Theta Tau Rho Chapter, the California Scholarship Federation, and the Philomathian Society. She has presented programs incorporating a variety of nursing topics based on the Modeling and Role-Modeling Theory and paradigm, with an emphasis on clinical applications.

In 1985, she moved to Big Rock, Illinois, where she enjoyed teaching small community and nursing groups and working in a community shelter serving the women and children of Fox Valley. Later she moved to Geneva, Illinois, where she currently resides with her husband. Tomlin has had inquiries from staff nurses for help in integrating the framework into practice. She believes that elements of the theory and paradigm can be introduced easily in many settings and can be very valuable for practicing nurses (E. Tomlin, telephone interview, 1992). She was first editor for the newsletter of the Society for the Advancement of Modeling and Role-Modeling (E. Tomlin, curriculum vitae, 1992).

Tomlin identifies herself as a Christian in retirement from nursing for pay, but not from nursing practice. She is pursuing her interest in the practice of healing prayer, stating that she has always been interested in the interface of the Modeling and Role-Modeling Theory and Judeo-Christian principles. She is on the board of directors and works as a volunteer at Wayside Cross Ministries in Aurora, Illinois, where she teaches and counsels homeless women, most of whom are single mothers. She is semi-retired but continues to help them develop skills necessary to live healthier, happier lives (E. Tomlin, telephone interview, July 10, 1996).

Mary Ann P. Swain

Mary Ann P. Swain’s educational background is in psychology. She received her bachelor of arts degree in psychology from DePauw University in Greencastle, Indiana, and her master of science and doctoral degrees from the University of Michigan, both in the field of psychology.

Swain taught psychology, research methods, and statistics as a teaching assistant at DePauw University and later as a lecturer and Professor of Psychology and Nursing Research at the University of Michigan. She became the Director of the Doctoral Program in Nursing in 1975 and served in that capacity for 1 year. She was Chairperson of Nursing Research from 1977 to 1982. In 1983, she became Associate Vice President for Academic Affairs at the University of Michigan (M. Swain, curriculum vitae, February 1988).

She is a member of the American Psychological Association and an associate member of the Michigan Nurses Association. She developed and taught classes in psychology, research, and nursing research methods. She also collaborated with nurse researchers on various projects, including health promotion among diabetic patients and ways to influence compliance among patients with hypertension. She helped Erickson publish a model that assessed an individual’s potential to mobilize resources and adapt to stress, which is significant to the Modeling and Role-Modeling Theory.

Swain received the Alpha Lambda Delta, Psi Chi, Mortar Board, and Phi Beta Kappa awards while at DePauw University. In 1981, she was recognized by the Rho Chapter of Sigma Theta Tau for Contributions to Nursing and, in 1983, became an honorary member of Sigma Theta Tau. In 1994, she moved to Appalachia, New York, with her husband, when she accepted the position of Provost for Binghamton University.


The theory and paradigm Modeling and RoleModeling was developed using a retroductive process. The original model was derived inductively from the primary author’s clinical and personal life experiences. The works of Maslow, Erikson, Piaget, Engel, Selye, and M. Erickson were then integrated and synthesized into the original model to label, further articulate, and refine a holistic theory and paradigm for nursing. Erickson (1976) argued that people have mind-body relations and an identifiable resource potential that predicts their ability to contend with stress. She also articulated a relationship between needs status and developmental processes, satisfaction with needs and attachment objects, loss and illness, and health and need satisfaction. Tomlin and Swain validated and affirmed Erickson’s practice model and helped to expand and articulate labeled phenomena, concepts, and theoretical relationships.

The authors used Maslow’s theory of human needs to label and articulate their personal observations that “all people want to be the best that they can possibly be; unmet basic needs interfere with holistic growth whereas satisfied needs promote growth” (Erickson, Tomlin, & Swain, 2002, p. 56; Jensen, 1995). The authors further integrated the model to state that unmet basic needs create need deficits, which can lead to initiation or aggravation of physical or mental distress or illness. At the same time, need satisfaction creates assets that provide resources needed to contend with stress and promote health, growth, and development.

Piaget’s theory of cognitive development provides a framework for understanding the development of thinking. On the other hand, integration of Erik Erikson’s work on the stages of psychosocial development through the life span provides a theoretical basis for understanding the psychosocial evolution of the individual. Each of his eight stages represents developmental tasks. As an individual resolves each task, he or she gains strengths that contribute to character development and health. Furthermore, as an outcome of each stage, people develop a sense of their own worth and, therefore, a projection of themselves into the future. “The utility of Erikson’s theory is the freedom we may take to view aspects of people’s problems as uncompleted tasks. This perspective provides a hopeful expectation for the individual’s future since it connotes something still in progress” (Erickson et al., 2002, pp. 62-63).

The works of Winnicott, Klein, Mahler, and Bowlby on object attachment were integrated with the original model to develop and articulate the concept of affiliated-individuation (AI). Object relations theory proposes that an infant initially forms an attachment to his or her caregiver after having repeated positive contacts. As the child grows and begins to move toward a more separate and individuated state, a sense of autonomy develops. During this time, he or she usually transfers some attachment to an inanimate object such as a cuddly blanket or a teddy bear. Later, the child may attach to a favorite baseball glove, doll, or pet, and finally onto more abstract things in adulthood, such as an educational degree, professional role, or relationship. On the basis of the work of these individuals, a theoretical relationship was identified between object attachment and need satisfaction. According to the theorists, when an object repeatedly meets an individual’s basic needs, attachment or connectedness to that object occurs. After further synthesis of these theoretical linkages and research findings, the authors identified a new concept, AI. They defined AI as the inherent need to be connected with significant others at the same time that there is a sense of separateness from them that enhances their uniqueness. AI runs across the life span from birth to death. Research supports that AI and object attachment are essential to need satisfaction, adaptive coping, and healthy growth and development.

The authors further state, “object loss results in basic need deficits” (Erickson et al., 2002, p. 88). Loss is real, threatened, or perceived; it may be a normal part of the developmental process, or it may be situational. Loss always results in grief; normal grief is resolved in approximately 1 year. When only inadequate or inappropriate objects are available to meet needs, morbid grief results. Morbid grief interferes with the individual’s ability to grow and develop to maximal potential. The work of Selye and Engel, as cited by Erickson, Tomlin, and Swain (1983), provided an additional conceptual basis for the beliefs the theorists hold regarding loss and an individual’s stress responses to that loss or losses. Selye’s theory pertains to an individual’s biophysical responses to stress, whereas Engel’s work explores the psychosocial responses to stressors.

The synthesis of these theories, with the integration of the primary author’s clinical observations and lived experiences, resulted in the development of the Adaptive Potential Assessment Model (APAM). The APAM focuses on the individual’s ability to mobilize resources when confronted with stressors, rather than the adaptation process. This model was first developed by Erickson (1976) and was later described in publication by Erickson and Swain (1982).

Erickson credits Milton H. Erickson with influencing her clinical practice and providing inspiration and direction in the development of this theory. Initially, he articulated the formulation of the Modeling and Role-Modeling Theory when he urged Erickson to “model the client’s world, understand it as they do, then role-model the picture the client has drawn, building a healthy world for them” (H. Erickson, telephone interview, November 1984).


The theory and paradigm Modeling and Role-Modeling contains multiple concepts.


The act of Modeling, then, is the process the nurse uses as she develops an image and an understanding of the client’s world—an image and understanding developed within the client’s framework and from the client’s perspective…The art of Modeling is the development of a mirror image of the situation from the client’s perspective…The science of Modeling is the scientific aggregation and analysis of data collected about the client’s model (Erickson et al., 2002, p. 95).

Modeling occurs as the nurse accepts and understands her client (Erickson et al., 2002, p. 96).


Lifetime Development

Lifetime development evolves through psychological and cognitive stages, as follows:

image Psychological Stages

    Each stage represents a developmental task or a decisive encounter resulting in a turning point, a moment of decision between alternative basic attitudes (e.g., trust versus mistrust or autonomy versus shame and doubt). As a maturing individual negotiates or resolves each age-specific crisis or task, the individual gains enduring strengths and attitudes that contribute to the character and health of the individual’s personality in his or her culture (Erickson et al., 2002, p. 61).

image Cognitive Stages

    Consider how thinking develops rather than what happens in psychosocial or affective development…Piaget believed that cognitive learning develops in a sequential manner, and he has identified several periods in this process. Essentially, there are four periods: sensorimotor, preoperational, concrete operations, and formal operations (Erickson et al., 2002, pp. 63-64).



Adaptation occurs as the individual responds to external and internal stressors in a health-directed and growth-directed manner. Adaptation involves mobilizing internal and external coping resources. No subsystem is left in jeopardy when adaptation occurs (Erickson et al., 2002).

The individual’s ability to mobilize resources is depicted by the APAM. The APAM identifies three different coping potential states: (1) arousal, (2) equilibrium (adaptive and maladaptive), and (3) impoverishment. Each of these states represents a different potential to mobilize self-care resources. “Movement among the states is influenced by one’s ability to cope [with ongoing stressors] and the presence of new stressors” (Erickson et al., 2002, pp. 80-81).

Nurses can use this model to predict an individual’s potential to mobilize self-care resources in response to stress.


Self-care involves the use of knowledge, resources, and actions, as follows:


Several studies have provided initial evidence for philosophical premises and theoretical linkages implied in the original book by Erickson, Tomlin, and Swain (1983), and later specified by Erickson (1990b). The APAM (Figures 25-1 and 25-2) has been tested as a classification model (Barnfather, 1987; Erickson, 1976; Kleinbeck, 1977) and as a predictor for health status (Barnfather, 1990b) and for length of hospital stay (Erickson & Swain, 1982), as it relates to basic need status (Barnfather, 1993). Findings from these studies provide beginning evidence for the proposed three-state model across populations, a relationship between health and ability to mobilize resources, and an ability to mobilize resources and needs status. Two other studies have shown relationships among stressors (measured as life events) and propensity for accidents (Babcock & Mueller, 1980) and resource state and ability to take in and use new information (Clementino & Lapinske, 1980). Finally, Benson (2003) has studied the APAM as applied to small groups.

Relationships among self-care knowledge, resources, and activities have been demonstrated in several studies (Acton, 1993; Baas, 1992; Irvin, 1993; Jensen, 1995; Miller, 1994). The self-care knowledge construct, first studied by Erickson (1985), was replicated and found to be significantly associated with perceived control (Cain & Perzynski, 1986) and quality of life (Baas, Fontana, & Bhat, 1997). Self-directedness, need for harmony (affiliation), and need for autonomy (individuation) were found when multidimensional scaling was used to explore relationships among self-care knowledge, resources, and actions. The author concluded that a positive attitude was a major factor when health-directed self-care actions were assessed (Rosenow, 1991). Physical activity in patients after myocardial infarction was shown to be affected by life satisfaction (not physical condition); life satisfaction was predicted by availability of self-care resources and resources needed. Furthermore, resources needed served as a suppressor for resources available (Baas, 1992). In a sample of caregivers, social support predicted for stress level and self-worth had an indirect effect on hope through self-worth (Irvin, 1993; Irvin & Acton, 1997), whereas persons with diabetes with spiritual well-being were better able to cope (Landis, 1991).

When the Modeling and Role-Modeling Theory was used as a guideline, interviews were used to determine the client’s model of the world. The following seven themes emerged (Erickson, 1990a):

Each model was unique and each warranted individualized interventions. Other qualitative studies on self-care knowledge showed that acutely ill patients perceived monitoring, caring, presence, touch, and voice tones as comforting (Kennedy, 1991); healthy adults sought need satisfaction from the nurse practitioner in primary care (Boodley, 1990, 1986); and hospice patients benefited from nurse empathy (Raudonis, 1991). Studies also showed relationships among mistrust and length of stay in hospitalized subjects (Finch, 1990); perceived enactment of autonomy, self-care, and holistic health in the elderly (Anschutz, 2000; Hertz & Anschutz, 2002); perceived support, control, and well being in the elderly (Chen, 1996); and loss, morbid grief, and onset of symptoms of Alzheimer’s disease (Erickson, Kinney et al., 1994; Irvin & Acton, 1996).

Other studies addressed linkages between role-modeled interventions and outcomes (Erickson, et al., 1994; Hertz, 1991; Irvin, 1993; Jensen, 1995; Kennedy, 1991). College level students who perceived satisfaction of needs were more successful in school. Seven nursing students who perceived that they were supported were more able to attain their goals for advanced education (Smith, 1980), the elderly who felt supported reported higher need satisfaction and were better able to cope (Keck, 1989), adolescent mothers who felt supported and perceived need satisfaction had a more positive maternal-infant attachment (Erickson, M., 2006; Erickson, M., 1996a; Erickson, M., 1996b), those with a strong social network reported better health (Doornbos, 1983), and persons convicted of sexual offenses and then were provided with support to remodel their worlds were able to develop new behaviors and move on with their lives (Scheela, 1991). Families and post–myocardial infarction patients who were able to participate in planning their own care through contracting had less anxiety and better perceived control and perceived support (Holl, 1992), and caregivers of adults with dementia who experienced theory-based nursing using the Modeling and Role-Modeling Theory perceived that their needs were met and that they were healthier (Hopkins, 1995). They also reported feeling that they were encouraged, which helped them accept the situation and transcend the experience of caregiving (Hopkins, 1995). Self-care resources, measured as needs, are related to perceived support and coping in women with breast cancer (Keck, 1989), physical well-being in persons with chronic obstructive pulmonary disease (Kline, 1990, 1988), and anxiety in hospitalized patients who have had cardiac surgery and their families (Holl, 1992). Finally, when AI was tested as a buffer between stress and well-being, a mediation effect was found (Acton, 1997; Acton, 1993; Acton, Irvin, Jensen, Hopkins, & Miller, 1997).

Other studies that operationalized self-care resources by measuring developmental residuals have shown that identity resolution in adolescents with facial disfiguration can be predicted by previous developmental residual (Miller, 1986). Chen (1996) found that feelings of control over one’s health (health control orientation) status in elderly individuals with hypertension correlated highly with self-efficacy and self-care. In addition, her work supported that health control orientation, self-efficacy, and self-care were associated with well-being. Through interviews of older adults living independently, Hertz, Rossetti, and Nelson (2006) were able to identify categories of self-care actions that encompassed important self-care activities.

Other researchers found that trust predicts for adolescent clients’ involvement in the prescribed medical regimen (Finch, 1987), perceived support and adaptation are related to developmental residual in families with newborn infants (Darling-Fisher, 1987; Darling-Fisher & Leidy 1988), mistrust predicts length of hospital stay, and positive residual serves as a buffer (Finch, 1987). Positive residual in the intimacy stage of healthy adults predicts for health behaviors (MacLean, 1992, 1990, 1987), developmental residual predicts for hope, trustmistrust residual predicts for generalized hope, autonomy-shame and doubt residual predicts for particularized hope in the elderly (Curl, 1992), and negative residual is related to speed and impatience behaviors in a healthy sample of military personnel (Kinney, 1992). Case study methods have been used to show relationships among needs, attachment, and developmental residual (Kinney, 1990, 1992; Kinney & Erickson, 1990) and needs and coping (Jensen, 1995), and two unpublished studies have shown relationships between healthy adults and need status (Erickson, Kinney, Stone, & Acton, 1990).

Studies have also been used to explore self-care knowledge in informants in the hospital (Erickson, 1985), perceived enactment of autonomy and life satisfaction in the elderly (Anschutz, 2000), the experience of persons 85 and older as they manage their health (Beltz, 1999), perceptions of hope in elementary school children (Baldwin, 1996), the experiential meaning of well-being and the lived experience in employed mothers (Weber, 1995, 1999), developmental growth in adults with heart failure (Baas, Beery, Fontana, & Wagoner, 1999), the individual’s ability to mobilize coping resources and basic needs (Barnfather, 1990a), the relationship between basic need satisfaction and emotionally motivated eating (Timmerman & Acton, 2001), relations among hostility, self-esteem, self-concept, and psychosocial residual in persons with coronary heart disease (Sofhauser, 1996), and the human-environment relationship when healing from an episodic illness (Bowman, 1998). Studies have explored the relationship between spiritual well-being and heart failure (Beery, Baas, Fowler, & Allen, 2002), spirituality in caregivers of family members with dementia (Acton & Miller, 1996), the implementation of a mind, body, spirit self-empowerment program for adolescents (Nash, 2007) and women with breast cancer (Kinney, Rodgers, Nash, & Bray, 2003), the meaning and impact of suffering in people with rheumatoid arthritis (Dildy, 1992), and the relationship between experiences of prolonged family suffering and evolving spiritual identity (Clayton, 2001). Studies with cardiovascular have continued as Baas (2004) studied self-care resources and quality of life in patients following myocardial infarction, and Baas et al. (2004) explored body awareness in heart failure or transplant patients. Similarly, Beery, Baas, Mathews, Burrough, and Henthorn (2005) developed an adjustment scale to measure self-report with implanted devices in cardiac patients, and Beery, Baas, and Henthorn (2007) reported on patient adjustments to the devices.

Tools that have been developed to test the Modeling and Role-Modeling Theory include the Basic Needs Satisfaction Inventory (Kline, 1988), the Erikson Psychosocial Stage Inventory (Darling-Fisher & Leidy, 1988), the Perceived Enactment of Autonomy tool designed to measure a prerequisite to self-care actions in the elderly (Hertz, 1991, 1999; Hertz & Anschutz, 2002), the Self-Care Resource Inventory (Baas, 1992), the Robinson Self-Appraisal Inventory designed to measure denial (the first stage in the grief process) in patients after myocardial infarction (Robinson, 1992), the Erickson Maternal Bonding-Attachment Tool designed to measure self-care knowledge as motivational style (deficit or being motivation) and self-care resource (Erickson, M., 1996b), a theory-based nursing assessment (Finch, 1990), and the Hopkins Clinical Assessment of the APAM (Hopkins, 1995).

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Feb 9, 2017 | Posted by in NURSING | Comments Off on Modeling and Role-Modeling
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